Adult/Gerontological Health Care I

UTI & STD Cases

Cut and Paste (or Print off) the following to a word document.  For each of those cases complete the following (create your own additional details as needed for the patient).  Complete and select one case to share with the instructor.   

1. A 24 year-old woman presents with two days of dysuria and urinary frequency. She has been forcing cranberry juice without improvement. She denies fever, chills, and flank pain, and has been sexually active with one partner for three months.

a. What other elements of history & physical would be key in your initial approach to her
illness?
b. How would you go about testing her urine?
c. Given pyuria, what drug and duration would you treat with in each of the following circumstances: 
   -  no recent similar illnesses? 
   -  she has diabetes mellitus? 
   -  this is her fourth UTI this year? 
   -  she had a UTI 10 days ago, treated with 3 days of TMP/SMX? 
d. How would you counsel her about risk factors for UTI? 

2. A 34 year-old woman presents with five days of dysuria and malaise, today with some back pain. She denies chills, nausea and vomiting. On exam she is not in distress, Temp is 38C, P 92, BP 122/70, R 16. She has moderate right CVA percussion tenderness, and no abdominal tenderness.

a. What other elements of history & physical would be key in your initial approach to her illness?
b. How would you go about testing her urine?
c. What antibiotic regimen does she need, in what setting? What if she's vomiting or pregnant?

3. A 37 year-old man presents with 5 days of dysuria and urinary frequency (small volume). He
denies fever, sweats and chills . On exam he is in no distress, afebrile, with a benign abdomen,
without penile discharge, and with a normal, nontender prostate.

a. What other elements of history & physical would be key in your initial approach?
b. How would you go about testing his urine?
c. What antibiotic regimen would you use?
d. Does he need to see a urologist?

4. A 62 year-old woman presents with her third UTI in a year. She had menopause 10 years ago and is not on estrogen replacement. On exam she is in no distress, afebrile, with a benign abdomen.

a. What other elements of history & physical would be key in your initial approach?
b. How would you go about testing her urine?
c. What treatment regimen would you use?

5. A 63 year old male with 3 day history of burning on urination, frequency, and urgency. He hasn’t had similar symptoms in the past.  What added information would you want? How would you approach his care? 

6. A 22 year old male complains of sharp perineal and rectal pain of 1 day’s duration. He has dysuria and frequency. He denies sexual contacts other than his wife. Temperature 103. Abdominal exam negative. Rectal: prostate feels swollen, is very tender. What added information would you want? How would you approach his care? 

7. A 21 year old male complains of pain on urination and a yellowish penile discharge of 2 days duration. What added information would you want? How would you approach his care? 

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