Instructions: Listen to the podcast episode available below, and then submit your answers to the multiple choice questions. You will review the answers and the material covered during your next Continuity Clinic Session.
Bacteriuria, UTI, and Pyelonephritis
1. A 28 yo female presents at 18 weeks with 3 days of malaise, fever, chills and back pain. She notes urinary frequency and appears diaphoretic and flushed. Exam shows temp of 39.5C, respiratory rate of 26, BP of 80/40 and pulse of 110 bpm. She has costovertebral angle tenderness. The fetal heart rate is 170 bpm. White blood cell count 4000/mm3. What is her clinical presentation most consistent with?
2. A 31 yo G1 with a family history of polycystic kidney disease presents at 28 weeks with intermittent right-sided flank pain. Urine dipstick shows trace protein. Renal ultrasound with slightly enlarged kidney size bilaterally, moderate right hydronephrosis and mild right ureteral dilation. Based on the findings, what is the most likely diagnosis?
3. A 21 yo G1 presents at 9w3d for her initial prenatal visit. She has occasional nausea but is otherwise without complaints. You order a screening urine culture which shows 100,000 CFU of E.coli. You contact the patient about the result, and she reports that she remains asymptomatic. What is the next best step?