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Complete blood count (CBC)
0%
0/23
Urinalysis and Pap smear
Urinalysis, urine culture, and potassium hydoxide prep (KOH)
30%
7/23
Urinalysis, urine culture, KOH prep, and urine pregnancy test
39%
9/23
Urinalysis, KOH prep, and nucleic acid amplification tests for N. gonorrhea and C. trachomatis
Select Answer to see Preferred Response
This patient of reproductive age and ureteropelvic symptoms should be screened for pregnancy in addition to other diagnostic studies (e.g., urinalysis, urine culture, and KOH prep.) Urinary tract infections and sexually transmitted infections can be a confounding differential diagnosis in a female patient of reproductive age. This patient may have bacterial vaginosis, trichomoniasis, or a urinary tract infection. Although the patient denies any sexual history, the physical exam findings do not agree with this assertion. Pregnancy should be ruled out given her sexual history and likely need for antibiotics. Incorrect Answers: Answer 1: CBC is insufficient to assess this patient's signs and symptoms. A leukocytosis may be present if systemic signs were evident. Answer 2: Although this patient has a high suspicion of sexual activity, Pap smears are not indicated until she is 21 years of age. Answers 3 & 5: While these (urinalysis, urine culture, KOH prep, and nucleic acid amplication tests for N. gonorrhea and C. trachomatis) are reasonable diagnostic investigations, both answers lack a screening assessment for pregnancy. Bullet Summary: Female patients of reproductive age with vaginitis should have a pregnancy test in addition to other diagnostic tests.
2.7
(14)
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