Hy 2365 "Help me, it hurts when I pee"

[tommyk]

Hy 2365

A 22-year-old woman named Sarah Michelle Gellar sees you for pain and burning on urination. She says she is a virgin and has never had sexual relations. The preg. Test at the office is HCG (-). She states that the symptoms started two days ago and have worsened since. She has a slight fever and has never had these symptoms before. She has hypothyroidism for which she takes thyroid hormone replacement. Otherwise she has no medical problems. Physical Examination is unremarkable including a normal pelvic examination. A KOH and normal saline "wet prep" is performed on her vaginal discharge and is negative. Urinalysis reveals numerous white blood cells. She has never had a kidney stone. Which of the following is the most likely pathogen?

1-Trichomonas vaginalis
2-Staph. Aureus
3-Klebsiella
4-Pseudomonas
5-E. coli
6-Trichomonas
7-Candidiasis
8-Staph. Saprophyticus
9-Group B Strep
10-Chlamydia
11-Proteus
12-Enterobacter















































































































a) ans is 5. Escherichia coli is the most common cause of UTI, accounting for 80-90% of cases. It originates from fecal flora that colonize the periurethral area (ascending infection). Klebsiella, Enterobacter and Proteus species cause most of the remaining cases. Gram-positive organisms, particularly Enterococcus faecalis and group B Streptococcus (GBS), are also clinically important pathogens. Infection with Staphylococcus saprophyticus, an aggressive, community-acquired organism, can present with upper urinary tract disease, and the infection is more likely to be persistent or recurrent. Group B Strep or GBS deserves special mention. GBS colonization has important implications during pregnancy. Intrapartum transmission leading to neonatal GBS infection can cause pneumonia, meningitis, sepsis, and death. Current guidelines recommend universal vaginal and rectal screening of all pregnant women at 35-37 weeks' gestation rather than treating on the basis of risk factors. Urea-splitting bacteria, including Proteus, Klebsiella, Pseudomonas, and coagulase-negative Staphylococcus, alkalinize the urine and may be associated with struvite stones. Chlamydial infections are associated with sterile pyuria and account for more than 30% of nonbacterial UTIs.

[Unregister]

Any link between UTI and Hypothyroidism or it just "happened" to be the pt's dx? Please help me to understand the mechanism. Thanks.

[md90]

I'm thinking that tommyk threw that in the hypothyroidism as a distractor.. as I read the question, the chief complaint was pain while peeing.. and the signs and symptoms pointed to a UTI; The hypothyroidism is good to know.. but don't believe that it has significance here...the meds to treat hypothyroidism.. side effects include tachycardia, heat intolerance, and/or tremors....

any other opinions???

[tommyk]

you are right again md90, twas just as you thought, a distractor, as is much of life. TK

[Unregister]

Thanks, MD90 and Tommyk.

Just a side note: I was taught that there is a link between autoimmune hypothyroidism and respiratory disease since thyroid and airways share embryological origins…

So, could a spread of chronic inflammatory process from the thyroid to other systems, increase susceptibility to an infection due to immune system dysregulation…???

[tommyk]

Possible, I guess...but I have not heard of major cases like that. For the Step 1, the NBME can ask very difficult stuff, and unusual stuff, but not questions that do not have a good deal of evidence based medicine to back it up. Thus, I would concentrate on mastering what is out there now, in your review books and your medical journals. Tommyk