Immune System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M45_F1.jpg"}},{"insert":"\n\nYou scribble something resembling a signature on the dotted line at the bottom of the page, and with a sigh, drop your pen on the desk and lean back in your chair. Your paperwork is finally up to date, and you swear that if you have to sign your name one more time today you\u0027ll explode. \n\nYou start thinking about how much time off you\u0027d get if you did, before your thoughts are cut short by the buzz of your intercom. Your first patient of the day has arrived.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M45_F3.jpg"}},{"insert":"\n\nIn walks a cheerful-looking young woman. You glance at her file and learn that she\u0027s 32-year-old Tara, a brand new patient. You introduce yourself and ask her what brought her to you today.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M45_F5.jpg"}},{"insert":"\n\nTara complains of experiencing pain when passing urine. You ask her about the nature of the pain, when it started, and whether she has any other symptoms.\n\n\u0022Hmm... I\u0027d call it a burning pain. I\u0027ve had it for about a week or two, I think? It was fairly mild at first, but it\u0027s slowly become worse. Oh \u2013 and my bladder always feels full,\u0022 she responds.\n\nYou ask if she\u0027s experienced redness or irritation around the genitals or unusual vaginal discharge. She replies in the negative. You also find out that she was completely healthy before this; and that she is not on any medications, including over-the-counter drugs or supplements.\n\nYou gently question Tara about her personal life. You learn that she has had a single stable sexual partner for the last 5 years. They use barrier contraception, while she is also on oral contraceptives. Her partner is in good health, and has no urinary or genital symptoms.\n\nTara has never smoked and doesn\u0027t drink anymore. \u0022I did drink heavily while I was in university, but I guess I grew out of it!\u0022 she says. There is no history of recreational drug use. She takes regular exercise and maintains a healthy, balanced diet.\n\nYou ask her about her family\u0027s health, and she states that her father had a \u0022mild heart attack\u0022 at the age of 60, around an year ago. He is still alive and on regular treatment.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M45_F17.jpg"}},{"insert":"\n\nYou ask if Tara would mind your performing a quick examination, to which she agrees. You ask her to stand up and measure her height as 5\u0027 5\u0022 (165 cm) and weight as 123 lbs (55.8 kg), giving her a BMI of 22 kg\/m2. He blood pressure is 110\/70 mmHg and resting pulse is 72 bpm. \n\nThe general examination is unremarkable. Tara lays on the couch and you examine her abdomen, pelvis and external genitalia \u2013 all of which seem normal. A quick cardio-respiratory examination is also unremarkable.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M45_F20.jpg"}},{"insert":"\n\nYou ask Tara when she last emptied her bladder. After some thought, she replies that she last used the bathroom just after she woke up, which she estimates as around 6 hours ago. You hand her a pot and ask her to provide a urine sample for dipstick testing. \n\nTara makes her way out to the restroom and returns a few minutes later with a sample in hand. You perform a urine dipstick test, which is negative for nitrites or leuckocyte esterase.\n"}]}


{"ops":[{"insert":"With all the information you\u0027ve gathered and no sign of infection on the dipstick, you consider your next step.\n\nWhat do you do next?\n"}]}
1. Order a urinalysis
2. Make a clinical diagnosis of UTI and start antibiotics