WBR1057

Author	[[PageAuthor::Abdurahman Khalil, M.D. [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Genitourinary, SubCategory::Infectious Disease
Prompt	[[Prompt::A 20 year old female college student comes to the Students health center complaining of urgency, frequency and itching for the last 3 days. She’s never had this problem before. She denies any fever, night sweating or pain. She smokes 2 pack/year, drinks 2 beers/day and she is sexually active with her new boyfriend and since then she started using oral contraceptives and her boyfriend uses condoms. Vitals are Temperature: 37, 1 c, heart rate: 78 respiration: 17 blood pressure: 134/67. The physical examination is normal except for mild tenderness over the pubic area. Tapping on Costco vertebral angel doesn't show any tenderness. No vaginal discharge. From her medical history, which one of the following is likely to be related to her problem?]]
Answer A	AnswerA::Alcohol
Answer A Explanation	AnswerAExp::Alcohol is not a risk factor for cystitis.
Answer B	AnswerB::Her age
Answer B Explanation	AnswerBExp::A young age doesn't propose a risk to cystitis.
Answer C	AnswerC::Using condom
Answer C Explanation	AnswerCExp::Using condoms reduces risk of UTIs and STDs
Answer D	AnswerD::The new relationship
Answer D Explanation	AnswerDExp::Sexual activity is the strongest risk factor for cystitis
Answer E	AnswerE::Using OCPs
Answer E Explanation	AnswerEExp::Incorrect
Right Answer	RightAnswer::D
Explanation	[[Explanation::This patient has a typical history of acute uncomplicated cystitis. The strongest risk factor is sexual intercourse,which facilitates the entry of bacterial flora into the genitourinary mucosa. Some preventive measures to reduce the risk of cystitis are : Cleaning genital areas prior to and after sexual intercourse. For sexually active women, and to a lesser extent men, urinating within 15 minutes of sexual intercourse to allow the flow of urine to expel the bacteria before specialized extensions anchor the bacteria to the walls of the urethra. Having adequate fluid intake, especially water. Not resisting the urge to urinate. Taking showers, not baths, or urinating soon after taking a bath. Practicing good hygiene, including wiping from the front to the back to avoid contamination of the urinary tract by fecal pathogens. Educational Objective: The strongest risk factor for cystitis is sexual intercourse. References: Hooton TM. Clinical practice. Uncomplicated urinary tract infection. N Engl J Med. 2012;366(11):1028-37.]]
Approved	Approved::No
Keyword	WBRKeyword::Cystitis, WBRKeyword::risk factor
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::