A 28-year-old woman presents to your office with symptoms of a urinary tract infection. This is her second infection in 2 months. You treated the last infection with Bactrim DS for three days. Her symptoms never really improved. Now she has worsening lower abdominal discomfort, dysuria, and frequency. She has had no fever or flank pain. Physical examination shows only mild suprapubic tenderness. Which of the following is the best next step in the evaluation of this patient?

a. Urine culture

b. Intravenous pyelogram

c. Cystoscopy

d. Wet smear

e. CT scan of the abdomen with contrast

the answer is below…

The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.

The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.

This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.

The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.

All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.

Medical doctors with an M.D. degree are required to pass this examination before being permitted to practice medicine in the United States of America

The correct answer is a; Urine culture.[3]

Approximately 15 to 20% of women develop urinary tract infections (cystitis) at some point during their lives. Cystitis is diagnosed when a clean-catch urine sample has a concentration of at least 100,000 bacteria per milliliter of urine and when the patient suffers the symptoms of dysuria, frequency, urgency, and pain. The most common etiology of urinary tract infections is E. coli. Treatment of a urinary tract infection involves obtaining a culture and starting a patient on an antibiotic regimen of sulfa or nitrofurantoin, which have good coverage against E. coli and are relatively inexpensive. Patients treated for a urinary tract infection should have a follow-up culture done 10 to 14 days after the initial diagnosis to document a cure. Patients treated for a UTI who have persistent symptoms after treatment should have a urine culture performed to evaluate for the presence of resistant organisms. Patients with acute pyelonephritis may be treated on an outpatient basis unless they cannot tolerate oral antibiotic therapy or show evidence of sepsis. Women who experience recurrent urinary tract infections with intercourse benefit from voiding immediately after intercourse. If this treatment method fails, then prophylactic treatment with an antibiotic effective against E. coli may help prevent recurrent UTIs. Urinary antispasmodics do not prevent infection.

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