Friday, July 23, 2010
36 yo AA G2P2A0 WWE
I saw this woman for a routine wwe but while taking her history, she revealed that she had recently been experiencing dysuria and urinary frequency. During the pelvic exam she had no unusual discharge or odor but did have some suprapubic tenderness duringt the bimanual exam. Both me and the WHNP were inclined to write this off as a run of the mill UTI and had the woman provide a urine specimen. As we discussed the case, we both came to the realization that perhaps we should also a wet mount in case she had another infection. When we did the wet mount, the diagnosis (if not the treatment) became obvious: bacterial vaginosis. The clue cells were easily seen. The primary difference in arriving at this diagnosis was the type and timeliness of follow up. The patient was asked to return after completing antibiotic treatment for another full exam. It made me realize the importance of sometimes looking deeper (no pun intended) than the assumed diagnosis.
Subscribe to:
Post Comments (Atom)
I had a chance to to collect and to view several different specimens. I'm learning how to use the microscope and what to look for. To add onto what you saw here--during routine OB visits, there were a number of patients who came in with vague complaints of discomfort. Flank pain, mild cramping and the like. The history sometimes gaves us the same thought. The NP and NM I was with clued me in--that BV is common in pregnancy and that doing the wet mount often shows BV or even yeast.
ReplyDeleteA valuable lesson to keep in mind! As we learned with regard to risk for PPROM and PTL, BV and the combo of genetics (IL6 or TNFa) can be disasterous. Knowing that the technical "criteria" for diagnosing BV is crucial...with a positive whiff amine test not necessarily a requirement...demonstrates how thorough examination can prevent potentially catastrophic outcomes... in this case, this young lady was not the text book and you guys did the right thing by checking her vaginal secretionS! Great job!
ReplyDeleteOverall, I think this reflected good management of this patient's condition. I don't think that treating for a UTI would have resulted in an adverse outcome, and the patient wasn't pregnant, so the risk for PROM was not a factor. It's nice, however, to pick up on a diagnosis that differes from the suspected one.
ReplyDeleteIt's sometimes annoying when they complain of an "odor", because you know it's going to add 10 minutes to your visit. BUT, you can make a huge difference in her quality of life - and you'll have a devoted patient!
ReplyDelete