A complicated urinary tract infection, whether localized to the lower or upper tract, is associated with an underlying condition that increases the risk of failing therapy.  Possible underlying conditions include:  

Jason, an 8 year old with type 1 diabetes, is being seen for a 3-day history of frequency and nocturia.  He denies flank pain and is afebrile.  The UA is negative for blood and nitrites, positive for large amount of leukocytes and ketones, trace protein.   Which of the following is the best test to order initially?

A 70 year old female patient, Lupita presents with urinary frequency and dysuria for the past 2 days.  She has a history of 3 UTI’s last year.   Allergies: Keflex, Lisinopril Urine with micro shows: Color – dark yellow  Clarity/turbidity – Cloudy pH – 6.2 Specific gravity – 1.005-1.025 Glucose – ≤130 mg/ Ketones – None Nitrites – positive Leukocyte esterase – positive Bilirubin – Negative Urobilirubin – Small amount (0.5-1 mg/dL) Blood – ≤3 RBCs Protein – ≤150 mg/d RBCs – ≤2 RBCs/hpf WBCs – TNTC Squamous epithelial cells – ≤15-20 squamous epithelial cells/hpf Casts – 0-5 hyaline casts/lpf Crystals – Occasionally Bacteria – Moderate Yeast – None   What is your diagnosis?

What differential diagnoses can you expect to see elevated urinary protein?

Dermabond is the best option for an eye lid laceration.  

The following statements are true regarding this EKG

A 16 year old male patient presents with 3 cm laceration to left lower leg which will require suturing. The wound was cleaned with chlorhexidine.  You instruct the nurse to irrigate with _____ ml of NS, pull up ____________ for anesthetization of the wound area.  You request a laceration tray, gloves and a ________ (size/kind) of suture. (3 points)

The different infarct patterns are named according to the leads with maximal ST elevation.  Match the infarct pattern with the leads of maximal ST elevation.

Beth presents with complaints of intermittent palpitations that started last week, with spells of lightheadedness and nausea, and feeling like “my heart beats out of my chest”.  You obtain an EKG and find the following rhythm:  

A 14-year-old was diagnosed and treated for left acute otitis media 3 weeks ago. She reports resolution of pain but persistent fullness feeling of her ear at today’s follow-up visit. You perform tympanometry and the results for the left ear are abnormal showing shallow peak/low compliance. What do you suspect is the cause?