Specter has the correct answers for all but the following 2.
67yo has 9mo history of persistent vulvar itching despite OTC Zinc oxide, vitamin E, hydrocortisone cream, and miconazole. She has DM, herpercholesterol. Erythematous swollen vulva, papules and pustules on medial aspect of thighs, and several excoriations. KOH prep of pustules show pseudohyphae and budding yeast. Why is the patient failing to respond to treatment?
A. contact dermatitis
B> Hypercholesterol
C. Self induced excoriations
D. DM
E. vulvar malignancy
Answer is NOT C
The answer is D. DM is one of the main reasons people don't heal. Unless obesity is an answer, that's worse.
3 days after c/s a 27yo has temperature 101.8 and mild pain with urination. No urinary urgency or frequency. She is bottle feeding. Incision is clean and intact. Breasts are tense, erythmatous, and tender. Uterus is firm, nontender and consistent in size with 20wk.
Leukocyte: 6500
Urine: RBC: 10-15/hpf and WBC: 1-2/hpf
Most likely diagnosis?
A. breast engorgement
B. Cystitis
C. ENdometritis
D. Mastitis
E. wound cellulitis
Answer is not B. Is is A? If so why? How can you rule out cystitis? Is it because of the normal WBC in the urine? Is mild pain with urination normal post c/s?
The answer is A. The timeline and presentation does not follow with mastitis. Mastitis is often a couple weeks or so postpartum. Mastitis is also unilateral and often only one section of that single breast. Breast engorgement is very very common, can cause a temp, etc. Timeline is perfect, as it often happens when the milk comes in (around day 3). The RBCs in the urine are likely from lochia, we see blood in urine all the time postpartum, and it's very hard to get a clean catch once a foley is out (should have been out PostOp day 1). There are practically no WBCs, which, from the info given, makes a UTI unlikely.
Also...not to be a buzzkill or anything, but I'm pretty sure we aren't supposed to be posting these questions here, but no one has said anything yet, so I figure, whatever.