The patient, a 28-year-old woman, has been sexually active with multiple partners since she
was 14 years old. She is now married and wants to have children. She has intermittent
breakouts of vulvar ulcers/sores but no other complaints. Her petvic examination during a
routine visit with her gynecologist was normal. She had a lump in her left breast.
Studies
Resutts
Sexually transmitted
infections (STIs), p. 756
Herpes simplex test, p. 731
Positive for herpes simplex virus-2 (HSV-2) (normal:
negative)
No change in serology 4 weeks later
Cytomegalovirus. p. 200
No antibodies detected
Chlamydia. p. 722
No antibodies detected
Gonorrhea, p. 761
Culture negative
Syphilis serology, p. 473
No antibodies detected
Pap smear, p. 743
Adequacy of specimen
Adequate
Category
Epithelial abnormality
Epithetial cell
abnormalities
Squamous, atypical cells
Human papillomavirus (HPV)
testing, p. 745
Positive for HPV 16
Diagnostic Analysis
The patient was informed of her test results. Her herpes titers indicated that the disease was
rather chronic, not acute. No treatment was recommended. Because of her age.
mammograms were contraindicated. A breast ultrasound indicated the lesion was not
cancerous. A fibroadenoma is common in this age-group. Because of her positive HPV
results and suspicious Pap smear, further evaluation was recommended.
Studies
Results
Colposcopy, p. 595
Several suspicious areas
Biopsy
Squamous cell carcinoma
Cervical cone biopsy. p. 720
Invasive squamous cell carcinoma
Hysteroscopy, p. 614
Critical Thinking Questions
- Why was mammography contraindicated for this patient?
- How is sexual promiscuity related to the risk for cervical cancer?
Glomerutonepnhritis
Diagnostic Analysis
The blood. protein, and RBC casts in the boy’s urine indicated a primary renal disorder. The
elevated creatinine and BUN levels indicated that the problem was severe and markedly
affecting his renal function. Both kidneys were probably equally impaired. Intravenous
pyelogram (IVP) was helpful only in ruling out Wilms tumor or congenital abnormality.
Normally an IVP would not be performed in light of this patient’s impaired renal function. It
is presented here for demonstration of the information it can provide. Renal ultrasound is a
much safer test to visualize the kidney to exclude neoplasm. The ultrasound findings were
compatible with an inflammatory process involving both kidneys. Renal biopsy was most
helpful in suggesting glomerulonephritis. The history of recent pharyngitis, fever, the
positive ASO titer, the positive ADB titer, and the finding of immunoglobulin IgG antibodies
on the immunofiuorescent stain all suggested poststreptococcal glomerulonephritis.
The patient was placed on a 10-day course of penicillin. He was given antihypertensive
medication, and his fluid and electrolyte balance was closely monitored. At no time did his
creatinine or BUN level rise to a point requiring dialysis. After 6 weeks, his renal function
retumed to normal (creatinine, 0.7 mg/dL; BUN, 7 mg/dL). His antihypertensive medications
were discontinued, and he remained normotensive and retumed to normal activity.
Critical Thinking Questions
- At what point would the BUN and creatinine have signified the need for dialysis?
- What was the cause of the patient’s hypertension?
- What would you do if this patient had developed a swotlen mouth and neck after the
IVP?