Step 2

Social Science 2

A 56-year-old woman presents to the office for a follow-up examination. She went to the office 3 weeks ago for burning with urination and lower abdominal pain. She was diagnosed with a simple urinary tract infection and was prescribed a 5-day course of nitrofurantoin at that time. Today she states that the pain with urination is resolved, and she has no other complaints. Past medical history is significant for hypertension and type 2 diabetes. She takes lisinopril and metformin. HbA1c was 6.2% one month ago. Serum potassium and creatinine were normal at that time. She does not drink alcohol or use drugs. Vital signs are temperature 37.1°C (98.6°F), blood pressure 132/74 mmHg, pulse 78 beats/min, and respirations 16/min. Physical examination shows no abnormalities. A repeat urinalysis is performed and shows the following:

  • Specific gravity: 1.018
  • pH: 6.0
  • Glucose: negative
  • Protein: negative
  • Ketones: negative
  • Leukocyte esterase: negative
  • Nitrites: negative.
  • RBCs: 3/hpf
  • WBCs: 1/hpf

The patient is known to keep all her appointments, is adherent with her medications, and maintains a strong patient/physician relationship. All vaccines and health maintenance screening tests are up to date.

Which of the following are the most appropriate tests at this time?

  • A) Fasting glucose and HbA1c
  • B) Serum electrolyte levels
  • C) Testing not indicated at this time
  • D) Ultrasound of the bladder
  • E) Urine albumin/creatinine ratio


Lloyd Taylor


Dr. Ted O'Connell