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:
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?
The correct answer is:
C) Testing not indicated at this time
The patient has recovered from her previous illness, and ordering further testing is not appropriate. The patient keeps her appointments, takes her medications as prescribed, and maintains a relationship with her physician. Any further testing is unnecessary and can cause the patient unnecessary anxiety and expense.
Answer choice A: Fasting glucose and HbA1c, is incorrect. Although the patient will need to have her glucose and A1c levels monitored, she does not need those tests to be run at this time as her health maintenance screening tests are up to date, and her HbA1c was tested one month ago.
Answer choice B: Serum electrolyte levels, is incorrect. Serum electrolyte levels are monitored to evaluate electrolyte imbalances, which can occur for a variety of reasons. Electrolyte imbalances can be caused by dehydration, certain medications such as lisinopril, kidney or liver disease, hormonal imbalances, or a variety of other medical conditions. Her serum potassium and creatinine are being monitored while she is taking lisinopril, so serum electrolytes are unnecessary at this time.
Answer choice D: Ultrasound of the bladder, is incorrect. Although the patient had a previous urinary tract infection, she has no symptoms currently and no history to suggest an abnormality of the urinary system, so she does not warrant an ultrasound.
Answer choice E: Urine albumin/creatinine ratio, is incorrect. Although a urine/albumin level should be monitored in this patient with diabetes and hypertension, her health maintenance screening is reported to be up to date, and her urinalysis is negative for protein.
Key Learning Point
Ordering unnecessary tests or procedures can have adverse effects on patients, including unnecessary anxiety as well as financial impacts. This falls under the category of beneficence as well as nonmaleficence.
