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By Ralph W. Hale

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Philadelphia, PA: Saunders; 2005:12-26. SECTION Clinical Cases II This page intentionally left blank Case 1 A 48-year-old G3 P3 woman complains of a 2-year history of loss of urine four to five times each day, typically occurring with coughing, sneezing, or lifting; she denies dysuria or the urge to void during these episodes. These events cause her embarrassment and interfere with her daily activities. The patient is otherwise in good health. A urine culture performed 1 month previously was negative.

For example, a clinical scenario may describe an 18-year-old adolescent female at 24 weeks’ gestation who develops dyspnea 2 days after being treated for pyelonephritis. The student must first diagnose the acute respiratory distress syndrome, which often occurs 1 to 2 days after antibiotics are instituted. Then, the student must understand that the endotoxins that arise from gramnegative organisms cause pulmonary injury, leading to capillary leakage of fluid into the pulmonary interstitial space.

In fact, the student’s guess may be correct, but for the wrong reason; conversely, the answer may be a very reasonable one, with only one small error in thinking. Instead, the student should verbalize the steps so that feedback may be given at every reasoning point. ” Rather, the student should reason it in a way such as the following: “The most common cause of a nontender infectious ulcer of the vulva is syphilis. Painless adenopathy is usually associated. In pregnancy, penicillin is the only effective therapy to prevent congenital syphilis.

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