TABLE 3.

Questions related to Case A and Case B.

Questions	Model Answer/Instructor’s Key
1. Which urine specimen is most likely to have been provided by the 18-year-old student?	Case B
2. Briefly explain the significance of the results obtained by the dipstick method for each of the two patients.	Urine Sample Case A indicates only the presence of alkaline pH (Fig. 2, Table 1). Alkaline urinary pH can be associated with: urinary tract obstruction, pyloric obstruction, salicylate intoxication, renal tube acidosis, chronic renal failure, and respiratory diseases that involve hyperventilation. However, the pH alone is not indicative for disease as the patient’s diet and certain medications might also have an influence (11). Urine Sample Case B indicates the presence of nitrite, leukocytes, erythrocytes, and hemoglobin, plus alkaline pH (Fig. 2, Table 1). The presence of nitrite is highly specific for bacteriuria (96.6 – 97.5%) because most bacterial species causing UTI reduce nitrate in the urine to nitrite (9, 10). The presence of leukocytes (an enzyme released by white blood cells) in urine (pyuria) is a good and strong indicator for inflammation and UTI. The presence of red blood cells/erythrocytes indicates glomerular damage or bleeding somewhere in the urinary tract. Presence of hemoglobin in the urine indicates lysis of the red blood cells in urine, renal damage, but could also be due to normal menstrual flow (6). Taken together, the presence of nitrite, leukocyte esterase, and blood in the urine indicates urinary tract infection/cystitis or sexually transmitted infection (cervicitis, urethritis, etc.)
3. What is the likely diagnosis in each case?	Case A: Urinary retention secondary to benign prostatic hyperplasia Case B: Cystitis
4. For Case B, what additional symptoms would you ask about?	Bladder dysfunction: frequency, hesitancy, bladder pain, bladder cramping
5. Describe an appropriate management plan for the student with dysuria (Case B). Are additional tests required? Are follow-up urine tests required? Which antibiotic is appropriate? (Refer to the Table of bacterial susceptibility data derived from the testing of community laboratory isolates in Auckland (Appendix 1).)	Antibiotic therapy will shorten duration of symptoms considerably. Start treatment with nitrofurantoin. Urine culture is not required unless complicating factors are present (fever, flank pain, recent episode of cystitis within one month). If symptoms persist for five days, a mid-stream urine sample should be sent for urine culture—antimicrobial susceptibility testing is required. Culturing the urine to check resolution of an infection is NOT required.

UTI = urinary tract infection.