Identify and differentiate the symptoms from the signs in this patient. Did you find any remarkable detail in the personal and social history of our patient that can help to make the diagnosis? What results do you expect to find in the tests ordered? What are some future complications the patient is at risk of developing? Do the urinary incontinence and the cystocele have any relationship with dystocic deliveries? Why or why not? Is cystocele a cause of urinary tract infections? Explain your position. What could be the cause of the whitish and cottage cheese-like vaginal discharge the patient had in her last pregnancy? Is that common? Why or why not? What is the prognosis of Mrs. Meriwether’s cystocele? Can you mention other causes of urinary obstructions? According to the history, our patient was very concerned about having a tumor. What are some tumors of the female reproductive system that we should rule out in this case? Mrs. Meriwether had two episodes of renal colic produced by a renal lithiasis. Describe this diagnosis and the prognosis. Is this condition related to a chronic kidney disease? Why or why not? Case Study INFO to be used – Name: Mrs. Maggie Meriwether Age: 56 years old Gender: Female Description Mrs. Meriwether is a 56-year-old woman, who was apparently in good health until six months ago, at which point she started noticing an uncontrollable urge to urinate when she was exercising, lifting weights, sneezing, or coughing. The embarrassing part for her is that, although she has tried to suppress the urge, she has voided in her underwear very often. The problem has become more frequent, and she has to wear a sanitary pad constantly. The patient also shares that she has something protruding through her vagina. She is anxious because she thinks she has a tumor. After conducting a thorough medical interview and physical examination, the doctor diagnoses stress urinary incontinence and cystocele. Our patient is a mother of four children with vaginal deliveries complicated by shoulder dystocia. During her last pregnancy, she had a whitish and cottage cheese-like vaginal discharge. A year ago, Mrs. Meriwether had an episode of gastroenteritis accompanied by profuse vomiting and diarrhea, which produced moderate dehydration and electrolyte and acid-base imbalances. Our patient also indicates she has had two episodes of right renal colic produced a renal lithiasis. Patient has no history of smoking or alcohol intake. On physical examination we found: Remarkable Signs on Physical Exam by Systems Urinary system: Leakage of urine through the urethra during Valsalva maneuver Reproductive system: Soft mass protruding through the vagina, mostly when the patient is pushing Lab Tests Complete blood count (CBC) Urinalysis Pelvic ultrasound Cystourethrogram
