{"id":9426,"date":"2026-03-23T00:02:06","date_gmt":"2026-03-23T08:02:06","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=9426"},"modified":"2026-06-30T14:14:28","modified_gmt":"2026-06-30T22:14:28","slug":"usmle-step-2-ck-question-of-the-day-dysuria","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-dysuria","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Dysuria"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-dysuria\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 2 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-dysuria\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-dysuria\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-dysuria\/#Major_Takeaway\" >Major Takeaway<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-dysuria\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-dysuria\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Today, we\u2019re examining a clinical case of a 30-year-old woman arrives at the clinic experiencing issues with dysuria. What&#8217;s the most likely diagnosis? Do you know the answer? Let&#8217;s find out!<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A <strong>30-year-old woman<\/strong> presents to the <strong>outpatient clinic<\/strong> with a four-day history of <strong>dysuria<\/strong>, increased <strong>urinary frequency and urgency<\/strong>, and a <strong>sensation of incomplete bladder emptying<\/strong>. She does not have a <strong>fever, flank pain, vaginal discharge <\/strong>or <strong>itching<\/strong>. She is not sexually active. Vitals are within normal limits. On examination, she has <strong>suprapubic tenderness<\/strong>, without rebound or guarding. There is no <strong>costovertebral angle tenderness<\/strong>. <strong>Urinalysis reveals leukocytes and leukocyte esterase, but no nitrites or blood.<\/strong> A clean-catch urine sample is sent for culture. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following is the <em>most likely<\/em> diagnosis?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Vaginal candidiasis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Gonococcal cervicitis and urethritis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Interstitial cystitis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Chlamydial cervicitis and urethritis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Cystitis<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Learn with Osmosis\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iDxHtjjCMbU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 2 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">E. Cystitis<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Vaginal candidiasis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Vaginal candidiasis, or <strong>yeast infection<\/strong>, is often caused by <strong>antibiotic use<\/strong>, which <strong>disrupts the normal vaginal flora<\/strong> and allows for Candida overgrowth. <strong>Symptoms include itching and burning of the vagina<\/strong>, and a characteristic <strong>thick, white &#8220;cottage cheese-like&#8221; vaginal discharge<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Gonococcal cervicitis and urethritis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> <strong><a href=\"https:\/\/www.osmosis.org\/blog\/the-osmosis-quick-reference-guides-to-reproductive-and-sexual-health\">Neisseria gonorrhoeae<\/a><\/strong> is a common cause of <strong>sexually transmitted infections<\/strong>. <strong>Cervicitis <\/strong>and <strong>urethritis <\/strong>in women are commonly caused by Neisseria gonorrhoeae. With cervicitis, there is typically a <strong>mucopurulent discharge<\/strong>. Urethritis may also be seen <strong>concurrently <\/strong>and <strong>cause dysuria<\/strong>, however, most women with Neisseria gonorrhoeae are <strong>asymptomatic<\/strong>. This diagnosis is unlikely in this patient who is not <strong>sexually active<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Interstitial cystitis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> <strong>Interstitial cystitis<\/strong> is a chronic condition characterized by <strong>bladder pain, urgency, frequency, and nocturia<\/strong>. Onset of symptoms in interstitial cystitis tends to be more <strong>insidious and chronic<\/strong>, rather than <strong>acute<\/strong>, as seen with this patient. The <strong>urine is sterile<\/strong> in interstitial cystitis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Chlamydial cervicitis and urethritis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> <strong><a href=\"https:\/\/www.osmosis.org\/blog\/a-quick-reference-guide-to-common-conditions-related-to-sexual-health-bacterial-infections\">Chlamydia trachomatis<\/a><\/strong> is a <strong>sexually transmitted bacteria<\/strong> that can cause <strong>urethritis<\/strong>, leading to symptoms of dysuria. In women, <strong>chlamydial infection<\/strong> can also <strong>ascend to<\/strong> involve the <strong>cervix<\/strong>, producing a <strong>mucopurulent cervical discharge<\/strong>. While this patient does have dysuria, she has no vaginal discharge and is not sexually active.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient has <strong>cystitis<\/strong>. <strong>Cystitis<\/strong> is a <strong>urinary tract infection (UTI)<\/strong> of the bladder\/lower urinary tract and is most commonly caused by bacterial infections. Typical symptoms of cystitis include <strong>dysuria<\/strong> (painful urination), <strong>increased frequency of urination<\/strong>, <strong>urgency<\/strong>, a sensation of incomplete bladder emptying, and occasionally <strong>hematuria<\/strong>. The onset of symptoms tends to be <strong>acute onset<\/strong>, developing over a short period, which aligns with this patient&#8217;s <strong>4-day history<\/strong> of symptoms. Physical examination may reveal <strong>suprapubic tenderness<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The urinalysis findings further support the diagnosis of cystitis. The presence of <strong>pyuria<\/strong> or <strong>leukocytes<\/strong> seen on <strong>urine microscopy<\/strong> indicates an inflammatory or infectious process within the urinary tract. <strong>White blood cell count \u226510 leukocytes\/microL<\/strong> is consistent with a urinary tract infection. The presence of <strong>nitrites<\/strong>, produced by certain bacteria like E. coli, are often detected in bacterial <strong>UTIs<\/strong>, but their absence does not rule out a <strong>UTI<\/strong>, especially in the context of symptoms suggestive of cystitis. The presence of <strong>leukocyte esterase<\/strong> indicates a urinary tract infection since it is an enzyme released by leukocytes. A <strong>urine culture<\/strong> showing <strong>bacteriuria<\/strong> (<strong>\u2265105 colony-forming units\/mL<\/strong>) of a uropathogen confirms the diagnosis.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Cystitis<\/strong>, or <strong>inflammation of the bladder<\/strong>, is typically caused by <strong>bacterial infections<\/strong>. Patients with cystitis typically present with <strong>dysuria and suprapubic tenderness<\/strong>. Urinalysis can show <strong>pyuria, positive nitrites, and hematuria<\/strong>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch the Osmosis video:<\/strong> <strong><a href=\"https:\/\/www.osmosis.org\/learn\/Lower_urinary_tract_infection:_Clinical_sciences\">Lower urinary tract infection: Clinical sciences<\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Michels, T., &amp; Sands, J. E. (2015). Dysuria: Evaluation and Differential Diagnosis in Adults. American Family Physician, 92(9), 778\u2013786.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 2 CK practice questions? Try Osmosis from Elsevier today! Access your&nbsp;<em><a href=\"http:\/\/osmosis.org\/create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/em>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Follow the case of a 30-year-old woman with four days of dysuria, urgency, and suprapubic tenderness as clinicians review history, exam findings, and urinalysis results to navigate the differential and why certain tests guide decision-making.<\/p>\n","protected":false},"author":204,"featured_media":9430,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1370,45],"tags":[2780,733,2777,2781,2783,84,2784,2782,2787,2779,2786,2778,2785,185],"class_list":["post-9426","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-2-questions","category-step-2","tag-bladder-symptoms","tag-clinical-case","tag-dysuria","tag-leukocyte-esterase","tag-lower-urinary-tract-symptoms","tag-medical-education","tag-nitrites","tag-pyuria","tag-step-2","tag-suprapubic-tenderness","tag-urinalysis","tag-urinary-symptoms","tag-urine-culture","tag-usmle"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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A 55 year-old female\u2026","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE\u00ae Step 1 Question of the Day: Urinary Incontinence","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T073325.938.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T073325.938.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T073325.938.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T073325.938.webp 2x"},"classes":[]},{"id":3222,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-urgency-incontinence","url_meta":{"origin":9426,"position":5},"title":"USMLE\u00ae Step 2 CK Question of the Day: Urgency Incontinence","author":"Marina Horiates Kerekes, MD &amp; Team","date":"September 15, 2021","format":false,"excerpt":"We're back with a USMLE\u00ae Step 2 CK Question of the Day!\u00a0Today's case involves a 31-year-old woman with urinary incontinence. Which of the following interventions is used in treating this patient\u2019s condition? A 31-year-old woman has come to an outpatient clinic for urinary incontinence over the past week. 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