An obese 58-year-old woman is seen by her physician

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An obese 58-year-old woman is seen by her physician. Her chief complaint is perineal itching and soreness. When giving her health history, she also complains of being thirsty “all the time: and to be urinating more frequently. On pelvic examination, a white discharge is noted. A urine specimen is collected for a routine urinalysis.

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Urine Physical Examination

Color:       Yellow

Clarity:   Cloudy

Odor:        None

Urine Chemical Examination

Specific gravity:       1.015

pH:               6.0

Blood:               Moderate

Protein:           Trace

Leukocyte:           Positive

Nitrite:               Negative

Glucose:           500 mg/dl

Ketones:           Trace

Bilirubin:           Negative

Urobilinogen:           Normal

Ascorbic Acid:       None Detected

Microscopic Examination

RBC/hpf:           0-2

WBC/hpf:            10-25 clumps

Casts/lpf:            0-2 hyaline

Epithelials:           Many squamous epithelial cells/lpf

Bacteria:           Negative

Yeasts/hpf:           Moderate

Crystals/hpf:           Few urates

Identify any abnormal or discrepant urinalysis findings.

What is the most likely cause of this patient’s vaginitis?

What is the most likely origin or source of the white blood cells in this urine?

Which two microscopic findings suggest that this urine is not a midstream clean catch specimen?