Sally smith ihuman painful urination COMPLETE ANSWER KEY., Exams of Integrated Case Studies

Download Sally smith ihuman painful urination COMPLETE ANSWER KEY. and more Exams Integrated Case Studies in PDF only on Docsity! Sally smith ihuman painful urination COMPLETE ANSWER KEY. Sally Smith 34 y/o 5'4" (163 cm) 120.0 Ib (54.5 kg) Reason for encounter Painful urination Review Submitted on 03/1 4/2022 06:57:50 Case authored by: Sadiya Khan, MD x Do you have new or multiple SH sexual partners with simi ‘symptoms? SH Are you sexually active? SH control? Review of Systems (ROS) Are you using any form of birth iced cod PT aericy Ce last three months. It's just him. And, no, he's not having any symptoms. Yes. Yes. Mostly condoms, but my partner and | aren't always consistent. Select the major body systems that have not been touched on during the interview process for the HPI. @ Asked X Not asked Graded Question Have you noticed any bruising, bleeding gums, nose bleeds, or other sites of increased bleeding? Do you have problems with heat or cold intolerance, increased thirst, increased sweating, frequent urination, or change in appetite? Do you have problems with dizziness, fainting, spinning room, seizures, weakness, numbness, tingling, or tremor? Do you have any problems with nervousness, depression, lack of interest, sadness, memory loss, or mood changes, or ever hear voices ‘or see things that you know are not there? Do you have any problems with fatigue, difficulty sleeping, unintentional weight loss or gain, fevers, or night sweats? Do you have any problems with headaches that dont go away with aspirin or Tylenol (acetaminophen), double or blurred vision, difficulty with night vision, problems hearing, ear pain, sinus problems, chronic sore throals, or difficulty swallowing? Do you experience chest pain discomfort or pressure; pain/pressure/dizziness with exertion or getting angry; palpitations; decreased exercise tolerance; or blue/cold fingers and toes? Do you have problems with nausea, vomiting, constipation, diarrhea, coffee grounds in your vomit, dark tarry stool, bright red blood in your bowel movements, early satiety, or bloating? Information Obtained Response Clinic Notes Nope. Yes, lo a few things on that list. No, but I do feel a little lightheaded when | stand up. Uh...no. Weight? Sweating at night? Problems sleeping? None of that. What else did you ask again? Nope. No STC Exams Feedback © Performed Correctly * auscultate abdomen © You performed the simulation correctly. auscultate heart © You performed the simulation correctly. © Your documentation was correct. blood pressure genitourinary female exam A thorough gynecologic exam should be performed when you are presented with a case that potentially involves both the urinary and reproductive systems. There may be considerable "overlapping" of symptoms: © Dysuria: e.g., cy © Suprapubic discomfort: e.g., cystitis vs. early PID vs. chlamydia-related urethritis 2 Secondary systemic involvement (dehydration, septicemia): e.g., pyelonephritis vs. acute PID inspect skin overall Your examination should be directed toward signs of the following: © Dehydration: skin turgor © Infection: rash, skin lesions © Systemic illness: .g., icterus, pallor orthostatic blood pressure (BP) palpate abdomen In a case of a young, sexually active woman presenting with possible urosepsis, your abdominal exam should be directed toward signs of other primary and/or secondary conditions: © Perinephritic abscess © PlD-related abscess, peritonitis, or Fitzhugh-Curtis syndrome (perihepatitis secondary to PID) percuss back and spine Percussion of the back and spine is a technique used to look for signs of inflammation, fracture, infection, instability pulse respiration * Spo, * temperature ® Not Required, Not Inappropriate © cognitive status * height © weight Missed © auscuttate lungs © You did not auscultate all the locations. © You documented left lung and right lung correctly. eT ] ere)  Organize Koy a a _ Findings | Your Findings Case Findings Write Key Finding MsaP Key Finding MSAP Problem Relation Relation Statement Dysurla, urgency, frequency MSAP Dysurla, frequency, urgency NSAP Select - . ; Seterantial Tachycardia RELATED Right flank pain RELATED Diagnosis Right flank pain, (+) punch sign RELATED Suprapubie pain RELATED Rank UNKNOWN Fever (101.6 F), chills RELATED thostatic blood eral trl orihos ete Bignd preeeurs Tachycardia RELATED Fever, chills RELATED : ; Select Orthostatic hypotension; symptomatic RELATED RELATED Tests Dark colored/ vane: Hyperglycemia by report x several days | RELATED Hyperglycemia in a Type | Diabetic UNKNOWN in patient with Type 1 DM New sexual partner w/ inconsistent use RELATED Poor app’ RELATED eliblinTeeresuS TU aLatactionl Hx of recently new sexual partner UNKNOWN Pe etite UNKNOWN eee ERE Dark colored urine RELATED ‘Suprapuble pain RELATED Feedback In a young female, the symptom triad of dysuria, urinary frequency, and urgency (withaut vaginal discharge) provides a starting point for the development af your differential diagnosis. The pertinent presence or absence of other critical signs, and symptoms will then aid you in prioritizing your differential. Look first at the vital signs. We find a febrile, tachycardic patient with symptoms (lightheaded on standing) and documentation of orthostatic hypotension. This combination might suggest an infectious process. Could there be other explanations? What medical issues could link possible dehydration and presenting triad of symptoms? The pationt also has a new sexual partner with whom she has not used condoms consistently. Does this information impact your differential by either broadening or narrowing it? Finally, she has Type 1 DM and states she has poor glycemic control. How does this finding factor into your thoughts on a differential?  Organize Koy Your Differential Ranking Findings @ Correct € incorrect write Problem Differential Your Your Your Statement Diagnosis Lead Graded Alt Graded MNM Graded Select cystitis ° o| e gq « Differential Diagnosis ° ©,|e a « Rank perinephricabscess O ° e a e a pyelonephritis eo ee o a e urethritis °o o,|e a@ « Select Tests Feedback Acute pyelonephritis is the most likely diagnosis given this patient's progression of symptoms from lower urinary tract infection (dysuria, irrtative voiding, suprapubic discomfort) to systemic symptoms of fever, chills, and flank pain. Additionally, the patient's history of neahrolithiasis (two years prior to this presentation) raises concern for a recurrent episode presenting as a complicated UTI. This is less likely, however, given her description of her flank pain as being more visceral than colicky. Thus, pyelonephritis is the leading and also must-nol-miss diagnosis. This pationt's compounding risk factors of diabetes and prior nephrolithiasis raises further concern for the presence of a perinephric or intrarenal abscess. However, perinephric abscesses often have less UTI symptoms and no flank pain and rather present often as a fever of unknown origin. For these reasons, this is an alfernative diagnosis, but a must-not- miss as it can result in sepsis. Nephrolithiasis with cystitis are alternative diagnoses but much less likely as the pain is described is not colicky, but it should be a consideration because of her history of prior stones. Sexually transmitted infections should be considered in light of a new sexual partner and inconsistent use of condoms. Our patient lacks gynecologic symptoms suggestive of cervicitis, vaginitis, and/or PID, however urethritis is often found with chlamydial infections. Although a consideration, the focality of the pain suggests a urinary process is much more likely and sexually transmitted infections should only be re-considered if all testing is negative. Finally, while not a hypothesis to explain this patient's overall presentation, pregnancy must be ruled aut as a comorbid condition. er  Organize Key Feedback Findings @ Correct XMissed € Extraneous Write Problem cystitis: Statement @ urine culture ae @ urinalysis (UA) Differential Diagnosis _Mephrolithiasis/kidney calcull urinalysis (UA) Rank e : abdomen CT Differential Diagnosis € comprehensive metabolic panel (CMP) € basic metabolic panel (BMP) € urie acid, urine € uric acid, serum € calcium, urine (24 hour) creatinine, urine (24 hour) urine culture € renal ultrasound perinephric abscess abdomen CT X complete bload count (GBC) renal ultrasound pyelonephritis X blood culture and sensitivity abdomen CT @ urine culture @ urinalysis (UA) © complete blood count (CBC) @ comprehensive metabolic panel (CMP) € erythrocyte sedimentation rate (ESR) € renal ultrasound urethritis X Chlamydia, swab/PCR © urinalysis (UA) X Neisseria gonorrhoeae, swab/PCR € sexually transmitted disease screen (STD) rer} Feedback Diagnosis Acute pyelonephritis with E. coli bacteremia/sepsis syndrome. No evidence of renal stones as contributing factor.