Differential diagnosis

Differential Diagnosis PATIENT Nephrolithiasis Subjective 21 y/o, female Left flank pain Urinary frequency Low fluid intake Objective (+) CVA tenderness Flank pain Renal colic Hematuria Urinary frequency, urgency, dysuria costovertebral angle tenderness

Differential Diagnosis Patient Urinary Tract Infection Subjective: 21 y/o, Female Left flank pain Urinary frequency Fever and chills Vomiting No dysuria, gross hematuria, urgency No suprapubic pain/tenderness No history of sexual contact Objective: Temp.= 38.6°C (+) CVA tenderness (+) pyuria (+) bacteruria Dysuria with accompanying urgency and frequency Suprapubic pain/tenderness Fever, chills, and malaise Maybe accompanied by flank pain and CVA tenderness

Urinary Tract Infection Exists when pathogenic microorganisms are detected in the urine, urethra, bladder, kidney, or prostate. Access is through ascent of bacteria from the urethra to the kidney. Commonly caused by gram-negative bacilli.

Urinary Tract Infection Conditions affecting Pathogenesis Gender and Sexual activity Pregnancy Obstruction Neurogenic Bladder dysfunction Vesicoureteral Reflux Bacterial Virulence factors Genetic Factors Gender and Sexual Activity- females are more prone due to the proximity of the anus to the urethra, the short length of the urethra, and its termination beneath the labia. Sexual intercourse introduces bacteria into the bladder which may cause cystitis. Pregnancy- during pregnancy, there is reduced ureteral tone, decreased ureteral peristalsis, and temporary incompetence of the vesicoureteral valves. Obstruction- any impedement to the flow of urine results in hydornephrosis and this greatly increases frequency of UTI. Neurogenic bladder dysfunction- infection may be initiated by the use of catheters for bladder drainage and is favored by the prolonged stasis of urine in the bladder. VR reflux- allows for the reflux of bacteria and thus upper tract infection.

Genitourinary Tuberculosis Genitourinary tuberculosis (GUTB) may involve the kidneys, ureter, bladder, or genital organs The infection almost always affects the kidneys during the primary exposure to infection but does not present clinically. The spread to the kidneys from the lungs, bone, or a GI tract focus usually is hematogenous.

Genitourinary tuberculosis Patient Genitourinary tuberculosis Subjective 21 y/o Female (+) PTB (2005) (+) flank pain (+) urinary frequency (-) dysuria (-) gross hematuria (-) weight loss (+) easy fatigability Objective (+) CVA tenderness (+) fever 38.6 C 30-45 years M:F = 5:3 History of pulmonary tuberculosis flank pain Urinary frequency dysuria gross hematuria weight loss fatigue anorexia CVA tenderness low-grade fever http://emedicine.medscape.com/article/450651-overview http://www.merck.com/mkgr/mmg/sec10/ch76/ch76b.jsp

Differential Diagnosis PATIENT Pneumonia Subjective 21 y/o, female Fever & chills Dyspnea Chronic cough Easy fatigability Objective Tachypneic, on respiratory distress Tachycardia (+) palpable cervical lymph nodes ↑tactile & vocal fremiti Dullness to percussion (+) fine crackles (+) egophony, bronchophony & whispered pectoriloquy Fever, Cough, Dyspnea Chest pain Egophony, whispered pectoriloquy Crackles or rales, bronchial breath sounds dullness to percussion Increase tactile/ vocal fremiti

Pulmonary tuberculosis Tuberculosis is an infectious disease caused by mycobacteria, usually Mycobacterium tuberculosis transmitted by airborne droplet nuclei, which may contain fewer than 10 bacilli When inhaled, droplet nuclei are deposited within the terminal airspaces of the lung.

Pulmonary tuberculosis Patient Pulmonary tuberculosis Subjective (+) fever (-) weight loss (+) chronic cough (nonproductive) (-) hemoptysis Objective Trachea situated midline Increased tactile fremiti Dullness on percussion Increased vocal fremiti (+) Bronchophony, egophony, whispered pectoriloquy Fever Weight loss Cough (productive cough) Hemoptysis trachea midline Increased tactile fremiti Dullness on percussion Increased vocal fremiti Bronchophony, egophony, whispered pectoriloquy