Dysuria

Question 1

Definition of Dysuria

Answer 1

Pain or discomfort associated with urination that is localized to the bladder or urethra

Question 2

Common complain among …

Answer 2

healthy women

Question 3

What is it typically caused by?

Answer 3

Urinary Tract Infection

Question 4

Extensive work up?

Answer 4

NO

Question 5

DDx for Women of Reproductive Age (6)

Answer 5

1. Lower tract UTI - VERY COMMON!!!
2. Vaginitis - COMMON
3. Pyelonephritis - UNcommon
4. Urethritis - UNcommon
5. Perineal trauma - UNcommon
6. Interstitial cystitis - UNcommon

Question 6

Distinguishing symptoms and signs for:

Lower Tract UTI

Answer 6

Nocturia (WAKING UP TO PEE)

Cloudy or malodorous urine (CLOUDY AND SMELLY PEE!)

Question 7

Distinguishing symptoms and signs for:

Vaginitis

Answer 7

DISCHARGE
Perineal pruritus (ITCHING!!!)

Question 8

Distinguishing symptoms and signs for:

Pyelonephritis

Answer 8

Fever - RED FLAG!!!
Flank Pain - RED FLAG!!!
CVA Tenderness

Question 9

Distinguishing symptoms and signs for:

Urethritis

Answer 9

ahhhh shit idk

Question 10

Distinguishing symptoms and signs for:

Perineal Trauma

Answer 10

Evidence of trauma and tenderness on exam

Question 11

Distinguishing symptoms and signs for:

Interstitial Cystitis

Answer 11

FREQUENCY and URGENCY for 6 months… w/ negative workup

Question 12

DDx for Older Women

Answer 12

Vaginal atrophy - COMMON

Question 13

Distinguishing symptoms and signs for:

Vaginal Atrophy

Answer 13

Vaginal mucosal atrophy on examination

Question 14

DDx to consider for MEN

Answer 14

1. Prostatitis - COMMON

2. Urethritis - UNCOMMON!!!

Question 15

Distinguishing symptoms and signs for:

Prostatitis

Answer 15

HESITANCY (holding back)
URGENCY w/ DECREASED urine flow (feels like they have to go but only a couple drips comes out)
TENDER PROSTATE

Question 16

Distinguishing symptoms and signs for:

Urethritis (MEN)

Answer 16

Urethral DISCHARGE

Dysuria LOCALIZE TO PENIS (dingaling hurts)

Question 17

What does the pain feel like?

Answer 17

“burning” “sharp”

Question 18

Are you urinating more frequently?

Answer 18

Increased frequency

Question 19

When you attempt to urinate, do you have trouble w/ initiation?

Answer 19

Hesitancy

Question 20

Do you have a decrease in the stream of urine?

Answer 20

Kidney stone, prostatitis

Question 21

Does your urine have a foul order?

Answer 21

Lower tract UTI?

Question 22

Blood in urine?

Answer 22

Hematuria

Question 23

What color is your urine? Cloudy?

Answer 23

Pyuria

Question 24

Vaginal / penile discharge?

Answer 24

Think STI

Question 25

Vaginal Itching?

Answer 25

Vaginitis

Question 26

Do you feel a sudden urge to urinate?

Answer 26

URGENCY!

Question 27

Do you feel there is urine left in your bladder after urination?

Answer 27

Post-void residual

Question 28

Do you have any abdominal or back pain? Where?

Answer 28

could point to kidney stones??

Question 29

Fevers, nausea or vomiting

Answer 29

Think: pyelonephritis, PID (pelvic inflammatory disease), epididymitis

Question 30

Do you have constipation?

Answer 30

ask this

Question 31

Are you sexually active? Male, female or both? How many partners? Do you use protection? Painful intercourse? Female --> W/ insertion? Deep penetration?

Answer 31

Painful intercourse --> dyspareunia w/ insertion --> vaginitis, dryness/trauma deep penetration --> PID, endometriosis, pelvic mass

Question 32

Increased urination at night?

Answer 32

Nocturia

Question 33

RED FLAGS for DYSURIA (indicate complicated infection)

Answer 33

1. MALES 2. Infants or elderly 3. Symptoms more than 7 days 4. Immunosuppressing condition 5. Episode of acute pyelonephritis within the past year 6. Known anatomic abnormality 7. Diabetes mellitus 8. FEVER 9. Flank pain or tenderness