Other Urinary Symptoms Flashcards
What key history would you obtain from a patient that complained of urinary symptoms?
Duration Obstructive symptoms ( hesitancy, diminished stream, sense of incomplete bladder emptying, straining, postvoid dribbling) Irritative symptoms ( urgency, frequency, nocturia) Constitutional symptoms Bone pain Medications History of UTIs Urethral stricture Urinary tract instrumentation Stones Diabetes Alcoholism
What key physical exams would you perform on a patient with complaints of urinary symptoms?
Vital signs
Abdominal exam (including suprapubic percussion to assess for a distended bladder)
Genital and rectal exam
Focused neurologic exam
60 yo M presents with nocturia, urgency, weak stream and terminal dribbling. He denies any weight loss, fatigue or bone pain. He has had two episodes of urinary retention that required catheterization. Differentials?
Benign prostatic hypertrophy (BPH)
Prostate cancer
UTI
Bladder stones
60 yo M presents with nocturia, urgency, weak stream and terminal dribbling. He denies any weight loss, fatigue or bone pain. He has had two episodes of urinary retention that required catheterization. Differentials: BPH, prostate cancer, UTI, bladder stones. Workup?
Rectal exam UA CBC BUN/Cr PSA U/S - prostate (transrectal)
71 yo M presents with nocturia, urgency, weak stream, terminal dribbling, hematuria and lower back pain over the past four months. He has also experienced weight loss and fatigue. Differentials?
Prostate cancer BPH Renal cell carcinoma UTI Bladder stones
71 yo M presents with nocturia, urgency, weak stream, terminal dribbling, hematuria and lower back pain over the past four months. He has also experienced weight loss and fatigue. Differentials: prostate cancer, BPH, renal cell carcinoma, UTI, bladder stones. Workup?
Rectal exam UA CBC BUN/Cr PSA U/S - prostate (transrectal) CT - pelvis IVP
18 yo M presents with burning sensation during urination and urethral discharge. He recently has unprotected sex with a new partner. Differentials?
Urethritis
Cystitis
Prostatitis
18 yo M presents with burning sensation during urination and urethral discharge. He recently has unprotected sex with a new partner. Differentials: urethritis, cystitis, prostatitis. Workup?
Genital & Rectal exam
UA, urine culture
Gram stain and culture of urethral discharge
Chlamydia and gonorrhea PCR
45 yo diabetic F presents with dysuria, urinary frequency, fever, chills and nausea over the past three days. There is left CVA tenderness on exam. Differentials?
Acute pyelonephritis
Nephrolithiasis
Renal cell carcinoma
Lower UTI (cystitis, urethritis)
45 yo diabetic F presents with dysuria, urinary frequency, fever, chills and nausea over the past three days. There is left CVA tenderness on exam. Differentials: acute pyelonephritis, nephrolithiasis, renal cell carcinoma, lower UTI (cystitis, urethritis). Workup?
UA Urine culture and sensitivity CBC BUN/Cr U/S - renal CT - abdomen
