Question

A 22 year old black woman present with complaints of burning and frequency of urination for the past 2 to 3 days. It is getting worse. She feels she has to void, rushes to the bathroom and then is only able to void a small amount. it is painful. There is no sign of blood in the urine. She denies fever, chills, diarrhea, nausea, vomiting or vaginal discharge.

" I have to rush to the bathroom, and it hurts when I urinate".

Physical Ex:

Essentially unremarkable. Negative suprapubic tenderness: negative costovertebral angle tenderness. Negative abdominal pain and benign abdominal exam. Negative back pain. Afebrile. Vital signs normal. No complaints of vaginal discharge. Uranalysis shows+ WBCs, trace RBCs.

• What additional data are important to factor into this picture? Do you do vaginal ex and why? Should you do urine culture and sensitivity?
• What are things in the medical history that may provide clues to the possible cause of dysuria?
• What are the possible differential diagnoses for this patient and how do you rule them in or out?

Answer 1

A.The patient should be asked for the additional informations like use of forms soaps which can cause chemical irritation.

History of trauma or any sort of catheterization

Or signs and symptoms of vulvitis should be assessed

B.Yes, the vag. examination should be done in order to rule out the Vulvo vaginitis.

C.

In order to rule out urinary tract infections and Volvo vaginitis cultural sensitivity tests should be done.

In order to rule out urinary tract infections and Volvo vaginitis cultural sensitivity tests should be done.

D.

The medical history of the patient indicates that the patient is not having any kind of fever or any inflammatory indicator, hence.

Vaginitis and urethritis could be ruled out as there is no sign and symptom of pain or any sort of discharge.Also, the urine is clear and the urine examination results are fine. Hence further. We can decline urethritis or vaginitis.

E.diffrential diagnosis:

Pyelonephritis, urethritis,vulvovaginitis,contact sensitivity ( due to use of chemicals, soaps,)

Explantion: image