Dysuria

HISTORY:

Dysuria for ‍ ‍hoursdays

‍frequency

‍urgency

‍foul-smelling urine

‍hematuria

‍suprapubic pressure

‍abdominal pain

‍flank pain

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍nausea

‍vomiting

‍incontinence

‍hesitancy

‍nocturia

Treatments tried: ‍none, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

CVA tenderness: ‍negativepositive on Rpositive on L

Anorectal: DRE ‍normal, prostate ‍normal, anus ‍normal

Genital: ‍normal, testicles ‍normal, penis ‍normal

Pelvic: vulva ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍no cervical motion tenderness



ASSESSMENT:

‍Urinary tract infection ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Urinalysis

- Urine culture

- STI testing for chlamydia and gonorrhea

- Blood work: ‍CBC, ‍creatinine, ‍CRP

- Pelvic ultrasound

- CT scan of the abdomen and pelvis

- Cystoscopy

- ‍Antibiotics

- ‍Analgesics

- ‍Phenalgesics

- ‍Fluconazole

- ‍Valacyclovir

- Increase fluid intake

- Avoid caffeine, alcohol, and spicy foods

- Referral to urologist

- Referral to gynecologist

- Follow-up in ‍ ‍weeksmonths

- Return if symptoms worsen or if fever develops