1. Differential diagnosis

2. 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

3. 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

4. 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.

5. 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.

6. 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.

7. 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

8. 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

9. 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.

10. 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