Post on 04-Jan-2016
CASE PRESENTATION(Evidence-based medicine)By: Intern Sheena B. FernandoBlock O
General Data:
This is a case of A.E, 43 year-old male, married, Catholic, right-handed, from Taguig City who came in due to dysuria.
History of Present Illness
One week PTC - (+) dysuria, (+) dribbling, (+) flank pain on the left side, VAS 8/10 Described as ‘parang namamanhid’radiating to the left lower abdominal quadrant, (-) frequency, (-) penile discharge, (-)fever, (-) vomiting(-) passage of urine sediments,(-) nocturia, (-) straining, (-) urgency, (-) retentionNo consult done.No medications taken.
3 Days PTC - persistence of symptoms, sought consult at private MD, prescribed with Ciprofloxacin 500mg/tab, 1 tab BID x 7 days, on Day 2 of treatment, Rowatinex tablet, 1 tablet TID x 7 days, HNBB (Buscopan) 10mg/tab, 1 tab TID x 5 days. Temporary relief of symptoms.KUB Ultrasound was done and showed Mild hydronephrosis with nephrolithiases left.
Few hrs PTC, persistence of symptoms
Consult at AMBU
Review of Systems
•No weight loss, no headache, no easy fatigability, no loss of appetite, no jaundice•No cough, no colds, no difficulty of breathing, no chest pain•No orthopnea, no paroxysmal nocturnal dyspnea, no palpitation•No abdominal pain, no diarrhea, no change in bowel movement, no melena, no hematochezia, no hematemesis•No polyuria, polydipsia, polyphagia•No loss of consciousness, no seizures
Past Medical History
(-) previous operation (+) previous hospitalization due to AGE
1989, San Juan De Dios Hospital (+) Hypertension since May 2008
HBP 160/110 UBP 120/90 with poor compliance to unrecalled medications
(-) DM, (-) PTB, (-) BA (-) allergy to food and drugs
Family History
Personal and Social History finished 3rd year HS works as a family driver - his family’s
source of income drinks alcohol, once a week (beer, gin
and hard drinks) non-smoker prefers to eat fatty and salty food drinks water from NAWASA, unboiled,
consuming 1 liter of water per day.
Sexual History
Coitarche at 15 years old With 3 nonpromiscuous sexual partners (-) MSM
Physical Examination
conscious, coherent, in painVital Signs: BP= 140/90mmhg HR=84 bpmRR=20cpm T= 36.5C BMI= 22.49 kg/m2
SHEENT: dirty sclerae, pink palpebral conjunctivae, no nasoaural discharge, no cervicolympadenopathy, no TPC, PERTL 2-3 mm
CHEST: symmetric chest expansion, no retraction, clear breath sounds
CVS: adynamic precordium, distinct heart sounds, normal rate regular rhythm, no murmur
ABDOMEN: flabby, normoactive bowel sounds, nontender, (+) costovertebral angle ternderness left
EXTREMITIES: full and equal pulses, no cyanosis, no edema
GENITALIA: grossly normal genitalia, no discharge
DRE: good sphincteric tone, no skin tags, no masses, no tenderness, no blood on examining finger, empty rectal vault
Differential Diagnoses
Assessment
Complicated UTIMild Hydronephrosis with Nephrolithiases,
LeftHypertension Stage II, uncontrolled
Plan
Diclofenac 25mg/ml, 1 amp TIM was given Low salt, low fat diet Dx: FBS, Crea, Na, K, TG, TC, LDL, HDL
12L ECG, Long Lead IIUrinalysis
Tx: Continue: 1. Ciprofloxacin 500mg/tab, 1 tablet BID for 5 more days Start: 2. Diclofenac Na 50mg, 1 tab TID and PRN for pain on
full stomach 3. Losartan + HCTZ 50mg/12.5mg 1 tab OD
TCB once with results at OPD DFCM after 1 week Refer to Urology-Surgery OPD Basis Advised
Diagnostic Dilemma
In adult patients with clinical symptoms of renal stones, what is the sensitivity and specificity of KUB-UTZ compared to CT scan in confirming the diagnosis, using a cross sectional study?
Population
Adult patients with clinical symptoms of renal stones
Intervention
KUB UTZ
Comparison
CT scan
Outcome Sensitivity and specificity in confirming the diagnosis
Method Cross sectional study
KUB UTZ: Diagnostic Threshold - 30Therapeutic Threshold – 80Pre-Test Probability – 70%
Clinical Dilemma
In adult patients diagnosed with renal stones, is Rowatinex effective in facilitating passage of renal stones, using a randomized control trial?
Population
Adult patients with renal stones
Intervention
Rowatinex
Comparison
Placebo
Outcome Effect in facilitating passage of renal stones
Method Randomized control trial
Thank you!