Question

Mrs. C., a 66-year-old woman, presents to your practice with a complaint of recent onset of leaking urine. She has no prior history of this. On further questioning you discover that she is newly married, after being widowed for 15 years, during which time she had no sexual partners. She and her new husband have just returned from a cruise, and she reports that he is a “passionate” lover and she is having difficulty meeting his needs for daily intercourse. Other symptoms that Mrs. C. reports are vaginal burning and general discomfort “down there.”

Medications: Takes fish oil at bedtime, vitamin D 3 1,000 IU daily. No known drug allergies.

Vital signs: Blood pressure (BP) 128/76 mm Hg, pulse 82 (regular), respiratory rate 16 breaths/min, temperature 98.2°F (oral), BMI 23.4. A staff member has obtained a urine specimen for dipstick.

Findings are as follows:

Nitrite—negative

Leukocyte esterase—negative

Blood—trace

Protein—trace

Glucose—negative

Ketones—negative

Specific gravity—1.015

1. What additional subjective data are you seeking?

2. What additional objective data will you be

assessing for?

3. What national guidelines are appropriate to

consider?

4. What tests will you order?

5. Are there any screening tools that you want to

use?

6. What are the differential diagnoses that you are

considering?

7. What is your plan of care?

Answer 1

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Men presenting with urinary incontinence Haematuria Initial assessment History Physical examination Questionnaire Voiding diary Urinalysis Post void residual if voiding difficulty Pad test Strong Strong Strong Strong Strong Pain .Recurrent UT Previous pelvic radiotherapy Abnormal DRE Findings suspicious of voiding dysfunction Strong Weak PWhen standardised assessment is requiredy Further assessment For specialist review Discuss management options Individualised behavioural and physical therapies induding pelvic floor muscle training Strong Urgency incontinence Stress incontinence Mixed incontinence Advise on bowel function, drugs, co-morbidity, fluid intake Advise on weight loss Offer pads or other containment device if needed Offer timed or prompted voiding in elderly/care-dependent people Strong Strong Strong Strong Urgency predominant Stress predominant Antimuscarinics strong or mirabegron Strong Failed conservative or drug therapy Consider urodynamics and lower urinary tract assessment Strong Urgency incontinence Mixed incontinence Stress incontinence individual patient assessment Advise onabotulinumtoxin A Offer fixed sling or artificial urinary sphincter to men with PPI Weak or sacral nerve stimulation Strong Bladder augmentation or urinary diversion Weak Available evidence refers mainly to women
these are the national guidelines .

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5.here screwing test for suspected kidney disease is

-measurement of serum creatinine level, complete blood count, urinalysis, and fractional excretion of sodium. Ultrasonography of the kidneys should be performed in most patients,

Here further screening test for UTI are -

Common laboratory tests for urinary tract infections (UTIs) include:

• Urinalysis—most UTIs are detected by performing a urinalysis, which looks for evidence of infection, such as bacteria and white blood cells in a sample of urine.
• Urine culture—for people who have recurring UTIs and those who are hospitalized, urinalysis results are confirmed with a urine culture.
• Susceptibility testing—this is done if there are microbes identified by the culture to determine which antibiotics will inhibit the growth of the bacteria or yeast causing the infection. The results will help a healthcare practitioner determine which drugs are likely to be most effective in treating a person's UTI.
• 6..ans .the possible diagnosis are - 1.urinary incontinence.2.urinary track infection 3 . Kidney injury
• 7 ans ..
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