1) My 1st impression with the presenting symptoms is urinary tract infection with candida vaginitis (Yeast Infection). My differential diagnoses are exposure to foreign body and Allergic vaginitis.
2) My diagnosis for Mrs. Jones is urinary tract infection with genitourinary candidiasis (yeast infection). The priority is to treat the UTI because untreated UTI can lead to pyelonephritis and then candida vaginitis, although both can be treated simultaneously. The subjective and objective data is that Mrs. Jones is running a low grade fever at 99.8, her blood sugars are not controlled and it is evident by her hemoglobin A1C report which is 8.3% that is significantly high. She is also complaining of burning on urination and slight discomfort of vague pain. Her fasting blood sugar is 188 and non-fasting 233 which suggest poor blood glucose control and that alone increase her risk for getting urinary tract infection as well as yeast infections. Secondly she has been douching with vinegar and water which is causing more problems and causing further irritation. Her urine is cloudy which further suggest the UTI, and urine dipstick shows bacteria with trace blood suggestive also of yeast infection. She is also having vaginal drainage that is thick and odorless which is seen in candida vaginitis (Yeast infections).
3) Medication ciprofloxacin 250 mg PO q 12 h x 3 days Miconazole vaginal use as directed (1 applicatorful vaginal cream per vagina every night x 3 days)
4) I would like to order the culture and sensitivity for the Urinalysis to use the best antibiotics that is sensitive to the urinary tract infection
5) Mrs. Jones uncontrolled diabetes is the biggest culprit in the development of UTI and candida vaginitis. Her increase use of douching with vinegar and vagisil has contributed to yeast infection and her drinking 2 to 3 glass of wine can also irritate her bladder and worsen the UTI. Mrs. Jones needs to increase fluid intake drink 8 to 10 glasses of water, No douching.
6) If symptoms persist after completing the treatment, call the provided for follow up appointment.
7) Self-care: Keep vaginal area clean and dry, increase and drink plenty of fluid, no douching, wipe from front to back, good hand washing, avoid use of tampons or deodorant pads, wear cotton underwear, avoid sexual intercourse till treatment is completed.
Male genitalia case study
1) I would expect to see increase in WBC with positive nitrates; depending upon the urinalysis I will decide whether to send the cultures and also the severity of symptoms. In this case patient is having super pubic tenderness with increase burning on urination, I would most likely order the culture and sensitivity.
2) In rectal exam since the wall is in contact with the peritoneum, we may be able to detect the tenderness of peritoneal inflammation and the nodularity of peritoneal metastases, the nodules or the shelf lesions will feel hard and nodular on the tip of examining finger. The prostate gland should feel like a pencil eraser, firm smooth and slightly moveable and contender if normal.
3) My diagnosis would be Urinary tract infection and benign prostate hypertrophy. Differential diagnosis would be
