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!