The Investigation of Symptoms
The investigation of any degree of discomforts coming from the suprapubic area, with the focus being on asking the patient whether she may have experienced severe, moderate, or mild flank pain coupled with vomiting in recent days, will be one way of understanding the nature of Christine Smith's concern. The clinical presentation will be essential in the case-conceptualization, where a positive diagnosis will be established if the patient reports nausea and vomiting, fever, and costovertebral angle pain (Caughey, Lyell, & Tran, 2005).
Medical History and Lifestyle
Another critical issue in the case-conceptualization is questioning Christine Smith on her medical history and lifestyle. The centrality answers why and how the issue has become weighty to the extent of seeking medical attention. The questions will revolve around predisposing factors, where the patient will be expected to outline known risks such as having an indwelling urinary catheter, irresponsible sexual behaviors, or type-2 diabetes. The patient will also be investigated on her medical history, where the questions will be about bladder infections, trauma to the flanks, and UTIs. The patient will also be asked about her struggles with calculi tumor, as benign or malignant tissues can cause bladder outflow obstruction, thus causing the bacteriuria, where the uropathogens infect the parenchyma and renal pelvis (Crutchlow, Dudac, MacAvoy, & Madara, 2002).
Components of the Physical Exam
What components of the physical exam are necessary in reviewing the case?
One of the indicative elements of the physical exam will be blood pressure, where the systolic output should be below 90mm/Hg. Fever will also be critical in confirming the infection, as pyelonephritis is symptomized with a temperature above 39.4°C. Abdominal examination will also increase suspicion, where the clinician will record costovertebral angle tenderness in the event the patient is suffering from pyelonephritis (Caughey, Lyell, & Tran, 2005). A pelvic exam is also vital, where adnexa will be present as well as unilateral discomfort over the cervix and uterus.
Differential Diagnoses and Final Diagnosis
Which differential diagnoses should be considered in the case study? What was your final diagnosis?
The differential diagnosis will entail pregnancy, cervicitis, endometritis, appendicitis, cystitis, urethritis, and pelvic inflammatory disease. The final diagnosis will be chronic pyelonephritis.
References
Caughey, A. B., Lyell, D. J., & Tran, S. H. (2005). Blueprints Q&A step 3: Obstetrics & gynecology. Lippincott Williams & Wilkins.
Crutchlow, E. M., Dudac, P. J., MacAvoy, S., & Madara, B. R. (2002). Pathophysiology. Jones & Bartlett Learning.
