QUIZ: Dysuria, abdominal pain and fever *solved*

Author: Mateusz Palczewski

Wednesday, 06 January 2010 16:00

Case description: 52-years old man, with diabetes type II diagnosed 7 years ago complains about:

dysuria
abdominal pain, which can't be described
shivers, fever and malaise

Physical examination: Body temperature - 37,5 Celsius' degrees, slight tachycardia, orthostatic hypotonia. No pain on deep palpation of the abdomen. Lungs and heart regular upon auscultation.

QUIZ questions: What diagnosis would you make? Which laboratory tests would you order?

Comments

+1 #1 stiglar 2010-01-06 18:21

maybe fulminant pyelonephritis? How is Goldflamm's sign?

0 #2 Mateusz Palczewski 2010-01-06 19:50

Goldflamm's sign bilaterally negative

0 #3 MMader 2010-01-06 20:18

Ehh - fatigue
I've read "dysuria", I though "anuria" and I started think in wrong way

0 #4 AMMAR 2010-03-09 13:21

goldflamm's sign

0 #5 Mateusz Palczewski 2010-03-19 00:21

negative as I wrote previously

+1 #6 drmark15 2010-04-06 14:15

test for bun, crea.

0 #7 Mateusz Palczewski 2010-04-06 14:26

Creatinine 1.2, test for bun - 12 mg/dL.

0 #8 amazontoni 2010-04-17 21:35

Any previous diseases? Does he drink?

0 #9 Mateusz Palczewski 2010-04-18 10:00

Diabetes type II - nothing else. He doesn't drink more than occasionally. There is some connection between dysuria and tachycardia - try to figure it out, it's a big hint :-)

0 #10 amazontoni 2010-04-18 11:11

Dysuria is cummon to diabetes (almost all I have seen have some kind of germs there - candida and so on) May I ask for a hemoculture (for the fever)?

0 #11 Mateusz Palczewski 2010-04-18 13:21

Metycylin sensitive staphylococcus aureus - great way!

0 #12 amazontoni 2010-04-18 17:12

so we put him on antibiotics and he`s OK ;-)? I worry about this orthostatic hypotonia- no idea at all!

0 #13 Mateusz Palczewski 2010-04-18 18:39

Antybiotics for sure:-) but I am not sure if it would be enough... let me give you a big clue - check what MSSA causes.

0 #14 amazontoni 2010-04-19 12:10

Endocarditis? but i think we could hear the valves on ascultation...but we can check them with echo anyway :-)

0 #15 Mateusz Palczewski 2010-04-19 18:16

That's right... there are vegatations in echo. I don't think we always hear it ;-) What about dysuria?

+1 #16 amazontoni 2010-04-20 15:11

I`ll ask for urine- microbiology test... actually what is the problem- is there pain, itch, burning during urination? Maybe we should check the kidneys on echo too- its money-free after all :-)

0 #17 Mateusz Palczewski 2010-04-20 18:47

There is a pain during urination, none significant bacterias in urin. Ok, you could do an kidneys echo but what exactlly for?

As I wrote previous.. what could Staphyloccocus aureus cause beside endocarditis and what causes dysuria? ;-)

+1 #18 amazontoni 2010-04-20 19:02

Pyelonephritis ? :-) Diabetes really screws everything

+1 #19 Mateusz Palczewski 2010-04-20 21:24

Kidney echo is ok ;-) Try to think about this bacteria...

+1 #20 amazontoni 2010-04-21 19:50

Ok lets go back to the abdominal pain... S. aureus could cause food intoxication ... May be we should check the feces ? Dysuria could be caused by a concrement, cystits ...

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