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32/M presenting with right flank pain

32/M presenting with right flank pain. Angelie P. Dugasan November 25, 2009. Patient Profile. 32 year-old, male Married Roman Catholic Jeepney driver From Tondo , Manila Nonhypertensive , nondiabetic , non-asthmatic. History of Present Illness. History of Present Illness.

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32/M presenting with right flank pain

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  1. 32/M presenting with right flank pain Angelie P. Dugasan November 25, 2009

  2. Patient Profile • 32 year-old, male • Married • Roman Catholic • Jeepney driver • From Tondo, Manila • Nonhypertensive, nondiabetic, non-asthmatic

  3. History of Present Illness

  4. History of Present Illness

  5. Urinalysis

  6. History of Present Illness

  7. History of Present Illness

  8. Review of Systems (-) weight loss (-) anorexia (-) headache (-) chest pain (-) changes in bowel movement (-) melena (-) hematochezia (-) jaundice (-) bloatedness (-) muscle weakness

  9. Past Medical History (-) Hypertension (-) Diabetes Mellitus (-) Bronchial Asthma (-) previous hospitalizations/surgeries (-) known allergies

  10. Tapang-OlivoGenogram 60 59 40 36 34 32 29 Legend: - Hypertension Data taken on Nov. 18, 2009 by Int. Dugasan Informant: the patient 6 3

  11. Personal and Social History • (+) 3 pack year smoking history • Occasional alcoholic beverage drinker • Denies use of illicit drugs • High school graduate • Jeepney driver

  12. Physical Examination

  13. Assessment Acute Pyelonephritis T/C Urolithiasis

  14. Plan Diagnotics: • Urine GS/CS • KUB Ultrasound Therapeutics: • Ofloxacin 400mg/tab, 1 tab every 12 hours for 14 days • Diclofenac 25mg/ml apm – given IM, afforded relief of pain, 2-3 on VAS • Diclofenac 50mg/tab, 1 tab every 8 hours for pain, on full stomach • Paracetamol 500mg/tab, 1 tab every 4 hours for T >38.5 OC Increase oral fluid intake. Aggressive TSB for fever. Follow-up at OPD-FCM with lab results.

  15. Diagnostic Dilemma

  16. Diagnostic Dilemma

  17. Diagnostic Dilemma Among adults with urolithiasis, is the sensitivity and specificity of KUB ultrasound comparable to that of non-contrast CT Scan in detecting stones, in a cross-sectional study?

  18. Pre-Test Probability 0 0.3 0.5 0.8 1.0

  19. Therapeutic Dilemma

  20. Therapeutic Dilemma

  21. Therapeutic Dilemma In a RCT investigating adults with urolithiasis, what is more effective in reducing pain as measured by VAS, Anti-spasmodic or NSAIDs?

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