Unit 4: Acute Illnesses: Urinary, Renal, Dermatologic, Musculoskeletal & Infectious Diseases
Managing Acute Urinary Tract and Renal Disorders
Acute urinary and renal conditions include glomerulonephritis, nephrolithiasis, urinary tract infections (UTIs), and urethritis. Glomerulonephritis is characterized by inflammation of the kidneys, often occurring after a streptococcal infection, and can affect both children and adults. Symptoms typically appear one to one and a half weeks after the initial infection. Nephrolithiasis involves the formation of kidney stones, which may block urinary flow and cause severe pain. UTIs can affect any part of the urinary tract, including kidneys, ureters, bladder, or urethra. Urethritis is inflammation of the urethra caused by various irritants such as mechanical trauma, chemicals, viruses, or bacteria. The most common type of urethritis is nongonococcal urethritis (NGU), frequently linked to Chlamydia infection.
What are the clinical manifestations, diagnostic criteria, and treatment options for urinary tract infections?
| Condition | Clinical Manifestations | Diagnostic Criteria | Treatment |
|---|---|---|---|
| UTI | Uncomplicated: Frequent, urgent, painful urination (dysuria), suprapubic pain, foul-smelling urine, sometimes hematuria. Complicated: Fever, chills, flank pain, costovertebral tenderness, nausea, vomiting. | Uncomplicated: Urinalysis and urine culture confirm diagnosis; sterile pyuria if urinalysis positive but culture negative. Complicated: Imaging (renal ultrasound) to detect stones, hydronephrosis; persistent infections need specialist referral. | Increase fluid intake. Nonpregnant women: Nitrofurantoin or trimethoprim-sulfamethoxazole if resistance low; alternatives: fosfomycin, fluoroquinolones, cephalosporins. Pregnant women: Cephalexin or amoxicillin-based antibiotics preferred. Men: Similar antibiotics as women, adjusted per susceptibility. |
| Urethritis | Men: dysuria, frequency, urethral discharge, itching. Women: frequency, nocturia, dysuria, itching, fever, hematuria, discharge, pelvic discomfort, back pain. | Urinalysis, Gram stain, culture (especially young men), wet mount, tests for gonorrhea and chlamydia. | Azithromycin single dose or doxycycline for 7 days first-line; erythromycin and fluoroquinolones as alternatives. |
| Pyelonephritis | Chills, high fever (>100°F), frequent/painful urination, flank and groin pain, nausea, vomiting, urgency. | Urinalysis, urine and blood cultures, CBC, imaging (CT or ultrasound). | Antibiotics for at least 2 weeks; surgical intervention if obstruction occurs. |
| Nephrolithiasis | Sudden severe flank or abdominal pain due to obstruction; intermittent pain for partial blockage, constant pain for complete blockage; nausea, vomiting, hematuria, fever, costovertebral tenderness. | Urinalysis and culture for pH, bacteria, crystals, blood; CBC, metabolic panel, parathyroid hormone, vitamin D levels, 24-hour urine analysis; stone analysis crucial. | Hydration, pain management, facilitate stone passage. Specific treatments based on stone type (e.g., thiazides for calcium stones, urine alkalinization for uric acid stones). Urgent referral for severe symptoms. |
Managing Acute Skin and Nail Disorders
Acute skin conditions such as intertrigo, impetigo, and cellulitis involve various inflammatory and infectious processes. Intertrigo results from prolonged skin-to-skin contact in moist, warm areas, leading to bacterial or fungal overgrowth. Impetigo primarily affects infants and young children, presenting as either nonbullous or bullous lesions, often caused by Staphylococcus aureus. Cellulitis shows as localized redness, swelling, warmth, and pain, often accompanied by systemic symptoms and possible pus formation.
What are the clinical manifestations, diagnostic approaches, and treatments for bacterial skin infections?
| Infection | Clinical Manifestations | Diagnostic Criteria | Treatment |
|---|---|---|---|
| Impetigo | Honey-colored crusts, translucent vesicles or pustules on red, moist bases. | Diagnosis mostly clinical; culture and Gram stain for complicated or MRSA cases; urinalysis for children (2-4 years) to exclude nephritis. | Topical mupirocin; oral antibiotics (dicloxacillin, cephalexin) for extensive cases; antimicrobial washing. |
| Cellulitis | Erythema, swelling, warmth, pain; may include bullae, abscess, necrosis; systemic fever possible. | CBC with differential, renal function, pus culture, blood culture, imaging if needed. | Oral antibiotics and NSAIDs; IV antibiotics for severe cases; incision and drainage of abscesses. |
| Intertrigo | Redness, peripheral scaling, macerated plaques with itching, burning, sometimes odor or discharge. | Clinical diagnosis; KOH prep, Gram stain, Wood lamp for erythrasma. | Topical antifungals or antibacterials depending on the pathogen. |
| Furuncle/Carbuncle | Tender, warm nodules developing from folliculitis, often fever and malaise. | Clinical examination. | Incision and drainage; systemic antibiotics if systemic symptoms present. |
Viral Skin Infections
Warts caused by human papillomavirus (HPV) appear as small, firm, skin-colored papules commonly on hands and feet. Plantar warts are typically thicker on soles. Diagnosis is clinical, confirmed by pinpoint capillaries visible during lesion debridement. Treatment options include topical agents, cryotherapy, laser ablation, or surgical removal.
Tinea corporis (ringworm) presents as red, ring-shaped plaques with raised borders and central clearing, while tinea versicolor causes hypopigmented or hyperpigmented scaly patches on trunk and arms, often asymptomatic.
Fungal Infections: Presentations and Management
| Fungal Infection | Clinical Presentation | Diagnostic Criteria | Treatment |
|---|---|---|---|
| Dermatophyte Tinea | Annular or arcuate scaly plaques with central clearing; itching/burning possible. | KOH microscopy, Wood lamp for species identification. | Topical antifungals for skin; oral antifungals if scalp or nails involved. |
| Tinea Versicolor | Hypo- or hyperpigmented scaly papules and plaques on trunk and neck. | KOH prep, Wood lamp, skin cultures; liver tests if systemic treatment considered. | Topical antifungals first; systemic antifungals for resistant or widespread cases. |
| Candidiasis | White or gray plaques on mucous membranes (oral thrush); vaginal itching/discharge. | KOH prep, cultures; biopsy if uncertain. | Oral nystatin or fluconazole for oral; topical/systemic antifungals for other sites. |
Dermatological Office Procedures
Cryosurgery employs liquid nitrogen to freeze and destroy skin lesions but is contraindicated in patients with cold intolerance or hematologic disorders. It carries risks of pigment changes, especially in darker skin tones, and protective measures are needed near sensitive areas. Electrocautery uses electrical current for tissue cutting or cauterization, useful for vascular lesions and some skin cancers. Curettage involves scraping lesions and is typically used for seborrheic keratoses, warts, molluscum, and some cancers, often under local anesthesia.
Parasitic Skin Infestations
What are the clinical signs and treatments for common parasitic skin infestations?
Scabies: Presents with small papules and serpiginous burrows mainly in typical locations, accompanied by intense itching. Crusted scabies, severe and highly contagious, affects immunocompromised patients. Treatment includes topical permethrin 5% cream or oral ivermectin.
Pediculosis Capitis (Head Lice): Causes intense itching with visible lice and nits near neck and ears. Treatment involves permethrin or appropriate prescription medications for children.
Bed Bug Infestations: Cause itchy wheals and bloodstains on bedding. Management focuses on eradicating infestation and symptomatic relief.
Adnexal Disorders: Hair, Sweat Glands, and Nails
Common adnexal disorders include acne, rosacea, hyperhidrosis, and hidradenitis suppurativa.
Acne vulgaris manifests as comedones, papules, pustules, or nodules primarily on the face, neck, and upper trunk. Treatment aims to normalize keratinization, reduce sebum, and control inflammation using topical retinoids, antibiotics, and hormonal therapies.
Rosacea presents with facial flushing, erythema, papules, pustules, telangiectasia, and ocular symptoms. Management includes topical metronidazole, oral antibiotics, and lifestyle changes.
Hyperhidrosis is excessive localized sweating affecting quality of life. Treatments range from topical aluminum chloride to oral anticholinergics and botulinum toxin injections.
Hidradenitis Suppurativa involves chronic painful abscesses in apocrine gland-rich areas, managed with antibiotics, anti-inflammatories, and sometimes surgery.
Minor Burns: Features, Examination, and Management
Burns are classified by depth:
First-degree burns: Affect only the epidermis, appear red, glossy, painful (e.g., sunburn).
Second-degree burns: Involve dermis, cause blistering and severe pain.
Third-degree burns: Extend into subcutaneous tissue, dry, white or charred, with nerve damage leading to insensitivity.
Examination includes airway, breathing, circulation, burn depth, total body surface area (TBSA), and associated injuries. Circumferential burns need special attention due to vascular compromise risks.
Management involves topical antimicrobials like silver sulfadiazine, non-adherent dressings, analgesics, and tetanus prophylaxis.
Dermatitis and Other Skin Conditions
| Dermatitis Type | Clinical Features | Physical Exam Findings | Management |
|---|---|---|---|
| Eczematous (Atopic) | Itchy, red, dry patches with scaling; chronic scratching thickens skin. | Poorly defined lesions with crusting, oozing, lichenification. | Patient education, trigger avoidance, antihistamines, topical steroids, emollients. |
| Contact Dermatitis | Itching, burning, redness, swelling with clear borders; vesicular or scaly lesions. | Localized inflammation, sometimes linear patterns (e.g., poison ivy). | Avoid irritants/allergens; topical corticosteroids; symptomatic treatment. |
| Seborrheic Dermatitis | Red, flaky patches on scalp, face, ears, trunk. | Yellowish or white greasy scales; “cradle cap” in infants. | Antifungal shampoos, topical steroids, keratolytics. |
| Cutaneous Drug Reactions | Mild rash to severe (e.g., Stevens-Johnson syndrome). | Erythema, pustules, bullae, systemic symptoms. | Immediate cessation of offending drug, supportive care, corticosteroids, hospitalization for severe cases. |
Other conditions include:
Stasis Dermatitis: Caused by poor lower limb circulation, leading to skin discoloration, itching, ulceration. Managed with leg elevation, compression, corticosteroids, surgery if needed.
Urticaria (Hives): Transient, raised, itchy wheals anywhere on the body. Managed by avoiding triggers, antihistamines, epinephrine for severe reactions.
Corns and Calluses: Clinical Presentation and Management
| Aspect | Details |
|---|---|
| Clinical Manifestation | Corns: Painful lesions on toes or dorsal foot; Calluses: Generally painless thickened skin. |
| Examination | Corns appear as red, tender lesions often with deformities (e.g., hammertoes). Calluses mask underlying issues with thickened skin. |
| Management | Prevention via avoiding tight shoes, pressure-relieving pads, regular debridement, moisture control, orthotics; surgery if needed. Diabetic or vascular patients require close monitoring. |
Nail Disorders
Herpetic Whitlow presents with painful vesicles on distal fingers, sometimes tingling or numbness. Exam includes nail and lymph node assessment; genital herpes testing if indicated. Treatment includes drainage if necessary, cold compresses, and preventing viral spread.
Paronychial Infections cause pain, swelling, sometimes pus around nail fold; greenish discoloration may suggest Pseudomonas. Treatment: warm soaks, drainage if abscessed, topical antibiotics.
Onychomycosis features thickened, brittle, discolored nails. Oral antifungals preferred, topical agents adjunctive.
Musculoskeletal Injuries and Illnesses
| Condition | Clinical Manifestation | Examination Findings | Management |
|---|---|---|---|
| Sprains and Strains | Pain, swelling, muscle spasm (strain), bruising (sprain) | Deformity, limited ROM, guarding | Rest, Ice, Compression, Elevation (RICE), splinting, NSAIDs, physical therapy |
| Fractures | Pain, swelling, deformity, discoloration | Neurovascular status, palpable deformity | Immobilization, surgery if needed, pain control |
| Bursitis | Swelling, warmth, erythema, pain | Localized tenderness, swelling | NSAIDs, antibiotics if infected, aspiration, corticosteroids |
| Carpal Tunnel / De Quervain’s Tenosynovitis | Pain near thumb base, radiating along tendon | Tenderness, reduced ROM | Splinting, NSAIDs, physical therapy, corticosteroids |
| Sciatica | Radiating leg pain, limited motion | Neurological deficits | NSAIDs, rest, physical therapy |
| Joint Pain (Hand/Wrist/Elbow/Shoulder) | Localized pain, numbness, weakness | ROM, grip strength, neurological testing | NSAIDs, physical therapy, injections, surgery if indicated |
| Neck and Low Back Pain | Pain with limited movement, possible neurological signs | Posture, gait, ROM, neurological exam | NSAIDs, rest, physical therapy, imaging if necessary |
Infectious Diseases: Presentation, Examination, and Management
| Disease | Clinical Manifestation | Examination Features | Management |
|---|---|---|---|
| Lymphadenopathy | Swollen, painful, or firm lymph nodes | Size, location, tenderness, symmetry | Treat underlying cause; biopsy if malignancy suspected |
| Fever (Pyrexia) | Elevated temperature as immune response | Variable based on infection | Supportive care, antipyretics, treat cause |
| Infectious Mononucleosis | Fever, sore throat, lymphadenopathy | Cervical lymphadenopathy, splenomegaly | Supportive care; steroids if severe; avoid antibiotics to prevent rash |
| Tuberculosis | Chronic cough, weight loss, night sweats, fever | Rales, pleural effusion, lymphadenopathy | Prolonged multidrug therapy |
| Lyme Disease | Expanding circular rash (erythema migrans), flu-like symptoms, joint pain | Rash and regional lymphadenopathy | Early oral antibiotics, supportive care |
| Rocky Mountain Spotted Fever | Fever, rash, headache | Petechial rash, systemic signs | Prompt antibiotic therapy |
| Zika Virus | Fever, rash, conjunctivitis | Possible neurological symptoms | Supportive care, mosquito control |
| Influenza | Fever, chills, malaise, cough | Usually normal chest exam | Symptomatic treatment, antivirals within 48 hours |
| Mosquito-Borne Illnesses | Weakness, paralysis, rash, conjunctivitis | Rash, jaundice, lymphadenopathy | Supportive care, vector control, public health measures |
Summary Table: Infectious Disease Management
| Disease Category | Treatment Highlights |
|---|---|
| Bacterial infections | Antibiotics tailored to specific pathogens |
| Viral infections | Supportive care and symptom management |
| Tick-borne diseases | Early antibiotic treatment (e.g., doxycycline) |
| Mosquito-borne illnesses | Vector control and symptomatic management |
| Tuberculosis | Extended multidrug antibiotic therapy |
References
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