1-8 PATIENT NOTE: ACCIDENTALLY URINATING HISTORY: Describe the history you just obtained from this patient.

Include only information (pertinent positives and negatives) relevant to this patients problem(s). HPI: 39 YO FEMALE C/O ACCIDENTALLY URINATING. STARTED 6 MONTHS AGO, GETTING WORSE, HAPPENS 2-3 TIMES A DAY. MOVING, BENDING, LIFTING, SNEEZING, COUGHING AND LAUGHING AGGRAVATES IT. NO ALLEVIATING FACTORS. DOES NOT WEAR ABSORBENT PADS, DOES NOT OCCUR DURING SEX. DRINKS ABOUT 2 BOTTLES OF WATER A DAY, URINATES 5-6 TIMES A DAY, 1-2 AT NIGHT. STRONG URGES TO URINATE, FOLLOWED BY GUSHING. URINARY FREQUENCY INCREASED OVER THE LAST 6 MONTHS. UTI 5 YEARS AGO ALLEVIATED WITH CRANBERRY JUICE. LMP 2 WEEKS AGO NORMAL. LPS 9 MONTHS AGO NORMAL, MENARCHE AT AGE 14. ONE PREGNANCY, ONE CHILD, UNCOMPLICATED VAGINAL DELIVERY. DENIES ANY INFECTIONS, BURNING WITH URINATION OR VAGINAL DISCHARGE. DENIES BOWEL CHANGES ROS: NEGATIVE EXCEPT AS NOTED ABOVE ALLERGIES: NONE MEDICATIONS: NONE PMH: NONE FH: FATHER IS ALIVE AND WELL, MOTHER DIED IN A CAR ACCIDENT DURING HER CHILDHOOD SH: DENIES TOBACCO, ETOH, OR DRUG USE. WORKS AS A PARALEGAL, LIVES WITH HUSBAND AND CHILD. SEXUALLY ACTIVE WITH HUSBAND ONLY PHYSICAL EXAM: Describe any positive and negative findings relevant to this patients problem(s). Be careful to include only those parts of examination you performed in this encounter. THE PATIENT IS NO ACUTE DISTRESS AND VITALS ARE WITHIN NORMAL LIMITS. HER HEAD AND NECK APPEAR NORMOCEPHALIC AND ATRAUMATIC. HER BREATH SOUNDS ARE CLEAR TO AUSCULTATION BILATERALLY. HER HEART SOUNDS ARE NORMAL WITH S1/S2 WITH NO RUBS, GALLOPS OR MURMURS. HER ABDOMEN WAS NONTENDER AND NONDISTENDED. BOWEL SOUNDS WERE HEAR AND THERE IS LEFT SIDED CVA TENDERNESS PRESENT. REBOUND TENDERNESS WAS PRESENT ON PALPATION OF ABDOMEN. DATA INTERPRETATION: Based on what you have learned from the history and physical examination, list up to 3 diagnoses that might explain this patients complaint(s). List your diagnoses from most to least likely. For some cases. Fewer than 3 diagnoses will be appropriate. Then, enter the positive or negative findings from the history and physical examination (if present) that support each diagnosis. Lastly, list initial diagnostic studies (if any) you would order for each listed diagnosis (e.g. restricted physical exam maneuvers, laboratory tests, imaging, ECG, etc. DIAGNOSIS #1: STRESS INCONTINENCE

HISTORY FINDING(S) PHYSICAL EXAM FINDING(S) - moving, sneezing, coughing causes - bowel sounds present involuntary urination - left sided CVA tenderness present - strong urge to urinate - rebound tenderness present - urinary frequency increased in last 6 months DIAGNOSIS #2: PID HISTORY FINDING(S) PHYSICAL EXAM FINDING(S) - urinary frequency increased in last 6 months - bowel sounds present - young woman - left sided CVA tenderness present - rebound tenderness present DIAGNOSIS #3: UTI HISTORY FINDING(S) PHYSICAL EXAM FINDING(S) - urinates 5-6 times a day and 1-2 at night - bowel sounds present - urinary frequency increased in last 6 months - left sided CVA tenderness present - strong urge to urinate - rebound tenderness present DIAGNOSTIC STUDIES - PELVIC EXAM - U/S PELVIS - RECTAL EXAM - CBC - URINE ANALYSIS