Sandbox:Sahar

History and Physical Eexamination Ask for urinary symptoms such as: ❑ Dysuria ❑ Hematuria Physical Examination should asses for the presence of: ❑ Hypotension ❑ Pallor ❑ Edema ❑ Muffled heart sounds ❑ Swollen joints ❑ Organomaegally ❑ Lymphadenopathy ❑ Abdominal and pelvic examination ❑ Digital rectal examination ❑ Vaginal examination (in female)

Laboratory Investigations Check for urinanalysis and urine cullture ❑ Midstream clean catch is preferred. ❑ Avoid the use of antiseptic solutions prior to collection. Check routine blood tests such as: ❑ Complete blood count ❑ Liver function test ❑ Renal function test Perform a vaginal swab in sexually active patients ❑ Chlamydia ❑ Gonorrhoea In case of suspicion to urinary tuberculosis: ❑ Consider 3 consecutive first-void morning samples for acid-fast bacilli and polymerase chain reaction (PCR) testing In case of suspicion to schistosomiasis: ❑ Consider collecting a terminal urine sample between noon and 3 pm

Other Investigations Consider urinary tract ultrasound or computed tomography: ❑ If suspicious for renal stone ❑ If suspicious for masses ❑ If suspicious for nephritis Consider flexible cystourethroscopy and tissue biopsy: ❑ If suspicious for neoplasm