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Vaginal discharge. • Pregnancy risk. • Structural abnormalities. • Instrumentation of urethra or bladder. General Considerations Dysuria (painful urination) is a common reason for adolescents and adults to seek urgent medical attention. An inflammatory process (eg, infection; autoimmune disorder) underlies most causes of dysuria. 7% per year in sexually active young women. The key objective in evaluating women with dysuria is to exclude serious upper urinary tract disease, such as acute pyelonephritis, and sexually transmitted diseases.
PERSISTENT COUGH Causes of persistent cough include postnasal drip syndrome, asthma (including cough-variant asthma), GERD, chronic bronchitis, bronchiectasis, tuberculosis or other chronic infection, interstitial lung disease, and bronchogenic carcinoma. Persistent cough may also be psychogenic. Diagnostic Studies A. ACUTE COUGH Chest radiography should be considered for any adult with acute cough who shows abnormal vital signs or in whom the chest examination is suggestive of pneumonia. The relationship between specific clinical findings and the probability of pneumonia is shown in Figure 2-1.
Revised pneumonia probabilities based on history and physical examination findings. (Reproduced, with permission, from Metlay JP, Fine MJ: Testing strategies in the initial management of patients with community-acquired pneumonia. ) B. PERSISTENT COUGH Chest radiography is indicated if ACE inhibitor therapy-related and postinfectious cough are excluded by history. When the chest film is normal, evaluation for postnasal drip, asthma, and GERD should be initiated. The presence of typical symptoms of these conditions directs further evaluation or empiric therapy, though typical symptoms are often absent.