6. Patient Presentations Related to the Genitourinary/Renal System and Breasts

Patient presentations span all relevant age categories, special populations, and varied clinical settings.

The guide to clinical presentations in this category may include, but is not limited to, the following ways in which patients present for osteopathic medical care:

bleeding, abnormal genital (vaginal or uterine), such as menorrhagia, menometrorrhagia, non-gynecologic causes (e.g., in pregnant or anovulatory women) • breast conditions – masses, benign or malignant, including fibrocystic disease; nipple discharge, including galactorrhea; gynecomastia and mastitis; mastalgia • breast procedures – mastectomy (modified, radical), lumpectomy; augmentation or reduction; stereotactic biopsy • estrogen deficiency • genital lesions, inflammatory or neoplastic causes, local or systemic, male or female – excoriations and infestations; ulcers and erosions (painful or painless); vesicles, plaques and papules; vulvovaginitis • gynecologic and pelvic masses and lesions – cyst or tumor of uterus, ovaries, or fallopian tube – benign, malignant, or metastatic; pelvic adhesions • kidney disease, acute or chronic including nephrolithiasis or calculus disease (kidney stones); diabetic nephropathy; end-stage renal disease; hemolytic uremic syndrome; nephrotic syndrome; renal masses, solid or cystic • kidney injury, acute • menopause • menstrual abnormalities, including dysmenorrhea, ovulation pain (mittelschmerz); ovarian torsion; premenstrual syndrome; primary and secondary amenorrhea; toxic shock syndrome • pelvic infection and inflammation, female (e.g., endometriosis, pelvic inflammatory disease) • pelvic pain, acute or chronic • pelvic relaxation and pelvic organ prolapse – uterus, vagina, bladder (cystocele), bowel/rectum (enterocele, rectocele) • prostate conditions, including prostatitis; benign prostatic hyperplasia; masses, benign, malignant, or metastatic • sexually transmitted diseases and infections, male and female • testicular and scrotal conditions, including orchitis, epididymitis; testicular torsion; scrotal masses, painful or painless, benign or malignant (e.g., hydrocele, varicocele, tumor) • tubular necrosis, acute • urinary tract infections and conditions – upper vs lower, cystitis, urethritis, pyelonephritis, glomerulonephritis; obstruction; painful bladder syndrome/interstitial cystitis; dysuria, pyuria, hematuria (glomerular, extraglomerular, nephritic/nephrotic), bacteriuria (symptomatic or asymptomatic) • urination dysfunctions – altered frequency, incontinence (stress, urge, overflow, neurogenic), retention, enuresis (nocturnal or diurnal), hesitancy, congenital outflow tract abnormalitiesasymptomatic) • urination dysfunctions – frequency, altered frequency, incontinence (stress, urge, overflow, neurogenic), retention, enuresis (nocturnal or diurnal), hesitancy, congenital outflow tract abnormalities

CONSTITUTIONAL SIGNS AND SYMPTOMS
fatigue • fever • generalized weakness • involuntary weight loss • malaise • night sweats • pallor

PHYSICAL EXAM FINDINGS
cervical motion tenderness • costovertebral angle tenderness • pelvic organ prolapse and pelvic relaxation

LABORATORY TEST FINDINGS AND DIAGNOSTIC IMAGING
acid-base disorders (e.g., metabolic acidosis with elevated or normal anion gap, metabolic alkalosis) • blood urea nitrogen levels • CA-125 • calcium levels • CT scanning • cystoscopy • dipstick urinalysis and sediment microscopy • FSH levels • LH levels • magnetic resonance imaging • mammography • microscopy • nuclear medicine imaging • oxalate levels • prolactin levels • prostate-specific antigen levels • radiography • serum β-HCG levels • serum creatinine levels • serum estrogen levels • serum testosterone levels • struviteuria • ultrasonography • uric acid levels • urinary citrate levels • urinary protein levels • urine culture and sensitivity • vaginal wet mount, KOH prep