Clinical Correlation: Pelvis and Kidney
A 23 y.o.f. presents with complaints of lower abdominal pain. It began less than 72 hours ago. It is sharp in nature, 6 out of 10 in severity, constant, and non-radiating. She has noted no change with food but has anorexia and over the last few hours persistent nausea and vomiting. She has felt warm but has not checked her temperature. In general the patient appears in moderate distress. Her exam is unremarkable except for bilateral lower quadrant tenderness to palpation. She has some rebound in the right lower quadrant only. There was no CVA tenderness.
What is your differential diagnosis?
What part of the exam has been left out that would be essential for this patient?
What might be some complications of this patient’s illness?
A 38 y.o.m. comes to your office complaining of right scrotal swelling. He denies any heavy lifting or trauma to the area. There is no pain associated with the swelling. Your exam shows a distended left testicle with a fluctuant mass at the superior pole. It is nontender to palpation. You are unable to completely reduce it. There is no obvious inguinal bulge or discoloration. Transillumination does not reveal any solid components to the mass.
What is the differential diagnosis for this mass?
What would the next step be in diagnosing the etiology of this patient’s complaint?
A 36 y.o.f. comes to your office with complaints of severe low back pain and episodes of urinary incontinence. She is 22 weeks gestation and had developed low back pain over the last few weeks. Concerned about exposing her fetus to analgesics she sought treatment from an alternative health provider. Since then the pain has been severe, constant, and it to the point that she is having difficulty walking. On exam, she is in obvious distress. Her pelvic exam displayed poor rectal sphincter tone and “saddle anesthesia.”
What is the mechanism of this patient’s complaints?
What must be done for this patient?
A 77 y.o.m. is brought to the Emergency Department from his nursing care facility with a change in mental status. The nursing staff who knows him well noted that he had decreased appetite and low grade temperatures over the last 24 hours. The on-call physician was concerned about a UTI and the staff was supposed to send a urinalysis but have been unable to get an adequate sample. Currently, the patient is unresponsive to verbal stimuli. He is mildly tachycardic. His lungs and cardiovascular exam are otherwise unremarkable. His abdomen has decreased bowel sounds and there is a suprapubic mass that is soft and non pulsatile.
What is the likely scenario for this patient’s altered mental status?
What would be your initial treatment for this patient? What would be your long term recommendation for this condition?
An 18 y.o.m is sitting in your office looking very anxious! He states he has an erection for the last 8 hours. At first, he was not concerned but now it is becoming painful.
What is his diagnosis? Do you want to inquire further about this patient’s HPI (history of present illness)?
Describe, anatomically, the mechanism of an erection and what has malfunctioned to cause this condition?