Before you stuff yourself with turkey, unload some knowledge and take a stab at this month’s COtM.

HPI: A 63 y/o F presents with sudden, severe, cramping abd pain that awoke her from sleep 3 hours ago.  Pain is generalized and radiates to her lower back and causes her to feel nauseous but without vomiting.  The pain seems to come in waves although never fully resolves.  Has not felt this before.  Reports +burning dysuria and denies diarrhea, CP, SOB, fevers, chills, blood per rectum.

 

PMH: Stroke, COPD, rheumatoid arthritis, HTN

PSH: Partial colectomy

Meds: Nonadherent, only regularly takes Norvasc and Tylenol for pain

All: NKDA

SH: 30 pack year tobacco history, no EtOH or other drugs.

 

ROS: Otherwise negative

 

PE:

Vitals – T97.6 oral, HR 119, RR 20, BP 170/90

Gen – Bent over in bed holding abdomen but occasionally relaxes as pain resolves

CV – RRR, no m/r/g

Resp – Tachypnea, CTA b/l

Abd – Diffuse tenderness, decreased bowel sounds

The remainder of the physical exam was unremarkable.

 

Labs:

CBC – 11.7>13.6/40<231

CMP – K+ 3.0, Alk phos 167

Lactate – 5.1

Cardiac enzymes = negative

UA – LE trace, Nitrite +, many bacteria, no WBC, squamous 30

Remainder of labs WNL.

 

EKG – Sinus tachycardia without other alarming findings

CT A/P w/ IV con (oral contrast not tolerated): No acute findings, no obstruction, old post-surgical findings, no perinephric stranding

 

Take a week to digest that bolus of information and then have at it.  Best answer by next Saturday gets the bragging rights.  Happy sleuthing!

CHECK OUT THE ANSWER

The following two tabs change content below.

James Hassel

4th Year EM-IM Resident at SUNY Downstate/Kings County Hospital

Latest posts by James Hassel (see all)


James Hassel

4th Year EM-IM Resident at SUNY Downstate/Kings County Hospital

0 Comments

Leave a Reply

Avatar placeholder

Your email address will not be published. Required fields are marked *