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!
James Hassel
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