GU/Focal Problems for Urology Small Groups

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Case 1

You are the Clinical Clerk in ER and are asked to see Paul, a 30 year old man, who was awakened from sleep 2 hours ago by severe left sided back and flank pain which radiates into his left lower quadrant. He has never experienced such a pain before. His general health has been good and he has no intercurrent medical problems. On examination, he is in evident distress and is pale and sweating. His vitals include:

BP - 110/64
Pulse - 100/min
Temperature - 37.2°C

He is exquisitely tender on palpation of the left flank and is also uncomfortable in the left lower quadrant. There is no rebound tenderness. Bowel sounds are normal.

Laboratory investigations include:

Hgb - 138 g/l
WBC - 7,200
  WBC - 2-4/hpf
  RBC - >100/hpf
  Casts - 0
  Bacteria - 0
  1. Outline a brief differential diagnosis for Paul's presentation.
  2. What will be your immediate management steps?
  3. What further investigations will you order?
  4. What treatment options will be most likely to deal effectively with Paul's problem?

Case 2

Laura is a 53 year-old woman who presents with complaints of fatigue, a 4 kg weight loss and general malaise. She also describes right upper quadrant and back pain and early satiety with meals. She has previously been in good health and relates no significant medical or surgical history. She specifically denies any genitourinary symptoms. Her BP is 128/74. Abdominal examination reveals a non-tender mass in the right flank. Pelvic and rectal examinations are negative.

Laboratory investigations include:

Hgb - 140g/l
WBC - 10 200
  WBC - 2-4/hpf
  RBC - 0-1/hpf
  bacteria - 0
  1. List a brief differential diagnosis for this woman's complaints.
  2. What initial investigations will you consider for Laura?
  3. Based on the results presented in the Small Group Session, how will you investigate her further?
  4. From the findings of the investigations presented in the Small Group Session, what management options are appropriate to offer to Laura?

Case 3

Jenna is a 10 year-old girl referred because of recurrent UTIs. Over the past 2 years, she has had several episodes of frequency, urgency and pain with voiding. These symptoms have resolved with short courses of antibiotic prescribed through walk-in clinics. Her voiding is otherwise normal and she was "potty trained" at 21 months.

Jenna is otherwise in good health. Her mom recalls that she frequently complains of "tummy aches" and volunteers that JL seems less energetic than her brothers and sister. On examination, Jenna seems small for her age but there are no other positive findings except for some irritation and redness around the introitus.

Recent laboratory investigations include:

Hgb - 118g/l
WBC - 11,200
  WBC – 20-25/hpf
  RBC – 2-4/hpf
  bacteria – many
Urine C&S:
  >100,000 colonies of E coli sensitive to all antibiotics tested
  1. From Jenna’s presentation, what is your differential diagnosis of her problem?
  2. What will you recommend for her initial management?
  3. What further investigations will you order?
  4. What will you suggest for her long term management?