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
Urinalysis -
  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?