Stoned
Renal & Urinary System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S11_F1.jpg"}},{"insert":"\n\n"},{"insert":"\u0022.... and they sent him in, right after the ultrasound ....\u0022, you overhear two nurses talking to each other, while walking in for your shift.\n\nFor a couple of seconds, you ponder who this patient might be ...\n\n... when a nurse thrusts a file into your hand and quickly guides you over to the patient in question.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S11_F2.jpg"}},{"insert":"\n\n"},{"insert":"Paul is a 21-year-old college athlete.\n\nHe developed left sided abdominal pain a couple of hours ago, along with other clinical features highly suggestive of urolithiasis.\n\nPain management has already been initiated, and a series of basic investigations performed.\n\nYou quickly review his complete blood count, which is normal, and urinalysis, which shows 10 to 15 red cells (normal: 0-4) per high powered field, with no pus cells, and negative nitrite and leukocyte esterase tests.\n\nHis serum creatinine is 0.7 mg\/dL (normal: 0.5-1.5) and blood urea nitrogen (BUN) is 12 mg\/dL (normal: 7-20).\n\nAn X-Ray KUB was performed as well, but does not reveal any stones in the urinary tract.\n\nHowever, an ultrasound scan has identified features suggestive of left-sided ureteric obstruction, with moderate hydronephrosis.\n\nThis prompted the team at the emergency department to send the patient over to your unit, for further management of suspected urolithiasis.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S11_F3.jpg"}},{"insert":"\n\n"},{"insert":"A quick chat with Paul reveals that this is his first such episode.\n\nHis medical and surgical histories are unremarkable, and he has no drug or food allergies.\n\nOn examination, you find him to be afebrile and currently pain free.\n\nHis vital signs are stable with a blood pressure of 120\/75 mmHg, pulse rate of 80 bpm, and a respiratory rate of 16 cycles\/min.\n\nHis height is 183 cm, and weight is 82 kg, giving him a BMI of 24.5 kg\/m2.\n\nThere is mild tenderness over the left lower abdomen. A thorough systems examination reveals no other untoward findings.\n\nAfter completing the examination, you take a few moments to ponder your next steps.\n\nWhile all the clinical findings appear to point towards urolithiasis, you realize that it is advisable to confirm this before moving forward.\n"}]}
3
{"ops":[{"insert":"Which test will you order to confirm the clinical diagnosis?\n"}]}
1. A contrast-enhanced helical CT scan of the abdomen
2. Intravenous pyelography
3. A low-dose non-contrast CT scan of the abdomen
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