Charting Exercise: Oscar Brown
Oscar Brown, age 42, is a farmer from Texas. For the past week he has noted "twinges" in the right lower part of his back. He was awakened this morning by excruciating pain in his back, unresponsive to acetaminophen and the application of a hot water bottle. He spent 4 hours pacing the house, with intermittent bouts of vomiting before going to the hospital emergency department.
In the emergency department, Mr. Brown appears to be in pain and is pacing the floor of the examination room. He reports that his past medical health has been good with no previous hospitalizations, trauma, or surgeries. He does not take any regular prescription medications, does not use tobacco or alcohol, and has an active lifestyle on his farm working 12 to 14 hours a day. He does take over-the-counter medications, acetaminophen (Tylenol) for occasional headache and muscle pain. His family history is negative except that his father and grandfather occasionally "passed blood in their water," but no medical care was ever sought for this problem.
Physical examination reflects a normal temperature, tachycardia at 140 beats per minute, respirations 28, blood pressure of 138/78, cool moist skin, right flank pain, and abdominal pain without rebound tenderness. Laboratory findings include +1 proteins, +3 blood, and trace glucose on urine dipstick. Microscopic examination of urine shows red blood cells too numerous to count, a white blood cell count of 8 to 10, bacteria of 1 to 2, and calcium oxalate crystals.
Mr. Brown was sent to x-ray for an IVP and MRI of his abdomen.
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