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Chief Complaint

“I have severe back pain and it hurts when I urinate.”

History of Present Illness

KJ is a 58-year-old female who presents to the emergency department (ED) with complaints of fever, chills, dysuria, urgency, and back pain. Upon physical exam CVA tenderness is noted; no other significant physical findings. She has a fever of 101.2°F; however, she is hemodynamically stable in the ED.

Past Medical History

Hypertension × 10 years, congestive heart failure, hyperlipidemia, type 2 diabetes mellitus

Surgical History


Social History

Married, lives at home with husband and has 2 adult children who do not live at home


Penicillins (reported a rash as a child)

Home Medications

Lisinopril 40 mg PO daily

Carvedilol 6.25 mg PO BID

Furosemide 20 mg PO daily

Atorvastatin 40 mg PO daily

Metformin 500 mg PO BID

Physical Examination

Vital Signs

Temp 101.2°F, P 89, RR 18 breaths per minute, BP 139/73 mm Hg, Ht 5′4″, Wt 78 kg


Mild distress, nontoxic appearing


Atraumatic, pupils equal round and reactive to light and accommodation, moist mucosa, normal pharynx, normal tonsils and adenoids, normal tongue


Normal chest wall expansion; no rales, no rhonchi, no wheezing


Regular rate and rhythm, no murmurs, no gallops, normal S1 and S2


Soft, non-tender, non-distended, normal bowel sounds in all quadrants, no hepatosplenomegaly


No incontinence, complains of dysuria


No headache, focal numbness or weakness, dizziness, or seizures


CVA tenderness noted, normal ROM in upper and lower extremities, no swelling, no joint erythema; Integumentary: warm, dry, pink, with no rash, purpura, or petechia

Laboratory Findings

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Na = 140 mEq/L

BUN = 26 mg/dL

Hgb = 13.2 g/dL

K = 3.8 mEq/L

SCr = 1.0 mg/dL

Hct = 36%

Cl = 98 mEq/L

Glucose = 161 mg/dL

Plt = 280 × 103/mm3

CO2 = 26 mEq/L

WBC = 14.2 × 103/mm3



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