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LPHS

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LPHS

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    1. LPHS Alexandria aka Sasha Dubinkina CQC

    2. Any guesses?

    3. HPI: 45 yo male presented with right sided/ flank pain with occasional radiation to his right groin. This patient had numerous ER visits for the right flank pain. He has h/o chronic lower back pain, hypothyroidism, GERD, Crohn’s disease, CAD s/p CABG, nephrolithiasis, HTN, DM, IgA nephropathy diagnosed with biopsy in 2000. PMH: as per HPI SH: no EtOH, +tobacco, no illicits FH: +CAD, HTN, DM, prostate cancer

    4. Medications: Plavix, Crestor, Diazepam, Iron, Levothyroxin, Pantoprazole, Pentasa, Venlafaxine, Zetia, Zirtec, Metoprolol XL, Lisinopril, Morphine 60 mg BID and 15 mg q4h prn pain Physical Exam: T 98.4 BP 135/61 HR 84 RR 18 General: well groomed, pleasant, NAD Head: NCAT HEENT: PERRLA, EOMI, MMM, no oral lesions seen Neck: Supple, no LAD, no JVD CV: RRR, nl S1 and S2, no M/R/G appreciated Respiratory: CTAB Abd: well healed scar in RLQ, obese, ND, NT MSK: mild CVA tenderness on right, strength intact in all extremities, no c/c/e Neuro: CN II-XII wnl, no focal findings

    5. Labs: Na 140, K 3.6, Cl 107, CO2 28, BUN11, Cr 1.1, Glu 111, Ca 8.7, Phos 5.3, Mg 2.0 H/H 11.8/36, plt 197 UA: cloudy, ph 6.0, sp gr 1.024, Protein 1+, large blood, trace glu, trace ketones, neg bilirubin, Urobili 2.0, small leuks, RBC >100, WBC 9, none squam epith cells, many mucous cells. Imaging: kidney US – no hydronepthrosis, normal size, right and left kidney upper poles cysts CT stone protocol: left kidney tiny focus of high density, no obstructing stones

    6. Hematuria 2 or more RBC’s per hpf (1-10) on dipstick More sensitive to the presence of hemoglobin and myoglobin than RBC’s Detects: pseudoperoxidase activity of hemoglobin Prevalence of asymptomatic hematuria 0.18-16.1%

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