Pathophysiology and Pharmacology

Critical Analysis – What is the likely outcome?
Explain what would indicate a return to health for the patient; or other possible outcomes [if relevant].


Mark is a 58 year old male who presents to his GP due to a recent but on-going, dull ache in his lower back, on the left. Mark has a history of post-infection glomerulonephritis, which was treated successfully at the time, but he wonders if it has come back.


Mark’s past medical history includes:

  • 10 years ago, post-streptococcal glomerulonephritis
  • Osteoarthritis Left knee
  • Mild Rheumatoid Arthritis both hands
  • Peptic Ulcer, recent diagnosis [can’t remember specifically when]
  • Recurrent Depression, treated non-pharmacologically with CBT and ACT No recollection of recent injury to his back


Mark’s current medications includes:

  • Mycophenolate Mofetil 1500 mg, twice daily
  • Misoprostol [Cytotec] 400 µg, twice daily
  • Paracetamol [Osteomol] eight hourly [two tablets]


Mark’s family history includes:

  • He was adopted and no family history is available
  • Two daughters, both apparently healthy


Mark’s social history includes:

  • Married
  • Reformed heavy smoker
  • No illicit drug use
  • Normal, average diet
  • Left knee pain limits his activity
  • Recent spike in back pain has stopped any physical activity


Physical Examination:

  • 58 yo, Caucasian male, alert but obviously in significant discomfort
  • Height 6’ 2” [188 cm]
  • Weight 100 kg
  • Blood Pressure 125/73
  • Heart Rate 65 bpm
  • Respiration Rate 17 per minute
  • Temperature 37oC
  • Murphy’s percussion test [Murphy’s punch sign; costovertebral angle tenderness [CVAT]] positive [significant]
  • Significant bilateral supraclavicular lymphadenopathy


  • Abdomen is soft, with a tender, palpable mass in the Left flank region


Test Results:

  • Urine
    • White Blood Cells – higher than the normal reference range [high power field examination]

o Red Blood Cells – too numerous to count

  • Abdominal CT scan: o Well-defined, single, irregular, solid nodule, 8 cm diameter, superior pole of the Left kidney
    • Signs of invasion into surrounding adipose tissue
  • Chest X-ray: o Left lung: three, individual, solid lesions, each 2 – 2.5 cm in diameter

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