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
