Apply information from the Aquifer Case Study to answer
the following discussion questions:
Discuss the Mr. Payne’s history that would be
pertinent to his genitourinary problem. Include chief
complaint, HPI, Social, Family and Past medical
history that would be important to know.
Describe the physical exam and diagnostic tools to
be used for Mr. Payne. Are there any additional you
would have liked to be included that were not?
Please list 3 differential diagnoses for Mr. Payne and
explain why you chose them. What was your final
diagnosis and how did you make the determination?
What plan of care will Mr. Payne be given at this visit,
include drug therapy and treatments; what is the
patient education and follow-up?
iscuss the Mr. Payne’s history that would be pertinent to his genitourinary problem.
Include chief complaint, HPI, Social, Family and Past medical history that would be
important to know.
Forty-five-year-old white male truck driver complaining of two weeks of sharp, stabbing back
pain. The pain was better after a couple of days but then got worse after playing softball with his
daughter. Patient states this morning his pain is so bad that he had trouble getting out of bed.
Past Medical History: Diabetes, well controlled. Hypertension, fair control. Hyperlipidemia,
fair control.
Pertinent History
Mr. Payne has had little relief with the treatment prescribed. He is frustrated that he has been in
pain for more than a month. His pain has been progressively worse. It radiates down the lateral
, part of his left leg and side of his left foot. This pain is worse than the back pain. He does not
have any problems with bowel or bladder control and there is no weakness of his leg.
Past Surgical History: None
Social History: Works as a truck driver, which involves lifting 20-35 lbs 4 hours of the day,
married with 2 daughters,
Weight: 170 pounds
Body Mass Index: 24 kg/m2
Medication:
· metformin 500mg 2 twice daily
· glyburide 5mg 2 twice daily
· amlodipine 2.5 mg daily
· lisinopril 40 mg daily
· simavastin 40 mg daily
Allergies: No known drug allergies.
Describe the physical exam and diagnostic tools to be used for Mr. Payne. Are there any
additional you would have liked to be included that were not?
The patient’s physical exam included vital signs, which were within normal limits (98.6, 80bpm,
112, 130/82.) The patient presents as a well appearing, middle-aged man. I would examine the
patient standing and sitting. Back Exam – Standing: I would have the patient stand and I would
examine the curvature of his spine. I would palpate the patient’s paraspinous muscle. I would
watch him walk on his heels and toes. I would examine the patient’s ability to perform full range
of motion. I would have the patient perform a deep knee bend. Back Exam – Seated: I would
check for CVA tenderness. I would check for pain with the modified version of SLR. While he
does not exhibit a true tripod sign, he does complain of pain when his left leg is raised. Mr.
Payne’s reflexes are 2+ and equal at the knees and 1+ at both ankles. The motor exam reveals no
weakness of the muscles of the lower extremities. Back Exam – Supine: The patient would also
be asked to lay in the supine position. Physical exam would include passive Straight Leg Raise
(SLR or Lasegue's sign) The normal leg can be raised 80 degrees. The patient only raising their
leg <80 degrees, would indicate tight hamstrings or a sciatic nerve problem. In order to
the following discussion questions:
Discuss the Mr. Payne’s history that would be
pertinent to his genitourinary problem. Include chief
complaint, HPI, Social, Family and Past medical
history that would be important to know.
Describe the physical exam and diagnostic tools to
be used for Mr. Payne. Are there any additional you
would have liked to be included that were not?
Please list 3 differential diagnoses for Mr. Payne and
explain why you chose them. What was your final
diagnosis and how did you make the determination?
What plan of care will Mr. Payne be given at this visit,
include drug therapy and treatments; what is the
patient education and follow-up?
iscuss the Mr. Payne’s history that would be pertinent to his genitourinary problem.
Include chief complaint, HPI, Social, Family and Past medical history that would be
important to know.
Forty-five-year-old white male truck driver complaining of two weeks of sharp, stabbing back
pain. The pain was better after a couple of days but then got worse after playing softball with his
daughter. Patient states this morning his pain is so bad that he had trouble getting out of bed.
Past Medical History: Diabetes, well controlled. Hypertension, fair control. Hyperlipidemia,
fair control.
Pertinent History
Mr. Payne has had little relief with the treatment prescribed. He is frustrated that he has been in
pain for more than a month. His pain has been progressively worse. It radiates down the lateral
, part of his left leg and side of his left foot. This pain is worse than the back pain. He does not
have any problems with bowel or bladder control and there is no weakness of his leg.
Past Surgical History: None
Social History: Works as a truck driver, which involves lifting 20-35 lbs 4 hours of the day,
married with 2 daughters,
Weight: 170 pounds
Body Mass Index: 24 kg/m2
Medication:
· metformin 500mg 2 twice daily
· glyburide 5mg 2 twice daily
· amlodipine 2.5 mg daily
· lisinopril 40 mg daily
· simavastin 40 mg daily
Allergies: No known drug allergies.
Describe the physical exam and diagnostic tools to be used for Mr. Payne. Are there any
additional you would have liked to be included that were not?
The patient’s physical exam included vital signs, which were within normal limits (98.6, 80bpm,
112, 130/82.) The patient presents as a well appearing, middle-aged man. I would examine the
patient standing and sitting. Back Exam – Standing: I would have the patient stand and I would
examine the curvature of his spine. I would palpate the patient’s paraspinous muscle. I would
watch him walk on his heels and toes. I would examine the patient’s ability to perform full range
of motion. I would have the patient perform a deep knee bend. Back Exam – Seated: I would
check for CVA tenderness. I would check for pain with the modified version of SLR. While he
does not exhibit a true tripod sign, he does complain of pain when his left leg is raised. Mr.
Payne’s reflexes are 2+ and equal at the knees and 1+ at both ankles. The motor exam reveals no
weakness of the muscles of the lower extremities. Back Exam – Supine: The patient would also
be asked to lay in the supine position. Physical exam would include passive Straight Leg Raise
(SLR or Lasegue's sign) The normal leg can be raised 80 degrees. The patient only raising their
leg <80 degrees, would indicate tight hamstrings or a sciatic nerve problem. In order to
