A 56-year-old male wasÿbroughtÿto the emergency room with a chief complaint was right flank pain.History of present Illness:One day prior to admission, the patient developed a change in the colorÿofÿhis urineÿfrom pale yellow toÿredÿin color.ÿThere was no associated fever, painful urination, or penile discharge.ÿHe decided to consult with hisÿprimary physician the following day.One hour prior to admission, the patient developedÿsevereÿright flank pain associatedÿwith nausea. Upon admission, the patient wasÿnoted by the ER physician to be in severe pain, with a pain scale of 9 from aÿvisual analog pain scale from 1ÿ to 10. On physical exam, patient had theÿfollowing findings:Vital Signs BP: 140/90 mm HgHeart rate: 110 bpmRespiration rate: 15 breaths per minute patientTemperature: 98.6 deg CAll exam findings for the head, neck, heart, lungs, and abdomen wereÿnormal.On examination of the back, patient hadÿtenderness on the right flank upon palpation.On examination of the genitalia, there wasÿno penile discharge.Note of a 1 x 1 cm tophus on right big toe.The following diagnostic exams were orderedCBC with WBC differential countUrinalysisSerum uric acidKUB x-rayMRI Scan abdominopelvic areaPast Medical History:Diagnosed with gout one year prior to admissionOn medication with allopurinolNo heart and lung diseaseNo diabetes or hypertensionClick here to review the results of the diagnostic exam.Questions and topics for discussion:After considering his signs, symptoms, findings, and diagnostic exams, whatÿwould be theÿclinical diagnosisÿin thisÿpatient? (1 pt)What is causing the hematuria to occur?ÿ (1 pt)Why are his vitals (BP, HR, breathing) elevated? (1 pt)What is causing the severe right flank pain? (1 pt)How are the elevated levels of serum uric acid and positive uric acid crystals in the urinalysis related to your diagnosis? (1 pts)What pain medication would you provide to this patient? Why would you choose this medication? (2 pts)What treatment would you recommend for removing the cause of his pain?ÿ Explain your answer.ÿ (3 pts)

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