the kid with the swollen scrotum
the triage notes on my first patient yesterday:"mother states young man's scrotum is swollen..."
ok. so what could this be? hydrocele? epididymo-orchitis (but it should then have said "tender, red..."), torsion (but shouldn't be too swollen and would've been triaged higher)? hernia?... need to take a look. might need a bit of convincing to get a 9 yr old to show me his scrotum. [disclaimer: i'm a MO, so i can write this. stop reading if u're feeling sick already.] otherwise, not a bad case. probably surgical review.
Mum was chronological in her history: kid had swollen eyes a wk ago. GP gave Chlorsig. temporary relief...etc. Meantime, the kid was getting impatient and wanted to discuss an item located more southernly, which was obviously causing him more concern.
I let the mum continue: also noticed that his legs are a bit swollen. Ding! Ding!! Ding!!! I'm getting more excited!!! yep, pitting oedema up to the knees.
Finally, i allowed the kid to show me what was worrying him. maybe "worrying"'s the wrong word. "amusing" perhaps.
Sure, it's swollen, most likely a hydrocele or similar. I knew what to do next. and the good-old UA came very handy this time. "blood: heavy, protein: ++++"
called the paediatric registra before the results of the blood test came back. "...i think he has nephrotic syndrome..."
Best and quickest case i've seen so far. Interestingly, the kid also had an URTI 2 weeks ago.
posted by zhinger @ 2:24 pm
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