Apply information from the Aquifer Case Stud 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 assessment 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?

use references in apa style. case stud is attached

You are working with Dr. Lee today. She hands you a triage note from the nurse regarding your next patient, Mr. Payne:

Forty-five-year-old male truck driver complaining of two weeks of sharp, stabbing back pain after lifting a 10-lb. box. The pain was better after a couple of days but then got worse after playing softball with his daughter. This morning his pain is so bad that he had trouble getting out of bed.

Dr. Lee provides you some background information about low back pain.


Low Back Pain Prevalence, Cost, & Duration

Low back pain (LBP) is the fifth most common reason for all doctor visits. In the U.S., the lifetime prevalence of LBP is 60% to 80%. The direct and indirect costs for treatment of LBP are estimated to be $100 billion annually. Fortunately, most LBP resolves in two to four weeks.

Dr. Lee continues: “There are many causes for LBP. For presenting symptoms that have a broad differential diagnosis, I find it helpful to think of systems of etiologies in which diseases or conditions can be categorized.”


Common Causes of Back Pain

Musculoskeletal (MSK) and Non-MSK Causes of Back Pain

MSK Causes


· Degenerative disc disease

· Facet arthritis

· Sacroiliitis

· Ankylosing spondylitis

· Discitis

· Paraspinal muscular issues

· SI dysfunction


· Disc prolapse

· Spinal stenosis


· Lumbar strain

· Compression fracture

Non-MSK Causes


· Lymphoma/leukemia

· Metastatic disease

· Multiple myeloma

· Osteosarcoma


· Rheumatoid Arthritis


· Endometriosis

· Prostatitis

· Renal lithiasis


· Discitis

· Herpes zoster

· Osteomyelitis

· Pyelonephritis

· Prostatitis

· Spinal or epidural abscess


· Aortic aneurysm


· Hyperparathyroidism

· Osteomalacia

· Osteoporotic vertebral fracture

· Paget disease


· Pancreatitis

· Peptic ulcer disease

· Cholecystitis


· Endometriosis

· Pelvic inflammatory disease

Dr. Lee tells you: “Working from such a broad list is difficult. Having a shorter list of working diagnoses will help you conduct a more focused initial history and physical exam. What are the three most common causes of back pain?”

Degenerative joint disease

Disc herniation

 Lumbar strain

Dr. Lee suggests, “Now, let’s look a bit more at the risk factors for mechanical low back pain that you can review with Mr. Payne during your history.”

Dr. Lee continues, “The major task in treating back pain is to di