A 34-Year-Old Man Is Brought to the Emergency Department After

question 90

Multiple Choice

A 34-year-old man is brought to the emergency department after a snowmobile accident.  The patient was thrown 3 m (9.8 feet) and was dazed for several minutes afterward, although he was wearing a helmet and did not lose consciousness.  He now has left mid-back pain.  Blood pressure is 130/76 mm Hg and pulse is 98/min.  Breath sounds are clear and symmetric.  Heart sounds are normal.  The abdomen is soft and nontender.  There are no areas of spinal tenderness or step-offs.  The left costovertebral area is tender to palpation.  Focused Assessment with Sonography for Trauma reveals no pericardial or intraperitoneal free fluid, and chest and pelvic x-rays are normal.  The patient provides a clear urine sample without pain or difficulty.  Urinalysis shows 11-25 erythrocytes/hpf.  Complete blood count, serum electrolytes, and creatinine are within normal limits.  Which of the following is the best next step in management of this patient?

• A)CT scan of the abdomen and pelvis
• B)Reassurance and analgesics
• C)Retrograde cystourethrogram
• D)Selective renal angiography
• E)Urinary catheter insertion

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Definitions:

Catharsis

The process of releasing, and thereby providing relief from, strong or repressed emotions, often through art, drama, or other expressive activities.

Emotional Tension

The psychological stress and discomfort resulting from conflicts, challenges, or unresolved emotional issues.

Frustration-Aggression

A psychological theory proposing that frustration often leads to aggressive behavior, as aggression is seen as a way to release or address the frustration.

Pent-up Anger

Accumulated feelings of anger that have not been expressed and may result in emotional or physical tension.