[PedOncoDoc]

[QUOTE=DocIllinois;532354]

Originally Posted by ender18d

1. What, precisely, is a "night sweat?"

Hyperhidrosis during sleep, not related to the environment.

2. What does "pain greater on flexion than extension" suggest in the context of vertebral back pain? How does this fit with our differential at this point?

It can indicate a great many things; posterior ligamentous strain or tear, posterior disc herniation or sequestration pressing on ALL, lateral recess or dural attachments, muscle spasm of multifidus or other posterior rotator/ extensor

In the context of our Dx? Paraspinous infection in the form of spondylodiscitis.


3. Renal pathology is absolutely a consideration for low back pain, but there are a number of findings in our history and physical at this point that make renal issues less likely in this patient. What are they?

Assume the ballotment method was used during standard ab. quadrant exam, results negative. Outside of that, maybe a more renal-oriented doc/ medic can chime in?
4. Since we're talking about sepsis as a possible complication, what is it and how would we recognize it?

SIRS caused by the immune system's response to a severe infection, usually bacterial. Signs vary depending upon early or established sepsis. Flushed skin, decreased urination, low BP, elevated HR are common early signs.

Night sweat - for it to be concerning (from an oncologic standpoint) should be recurring and be sufficient to require change of bedclothes/sheets.

I'll defer to others on the flexion/extension question.

For renal eval - pain tends to be colicky if worried about stones (not constant such as in this case). Most commonly docs will pound on the costovertebral angle to check for kidney-associated pain (such as in pyelonephritis). Since kindeys are retroperitoneal the abdominal examination is less helpful (unless there is a large kidney mass - this will be picked up on abdominal exam). Other things associated with a renal cause - hematuria, cloudy/foul smelling urine (UTI progressing to pyelonephritis), other urinary symptoms (hesitancy, frequency, dysuria).

Sepsis is a lecture unto itself - different causes (hypovolemic, spine trauma, sepsis, cardiogenic, etc.) - compensated versus not, one could go on for a long time and I'm admittedly a bit rusty on the specific pathophysiology in these different scenarios.