CHIEF COMPLAINT: "My back hurts."
Jennifer is a 22-year-old law student who presents to the emergency room because of severe, cramping, left-sided back pain. The pain initially came and went, but has been constant for the last 8 hours. She has tried Tylenol and Motrin, but they only relieve the pain for a couple of hours. The pain does not radiate. She has felt feverish, but hasn't taken her temperature. She states that the pain started 2 days ago. She has been nauseated and has vomited today. She denies abdominal pain or diarrhea. She states that she started having pain with urination 2 days ago and now she is having difficulty urinating at all. She denies blood in her urine. She denies vaginal discharge, she denies pain with intercourse.
She is normally healthy. She has had several urinary tract infections over the past 5 years, which resolved with antibiotics. She takes oral contraceptives and has since age 17.
She does not smoke. She drinks alcohol on the weekends with friends. She tried marijuana in high school, but doesn't use any illicit drugs currently. Her mother is healthy; her father has asthma.
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If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.