Dr B Comber
The Urologist
Southport Hospital
Gold Coast
Date: 01/06/10
Dear Dr Comber,
Re: Mr Tom Cribb, DOB: 23/05/82
I am writing to refer Mr Cribb, a 28-year-old man, who has a renal mass and requires further assessment and management.
Mr Cribb, a smoker and an alcoholic, was initially seen on 12/05/10, with a complaint of severe pain in the right lower abdomen which was radiating to the groin. It was not associated with urinary or gastrointestinal symptoms, trauma or fever. IVP report provided no evidence of renal stones;however, the right kidney was found to be enlarged and ectopic, while his UFR had a few red cells. Consequently, an abdominal ultrasound was ordered to rule out any renal pathology.
Today, Mr Cribb reported that he has been experiencing pain in the right lower abdomen for 5 days that is responsive to Panadol. His abdominal examination indicated a mass present in the right lower abdomen. The ultrasound confirmed the presence of severe hydronephrosis and a mass attached to the liver. In addition, on RDE, a hard mass was detected, and the kidney was found to be situated below its normal position.
I would appreciate if you could further assess Mr Cribb’s condition.
Yours sincerely,
Doctor
Urgent Referral
The Duty Registrar
Emergency Paediatric Unit
Brisbane General Hospital
140 Grange Road
Kelvin Grove, QLD, 4222
Date:14/10/10
Dear Doctor,
Re. Amina Ahmed, 8 years old.
I am writing to refer Amina who has signs and symptoms of meningococcal meningitis for urgent assessment and management. She is the first child of a family of 5 migrated from Somalia. Despite being migrants, she and her father understand English.
Initially, Amina, accompanied by her parents, presented to me on 09/10/10 with complaints of fever, runny nose, cough and loss of appetite. Her temperature was 39.4 and pulse rate 85 BPM, but there was no rash or neck stiffness. However, her condition continued to deteriorate over the next two days as the fever could not be controlled by antipyretics. Therefore, blood and urine tests were ordered.
Unfortunately, today Amina became lethargic and listless. She vomited twice last night and had been having severe headaches. On examination, she was severely febrile with a temperature of 40.2 and a pulse rate of 110 beats per minute. There was macula-papular rash over the legs and
neck stiffness was present. Blood test showed leucocytosis.
Based on the above, I believe she needs urgent admission and management. Please note, Penicillin IV has been given as a stat dose.
Yours sincerely,
Doctor