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|History of present Illness:
One day prior to admission, the patient developed a change in the color of his urine from pale yellow to red in color. There was no associated fever, painful urination, or penile discharge. He decided to consult with his primary physician the following day.
One hour prior to admission, the patient developed severe right flank pain associated with nausea. Upon admission, the patient was noted by the ER physician to be in severe pain, with a pain scale of 9 from a visual analog pain scale from 1 to 10. On physical exam, patient had the following findings:
1. Vital Signs BP: 140/90 mm Hg
2. Heart rate: 110 bpm
3. Respiration rate: 15 breaths per minute patient
4. Temperature: 98.6 deg C
5. All exam findings for the head, neck, heart, lungs, and abdomen were normal.
6. On examination of the back, patient had tenderness on the right flank upon palpation.
7. On examination of the genitalia, there was no penile discharge.
8. Note of a 1 x 1 cm tophus on right big toe.
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