376 Chapter 10
6. Sandy White is a 52-year-old white female established patient who was seen in the office by Dr.
Kramer on January 15 with the chief complaint of low back pain. The patient has complained of
lumbosacral pain off and on for many months, but it has been getting worse for the last two to
three weeks. The pain is constant and gets worse with sneezing and coughing. There is no radia-
tion of the pain to the legs.
Past History reveals no history of trauma, no history of urinary symptoms, and no history of weak-
ness or numbness in the legs. She had measles during childhood. She's had high blood pressure
for a few years, Sandy also has a previous history of rectal bleeding from hemorrhoids. She had
an appendectomy and cholecystectomy in 1975. She also has diabetes mellitus, controlled by diet
alone.
Family History Sandy's mother died postoperatively at age 62 of an abdominal operation, the exact
nature of which is not known. She had massive bleeding. Her father died at the age of 75 of a myo-
cardial infarction. He also had .carcinoma of the bladden and diabetes mellitus. One sister has high