An 80-year-old woman is referred for surgical consultation after a solid renal mass is discovered incidentally while evaluating the cause of chronic abdominal pain. She presents alone without a family member. The patient has a history of hypertension, chronic atrial fibrillation, vitamin D deficiency, osteoporosis, and osteoarthritis. She has no history of previous surgery. Current medications include hydrochlorothiazide (25 mg daily), vitamin D3 (1000 IU daily), diltiazem (30 mg 4 times daily), calcium carbonate (500 mg 2 times daily), warfarin (2.5 mg at bedtime), and acetaminophen (500 mg 2 times daily). She lives alone at home and has an established advance directive. The patient uses a cane for ambulation and reports no falls. A review of systems survey completed on arrival is negative. Her temperature is 37°C (98.6°F), pulse is 90/min and irregular, respirations are 12/min, and blood pressure is 135/85 mm Hg. The patient is alert and oriented. Physical examination is noncontributory. Cardiac and pulmonary systems have been evaluated and were cleared by the primary care physician.
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