09 Jan Rectal: digital

Mr. K. is a 70-year-old Native American male who presents with complaints of nocturia. He indicates that he has been waking up to urinate more than 3 times each night. In addition, he reports having urinary frequency during the day, starting and stopping a stream, and doesn’t feel like his bladder is completely empty after urination. He denies any pain on urination, fever or chills. His last PSA 2 years ago was negative.

PMH: arthritis in both knees; takes over the counter ibuprofen as needed for joint pain.

Social history: non-smoker; drinks 2-3 beers on the weekend

Discussion Questions Part One

What additional assessments/diagnostic tests might be helpful in the work-up? (patient’s chief complaint)

Conduct a ROS on this patient.

List your differential diagnoses.

Share at least one tool that could be used to assess the severity of urinary symptoms in men.

What primary diagnosis are you choosing at this point?

Discussion Part Two (graded)

Physical Exam:

Discussion Part Two (graded)

Vital signs: blood pressure 140/80, heart rate 76, respirations 16, temperature 98.0;

weight 210 pounds; height 5’9”

General: no distress; no weakness or fatigue

HEENT: unremarkable

Heart: S1 and S2 RRR; no murmurs, gallops or rubs

Lungs: breath sounds clear throughout lung fields

Abdomen: soft, nontender with positive bowel sounds all 4 quadrants

GU: negative CVA tenderness

Rectal: digital rectal exam reveals enlarged prostate that is smooth and nontender

Discussion Questions Part Two

For the primary diagnosis, what non-pharmacological and pharmacological strategies would be appropriate?

Include the following: lab work and imaging studies

Describe patient education strategies.

Describe follow-up.

Describe any referrals that may be necessary.