[Solved]: Clinical Connections Case 10 HPI: F

Clinical Connections Case 10 HPI: F.C., a 76 yo M, presents to PCP office with c/o up 5-6 times per night to urinate and “only a little comes out. Sometimes I get a sudden urge to urinate and don’t make it to the bathroom”. He often has to strain to urinate and sometimes he has a post-void “dribble on the toilet seat”. His urine flow often stops and starts several times while voiding. PMH: “mild” COPD, iron-deficiency anemia, DJD of right hip, and obesity. He also reports recent history of recurrent UTIs. Records indicate a hospitalization four months ago with acute pyelonephritis. No surgeries. FH: His father is deceased of alcoholic cirrhosis, his mother is deceased and had DM and ESRD, his siblings are A&W. SH: He is employed part-time as a greeter at Walmart. He smokes 5 cigarettes per day and does not drink alcohol or use other substances. Meds: iron supplements daily, multivitamin daily, ibuprofen 600 mg PRN joint pain ROS: As above, otherwise remainder of 10 system review is negative. Exam: No significant findings except for a large prostate with smooth surface, no distinct nodules or indurations. BP 148/92, otherwise vitals are WNL. Labs: UA with positive white cells and bacteria, negative glucose, bilirubin, ketones, blood, or nitrites. No urine culture was obtained. CMP WNL, CBC Hgb 11 with mildly elevated white cells, neutrophils, and lymphocytes. Uric acid 6.3 mg/dL, PSA 20 ng/mL. Trans-abdominal US shows residual urine volume of 230mL. Questions What is your top differential diagnosis? Please support your answer (10 pts) Explain the pathophysiology of your diagnosis. (20 pts) What are three other diagnosis that should be considered? Please support your choices. (20 pts) What is the most important lab test reported and why? (20 pts) What additional tests should be ordered to confirm your diagnosis? (20 pts)