Mr. Frias is a 64-year-old Dominican businessman who comes intothe office with complaints of difficulty urinating. He stated thathe has excellent health except for a recent cold. Last night whenhe got up to go to the bathroom, he found that he had extremedifficulty starting his urine stream. Only a small amount of urinepassed, and he felt the urge to urinate more. He has noticed somenocturia and slight hesitancy. PMH: elevated lipids, chronic kneepain Social: Married 40 years, two children, no smoking, two etoh aweek Medications: ibuprofen PRN, Sudafed PRN PE: Abdomen soft,non-tender without masses or organomegaly. No CVA tenderness.Genitalia with uncircumcised penis, testes descended without massesor tenderness. o hernia or lymphadenopathy. Rectal: good sphinctertone. Prostate slightly enlarged, palpably firm, and non-tenderwith no bogginess or masses. Hemoccult negative. What additionalhistory would you need to further explore the patient’s chiefcomplaint? A bulleted list with referencing is sufficient. Focusedfor this visit, what lab tests would be most helpful? List threedifferentials, including your final diagnosis. What differentialswould you discuss with Mr. Frias? What subjective information orphysical presentation signs would lead you to consider the workingdiagnosis or rule it out? Explain the etiology of his currentcomplaint with respect to medications and prostate enlargement.
