plz evaluate this PN. -------------- Kaplan case 9 - irfanmir

[ArchivalUser]

I think there is some probem. Plz guide.


65 yo M c/o difficulty sleeping because of need to urinate.
Temp: 98.6 F. BP: 130/85 mmHg. HR: 82/min. RR: 16/min.


HPI:
65 yo otherwise healthy M c/o difficulty sleeping because of nocturia from 2 yrs.
- Nocturia : Insidious onset/ progressive 2 - 3 X /night.
- Inability to Initiate urination (usually in day time). Inability to empty bladder (usually in
night time)
- Failed attemt to relief the Sxs by restricting fluid intake in night.
- Asso Sxs: Wak stream, post urination dribbling.
- Denies: Pain/blod in urine, wt/appetite change, boby/back pain, fever/ chill, penile
dischrage, nausea.
- Medi: HCTZ Amitryptyline. NKDA.
PMH: HTN. Depression. DM (controlled with diet/exercise).
FH: none.
SH: Ex marine. No EtOH. No tobacco/illicit drug.
Sexual Hx: Not active from few yrs (incapable). Hx of STD.


PE:
Pt is not in acute distress but appear uncomfortable.
VS: WNL.
Chest: Chest sound normal BL.
Heart: RRR. S1S2 nomral. No M/G/R. PMI not displaced. No JVD
Abd: soft, nontender/nondistended/tympanic in all 4 Qs. NoCVA tenderness/discloration.
BS+. No mass/HSM.
Extremities: No rash/edema/ cyanosis/clubbing. DTRs 2+ BL. Motor/senation nomral.
Babinski - ve.
Gait normal.
Skin: no rash/edema.


DX:
BPH
Medication induced polyurea.
DM
Normal P Hydrocephalus
prostate cancer


TESTS:
CBC with electrolytes. BUN/Cr
Genitourinary / Digital Finger exam
Glucose test. hbA1c. Serum PSA
Urinanalysis /culture. Albuminuria.
Pelvic MRI / CT scan.
DDx: Tests:
697
401
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