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.
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