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WEEK#10&7 iHUMAN CASE (6550) COMPREHESVE CASE STUDY 62 YEAR OLD REASON;peeing all the time, Exams of Health sciences

WEEK #7 I HUMAN CASE (CLASS 6550) COMPREHESVE CASE STUDY 62 YEAR OLD REASON FOR ENCOUNTER;I’M PEEING ALL THE TIME ;LOCATION (Outpatient clinic with access to X-ray, ECG, and laboratory capabilities) LATEST CASE 2025 week 7 &week 10

Typology: Exams

2023/2024

Available from 01/09/2025

wergnkses254
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Download WEEK#10&7 iHUMAN CASE (6550) COMPREHESVE CASE STUDY 62 YEAR OLD REASON;peeing all the time and more Exams Health sciences in PDF only on Docsity!

WEEK #7 I HUMAN CASE (CLASS 6550)

COMPREHESVE CASE STUDY 62 YEAR OLD

REASON FOR ENCOUNTER;I’M PEEING ALL THE

TIME ;LOCATION (Outpatient clinic with access to

X-ray, ECG, and laboratory capabilities) LATEST

CASE 2025.

1. Patient Information

  • Age : 62 years old
  • Height : 6'1" (185 cm)
  • Reason for Encounter : "I'm peeing all the time" (suggests polyuria , urinary frequency , or urgency ).
  • Location : Outpatient clinic with access to X-ray, ECG, and laboratory capabilities. This context implies the need to investigate urinary tract, endocrine, or neurological causes. HPI Statement The patient is a 62-year-old male presenting with complaints of frequent urination, stating, "I'm peeing all the time." He reports the issue has progressively worsened over the past several weeks. He denies dysuria, hematuria, or suprapubic pain but notes waking up multiple times during the night to urinate (nocturia). He reports no fever, chills, or weight changes. His fluid intake is normal, and he denies excessive thirst or hunger. He has no history of recent illness or travel. The symptoms are interfering with his sleep and daily activities. History Past Medical History (PMH)
  • Hypertension (controlled with lisinopril).
  • No history of diabetes or kidney disease. Past Surgical History (PSH)
  • Appendectomy at age 25. Family History (FH)
  • Father: Type 2 diabetes and prostate cancer.
  • Mother: Hypertension and stroke. Social History (SH)
  • Non-smoker.
  • Drinks one cup of coffee daily and no alcohol.
  • Retired school teacher, moderately active. Review of Systems (ROS)
  • General : No weight loss, fatigue, or fever.
  • Endocrine : No excessive thirst or sweating.
  • Cardiovascular : No chest pain or palpitations.
  • Urinary : No dysuria or hematuria; frequency and nocturia are the primary complaints. Physical Examination General Appearance
  • Alert, cooperative, no acute distress. Vital Signs
  • Blood pressure: 135/80 mmHg
  • Heart rate: 72 bpm
  • Temperature: 98.6°F (37°C)
  • BMI: 24 kg/m² Abdomen
  • No masses or tenderness.
  • Normal bowel sounds.

Genitourinary

  • Digital rectal exam (DRE): Enlarged prostate, smooth, non-tender. Neurological
  • Intact sensation in perineal region, no motor deficits. **Diagnostic Testing
  1. Urinalysis**
  • Glucose : Negative
  • Protein : Negative
  • Blood : Negative
  • Leukocytes/Nitrites : Negative
  • Specific Gravity : Normal 2. Blood Tests
  • Fasting Blood Glucose : 92 mg/dL (normal)
  • HbA1c : 5.4% (normal)
  • PSA (Prostate-Specific Antigen) : 3.5 ng/mL (elevated for age)
  • Serum Creatinine : 1.0 mg/dL (normal)
  • Electrolytes : Normal 3. Imaging
  • Renal Ultrasound : No hydronephrosis or kidney stones.
  • Bladder Ultrasound : Post-void residual of 120 mL (elevated, indicating incomplete bladder emptying). 4. Other Tests
  • Urodynamic studies: Detrusor underactivity consistent with benign prostatic hyperplasia (BPH). Appropriate Selection and Ranking of Differential Diagnosis
  1. Benign Prostatic Hyperplasia (BPH) o Most likely based on symptoms (frequency, nocturia, incomplete emptying) and findings of an enlarged prostate with post-void residual urine.
  2. Diabetes Mellitus (DM) o Less likely due to normal blood glucose and HbA1c levels.
  3. Chronic Kidney Disease (CKD) o Unlikely as creatinine levels are normal and no proteinuria is detected.
  4. Urinary Tract Infection (UTI) o Unlikely due to absence of dysuria, fever, or positive urinalysis findings.
  5. Prostate Cancer o Needs to be ruled out given the elevated PSA level, but smooth prostate texture on DRE reduces likelihood. **Plan Covering All Critical Components of the Final Diagnosis
  6. Patient Education**
  • Educate the patient about BPH as a non-cancerous condition that can lead to urinary symptoms. 2. Lifestyle Modifications
  • Decrease fluid intake in the evening to reduce nocturia.
  • Limit caffeine and bladder irritants. 3. Pharmacological Management
  • Prescribe tamsulosin (0.4 mg daily) for symptom relief by relaxing prostate smooth muscle.
  • Consider adding finasteride if significant prostate enlargement persists after 6 weeks of treatment. 4. Diagnostic Follow-Up
  • Repeat PSA in 3 months to monitor trends and evaluate prostate cancer risk.
  • Refer to urology for further evaluation if PSA continues to rise or symptoms worsen. 5. Monitoring
  • Schedule a follow-up in 4 weeks to assess response to medication and symptom improvement. Clinical Exercise
  1. Case-Based Learning o Simulate scenarios involving BPH with and without complications (e.g., urinary retention or infection).
  2. Application of Urological Guidelines o Discuss American Urological Association (AUA) guidelines for BPH management.
  3. Team-Based Discussion

o Collaborate with peers to review cases of elevated PSA and decision-making regarding biopsy versus monitoring.

2. History Questions (Interview Questions) You are limited to 60 questions , so choose those that will guide your diagnosis efficiently. a) History of Present Illness (HPI): - Onset : When did the increased urination begin? - Frequency : How often are you urinating during the day and night? (e.g., nocturia, diurnal pattern). - Volume : Are you passing large amounts of urine (polyuria) or small amounts frequently? - Associated Symptoms : o Pain or burning during urination (dysuria)? o Urgency or inability to hold urine (urge incontinence)? o Blood in urine (hematuria)? - Triggers : Does it happen after drinking specific beverages (e.g., coffee, alcohol)? - Impact : How does it affect your daily life or sleep quality? b) Past Medical History (PMH): - History of diabetes (type 1 or 2), hypertension, or kidney disease? - Prostate problems (e.g., benign prostatic hyperplasia, prostate cancer)? - History of urinary tract infections (UTIs)? c) Family History (FH):

  • Any family history of diabetes, kidney disease, or prostate cancer? d) Social History (SH):
  • Fluid intake (e.g., excessive water, alcohol, caffeine)?
  • Smoking and alcohol habits? e) Review of Systems (ROS):
  • Endocrine : Weight changes, excessive thirst (polydipsia), or fatigue (diabetes-related symptoms)?
  • Cardiovascular : Edema, high blood pressure (renal function)?
  • Neurological : Numbness, tingling, or weakness (possible neuropathy)? 3. Physical Exam Perform a comprehensive physical exam to identify abnormalities: a) General Examination:
  • Assess general appearance (e.g., signs of dehydration, obesity).
  • Measure vital signs (blood pressure, pulse, temperature). b) Abdominal Examination:
  • Inspection : Check for distension or visible masses.
  • Palpation : Evaluate for bladder distension or tenderness in the suprapubic area.
  • Percussion : Assess for dullness over the bladder (urinary retention). c) Genitourinary Exam:
  • Examine external genitalia (if necessary).
  • Digital rectal exam (DRE) to assess prostate size, consistency, and tenderness.

d) Neurological Exam:

  • Assess reflexes and sensory function (e.g., sacral dermatomes for nerve dysfunction). 4. Assessment/Tests a) Diagnostic Tests:
  1. Urinalysis : o Check for glucose (diabetes), protein (renal disease), blood (infection or cancer), and ketones.
  2. Blood Tests : o Fasting blood glucose or HbA1c: Rule out diabetes. o Serum electrolytes, BUN, creatinine: Assess kidney function. o PSA (Prostate-Specific Antigen): Check for prostate pathology.
  3. Post-Void Residual (PVR) Volume : o Use ultrasound to evaluate for incomplete bladder emptying.
  4. Imaging : o Renal ultrasound or CT scan to evaluate for structural abnormalities.
  5. Specialized Tests : o Urodynamic studies to assess bladder function (if indicated). 5. Differential Diagnosis Based on the history, physical exam, and initial tests, consider the following:
  6. Benign Prostatic Hyperplasia (BPH) :

o Common in older men with urinary frequency, urgency, and nocturia.

  1. Diabetes Mellitus : o Polyuria and polydipsia are hallmark signs of uncontrolled diabetes.
  2. Urinary Tract Infection (UTI) : o Possible if dysuria or foul-smelling urine is reported.
  3. Overactive Bladder : o Characterized by urgency and frequency without infection.
  4. Diabetes Insipidus : o Consider if excessive thirst and very dilute urine are present.
  5. Chronic Kidney Disease (CKD) : o Polyuria can occur in early stages due to impaired concentrating ability.
  6. Prostate Cancer : o Rule out with DRE and PSA levels. 6. Plan a) Education and Counseling:
  • Explain potential causes and next steps to the patient.
  • Provide information on lifestyle changes that may help (e.g., fluid management). b) Symptomatic Management:
  • For BPH : Alpha-blockers (e.g., tamsulosin) or 5-alpha-reductase inhibitors (e.g., finasteride).
  • For UTI : Empiric antibiotics based on local resistance patterns.
  • For Diabetes : Blood sugar control with medications, diet, and exercise. c) Lifestyle Modifications:
  • Limit caffeine and alcohol intake.
  • Encourage a healthy diet and weight management. d) Follow-Up:
  • Monitor response to treatment and adjust medications as needed.
  • Reassess symptoms after 1-2 weeks and follow up with diagnostic test results. 2. History Questions (Interview) a) History of Present Illness (HPI):
  • Onset : When did you first notice increased urination? Was it sudden or gradual?
  • Pattern : o Do you urinate frequently during the day or night (nocturia)? o How many times do you urinate in 24 hours?
  • Volume : o Do you pass large amounts of urine (polyuria) or small frequent amounts (frequency)? o Have you noticed any changes in the color or smell of your urine?
  • Associated Symptoms : o Burning sensation or pain during urination (dysuria)?

o Feeling of incomplete bladder emptying? o Urgency or leakage before reaching the bathroom? o Blood in the urine (hematuria)? o Excessive thirst (polydipsia)?

  • Triggers : o Does this happen more after consuming caffeine, alcohol, or large volumes of fluids?
  • Impact : o Does this interfere with your daily activities or sleep? b) Past Medical History (PMH):
  • History of: o Diabetes mellitus : Common cause of polyuria and polydipsia. o Prostate problems : Benign prostatic hyperplasia (BPH) or prostate cancer can cause frequency, urgency, or retention. o Chronic kidney disease : Early CKD may present with nocturia or polyuria. o Urinary tract infections (UTIs) : Can cause dysuria, urgency, and frequency. c) Family History (FH):
  • Any family history of: o Diabetes (Type 1 or 2)? o Kidney disease or stones? o Prostate cancer? d) Social History (SH):
  • Diet and Fluid Intake : o Do you consume excessive water or high amounts of caffeine? o Alcohol consumption?
  • Tobacco Use : Smoking can predispose to bladder cancer.
  • Physical Activity : Level of physical activity can influence metabolic health. e) Review of Systems (ROS):
  • General : Fatigue, weight loss, fever, or chills?
  • Endocrine : Symptoms of hyperglycemia (e.g., polydipsia, polyphagia, blurred vision)?
  • Cardiovascular : Swelling in extremities, palpitations?
  • Neurological : Weakness, numbness, or urinary incontinence?
  • Urinary : Recurrent UTIs or previous kidney stones? 3. Physical Examination a) General Assessment
  • Inspect for signs of dehydration (dry mucous membranes, sunken eyes).
  • Check body weight for recent fluctuations (sudden weight loss in diabetes or cancer). b) Vital Signs
  • Blood Pressure : Hypertension suggests chronic kidney disease.
  • Pulse : Tachycardia can occur in dehydration.
  • Temperature : Fever indicates infection.

c) Abdominal Examination

  • Inspection : Look for visible masses, distension, or scars.
  • Palpation : Assess for tenderness (suprapubic or flank pain).
  • Percussion : o Dullness over the bladder suggests urinary retention. o Flank tenderness suggests pyelonephritis or kidney stones. d) Genitourinary Exam
  • Perform a digital rectal exam (DRE) to evaluate prostate size and texture.
  • Inspect external genitalia for abnormalities or signs of infection. e) Neurological Exam
  • Check for perineal sensation and reflexes to rule out spinal cord issues affecting bladder control. 4. Assessment and Diagnostic Tests a) Urinalysis:
  • Glucose : Indicates diabetes.
  • Protein : Suggests kidney damage.
  • Blood : Indicates UTI, stones, or malignancy.
  • Specific Gravity : Evaluates urine concentration. b) Blood Tests:
  • Fasting Blood Glucose/HbA1c : Assess for diabetes.
  • Serum Creatinine and BUN : Evaluate kidney function.
  • Electrolytes : Abnormalities suggest metabolic disorders.
  • PSA (Prostate-Specific Antigen) : Rule out prostate cancer. c) Imaging:
  • Renal Ultrasound : Evaluate kidney structure and bladder.
  • CT KUB : Rule out stones or tumors. d) Special Tests:
  • Post-Void Residual Volume : Determine bladder emptying efficiency.
  • Urodynamic Studies : Evaluate bladder function if neurological issues are suspected. 5. Differential Diagnosis Based on the patient’s history and physical exam, consider:
  1. Diabetes Mellitus (Type 2) : o Polyuria and polydipsia with possible weight loss.
  2. Benign Prostatic Hyperplasia (BPH) : o Common cause of frequency, nocturia, and incomplete voiding in older males.
  3. Urinary Tract Infection (UTI) : o Dysuria, urgency, and frequency with possible fever.
  4. Chronic Kidney Disease : o Polyuria in early stages due to impaired concentration.
  5. Diabetes Insipidus : o Dilute urine and excessive thirst. 6. Management Plan

a) Education and Counseling

  • Explain potential causes based on the findings and tests.
  • Address concerns about prostate health and diabetes. b) Symptomatic Treatment
  • BPH : Prescribe tamsulosin or finasteride.
  • UTI : Start empiric antibiotics pending culture results.
  • Diabetes : Initiate glycemic control measures (diet, oral agents, or insulin). c) Lifestyle Modifications
  • Reduce fluid intake before bedtime.
  • Avoid caffeine and alcohol. d) Follow-Up Plan
  • Review test results within 1 week.
  • Monitor for symptom improvement and adjust treatment accordingly.