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A 60-year-old male presents for an acute visit. He mentions that over the past several years, he has noticed an increased frequency of urination, particularly at night. However, when he tries to urinate, he often needs to wait for several seconds to initiate urination. His urinary stream often stops and starts. He denies abdominal pain, flank pain, fevers/chills, and blood in his urine. He has tried eliminating fluids after dinner without any improvement in symptoms.

1. What other elements of the patient’s history, current complaint, and review of systems are needed to evaluate this problem?

2. What systems would be important to evaluate in your problem-focused physical exam? Why?

3. What is your differential diagnosis? What would make you consider each of the diagnoses?

4. What further work-up and testing would you order? When would you consider referring to urology?

5. The patient asks if he should be screened for prostate cancer. How would you counsel this patient?

SCIENCE
HEALTH SCIENCE
NURSING
NUR 668

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