Blocked
Male Reproductive System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S19_F1.jpg"}},{"insert":"\n\n"},{"insert":"The cafeteria\u0027s sandwich tastes unusually good today, almost like real food, you think.\r\n \r\nYou begin to wonder what the cook may have gotten wrong (or right?), and then remember that you skipped dinner last night.\n\nYour pager decides to go off just then - no lunch for you today. Just as well, you think - it probably saved you from food poisoning.\r\n \r\nYou toss your barely eaten meal in the trash and head out to see the patient.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S19_F2.jpg"}},{"insert":"\n\n"},{"insert":"Mr. Wayne is a not-so-cheerful 69-year-old African-American who complains of progressively worsening difficulty in urination for the past 6 months.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S19_F3.jpg"}},{"insert":"\n\n"},{"insert":"He describes his symptoms and tells you that he experiences hesitancy, a weak stream, straining and a feeling of incomplete voiding almost half the time that he goes to urinate.\r\n\r\nYou ask about storage symptoms such as frequency and urgency, as well as about hematuria, weight loss, and low back pain, to all of which he replies negatively with a shake of his head.\n\nYou quickly look over his previous medical records and notice that he has been healthy before this began. You ask to examine him, and he gives you the go-ahead.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S19_F4.jpg"}},{"insert":"\n\n"},{"insert":"His vitals are as follows: temperature 98 \u02daF, blood pressure 128\/88 mmHg, pulse rate 88 bpm, respiratory rate 22 cycles\/min. Cardiopulmonary auscultation reveals no abnormalities.\r\n\r\nThe urogenital system examination reveals no abnormalities as well, and no indurations are felt along the urethra.\n\nDigital rectal examination reveals a moderately enlarged prostate with preservation of the sulci; it is firm to hard in consistency, with a freely mobile rectal mucosa. No nodules are felt on the gland.\n\nYou calculate Mr. Wayne\u0027s International Prostate Scoring System (IPSS) score, which amounts to 18.\r\n \r\nYou also perform uroflowmetry and note a urinary flow rate of 7ml\/s, with a total voided volume of 150 ml over 2 mins. The detrusor muscle pressure is 98 cmH2O.\n"}]}
4
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S19_F5.jpg"}},{"insert":"\n\n"},{"insert":"A urinalysis, renal profile, and complete blood count are all normal.\r\n\r\nYou make a provisional diagnosis of bladder outlet obstruction (BOO) due to benign prostatic enlargement and consider your next line of action.\n"}]}
5
{"ops":[{"insert":"How will you investigate further?\n"}]}
1. Request a CT scan and prostate specific antigen (PSA) assay
2. Request an ultrasound scan and PSA assay
3. Schedule a prostate biopsy
8
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9
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7
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6
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