Week5:APEAPredictorAssignment - Part 1 ,f ,f ,f ,f ,f ,f ,f
Chief complaint: 52-year-oldAfricanAmerican male presented to the office with chief complaint of
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voiding difficulty and pain.
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HPI: “I been having some dribbling and discomfort pain after peeing for some time now. I have been
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
going to the bathroom more often since I do not feel like I have finish peeing all the way. The reason I
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
am here today is because last night, I noticed a small amount of blood in my semen after having
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
intercourse with my wife. I did not want to come, but this is really scaring me and my wife said this is
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
not normal.”
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Patient Medical History: Current treatment for diabetes, hyperlipidemia, hypertension, erectile
,f ,f ,f ,f ,f ,f ,f ,f ,f
dysfunction
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Childhoodillnesses:Varicella,commoncold Patient ,f ,f ,f ,f ,f
,f surgical history: Hernia repair Hospitalizations: ,f ,f ,f ,f
,f None
Immunization: Up to date on all vaccinations ,f ,f ,f ,f ,f ,f
Allergies: NKDA ,f
Currentmedications: Metformin 500 mg BID daily,Atorvastatin 20mg at bedtime,Amlodipine 10
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mg daily and Cialis 10mg PRN.
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Family History: Children are healthy. Mother has diabetes and cholesterol. Father has HTN,
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BHP, and hyperlipidemia. Brother: BPH, PGM: Deceased unknown causes and PGF: erectile
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
dysfunction died at 73 from heart attack.
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Lifestyle: In monogamous married relationship with his wife of 20 years. The patient works at the
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local High school as a math teacher. Due to the COVID-19 quarantine, he has been working from
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
home, lives a sedentary lifestyle, increase his weight and food intakes.
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PE: Height 5’11’,Weight 234 pounds
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Vital signs: BP151/94, Temp. 97.8, P86, Oxygen sat 99% on room air.
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General: African-America male. Alert, oriented, cooperative. Pt appears unease and changing
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positions in chair every couple of minutes.
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Skin: Skin warm, moist, intact. Skin color dark brown skin tone without cyanosis or pallor.
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
,f HEENT: Head norno-cephalic. Hair thin coarse hair with a bald circular spot on back of head. Eyes:
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
,f Sclera clear, conjunctive: white, PERRLA. EOMs intact with no AV nicking noted.
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
Nose: Nares patent without exudate. Sinuses non-tender to palpation. Nasal septum without deviation.
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
, Throat: Oropharynx most without lesion or exudate.Teeth in need of repair. Gums swollen and red.
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
Tongue midline, pink, smooth without lesion.
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Lungs: Lungs clear bilaterally to auscultation without labored breathing. Chest symmetrical without
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rashes or lesions noted.
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CV: Heart S1 and S2 noted without murmurs, noted. No parasternal lifts, heaves, and thrills.
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
Peripheralpulses equally bilaterally. PMI 5thICS displaced 4cm laterally.Trace edema in lower
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extremities.
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Abdomen:Abdomen round, soft without bowel sounds noted on all four quadrants. ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
Rationale in the identified body system: ,f ,f ,f ,f ,f
Based on the National Institute Diabetic and Digestive and diabetes and digestive and kidney
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
disease (NIDDK), men over 40-year-old with associated risk factor and family history of benign
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
prostatic hyperplasia are prevalence of developing urological conditions. Urology was selected as
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
the body system based on the patient chief compliant of dribbling, discomfort pain after voiding and
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
the presence of blood after intercourse, which are all signs and symptoms of the three-differential
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
diagnosis. The patient also has associated risk factors such as diabetes, hyperlipidemia,
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
hypertension, erectile dysfunction, age, obesity, lack of physical exercise and African American
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descent (NIDDK, 2021a).
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DifferentialDiagnosis: ,f
For proper diagnosis and treatment, it is essential to be able to differentiate and identify the origins of
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
each condition using the patient’s physical exam, medical history, and chief complaint. The following
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
are the three differential diagnoses.
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1. Benign Prostatic Hyperplasia (BPH) (N40.0) ,f ,f ,f ,f
2. Acute Prostatitis (N41.0) ,f ,f
3. Malignant neoplasm of prostate (C61) ,f ,f ,f ,f
The prostate is a walnut-shaped gland that produces prostate fluid to aid in the transfer of semen.
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
Prostate fluid is an essential component in a man’s fertility. The urethra is the mode that transfer
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
semen and urine out of the body through the penis (NIDDK, 2018). Benign prostatic hyperplasia,
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
acute prostatitis and malignant neoplasm are all abnormal conditions of the prostate that originate
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f , f
from different origins. Many of the sign and symptoms along with risk factors of these conditions
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
may overlap making it difficult to diagnose. Understanding the pathophysiology and knowing the
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
risk factors, demographics, occurrences, and clinical presentation of each condition can assist in
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
narrowing the diagnose for proper treatment.
,f ,f ,f ,f ,f ,f
Pathophysiology:
Benign prostatic hyperplasia (BPH) is characterized by increase proliferation of epithelial cell and
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
smooth muscle with the prostatic resulting in hyperplasia and an enlargement of prostate
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
(Lokeshwar, S. D., el. at, 2019). As the prostate gland enlarges it presses against the urethra
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
decreasing urine and prostate fluid flow. The pressure thickens and weakens the bladder wall
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
decreasing ability to completely empty out the bladder resulting in urine residue (NIDDK,
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
Chief complaint: 52-year-oldAfricanAmerican male presented to the office with chief complaint of
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
voiding difficulty and pain.
,f ,f ,f ,f
HPI: “I been having some dribbling and discomfort pain after peeing for some time now. I have been
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
going to the bathroom more often since I do not feel like I have finish peeing all the way. The reason I
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
am here today is because last night, I noticed a small amount of blood in my semen after having
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
intercourse with my wife. I did not want to come, but this is really scaring me and my wife said this is
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
not normal.”
,f ,f
Patient Medical History: Current treatment for diabetes, hyperlipidemia, hypertension, erectile
,f ,f ,f ,f ,f ,f ,f ,f ,f
dysfunction
,f
Childhoodillnesses:Varicella,commoncold Patient ,f ,f ,f ,f ,f
,f surgical history: Hernia repair Hospitalizations: ,f ,f ,f ,f
,f None
Immunization: Up to date on all vaccinations ,f ,f ,f ,f ,f ,f
Allergies: NKDA ,f
Currentmedications: Metformin 500 mg BID daily,Atorvastatin 20mg at bedtime,Amlodipine 10
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
mg daily and Cialis 10mg PRN.
,f ,f ,f ,f ,f ,f
Family History: Children are healthy. Mother has diabetes and cholesterol. Father has HTN,
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
BHP, and hyperlipidemia. Brother: BPH, PGM: Deceased unknown causes and PGF: erectile
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
dysfunction died at 73 from heart attack.
,f ,f ,f ,f ,f ,f ,f
Lifestyle: In monogamous married relationship with his wife of 20 years. The patient works at the
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
local High school as a math teacher. Due to the COVID-19 quarantine, he has been working from
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
home, lives a sedentary lifestyle, increase his weight and food intakes.
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
PE: Height 5’11’,Weight 234 pounds
,f ,f ,f ,f ,f
Vital signs: BP151/94, Temp. 97.8, P86, Oxygen sat 99% on room air.
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
General: African-America male. Alert, oriented, cooperative. Pt appears unease and changing
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
positions in chair every couple of minutes.
,f ,f ,f ,f ,f ,f ,f
Skin: Skin warm, moist, intact. Skin color dark brown skin tone without cyanosis or pallor.
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
,f HEENT: Head norno-cephalic. Hair thin coarse hair with a bald circular spot on back of head. Eyes:
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
,f Sclera clear, conjunctive: white, PERRLA. EOMs intact with no AV nicking noted.
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
Nose: Nares patent without exudate. Sinuses non-tender to palpation. Nasal septum without deviation.
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
, Throat: Oropharynx most without lesion or exudate.Teeth in need of repair. Gums swollen and red.
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
Tongue midline, pink, smooth without lesion.
,f ,f ,f ,f ,f ,f
Lungs: Lungs clear bilaterally to auscultation without labored breathing. Chest symmetrical without
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
rashes or lesions noted.
,f ,f ,f ,f
CV: Heart S1 and S2 noted without murmurs, noted. No parasternal lifts, heaves, and thrills.
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
Peripheralpulses equally bilaterally. PMI 5thICS displaced 4cm laterally.Trace edema in lower
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
extremities.
,f
Abdomen:Abdomen round, soft without bowel sounds noted on all four quadrants. ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
Rationale in the identified body system: ,f ,f ,f ,f ,f
Based on the National Institute Diabetic and Digestive and diabetes and digestive and kidney
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
disease (NIDDK), men over 40-year-old with associated risk factor and family history of benign
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
prostatic hyperplasia are prevalence of developing urological conditions. Urology was selected as
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
the body system based on the patient chief compliant of dribbling, discomfort pain after voiding and
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
the presence of blood after intercourse, which are all signs and symptoms of the three-differential
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
diagnosis. The patient also has associated risk factors such as diabetes, hyperlipidemia,
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
hypertension, erectile dysfunction, age, obesity, lack of physical exercise and African American
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
descent (NIDDK, 2021a).
,f ,f ,f
DifferentialDiagnosis: ,f
For proper diagnosis and treatment, it is essential to be able to differentiate and identify the origins of
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
each condition using the patient’s physical exam, medical history, and chief complaint. The following
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
are the three differential diagnoses.
,f ,f ,f ,f ,f
1. Benign Prostatic Hyperplasia (BPH) (N40.0) ,f ,f ,f ,f
2. Acute Prostatitis (N41.0) ,f ,f
3. Malignant neoplasm of prostate (C61) ,f ,f ,f ,f
The prostate is a walnut-shaped gland that produces prostate fluid to aid in the transfer of semen.
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
Prostate fluid is an essential component in a man’s fertility. The urethra is the mode that transfer
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
semen and urine out of the body through the penis (NIDDK, 2018). Benign prostatic hyperplasia,
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
acute prostatitis and malignant neoplasm are all abnormal conditions of the prostate that originate
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f , f
from different origins. Many of the sign and symptoms along with risk factors of these conditions
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
may overlap making it difficult to diagnose. Understanding the pathophysiology and knowing the
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
risk factors, demographics, occurrences, and clinical presentation of each condition can assist in
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
narrowing the diagnose for proper treatment.
,f ,f ,f ,f ,f ,f
Pathophysiology:
Benign prostatic hyperplasia (BPH) is characterized by increase proliferation of epithelial cell and
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
smooth muscle with the prostatic resulting in hyperplasia and an enlargement of prostate
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
(Lokeshwar, S. D., el. at, 2019). As the prostate gland enlarges it presses against the urethra
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
decreasing urine and prostate fluid flow. The pressure thickens and weakens the bladder wall
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
decreasing ability to completely empty out the bladder resulting in urine residue (NIDDK,
,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f ,f
