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Benign Prostatic Hyperplasia
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BPH Benign increase in
size of prostate Hyperplasia of
stromal and epithelial cells
Nodules
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Patient W.M. 76 yo Recurrent UTIs Acute pyelonephritis Urinary frequency, urgency,
incontinence, and nocturia
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Past Medical History Hypothyroidism COPD Obesity 1 ppd smoker Father – alcoholic Mother – DM type 2
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Review of Symptoms Strain to initiate urination Urinary flow stops and then starts Post-void dribbling
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Medications Ipratropium bromide Ibuprofen Levothyroxine Ferrous sulfate
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Case Question 1:For what condition is the patient probably taking ipratroprium bromide?
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Ipratropium bromide is used to relieve bronchial spasms
Anticholinergic
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Answer:
COPD
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Case Question 2:For what condition is the patient probably taking levothyroxine?
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Synthetic thyroid hormone
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Answer:
Hypothyroidsim
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IPSS International Prostate Symptom Score 8 question survey Standardize patients
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Case Question 3:Based on the patient’s IPSS, is his condition of prostatic enlargement considered mild, moderate or severe?
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Case Question 4:Based on the patient’s BMI, is the patient technically overweight or obese?
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BMI Measure of body fat
Underweight < 18.5 Normal weight = 18.5-24.9 Overweight = 25-29.9 Obesity > 30
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Vital Signs
Patient’s BMI = 33.8%
BP 135/85 (R arm) 130/85 (L arm)
RR 16, unlabored HT 6’0”
P 80 and regular T 98.6 F WT 249 lbs
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Physical Exam All normal Urinary Function Tests
Uroflowmetry Transabdominal ultrasound Pressure flow study
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Case Question 5:Which urinary function test(s) is/are consistent with an enlarged prostate?
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Uroflowmetry Normal: 10 – 21 mL/sec Patient: 7 mL/sec
Residual Urine Volume > 50 mL significant Patient: 110 mL
Bladder Voiding Pressure Weak < 100 cm H2O
Patient: 74 cm H2O
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Case Question 6:Identify all abnormal results of this patient’s urinalysis
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Color Straw
Bilirubin (-)
WBC 2/HPF
Appearance Clear Ketones (-)
RBC 2/HPF
SG 1.017
Blood (-)
Bacteria Trace
pH 6.4
Urobilinogen (-)
Crystals (-)
Glucose (-)
Nitrites (-)
Culture Not indicated
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Blood Test ResultsNa 141 meq/L
MCHC 31.8 g/dL
LDH 219 IU/L
K 3.9 meq/L
Plt 282000/mm3
Bilirubin 1.2mg/dL
Cl 109 meq/L
WBC 8700/mm3
Protein 5.9mg/dL
HCO3 32 meq/L • Neutros 65%
Cholesterol 255mg/dL
BUN 15 mg/dL
• Lymphs 27%
Ca 8.7mg/dL
Cr .8 mg/dL
• Monos 5%
Mg 2.2mg/dL
Glu 119 mg/dL
• Eos 2%
PO4 2.8mg/dL
Hb 13.9 g/dL
• Basos 1%
Uric acid 6.3mg/dL
Hct 41%
AST 31 IU/L
T4 3.5µg/dL
MCV 97 fL
ALT 41 IU/L
TSH 107.9µU/mL
MCH 28.7 pg
Alk phos 52 IU/L
PSA* 5.2ng/mL
*PSA 13 months ago was 5.0 ng/mL
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Case Question 7:Is the patient experiencing an electrolyte imbalance?
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Na 141 meq/L
MCHC 31.8 g/dL
LDH 219 IU/L
K 3.9 meq/L
Plt 282000/mm3
Bilirubin 1.2mg/dL
Cl 109 meq/L
WBC 8700/mm3
Protein 5.9mg/dL
HCO3 32 meq/L • Neutros 65%
Cholesterol 255mg/dL
BUN 15 mg/dL
• Lymphs 27%
Ca 8.7mg/dL
Cr .8 mg/dL
• Monos 5%
Mg 2.2mg/dL
Glu 119 mg/dL
• Eos 2%
PO4 2.8mg/dL
Hb 13.9 g/dL
• Basos 1%
Uric acid 6.3mg/dL
Hct 41%
AST 31 IU/L
T4 3.5µg/dL
MCV 97 fL
ALT 41 IU/L
TSH 107.9µU/mL
MCH 28.7 pg
Alk phos 52 IU/L
PSA* 5.2ng/mL
*PSA 13 months ago was 5.0 ng/mL
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8. Renal Function?Na 141 meq/L
MCHC 31.8 g/dL
LDH 219 IU/L
K 3.9 meq/L
Plt 282000/mm3
Bilirubin 1.2mg/dL
Cl 109 meq/L
WBC 8700/mm3
Protein 5.9mg/dL
HCO3 32 meq/L • Neutros 65%
Cholesterol 255mg/dL
BUN 15 mg/dL
• Lymphs 27%
Ca 8.7mg/dL
Cr .8 mg/dL
• Monos 5%
Mg 2.2mg/dL
Glu 119 mg/dL
• Eos 2%
PO4 2.8mg/dL
Hb 13.9 g/dL
• Basos 1%
Uric acid 6.3mg/dL
Hct 41%
AST 31 IU/L
T4 3.5µg/dL
MCV 97 fL
ALT 41 IU/L
TSH 107.9µU/mL
MCH 28.7 pg
Alk phos 52 IU/L
PSA* 5.2ng/mL
*PSA 13 months ago was 5.0 ng/mL
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9. Hepatic Function?Na 141 meq/L
MCHC 31.8 g/dL
LDH 219 IU/L
K 3.9 meq/L
Plt 282000/mm3
Bilirubin 1.2mg/dL
Cl 109 meq/L
WBC 8700/mm3
Protein 5.9mg/dL
HCO3 32 meq/L • Neutros 65%
Cholesterol 255mg/dL
BUN 15 mg/dL
• Lymphs 27%
Ca 8.7mg/dL
Cr .8 mg/dL
• Monos 5%
Mg 2.2mg/dL
Glu 119 mg/dL
• Eos 2%
PO4 2.8mg/dL
Hb 13.9 g/dL
• Basos 1%
Uric acid 6.3mg/dL
Hct 41%
AST 31 IU/L
T4 3.5µg/dL
MCV 97 fL
ALT 41 IU/L
TSH 107.9µU/mL
MCH 28.7 pg
Alk phos 52 IU/L
PSA* 5.2ng/mL
*PSA 13 months ago was 5.0 ng/mL
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10. Hb, Hct, MCV, MCH, MCHC?Na 141 meq/L
MCHC 31.8 g/dL
LDH 219 IU/L
K 3.9 meq/L
Plt 282000/mm3
Bilirubin 1.2mg/dL
Cl 109 meq/L
WBC 8700/mm3
Protein 5.9mg/dL
HCO3 32 meq/L • Neutros 65%
Cholesterol 255mg/dL
BUN 15 mg/dL
• Lymphs 27%
Ca 8.7mg/dL
Cr .8 mg/dL
• Monos 5%
Mg 2.2mg/dL
Glu 119 mg/dL
• Eos 2%
PO4 2.8mg/dL
Hb 13.9 g/dL
• Basos 1%
Uric acid 6.3mg/dL
Hct 41%
AST 31 IU/L
T4 3.5µg/dL
MCV 97 fL
ALT 41 IU/L
TSH 107.9µU/mL
MCH 28.7 pg
Alk phos 52 IU/L
PSA* 5.2ng/mL
*PSA 13 months ago was 5.0 ng/mL
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11. T4 and TSH?Na 141 meq/L
MCHC 31.8 g/dL
LDH 219 IU/L
K 3.9 meq/L
Plt 282000/mm3
Bilirubin 1.2mg/dL
Cl 109 meq/L
WBC 8700/mm3
Protein 5.9mg/dL
HCO3 32 meq/L • Neutros 65%
Cholesterol 255mg/dL
BUN 15 mg/dL
• Lymphs 27%
Ca 8.7mg/dL
Cr .8 mg/dL
• Monos 5%
Mg 2.2mg/dL
Glu 119 mg/dL
• Eos 2%
PO4 2.8mg/dL
Hb 13.9 g/dL
• Basos 1%
Uric acid 6.3mg/dL
Hct 41%
AST 31 IU/L
T4 3.5µg/dL
MCV 97 fL
ALT 41 IU/L
TSH 107.9µU/mL
MCH 28.7 pg
Alk phos 52 IU/L
PSA* 5.2ng/mL
*PSA 13 months ago was 5.0 ng/mL
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12. Single most significant result?Na 141 meq/L
MCHC 31.8 g/dL
LDH 219 IU/L
K 3.9 meq/L
Plt 282000/mm3
Bilirubin 1.2mg/dL
Cl 109 meq/L
WBC 8700/mm3
Protein 5.9mg/dL
HCO3 32 meq/L • Neutros 65%
Cholesterol 255mg/dL
BUN 15 mg/dL
• Lymphs 27%
Ca 8.7mg/dL
Cr .8 mg/dL
• Monos 5%
Mg 2.2mg/dL
Glu 119 mg/dL
• Eos 2%
PO4 2.8mg/dL
Hb 13.9 g/dL
• Basos 1%
Uric acid 6.3mg/dL
Hct 41%
AST 31 IU/L
T4 3.5µg/dL
MCV 97 fL
ALT 41 IU/L
TSH 107.9µU/mL
MCH 28.7 pg
Alk phos 52 IU/L
PSA* 5.2ng/mL
*PSA 13 months ago was 5.0 ng/mL
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Case Question 13:Provide three strong lines of evidence that this patient does not have prostate cancer
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1. Low PSA
1. Physical exam findings
1. Low WBC count
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Case Question 14:Pharmacotherapy or surgery?
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Case Question 15:When a patient with mild-to-moderate BPH does not respond to pharmacotherapy with 5α-reductase inhibitors or α1-blockers, what can be inferred?
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the end