3-3 PATIENT NOTE: BLOODY URINE HISTORY: Describe the history you just obtained from this patient.

Include only information (pertinent positives and negatives) relevant to this patients problem(s). HPI: 42 YO MALE C/O BLOODY URINE STARTED YESTERDAY, APPROXIMATELY A TEASPOON OF BRIGHT RED BLOOD WITH SOME CLOTS, NO UNUSUAL ODOR, NO OTHER DISCHARGE. URINAY SYMPTOMS BEGAN A TWO MONTHS AGO WITH BURNING WITH URINATION, INCREASED FREQUENCY, STRAINING, DRIBBLING, DECREASED STREAM AND NOCTURIA. PATIENT DENIES BOWEL CHANGES, DIARRHEA, CONSTIPATION, RECENT INFECTIONS, OR PREVIOUS EPISODES. ROS: NEGATIVE EXCEPT AS NOTED ABOVE ALLERGIES: PENICILLIN LEADS TO RASH MEDICATIONS: NONE PMH: GOUT IN RIGHT HALLUX FIVE YEARS AGO, RELIEVED BY MEDICATION PSH: APPENDECTOMY AT AGE 15 FH: FATHER DECEASED AT AGE 74 DUE TO RENAL FAILURE, MOTHER ALIVE AND WELL SH: DENIES TOBACCO, ETOH, OR DRUG USE, WORKS AS POLICE OFFICE, LIVES WITH WIFE OF 20 YEARS. PHYSICAL EXAM: Describe any positive and negative findings relevant to this patients problem(s). Be careful to include only those parts of examination you performed in this encounter. HE IS IN NO ACUTE DISTRESS. HIS VITALS ARE WITHIN NORMAL LIMITS. HIS BREATH SOUNDS ARE CLEAR BILATERALLY. HIS HEART SOUNDS ARE NORMAL WITHOUT RUBS, GALLOPS, MURMURS. HIS ABDOMEN IS NONTENDER AND NONDISTEDED. BOWEL SOUNDS WERE PRESENT AND THERE WAS NO CVA TENDERNESS. THERE WAS NO CYANOSIS, CLUBBING OR EDEMA OF EXTREMITIES NOTED. DATA INTERPRETATION: Based on what you have learned from the history and physical examination, list up to 3 diagnoses that might explain this patients complaint(s). List your diagnoses from most to least likely. For some cases. Fewer than 3 diagnoses will be appropriate. Then, enter the positive or negative findings from the history and physical examination (if present) that support each diagnosis. Lastly, list initial diagnostic studies (if any) you would order for each listed diagnosis (e.g. restricted physical exam maneuvers, laboratory tests, imaging, ECG, etc. Diagnosis #1: UTI HISTORY FINDING(S) PHYSICAL EXAM FINDING(S) - BRIGHT RED COLOR URINE - NONTENDER ABDOMEN - BURNING URINATION - NO CVA TENDENESS - INCREASED FREQUENCY Diagnosis #2: Bladder Cancer HISTORY FINDING(S)

PHYSICAL EXAM FINDING(S)

- BURNING URINE -BRIGHT RED COLOR BLOOD - INCREASED FREQUENCY, HESITENCY, STRAINING

- NONTENDER ABDOMEN - NO CVA TENDERNESS

Diagnosis #3: BPH HISTORY FINDING(S) PHYSICAL EXAM FINDING(S) - HESITENCY WHILE URINATION - NONTENDER ABDOMEN - STRAINING, INCREASED FREQUENCY - NO CVA TENDERNESS - BURNING URINATION Diagnostic studies -RECTAL EXAM -GENITAL EXAM -UA -URINE CULTURE -URINE CYTOLOGY -CYSTOSCOPY -CT ABDOMEN AND PELVIS