Reference no: EM133990022

Question

A 50 y.o. male presents with c/o urinary frequency. He claims, "All I seem to do is go to the bathroom-I'm going to put a desk and TV in there." He says it has been going on for months and cannot recall exactly how long, but he voids every 1 to 2 hours during the day and then must get up to void through the night. He does not have any other urinary symptoms and has not noticed any change in the appearance or color of his urine, including no visible blood. Patient has a history of type 2 diabetes for the past 10 years, which he admits has been poorly controlled. He occasionally checks his blood glucose at home, and it is usually "closer to 200 than 100." He takes metformin 1000 mg BID and liraglutide daily. He pretty much eats what he chooses. "I know better, but I live alone and have bad habits." His review of systems is positive for tingling and discomfort in his feet. He tires easily but says he really does limited activity. He denies blurred vision, rashes, dizziness, chest pain, palpitations, shortness of breath or cough, abdominal pain, diarrhea, constipation, or joint pain.

Family History

Father, diabetes, heart disease, kidney disease
Mother, heart disease
Brother, heart disease
Psychosocial History

An accountant who works in an office setting where he is sedentary. Smokes approximately one-half-pack per day and drinks four to five beers weekly. Diet consists largely of fast food. Has tried decreasing his intake of fluids, but that does not seem to make a difference in his voiding.

Physical Examination

Vital signs: T 98.8, BP 154/94, HR 76, A1C 9.0, HT 70, WT 210 lbs.

Laboratory results: Urine negative for WBC, RBC, +1 glucose, -ketones.

General: Overweight, well-groomed, alert and oriented, in no apparent distress.

Eyes: PERRL, EOMs intact, alignment symmetrical, conjunctiva pink and moist. Funduscopic exam some narrowing and hard exudates. Disc normal and no neovascular changes noted. Remainder of HEENT normal. Neck full ROM, no bruits.

CV: RR&R, S1/S2, no murmur or extra sounds.

Respiratory: Lungs slight decreased breath sounds but no crackles, wheezes.

Abdomen/GU: Protuberant and soft. Normal bowel sounds, no suprapubic or other abdominal tenderness, no masses, no bruits. Rectal exam negative for occult blood, prostate symmetrical and smooth, slightly enlarged.

MS: Full ROM, strength equal and normal.

Skin: No lesions.

Questions

1. What three conditions would be considered in your differential diagnosis, with most likely condition listed first (with rationale)?

2. What further history, further examination, and diagnostic studies are warranted to explore your differential diagnosis?

3. What is the final diagnosis?