AccessMedicine's Case of the Week: Emergency Medicine Case

From: Graber and Wilbur’s Family Medicine Examination and Board Review, 5th Edition

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Case

A 63-year-old male presents to the ED with a 2-day history of fever, urinary frequency, dysuria, and difficulty initiating the urinary stream. He also relates having some perineal pain. On examination, his vitals are stable except for a temperature of 38.5°C. His rectal examination is remarkable for a tender, warm, edematous prostate. There are no perirectal masses and the stool is heme negative. He has no penile lesions, discharge, scrotal masses, or tenderness. He does not exhibit any costovertebral angle tenderness. His UA is positive for 10 WBCs/HPF, 1+ nitrite, 1+ leukocyte esterase.

Question 1 of 3

What is the most likely diagnosis in this patient?

 A - Pyelonephritis

 B - Perirectal abscess

 C - Epididymitis

 D - Acute prostatitis

 E - Cystitis


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Julie Grishaw, ACNP

Senior Editor, McGraw-Hill Education

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