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Pаtient Histоry аnd Physicаl Exam: HPI: This is a 60-year-оld male patient whо presents with a complaint of “low back pain and a problem with urination” that began 2-3 days ago. He reports his symptoms started as increased urinary frequency and “the urge to pee” more often than usual. The symptoms progressed to sensation of incomplete voiding, weak urine stream, burning with urination, and pain at the tip of his penis over the last 36 hours. Since the onset, he states the pain is worse. The pain has now also spread to the generalized low back area and perineal area for the last 24 hours. Pt woke up this morning feeling “feverish” with chills but could not measure his temperature at home. Pt reports associated generalized body aches that began today and nausea without vomiting. Additionally, he reports generalized malaise and fatigue. He denies abdominal pain, hematuria, flank pain, night sweats, testicular pain or swelling, urethral discharge, and reports no unexpected weight loss or gain. Pt denies any preceding trauma or injury. He denies being sexually active since onset of these symptoms and denies history of exact similar symptoms in the past. No history of chronic back pain. No history of frequent UTIs or known STI/STD in the past. Medications: HCTZ 25mg, one tablet taken PO daily Aspirin 81mg, one tablet taken PO daily Atorvastatin 40mg, one tablet taken PO at bedtime Tamsulosin 0.4mg, one tablet taken PO daily Daily multivitamin (generic, OTC) – one tablet taken PO daily at breakfast Allergies: Ciprofloxacin (anaphylaxis by hx, as patient reports hx of throat swelling, rash, and itching once when taking this medication which required an ER visit) Past Medical History: Chronic conditions: Primary Hypertension (diagnosed 15 years ago) Hyperlipidemia (diagnosed 20 years ago) BPH (diagnosed 7 years ago) Surgeries: Appendectomy (at age 35) B/L tonsil- and adenoidectomy (age 19) Health Maintenance/Immunizations: Up-to-date on most recommended, age-appropriate vaccines including COVID, influenza, Tdap. He has not had a shingles or a pneumonia vaccine. Pt last colonoscopy was 11 years ago at age 49 (no concerning findings reported). Family History: Father: alive, 87 years old. Known hx of hypertension, hyperlipidemia Mother: alive, 85 years old. Known hx of obesity, thyroid cancer (s/p thyroidectomy), HTN, hyperlipidemia Brother 1: alive, age 62, history of Type 1 DM Sister 2: alive, age 64, history of breast cancer s/p chemo and radiation Children: three, all alive and well Child 1 (female): Age 32, healthy Child 2 (male): Age 35, hx of kidney stones, HTN Child 3 (female): Age 36, hx of uterine fibroids, Type 1 autoimmune diabetes mellitus Social History: Tobacco/Vape: Remote hx of tobacco use (age 18-25, quit since age 25) Alcohol: An occasional glass of whiskey at family events Illicit drugs: Denies drug use since age 21-25 (when he was using marijuana) Marital/Sexual: Pt is divorced, recently started dating a 57 y/o female 3 months ago and is sexually active with that person. No reported contraceptive or birth control methods as he reports his partner is post-menopausal. Living situation: Lives in a condo in El Centro Job: Retired information technology (IT) software developer Hobbies: Building model airplanes, riding his bicycle every weekend, walks on the beach Diet: Pescatarian Religion: Catholic Sleep: Averages 7 hours of sleep per night ROS: Constitutional: See HPI. Skin: Denies hair changes, nail changes, rash, lesions, bruising, or skin discoloration. HEENT: Denies rhinitis, sore throat, congestion, ear pain or discharge, eye pain or change in vision, or headache. Denies hearing loss, tinnitus, or nasal discharge. No lymph node or gland swelling reported. CV/PV: No chest pain, palpitations, swelling, cyanosis, or edema of extremities. No syncope reported. Pulmonary: No cough, SOB, dyspnea, orthopnea, or PND. GI: See HPI. Denies constipation, diarrhea, fecal incontinence, abdominal distention, or heartburn. No blood in stool reported or dark/tarry stools. GU: See HPI. Denies urinary incontinence. MSK: See HPI. Denies joint swelling, or joint discoloration. No changes in gait. Neuro: Denies dizziness or lightheadedness, dysarthria, slurred speech, or weakness. Denies seizures, tremors, or confusion. No perineal area loss of sensation. Psych: Denies depression, mania, suicidal ideation, homicidal ideation or hallucinations. Endocrine: Denies heat or cold intolerance, polydipsia, or polyphagia. Heme/Lymph: Denies easy bruising or gum bleeding. Physical Exam Findings: VITAL SIGNS: Temperature: 38.3°C (100.9°F) Pulse rate: 89 bpm Respiration Rate: 19/min Blood pressure: 128/82 mmHg. Oxygen saturation: 99% on room air Weight: 79.5 kg (175 lb) Height: 182 cm (72 in) GEN: Well-developed, well-nourished male. Febrile. Appears in no general distress. Alert and oriented x 4, answering questions appropriately. HEENT Atraumatic, normocephalic. Ear canals clear bilaterally, TMs pearly gray with no bulging or defect noted. Nares patent, septum intact. Lips and gingiva normal in appearance, posterior pharynx without erythema or exudates. PERRLA, EOMI B/L. NECK: Neck is supple, no masses, trachea midline, no thyroid nodules, masses. No LAD, lymph node tenderness or enlargement. SKIN: No bruising, cyanosis, or pigment changes appreciated, without obvious lesions or rashes. Normal hair pattern. HEART: Regular rate, regular rhythm with normal S1, S2, without rubs, murmurs or gallops auscultated. No peripheral edema noted. No JVD. LUNGS: Clear to auscultation B/L. No adventitious breath sounds. No noted increased respiratory effort. No wheezing or stridor. PERIPHERAL VASCULAR: Capillary refill brisk throughout extremities, < 2s. No peripheral edema. Pulses 2+ and intact at DP, PT, brachial and radial B/L. No digital clubbing noted. ABD: Normoactive bowel sounds heard throughout all quadrants. Soft, non-distended abdomen without tenderness to light or deep palpation. No rebound or guarding noted. No hepatosplenomegaly noted. No abdominal bruits or pulsatile masses. No CVA tenderness elicited B/L. GU/Rectal: Normal sphincter tone. No hemorrhoid, mass, or lesions noted externally. Perineal area TTP to palpation without rash or discoloration. Rectal exam reveals tender, firm, and enlarged prostate without nodularity or mass appreciated. Pt did not tolerate this aspect of the exam well. Hemoccult testing was not performed. NEURO: Pt alert and oriented x 4, following commands appropriately. Speech clear and without slurring. No facial asymmetry. Gait steady and without limp or need for assistance. Strength 5/5 in all extremities and major muscle groups, equally throughout B/L sides. No sensory deficit appreciated throughout extremities. PSYCH: Affect and mood normal. Judgment and insight intact; no confusion. No homicidal or suicidal ideation. No pressured or tangential speech. No evidence of hallucinations. Section Task 3: (A.) Based on the provided historical and physical exam information up to this point, please review and update your differential diagnosis list as you see fit. You may add/change diagnoses as necessarily to update this list. After your review, please list your updated top three (3) most likely diagnoses. Your number 1 (top) diagnosis should be the diagnosis you feel is most likely in this case. [PLO 2] (B.) Then, please select and list a total of three (3) diagnostic tests that will be useful in establishing your suspected diagnoses. These may include laboratory tests, imaging, and/or diagnostic procedures. [PLO 3] (C.) Explain your reasoning for each test. Include the medical condition for which you are testing and your expected test result for that condition.