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Review Question - QID 102735

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QID 102735 (Type "102735" in App Search)
A 51-year-old man presents to the emergency department with an episode of syncope. He was at a local farmer's market when he fainted while picking produce. He rapidly returned to his baseline mental status and did not hit his head. The patient has a past medical history of diabetes and hypertension but is not currently taking any medications. His temperature is 97.5°F (36.4°C), blood pressure is 173/101 mmHg, pulse is 82/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for clear breath sounds and a S4 heart sound. Rectal exam reveals a firm and nodular prostate that is non-tender and a fecal-occult sample that is negative for blood. Which of the following is this patient's presentation most concerning for?

Benign prostatic hyperplasia

9%

1/11

Normal physical exam

0%

0/11

Prostate abscess

0%

0/11

Prostate cancer

64%

7/11

Prostatitis

18%

2/11

Select Answer to see Preferred Response

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This patient is presenting with an incidentally discovered firm and nodular prostate which is concerning for prostate cancer.

Prostate cancer screening with a digital rectal exam and a PSA is no longer routinely performed; however, it is performed occasionally in elderly patients per patient request. If a rock-hard, nodular prostate is discovered incidentally on physical exam, it is possible that the patient may have prostate cancer and should undergo further workup for their malignancy including a biopsy followed by either surgery or external radiation. If there is metastatic disease, then androgen blockade is often indicated with treatment including flutamide followed by leuprolide/goserelin.

Incorrect Answers:
Answer 1: Benign prostatic hyperplasia would present with a firm/smooth, enlarged prostate and may present with urinary retention. Treatment includes tamsulosin and finasteride.

Answer 2: Normal physical exam would present with a normal-sized, smooth prostate that is nontender.

Answer 3: Prostate abscess would present with a fever, pyuria, and a fluctuant/tender mass in the prostate. Drainage and IV antibiotics are indicated in this condition.

Answer 5: Prostatitis would present with a fever, pyuria, and a soft/boggy/tender prostate. IV antibiotics are indicated in this condition.

Bullet Summary:
Prostate cancer presents with a firm, nodular prostate.

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