Case 44 – History


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Case 44

Longstanding urinary incontinence and frequency


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Brief Medical History

The patient was an elderly Caucasian man, living independently, with diabetes and symptoms of urinary incontinence alternating with urinary frequency for approximately one year.

He was found to have an elevated PSA level 9 months prior to death.

Follow-up PSA level (6 months prior to death) showed the PSA had decreased somewhat.

The clinical plan at that time was to consider biopsy should the PSA level rise again.


Two days prior to death

During a routine clinic visit 2-days prior to death, the patient was found to have elevated blood pressure and elevated creatinine.

He was taken off metformin and prescribed an antihypertensive medication.


One day prior to death

The next day (one day prior to death), the patient noted a severe headache and was unable to speak with his grandchildren by phone.
The family is unsure whether he could not speak due to his headache or due to some other impairment.


Day of Death

On the day of death in the morning, he apparently passed out.

He recalls waking from this event and finding that he had urinated on himself; but does not recall losing consciousness.

Later that day, he passed out again and, upon awakening, found blood in his underwear.

At this point, he called his family and was advised to call for an ambulance (911).

Paramedics arrived and brought him to the emergency room where he was admitted.

He was found to be in renal failure with leg swelling, anemia, elevated creatinine, and an elevated BNP.

His blood pressure was noted to be normal (no longer elevated), and the patient was considered stable and not in any “crisis.”

He was sent off for an unspecified ultrasound.

The patient died later that day.

The patient’s mother lived till age 93.

The patient’s father died at approximately age 70 with a long history of unspecified heart disease including multiple “heart attacks.”

The history is obtained from the family.


Next: Part 1

Discussion Questions

This case is for independent assessment. There are no discussion questions.