A 71-year-old man returns for follow-up of benign prostatic…
A 71-year-old man returns for follow-up of benign prostatic hyperplasia (BPH). He has been taking tamsulosin 0.4 mg daily for the past six months with only mild improvement in urinary hesitancy, weak stream, and nocturia. Digital rectal examination reveals a symmetrically enlarged prostate, and ultrasound estimates the prostate volume at 55 mL. There is no evidence of urinary tract infection or prostate cancer. What is the most appropriate next step in management?
Read DetailsA 55-year-old woman presents with severe right upper quadran…
A 55-year-old woman presents with severe right upper quadrant pain that began four hours after eating a cheeseburger. She reports nausea but no vomiting. Temperature is 100.2°F (37.9°C). On examination she has focal right upper quadrant tenderness. Which additional physical examination finding would most strongly increase your suspicion for acute cholecystitis?
Read DetailsA 34-year-old woman presents with a 2-month history of inter…
A 34-year-old woman presents with a 2-month history of intermittent burning epigastric pain. The discomfort frequently awakens her during the night but typically improves after she eats a small snack. She denies weight loss, dysphagia, hematemesis, melena, or regular nonsteroidal anti-inflammatory drug use. Her vital signs and abdominal examination are unremarkable. Based on her presentation, which diagnosis should be highest on the family nurse practitioner’s differential diagnosis?
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