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Since this patient has had a cough for 2 months it is considered a chronic cough. Considering his history of being a smoker and unknown family history, the differential of lung cancer must be ruled out, as Thomas et al. (2022) notes that a common symptom of lung cancer (D02.20) is cough, as well as hemoptysis and dyspnea and a risk factor is family history of lung cancer. Another differential for his cough can also be allergic rhinitis (J30.9) due to post-nasal drip irritating the back of the throat resulting in chronic cough (Cash et al., 2021). However, the leading diagnosis in this case would be COPD (J44.9) related to his smoking ½ packs of cigarettes a day. According to Han et al. (2022), smokers have an increased risk for chronic bronchitis or emphysema and frequent exacerbations. To treat this patient, an inhaled short-acting beta-agonists like Albuterol MDI (90mcg/actuation) as needed may be prescribed for Stage I COPD (Cash et al., 2021).
First off, taking a set of vital signs and completing a thorough health history and physical exam, which would include the HEENT, cardiovascular, and respiratory systems for his cough. A chest x-ray may be ordered to rule out other differential diagnoses or assess for hyperinflation of the lungs or a chest CT can be done to assess for emphysema (Cash et al., 2021). Spirometry is the gold standard tool to assess airflow and is best when done before and after administration of a bronchodilator (Han et al., 2022). If the patient is having shortness of breath, an EKG may be done in office to rule out heart related causes (Cash et al., 2021). Smoking cessation and avoiding environmental triggers would be encouraged. Because the patient is coughing and is over the age of 65, it is recommended by the CDC to offer this patient the pneumococcal vaccines (CDC, 2022).
As for the patient’s other chief complaint of frequent urination, a differential diagnosis may be Type 2 Diabetes Mellitus (E11.9). Symptoms of T2DM include polyuria, polydipsia, and polyphagia (Ai-Yu & Hung-Chun, 2022). Another possible differential is prostatitis (N41.0). A patient with prostatitis could have urinary frequency, fever, and lower back pack (Cash et al., 2021). However, my leading diagnosis for this patient’s urinary frequency would be benign prostatic hyperplasia (N40.1); furthermore, other signs and symptoms of BPH are urinary urgency, nocturia, and sometimes hematuria (Cash et al., 2021). BPH is common in the aging male and the risk for developing BPH increases by 60% after the age of 60 (McVary, 2021). Treatment for BPH includes the alpha-adrenergic receptor blocker, Tamsulosin 0.4mg PO daily (McVary, 2021).
In this aspect, the physical exam would then include the genitourinary system, along with a rectal exam to assess the prostate. A urinalysis and urine culture if necessary, to assess for infection and hematuria (Cash et al., 2021). Since the patient has an unknown family history and is over the age of 50, a prostate-specific antigen level (PSA) must be obtained (Cash et al., 2021). The American Urological Association provides a questionnaire that is utilized to determine the severity of symptoms, how bothersome they are, and the patient’s response to treatment (McVary, 2021).
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