HISTORY AND PHYSICAL EXAMINATION Patient is an 81-year-old male.

The patient has a history of blood in the urine and has had trouble urinating and infections in the urinary tract. The patient has nocturia twice per night with a slow urinary stream, back pains and back pains. An IVP done March 1, 1988, showed a distended urinary bladder with a large postvoid residual. Upper tracts were unremarkable except for some cortical scarring and small cortical renal cysts. Cystoscopy was performed, which revealed a deep diverticulum of the bladder with inflammatory or neoplastic lesion within the diverticulum. This area was biopsied, and biopsy showed ulceration and chronic inflammation of the bladder but no malignancy. The patient may have a stone beneath this area, but we cannot tell that well under the local anesthesia. The patient had obstructive BPH with a large residual urine. A TURP is recommended. Patient may need an open resection of the bladder diverticulum if any tumor is found at the time of TUR. The plan is to do a transurethral resection of the prostate and further biopsies and TUR of this lesion of the diverticulum, but not to resect anything deeply in the diverticulum for fear of rupturing the stick. The patient is aware of this and the risks, complications, and alternatives, and the possibility of requiring open surgery or drainage. The patient is agreeable with this and is admitted to the hospital for the above-mentioned procedure. (0.50, FORMAT ERROR) An IVP done March 1st 88, showed a distended urinary bladder with a large post void residual. Upper tracts were unremarkable, except for some cortical scarring and a small cortical renal cyst. Cystoscopy was performed which revealed a deep diverticulum in the bladder with inflammatory or neoplastic lesion within in the diverticulum. This area was biopsied and biopsy showed ulceration and chronic inflammation of the bladder, but no malignancy. The patient may have a stone beneath this area, but we cannot tell about well under the local anesthesia. The patient had obstructive BPH with a large residual urine, a TURP is recommended. Patient may need to open resection of the bladder diverticulum if any tumor is found at the time of the TUR. The plan is to do a trans-retro resection of the prostate and further biopsies and TUR of this lesion of the diverticulum but not to resect anything deeply in the diverticulum for ______ rupturing the tic. The patient is aware of these and the risks, complications, and alternatives and the possibility of requiring open surgery or drainage. The patient is agreeable with these and is admitted to the hospital for the above mentioned procedure. PAST MEDICAL HISTORY: He has had a Past medical history is that of (3.00, CREATIVE TRANSCRIPTION) mild heart attack, hip replacement, hernia ______ a heart attackherniorrhaphy.(3.00, INCORRECT MEDICAL WORD) ALLERGIES: None. MEDICATION: Bactrim, Pyridium, cephalexin, ______,Theo-Dur,(0.50, BLANK) arthritis medsmedications (0.50, FORMAT ERROR), and aspirin.

REVIEW OF SYSTEMS: Weight loss, ear problems, constipation, back pains, joint pains. SOCIAL HISTORY: Married, retired, 5. Retired. Five children, does. Does not smoke; quit about 12 years ago, drinks alcohol and a couple of wine for dinner.. Drinks alcohol, 1 cup of wine at dinner. (0.50, GRAMMAR ERROR) FAMILY HISTORY: CancerFamily history of cancer and arthritis. PHYSICAL EXAMINATION: Physical exam reveals a well-nourished male within (0.50, GRAMMAR ERROR) no acute distress. HEENT: Pupils equal, round, and reactive. react .(0.50, GRAMMAR ERROR) Ears, nose, and throat clear. NECK: Neck is supple, noSupple. No JV distention or bruit. LUNGS: Lungs clearClear to P&A. HEART: Heart regular inRegular rhythm, no murmur. ABDOMEN: Soft, nontender, well. Well-healed inguinal hernial orificeherniorrhaphy (3.00, INCORRECT MEDICAL WORD)scar, and hip scar. EXTREMITIES: Extremities withoutWithout cyanosis, clubbing, or edema. NEUROLOGICAL: Oriented x 3 with no gross deficit. IMPRESSION: Benign prostatic hypertrophy, possible. Possible bladder tumor or stone within bladder diverticulum. RECOMMENDATION: TUR of prostate and further biopsies of a (0.25, ARTICLE(0.50, ARTICLE OMISSION)bladder lesion, possible open diverticulectomy, and tumor resection.

NP: 12.50 LC: 40.29 QA: 68.97%