1. Step 6
1.1. Review session 1
1.2. Report new knowledge
1.2.1. Review anatomy of urinary tract
1.2.2. Benign prostatic hyperplasia
1.2.2.1. presentation
1.2.2.2. pathophysiology
1.2.2.3. diagnosis
1.2.2.4. complication
1.2.3. Prostate cancer
1.2.3.1. screening
1.3. 30 minutes
1.3.1. The scribe does not have to write in this step!
2. Step 8
2.1. Diagnostic decision
2.1.1. BPH
2.2. Mechanism
2.2.1. multifactorial
2.3. Presentation
2.3.1. LUTS
2.4. Supporting data
2.4.1. rectal digital exam
2.4.2. history and physical examination
2.5. 10 minutes
3. Step 7
3.1. Inquiry plan and info gathering
3.1.1. History of presenting complaint
3.1.1.1. progression over 6-12 months
3.1.1.1.1. urgency
3.1.1.1.2. weak stream
3.1.1.1.3. hesitancy
3.1.1.2. concerned about cancer
3.1.2. Previous medical / surgical history
3.1.2.1. inguinal hernia repaired
3.1.2.1.1. 3 years ago
3.1.2.2. STD at 28
3.1.2.2.1. antibiotics
3.1.3. Drug history / allergy
3.1.3.1. none
3.1.4. Family history
3.1.4.1. grandfather had prostate issue
3.1.5. Social / occupational history
3.1.5.1. not smoker or alcoholic
3.1.5.2. 4 cups of coffee
3.1.5.3. exerciser each week
3.1.5.4. married with 2 children
3.1.5.4.1. no issues
3.1.5.5. great sexual life
3.1.5.6. hard worker
3.1.6. Systemic review
3.1.7. Physical examination
3.1.7.1. vitals
3.1.7.1.1. 72 BPM
3.1.7.1.2. RR 12
3.1.7.1.3. BP 140/90 lying and standing
3.1.7.1.4. temp 37
3.1.7.2. digital rectal exam
3.1.7.2.1. firm and slightly asymmetric
3.1.7.2.2. mild enlarged
3.1.7.2.3. median groove difficult to palpate
3.1.7.3. Neurological exam normal
3.1.7.4. Abdominal exam normal
3.1.8. tests results
3.1.8.1. Urinalysis norma
3.1.8.2. CBC normal
3.1.8.3. PSA 7.5
3.1.8.3.1. elevated
3.1.8.4. ultrasaound normal
3.1.8.5. MSU normal