ASSESSMENT 10 HISTORY: Describe the history you just obtained from this patient.

Include only information (pertinent positives and negatives) relevant to this patients problem(s). HPI: 52 YO M COMES IN FOR BLOOD PRESSURE CHECK UP. DIAGNOSED WITH HYPERTENSION 1 YEAR AGO, STARTED ON HTCZ. 6 MONTHS AGO PUT ON PROPRANOLOL. MOSTLY COMPLIANT WITH MEDICATIONS. IN THE LAST 6 MONTHS, PATIENT REPORTS DECREASED ERECTIONS, 4/10 SEVERITY. NO EARLY MORNING ERECTIONS, DECREASED LIBIDO, NO MARITAL PROBLEMS. FEELS FINE TODAY, DOES NOT MONITOR BLOOD PRESSURE AT HOME. LAST CHECK WAS 6 MONTHS AGO WITH NORMAL RESULTS. DENIES FATIGUE, HEADACHE, DIZZINESS, CHEST PAIN, OR SHOTNESS OF BREATH. NO CHANGES IN WEIGHT APPETITE, BOWEL OR BLADDER. ROS: NEGATIVE EXCEPT AS NOTED ABOVE ALLERGIES: NONE MEDICATIONS:HCTZ, PROPRANOLOL PMH: NONE PSH: NONE FH: FATHER DECEASED FROM HEART ATTACK AT AGE 47, MOTHER ALIVE WITH PARKINSONS DISEASE SH: DENIES TOBACCO, ETOH OR DRUGS, WORKS PART TIME AT HOME DEPOT, SEXUALLY ACTIVE WITH WIFE ONLY PHYSICAL EXAM: Describe any positive and negative findings relevant to this patients problem(s). Be careful to include only those parts of examination you performed in this encounter. THE PATIENT IS NO ACUTE DISTRESS AND VITALS ARE WITHIN NORMAL LIMITS EXCEPT BP 155/98. HIS HEENT APPEARS NORMOCEPHALIC AND ATRAUMATIC AND NO FUNDOSCOPIC ABNORMALITIES. HIS NECK IS SUPPLE WITH NO LYMPHADENOPATHY. HIS BREATH SOUNDS ARE CLEAR TO AUSCULTATION BILATERALLY. HIS HEART SOUNDS ARE NORMAL S1/S2. HIS ABDOMEN IS SOFT AND NONTENDER AND NONDISTENDED. HIS MOTOR STRENGTH IS 5/5 THROUGHOUT AND SENSATIONS INTACT TO DULL AND PIN PRICK. HIS REFLEXES ARE 2+ THROUGHOUT. DATA INTERPRETATION: Based on what you have learned from the history and physical examination, list up to 3 diagnoses that might explain this patients complaint(s). List your diagnoses from most to least likely. For some cases. Fewer than 3 diagnoses will be appropriate. Then, enter the positive or negative findings from the history and physical examination (if present) that support each diagnosis. Lastly, list initial diagnostic studies (if any) you would order for each listed diagnosis (e.g. restricted physical exam maneuvers, laboratory tests, imaging, ECG, etc.

Diagnosis #1: DRUG INDUCED ERECTILE DYSFUNCTION HISTORY FINDING(S) PHYSICAL EXAM FINDING(S) -HYPERTENSIVE FOR 1 YEAR -PATIENT IS IN NO ACUTE DISTRESS -ON MEDICATIONS -BP: 155/98 -C/O DECREASED ERECTIONS -NO FUNDOSCOPIC ABNORMALITIES Diagnosis #2: HYPOGONADISM HISTORY FINDING(S) -C/O DECREASED ERECTIONS -C/O NO MORNING ERECTIONS -ON MEDICATIONS FOR HTN Diagnosis #3: DEPRESSION HISTORY FINDING(S) -ON MEDICATIONS -C/O DECREASED ERECTIONS -C/O NO MORNING ERECTIONS Diagnostic Studies: -GENITAL EXAM -RECTAL EXAM -TESTOSTERONE -LH/FSH -DOPPLER U/S PENIS

PHYSICAL EXAM FINDING(S) -PATIENT IS IN NO ACUTE DISTRESS -BP: 155/98 -NO FUNDOSCOPIC ABNORMALITIES

PHYSICAL EXAM FINDING(S) -PATIENT IS IN NO ACUTE DISTRESS -BP: 155/98 -NO FUNDOSCOPIC ABNORMALITIES