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John is a 43 year old, white male who is single, has no children, is unemployed, and is uninsured. He has been

treated for hypertension and erectile dysfunction for the past 3 years and has presented to the emergency department four times in the last month with complaints of not being able to urinate. His home medications include Aspirin 81 mg daily, Plavix 75 mg daily, Metoprolol 50 mg twice a day, and Viagra as needed. He has developed urinary retention and has been catheterizing himself at home for approximately one week with the foley catheter he pulled out of the trash at his last emergency room visit. His older sister, the only surviving relative, has brought him to the emergency department with confusion, hypothermia, tachycardia, tachypnea, hypotension.

1) Based on the above symptoms what other assessments, tests or procedures would the MD order or perform to help diagnosis the problem?

2) What results would you expect to find and why?

3) Based on your results what is the cause and pathology?

4) What are the patient's risk factors?

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