Case Study

Previous Information:

A 73-year-old male patient, Samuel J., presents to you for his annual physical with ongoing fatigue. His vital signs are 142/86, P 74, and a weight gain of 15 pounds from the previous visit 6 months ago for a urinary tract infection. He further expresses concerns over his nighttime insomnia, daytime napping, slow weight gain, and growing lack of motivation to engage in his hobbies (tennis and ham radio operation) and part-time job (at a local big box appliance and tech store), which he formerly enjoyed. His wife of 45 years died within the last year, and he expresses concerns that he is not eating properly since she had done most of the grocery shopping and cooking. His own father died at age 75 after complications of a stroke sustained at age 74, and he does not want to end up the same way. PMH is significant for hernia operation at age 32 during his military service as a Navy radio operator on a submarine. He has one daughter who lives about 10 miles away from him and with whom he enjoys a close relationship. He has a military pension and Social Security income and is covered by Medicare and TriCare supplemental insurance. His home is easy to maintain and paid for, and his vehicle is paid for and in good condition.

New Information:

Samuel J. further describes shortness of breath in the mornings and occasionally during the day. He states that sometimes he is greatly fatigued and short of breath during the day and sometimes at night has a troublesome cough. He has noticed his ankles swell from time to time. He believes he has more trouble urinating now than before his last visit for the urinary tract infection and sometimes wakes up at night having to urinate. Mr. J.’s father was diagnosed with prostate cancer when he was 67, and is now deceased.

Questions:

1. Identify at least three disease processes for which USPSTF screening is appropriate for Mr. J. at this point.

2. What are the findings that are suggestive of each of these diseases?

3. What screening tests should be performed, and what is the rationale for performing these tests?