3. A 32-year-old man comes to his physician complaining of frequency, dysuria, and urgency for several days, as well as pain in the perineal region. The digital rectal examination is extremely painful. He most likely has
A. A primary chancre of syphilis in his genital organs
B. A bladder infection
C. Pyelonephritis
D. Kidney stones
E. Acute prostatitis
I think C
To determine the correct answer, we need to consider the symptoms mentioned in the question stem. The patient complains of frequency, dysuria, urgency, and pain in the perineal region. Additionally, the digital rectal examination is extremely painful. Let's analyze each option to see which one matches these symptoms:
A. A primary chancre of syphilis in his genital organs: This is unlikely because syphilis typically presents with painless genital ulcers and does not cause urinary symptoms such as dysuria and urgency.
B. A bladder infection: While a bladder infection may cause symptoms like dysuria, urgency, and frequency, it is less likely to cause perineal pain or pain during a digital rectal examination.
C. Pyelonephritis: Pyelonephritis typically presents with symptoms such as fever, flank pain, and nausea/vomiting, which are not mentioned in the patient's presentation.
D. Kidney stones: Though kidney stones can cause urinary symptoms and pain in the perineal region, pain during a digital rectal examination is not a typical feature.
E. Acute prostatitis: Acute prostatitis is the inflammation of the prostate gland and commonly presents with symptoms such as dysuria, urgency, frequency, perineal pain, and pain during a digital rectal examination. This option matches the patient's symptoms the most.
Therefore, the most likely diagnosis for this patient is E. Acute prostatitis.