Aquifer Mr Payne genitourinary case study guide
Using the Aquifer case study, discuss the history pertinent to Mr Payne's genitourinary problem, describe the physical exam and diagnostic tools used and any you would add, list three differential diagnoses with reasoning and your final diagnosis, and set out the plan of care including drug therapy, education and follow-up.
Editorial process
Last reviewed · August 14, 2026
Four questions, one of them about what is missing
The first question asks for pertinent history and the word pertinent is the instruction. A genitourinary presentation in an adult man has a specific set of questions attached, and listing a complete history wastes the answer. The chief complaint and its characterisation come first, then a history of present illness covering onset, duration, progression, and the symptom pattern itself — storage symptoms such as frequency, urgency and nocturia against voiding symptoms such as hesitancy, weak stream, straining and incomplete emptying, since which group dominates points at different causes. Then fever, flank or suprapubic pain, haematuria, weight loss and bowel change as red flags; past medical history including diabetes, neurological disease and prior instrumentation; medications with anticholinergic or sympathomimetic effects; family history of prostate cancer; and a social and sexual history taken properly rather than apologetically. Ask each of those deliberately, because the marks are for a focused history rather than a thorough one.
The second question has a clause worth taking seriously: are there any additional diagnostics you would have liked that were not included. That is an invitation to critique the workup, and it is where an average answer becomes a good one. Look for what is conspicuously absent — a post-void residual, a urinalysis, a symptom score, a prostate-specific antigen with the shared decision-making conversation that should precede it, renal function — and say what each would change. Then the three differentials should be genuinely competing rather than one diagnosis and two unlikely alternatives, and each needs the finding that supports it and the finding that would argue against it. The plan then follows from the final diagnosis: drug therapy with class, dose and the counselling that goes with it, non-pharmacological measures, the specific education Mr Payne needs, and a follow-up interval with the symptoms that should bring him back sooner.
Likely learning objectives
Inferred from the brief — check these against your own rubric.
- 01Take a focused genitourinary history rather than a complete one.
- 02Distinguish storage from voiding symptoms and their diagnostic implications.
- 03Critique a diagnostic workup by identifying what was not done.
- 04Construct three competing differentials with supporting and refuting findings.
- 05Write a plan that includes drug class, dosing, education and follow-up interval.
Read the full question
Review every instruction before using the planning guidance that follows.
Course-wide instructions that accompany this question
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Turn the brief into deliverables
- 01Pertinent history: chief complaint, history of present illness, social, family and past medical.
- 02The physical examination and diagnostic tools used.
- 03Additional diagnostics you would have wanted, with reasons.
- 04Three differential diagnoses with reasoning.
- 05The final diagnosis and how you reached it.
- 06A plan of care with drug therapy, patient education and follow-up.
History, examination, differentials, then the plan
The pertinent history
Cover complaint, symptom pattern, red flags and relevant background.
Examination and diagnostics used
Describe what the case performed and what each finding contributes.
What was missing
Identify omitted investigations and what each would change.
Three differentials
Set out competing diagnoses with evidence for and against each.
Final diagnosis and plan
Justify the diagnosis and set out therapy, education and follow-up.
Genitourinary references for an adult male presentation
Recommended databases
- StatPearls via NCBI Bookshelf
- MedlinePlus
- PubMed
- The Aquifer case study itself
- Cochrane Library
Search sequence
- 1.Work through the case and list every finding before reading around it.
- 2.Separate the symptoms into storage and voiding groups.
- 3.Read current references on the two or three conditions the pattern suggests.
- 4.Check which investigations current guidance expects for this presentation.
- 5.Confirm drug class and dosing from a current source before writing the plan.
Reference shortlist
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Nothing here is cleared for citation until you have read it.
- 01
Benign Prostatic Hyperplasia
StatPearls, NCBI Bookshelf · 2024
The commonest cause of male lower urinary tract symptoms, with its workup and drug therapy.
- 02
Acute Bacterial Prostatitis
StatPearls, NCBI Bookshelf · 2023
A competing differential distinguished by fever, pain and examination findings.
- 03
Prostate Cancer Screening
StatPearls, NCBI Bookshelf · 2023
The shared decision-making conversation that must precede a prostate-specific antigen test.
- 04
Prostate Diseases | Prostatitis | Enlarged Prostate
MedlinePlus, National Library of Medicine · 2024
Plain-language material for the patient education section of the plan.
Review before submission
Common mistakes
- Reproducing a complete history when the question asks for the pertinent one.
- Failing to separate storage from voiding symptoms.
- Skipping the additional diagnostics question, which is separately graded.
- Offering differentials that nobody would seriously consider.
- Naming a drug without class, dose or counselling points.
- Ending the plan without a follow-up interval or return precautions.
Submission checklist
- History is focused on the genitourinary complaint.
- Red flags are explicitly asked about.
- At least one omitted diagnostic is identified with its rationale.
- Three differentials each carry supporting and refuting evidence.
- Drug therapy includes class, dose and counselling.
- Follow-up timing and return precautions are stated, with APA citations.
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Written by
Aaron Bishop
MA, Education
assignment interpretation and research-methods coaching across disciplines
Aaron leads the EssayCrackers editorial desk. He works on how assignment briefs are read — what a rubric is actually asking for, and where students most often answer a different question than the one set.
Reviewed by
Dr. Nathan Cole
PhD, Rhetoric & Composition
Argumentation and thesis development
Nathan teaches first-year composition and directs a university writing center. He reviews EssayCrackers guides for argumentative soundness and citation accuracy.