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John, aged 65 years, presents for a general check-up. You know he had a radical prostatectomy for prostate cancer approximately 18 months ago, so you enquire specifically about the effects this has had on his life. John’s current cancer status is clear, and he tells you he voids well, with minor urinary incontinence when he plays golf. However, he has experienced erectile dysfunction (ED) since the prostatectomy. He has not been able to achieve satisfactory erections with oral medications and thinks that his penis has shrunk in size. His other medical history includes hypertension, dyslipidaemia and gout. He has been prescribed sildenafil 50 mg to treat his ED.
1.What can you tell John about prostate cancer survivorship and male sexual function? 2.What do you know about the penile rehabilitation program? 3.Is cardiovascular assessment relevant in John’s case? 4.What factors, other than ED, need to be considered and may play a part in John’s sexual dysfunction? 5.What online resources could you recommend to John to help manage his condition? 6.What are the key elements that constitute an effective prostate cancer rehabilitation management plan? #Week22_Case2
Timoti, aged 45 years, is a single man who works as an information technology worker. For the past five years, he has had difficulty maintaining his erection, and his erectile dysfunction (ED) has recently worsened. He reports difficulty engaging in sexual intimacy despite using sildenafil 50 mg occasionally. He leads an active lifestyle and goes to the gym regularly. 1.What would be your initial approach to this consultation? 2.What are your next steps, and what investigations will you organise? 3.What would you tell Timoti? 4.What would be your choice of treatment for Timoti? 5.How would you respond? 6.What advice would you give Timoti about regenerative therapy ? 7.What would be your next step when Timoti comes for his follow-up appointment? #Week22_Case1
Maurice, aged 57 years, presents with sudden-onset chest pain and shortness of breath since this morning. He reports that he was well when he went to bed last night, and he went to work this morning as usual. Once at work, he received a telephone call from the local hospital advising that his son had been involved in a motor vehicle accident. Maurice has a background of hypertension and hypercholesterolaemia, which he has been managing with diet and exercise. He takes an over-the-counter multivitamin but no other regular medications. He is a non-smoker and drinks approximately 1–2 standard drinks of alcohol on the weekends only. 1.What further history would you seek from Maurice? 2.What conditions would you include in your differential diagnosis? 3.What investigations would you expect the hospital to perform on Maurice? 4.What is your working diagnosis for Maurice, given his investigation results? 5.What are the causes of stress cardiomyopathy? 6.How is stress cardiomyopathy typically managed? 7.What is the prognosis for patients with stress cardiomyopathy? #Week21_Case4
