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A 60-Year-Old Man Comes to the Emergency Department Due to Severe

question 563

Multiple Choice

A 60-year-old man comes to the emergency department due to severe abdominal pain and an inability to void urine for the past 18 hours. The patient has a year-long history of urinary hesitancy and a weak urinary stream but has always been able to urinate prior to today. He has not had fever, chills, dysuria, or recent genitourinary trauma or procedures. The patient also has a history of chronic arthritis of the lumbar spine and was recently prescribed baclofen, which has provided some pain relief. He does not use tobacco, alcohol, or illicit drugs. Temperature is 36.5 C (97.7 F) , blood pressure is 145/90 mm Hg, pulse is 95/min, and respirations are 18/min. The patient appears restless and in moderate distress. Abdominal examination reveals suprapubic fullness and moderate tenderness to palpation with no guarding or rebound tenderness. An enlarged, smooth, nontender prostate is palpated by digital rectal examination; no masses or fecal impaction are present. There is no tenderness to palpation of the lower back. Abbreviated testing of strength and sensory function is normal. Laboratory results are as follows: What is the best next step in management of this patient?

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