An 83-year-old man examined on admission for end-of-life care due to profound dementia. His wife states that his penis has not changed in appearance, but knows that he always had concerns about it. To her knowledge he never had trouble voiding. Patient too impaired to discuss any topic coherently. Wife considers it unlikely he would have disclosed any symptom of this type to her.
PHYSICAL EXAMINATION
Markedly demented man. Does not show psychic or physical distress in his facial expression, body posture, or tone of his nonverbal vocalizations. No pressure ulcers. Several scabbed areas on shins from bumping into things due to absent safety awareness and poor muscular control. Breathing easy and quiet, no gurgling on secretions. Penis as shown.
WHAT’S YOUR DIAGNOSIS?
(Answer on next page.)
