75M with complaints of burning micturition and hematuria since 9 days

Hi, I am Sruthi, 5th Sem Medical Student.This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 

Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.”

I have been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan. 

CHIEF COMPLAINTS:
Fever since 10 days
Burning micturition since 9 days
Hematuria since 9 days 

HISTORY OF PRESENTING ILLNESS:
The patient was asymptomatic 10 days ago,then he developed fever which is continuous, low grade,progressive and is associated with chills and rigor and it is relieved on medication 
He developed burning micturition 9 days ago,which was recurrent.Patient had similar complaints 9 years back
He developed hematuria 9 days ago,with clots of blood in the urine
No H/O cough,cold

PAST HISTORY :
K/C/O carcinoma of bladder
Similar complaints 9 years ago
No H/O HTN,DM,TB ,blood transfusion 

SURGICAL HISTORY:
Surgery for carcinoma of bladder in 2014

FAMILY HISTORY :
Not significant 

PERSONAL HISTORY:
Mixed diet
Reduced appetite 
Sleep -Adequate 
Bowel movements-Regular
Bladder movements- not regular  with interrupted flow of urine

 PHYSICAL EXAMINATION:

GENERAL EXAMINATION:

The patient is conscious,coherent,
Cooperative.
Well oriented to time,place and person.
Pallor -Present
Icterus-No
Clubbing - No
Cyanosis - No
Lymphadenopathy-No
Pedal odema- No

Vitals:
BP:100/80 mmHg
PR:76bpm
RR:22cpm
SpO2:99%





SYSTEMIC EXAMINATION :

CVS:
S1,S2 heard 
No murmurs 

Respiratory system:
 No wheeze
Central position if trachea
Normal vesicular breath sounds 

Abdomen:
Tenderness- epigastrium and umbilical region
No palpable mass
No scars
No organomegaly 

Central Nervous System:
No neurological deficits 

INVESTIGATIONS:














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