A physician-validated, board-style question from the Active Transport QBank. Try it, then check the reasoning for every option.
A 58-year-old man comes to the clinic complaining of increased urinary frequency for the past 3 days. The patient reports that he has had to get up every few hours in the night to go to the bathroom, and says "whenever I feel the urge I have to go right away.” Past medical history is significant for a chlamydial infection in his twenties that was adequately treated. He endorses lower back pain and subjective warmth for the past 2 days. A rectal examination reveals a slightly enlarged prostate that is tender to palpation. What is the most likely explanation for this patient’s symptoms?
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A
Chemical irritation of the prostateIncorrect. Chronic prostatitis/CPPS is noninfectious and presents with prolonged pelvic pain without fever or markedly tender prostate.
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B
Infection with Escherichia coliCorrect. In men over 35, E. coli is the most common cause of acute bacterial prostatitis, fitting this patient's age and acute febrile presentation.
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C
Prostatic adenocarcinomaIncorrect. Prostate cancer typically presents with obstructive symptoms or asymptomatic PSA elevation, with a hard nodular prostate — not a tender warm prostate with fever.
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D
Reinfection with Chlamydia trachomatisIncorrect. Chlamydial reinfection is more typical of younger sexually active men; the systemic febrile presentation and age make E. coli far more likely.
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E
Benign prostatic hyperplasia flareIncorrect. BPH causes obstructive symptoms (weak stream, hesitancy) and a smooth nontender prostate; it does not produce fever and an exquisitely tender, warm prostate.
↑ Tap an answer to reveal the reasoning
Answer: B. An older man with urinary frequency, urgency, fever, low back pain, and a tender enlarged prostate on rectal exam has acute bacterial prostatitis. In men older than 35 or with risk factors such as BPH, urinary instrumentation, or obstruction, the most common cause is Escherichia coli (and other Enterobacteriaceae such as Klebsiella, Proteus, Enterobacter). In younger sexually active men, Neisseria gonorrhoeae and Chlamydia trachomatis dominate.
This patient is 58 years old with a remote, treated chlamydia infection — well over the age cutoff and with no recent exposure history — so E. coli is far more likely than reinfection with Chlamydia. The fever and systemic features support a bacterial infection rather than chronic noninfectious chemical irritation (chronic prostatitis/CPPS) or carcinoma.
Palpation of the prostate should be GENTLE in suspected acute prostatitis — vigorous massage can precipitate bacteremia. Diagnosis is confirmed with urinalysis and urine culture (often positive even without prostate massage). Treatment is a prolonged course (typically 4–6 weeks) of fluoroquinolone or TMP-SMX with good prostate penetration.
**Why each option:**
**A.** Chronic prostatitis/CPPS is noninfectious and presents with prolonged pelvic pain without fever or markedly tender prostate.
**B.** Correct. In men over 35, E. coli is the most common cause of acute bacterial prostatitis, fitting this patient's age and acute febrile presentation.
**C.** Prostate cancer typically presents with obstructive symptoms or asymptomatic PSA elevation, with a hard nodular prostate — not a tender warm prostate with fever.
**D.** Chlamydial reinfection is more typical of younger sexually active men; the systemic febrile presentation and age make E. coli far more likely.