A 54-Year-Old Man Is Evaluated for Erectile Dysfunction

question 301

Multiple Choice

A 54-year-old man is evaluated for erectile dysfunction.  The patient has been having problems attaining and maintaining erections during sexual activity for the past 6 months.  Prior to the development of this problem, he had an active and satisfactory sex life.  The patient continues to have normal early-morning penile erections.  Medical history is notable for hypertension, mixed hyperlipidemia, gastroesophageal reflux, and lumbar stenosis with a chronic right L4 radiculopathy.  His current medications include ibuprofen, ranitidine, lisinopril, and atorvastatin.  The patient smokes a pack of cigarettes daily and drinks alcohol only on social occasions.  Blood pressure is 144/78 mm Hg and pulse is 80/min.  BMI is 35 kg/m².  Physical examination shows normal body hair distribution and testicular size with no gynecomastia.  Which of the following is the most likely cause of this patient's erectile dysfunction?

• A)Adverse effect of medication
• B)Atherosclerotic vascular disease
• C)Decreased testosterone production
• D)Hyperprolactinemia
• E)Lumbar radiculopathy
• F)Psychosocial factors

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