A 67-Year-Old Man Comes to the Office Due to Worsening

question 1004

Multiple Choice

A 67-year-old man comes to the office due to worsening urinary frequency, hesitancy, and nocturia for the past year.  He wakes up 2 or 3 times a night to void.  The patient also says that the force of his urinary stream is decreased and he feels that his bladder is not completely evacuated after voiding.  He has a history of hypertension and osteoarthritis.  The patient has a 35-pack-year smoking history but stopped smoking 10 years ago.  Temperature is 37.1 C (98.8 F) , blood pressure is 130/80 mm Hg, and pulse is 78/min.  Physical examination shows a soft and nontender abdomen.  Rectal examination reveals an enlarged, smooth prostate with no nodules and normal rectal sphincter tone.  Postvoid bladder scan shows 75 mL of urine (normal, <12 mL) .  Serum creatinine and urinalysis are normal.  Serum prostate-specific antigen is 2.8 ng/mL (age-adjusted reference value <4.5 ng/mL) .  Which of the following is the best next step in management of this patient?

• A)5-alpha-reductase inhibitor
• B)α-adrenoreceptor blocker
• C)Intermittent urinary catheterization
• D)Transrectal prostate biopsy
• E)Transurethral prostate resection
• F)Urodynamic studies

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Definitions:

Smear

a thin layer of a substance spread over a surface, especially for laboratory examination.

Total Abdominal Hysterectomy

A surgical procedure to remove the uterus through an incision in the abdomen.

Abbreviation

A compacted form of a word or phrase.

Sexually Transmitted Infections

Infections that are primarily spread through sexual contact, including diseases like HIV, gonorrhea, and chlamydia.