Nokea
A common cause of decreased libido in men is due to:
- A. Decreased blood flow in the hypogastric arterial system
- B. Endocrine dysfunction
- C. Neurologic deficit
- D. Impaired neural innervation
Correct Answer: B
Rationale: Endocrine dysfunction, particularly low testosterone, is a common cause of decreased libido in men.
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Which of the following is a typical sign of diabetic ketoacidosis (DKA)?
- A. Excessive urination
- B. Ketone bodies in the urine
- C. High blood pressure
- D. Slow heart rate
Correct Answer: B
Rationale: Diabetic ketoacidosis often results in the presence of ketone bodies in the urine, along with hyperglycemia.
Several years later, Mr. Hunter, who is now 75 years old, seeks additional intervention for his urinary symptoms that have progressed further. He now experiences slow urinary stream, hesitancy, straining, and a feeling of incomplete emptying in addition to the previous urinary urgency and frequency. At times, he has noted blood in his urine. He has had five urinary tract infections (UTIs) in the past 2 years. His current IPSS is 24, with a bother score of 5 indicating severe voiding symptoms with high impact on his quality of life. Mr. Hunter’s updated medical history includes hypertension, coronary artery disease, benign prostatic hyperplasia, cataract surgery 4 years ago, and two falls within the past year while rushing to the bathroom during the night. Current medications are aspirin, metoprolol, finasteride, and tamsulosin. Physical examination reveals an enlarged, nontender prostate, about 50 g in size without discrete nodules. Upon further evaluation, the intermittent hematuria is attributed to BPH. Postvoid residual volume is 110 mL. Uroflowmetry reveals urinary flow rate of 12 mL/s. Which of the following is the best next step in management?
- A. Start tadalafil.
- B. Switch from tamsulosin to silodosin.
- C. Switch from finasteride to dutasteride.
- D. Perform surgical resection of prostate.
Correct Answer: D
Rationale: Given the severity of his symptoms and the failure of medical therapy, surgical resection of the prostate is the best option.
Mr. B is an 82-year-old enrolled in your primary care clinic panel. His wife is his primary caregiver and feels stressed and overwhelmed. What option would be appropriate for Mr. B except:
- A. Adult day program
- B. Assisted living
- C. Skilled nursing facility
- D. In-home paid care provider
Correct Answer: C
Rationale: Skilled nursing facilities are typically for patients who require higher levels of medical care, which may not be needed for Mr. B.
What is the most appropriate first step in treating a patient with acute asthma exacerbation?
- A. Administer oral corticosteroids
- B. Provide oxygen therapy
- C. Administer a short-acting beta-agonist (SABA)
- D. Give intravenous fluids
Correct Answer: C
Rationale: The first line treatment for acute asthma exacerbation is a short-acting beta-agonist to relieve bronchoconstriction
Which of the following is true about tolterodine?
- A. It should be avoided in men with prostatic hypertrophy.
- B. It increases the risk of constipation compared with oral oxybutynin.
- C. It acts by ablating detrusor spasms.
- D. It has greater risk of adverse effects with its twice-daily formulation.
Correct Answer: C
Rationale: Tolterodine is an anticholinergic that reduces detrusor spasms to alleviate symptoms of overactive bladder.