American College of Physicians: Internal Medicine — Doctors for Adults ®

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The MKSAP Challenge

From the October ACP Observer, copyright 2005 by the American College of Physicians.

Clinical scenario

A 64-year-old man is evaluated for increased urinary frequency and hesitancy and a worsening urine stream of six months' duration.

He also notes increased nocturia from his baseline of needing to urinate one to three times per evening. His history is remarkable for benign prostatic hyperplasia treated with doxazosin. He does not take any other medications or supplements.

On physical examination, pulse rate is 70/min and blood pressure is 100/70 mm Hg. Examination of the prostate shows a moderately enlarged, symmetric, nontender gland without nodules. Renal chemistry tests are normal, prostate-specific antigen level is 1 ng/mL (compared with 1.2 ng/mL last year) and urinalysis is negative for erythrocytes and leukocytes.

Which of the following medication changes is most likely to improve the patient's symptoms?

A. Increase doxazosin
B. Change to terazosin
C. Add finasteride
D. Change to duloxetine

Answer

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