USMLE · Question #607
A 60-year-old male with a past medical history of hyperlipidemia and hepatic dysfunction comes to the physician for a routine examination. He states that he has had difficulty initiating urination for
The correct answer is E. selectively blocks alpha-1 receptors. This patient has the clinical findings consistent with benign prostatic hyperplasia (BPH). He also seems to have hypertension. BPH usually presents with difficulty initiating urination, a decreased urinary stream, nocturia, high postvoid residual volume and urinary retention. Hig
Question
A 60-year-old male with a past medical history of hyperlipidemia and hepatic dysfunction comes to the physician for a routine examination. He states that he has had difficulty initiating urination for the past seven months with an intermittent urine stream and urinary urgency. Vitals reveal a blood pressure of 150/90 mmHg,a heart rate of 65/min, a temperature of 37.0°C (98.6°F) and a respiratory rate of 12/min. Digital rectal examination reveals diffuse enlargement of the prostate. The most appropriate pharmacologic treatment for this patient is most likely a drug that:
Options
- Aactivates central alpha-2 receptors
- Bblocks alpha and beta receptors
- Cblocks muscarinic receptors
- Dinhibits 5-alpha reductase
- Eselectively blocks alpha-1 receptors
How the community answered
(61 responses)- A3% (2)
- B2% (1)
- C7% (4)
- D18% (11)
- E70% (43)
Explanation
This patient has the clinical findings consistent with benign prostatic hyperplasia (BPH). He also seems to have hypertension. BPH usually presents with difficulty initiating urination, a decreased urinary stream, nocturia, high postvoid residual volume and urinary retention. High concentrations of alpha-1-adrenergic receptors are found in the smooth muscle of the bladder neck and stroma and capsule of the prostate. Stimulation of these receptors causes increased smooth muscle tone and blockade of these receptors can reversibly relax these muscles, leading to decreased urinary symptoms. Terazosin and doxazosin are examples of alpha-l- adrenergic antagonists that act in vascular smooth muscle, producing relaxation and relief of urinary symptoms. They are indicated for the treatment of both BPH and hypertension (vascular smooth muscle).
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