291) A 66 year old man with past medical history of hypertension and type-2 diabetes mellitus is evaluated in your office during a regular follow up visit for his diabetes. During this visit, he reports problem getting and maintaining an erection. On the times that he does have an erection, they are very soft. He says this problem began approximately 10 months ago and has slowly worsened but he was too embarrassed to disclose this during his previous visits. He still has a strong sexual desire and this problem has caused strain in his current relationship. He is physically very active walking two to three miles per day. His medications include glipizide and hydrocholrthiazide. He says his home blood sugars have been “perfect”. A Hemoglobin A1C 2 weeks ago was 6.0gm% . He currently does not smoke after having quit smoking 15 years ago. Physical examination shows blood pressure 140/90 mmHg, pulse 86, respiratory rate 20 bpm. Genitilia and testicles are normal in size . Peripheral pulses are normal. Rest of the physical examination is normal. Which of the following is the most appropriate next step in managing this patient?
A) Obtain Serum Total Testosterone
B) Obtain Nocturnal Penile Tumescence
C) Start Sildenafil
D) Prescribe Vacuum assisted erection device
E) Switch Hydrochlorthiazide to ACE inhibitor
Filed under: Uncategorized, USMLE Test Prep | Tagged: Archer endocrinology, ARCHER UROLOGY, erectile dysfunction, internal medicine board review, male sexual dysfunction, usmle step 3 endocrinology, usmle step 3 urology | 13 Comments »
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