Mr. Hunter, a 69-year-old man, complains of urinary frequency and urgency that have increased over the past several months. There is no dysuria, hematuria, or sensation of incomplete voiding. He drinks 2 cups of coffee daily and diet cola multiple times a day. His International Prostate Symptom Score (IPSS) is 6, with a bother score of 1 indicating mild voiding symptoms with low impact on his quality of life. His medical history includes hypertension, coronary artery disease, and benign prostatic hyperplasia. Current medications are aspirin, metoprolol, and hydrochlorothiazide. Physical examination reveals normal sized prostate. Which of the following is the best next step?

Correct Answer: C

Rationale: The correct next step is C: Lifestyle modifications. Given the patient's history of mild voiding symptoms and benign prostatic hyperplasia, the first approach should be conservative management. Lifestyle modifications, such as reducing caffeine intake from coffee and diet cola, can help alleviate urinary symptoms. Additionally, optimizing fluid intake and bladder habits can also improve symptoms. Urinalysis (choice A) may be considered later if symptoms persist or worsen. Cystoscopy (choice B) is invasive and not indicated at this stage. Tamsulosin (choice D) is a medication for BPH, but since the patient's symptoms are mild and bother score is low, starting with lifestyle modifications is more appropriate.

Correct Answer: C

Rationale: The correct answer is C: There is moderate quality evidence to suggest control of cardiovascular and metabolic risk factors, such as blood pressure, weight, and blood sugar, may reduce the risk of dementia. This statement is true because studies have shown that managing cardiovascular and metabolic risk factors can help reduce the risk of developing dementia. High blood pressure, obesity, and diabetes have been linked to an increased risk of cognitive decline and dementia. By controlling these risk factors through lifestyle changes or medication, individuals can potentially lower their risk of developing dementia. Choice A is incorrect because while vitamin B12 and fish oil may have some benefits for cognitive health, the evidence supporting their use in preventing dementia is not strong. Choice B is incorrect because while genetics and family history play a role in dementia risk, there are behavioral interventions, such as maintaining a healthy lifestyle and managing risk factors, that can help reduce the risk of dementia. Choice D is incorrect because there is not enough strong evidence to support the claim that cannabinoids can reduce rates

Correct Answer: E

Rationale: I believe you made a typo in listing the correct answer as "E" while there is no "E" option in the choices provided. Could you please confirm the correct answer choice so I can provide you with a detailed explanation and summary of why the correct answer is correct and why the other choices are incorrect?

Correct Answer: C

Rationale: Correct Answer: C - Suggesting completion of an advance directive at the visit with his goals of care in mind. Rationale: 1. Age and health concerns: At 81 years old with weight loss, fatigue, and a history of falls, addressing end-of-life planning becomes crucial. 2. Advance Directive: Helps the patient make decisions about the care they want if they become unable to communicate their wishes. 3. Goals of care: Understanding his wishes ensures healthcare decisions align with his values, enhancing patient autonomy and quality of care. Summary: - A: Blood pressure is important but not the priority compared to end-of-life planning. - B: Cognitive testing is valuable, but addressing care preferences takes precedence. - D: Colonoscopy report is not urgent compared to ensuring the patient's wishes are known for future care.

Correct Answer: C

Rationale: The correct answer is C: Start a high-calorie supplement twice a day. After an acute ischemic stroke, nutritional support is crucial for recovery and prevention of complications. Malnutrition is common post-stroke due to swallowing difficulties and decreased appetite. High-calorie supplements can help meet the patient's nutritional needs. Choice A (escitalopram) is a selective serotonin reuptake inhibitor used for depression and anxiety, which may not be the immediate priority in this case. Choice B (eszopiclone) is a nonbenzodiazepine hypnotic used for insomnia, which is not directly related to managing the patient's stroke. Choice D (changing the time of physical therapy) may be beneficial, but ensuring adequate nutrition is more critical in the acute phase of stroke recovery.