CASE 28 - HTN F/U

Question 1

I think it is my age. Isn’t that right, doctor? (Impotence)

Answer 1

No, I don’t think it’s because of your age.

I worry more about your medications. However, testosterone levels can decrease with age, and we will check for that.

Question 2

Specific Qs:

Answer 2

1. Compliance.
2. Last BP checkup.
3. Home monitoring of BP.
4. Meds SEs:
5. Impotence questioning ==> nocturnal/morning erections, depression, anxiety/stress, claudication, libido, marital/work problems.

Question 3

PEx:

Answer 3

1. Head and neck exam ==> Fundoscopic exam, carotid auscultation.
2. CV exam ==> P + A.
3. Chest ==> A.
4. Abdo ==> A + P.
5. Extr ==> I + Palpation of peripheral pulses.
6. Neuro ==> DTRs + Babinski + Sensation and strength in bil lower extremities.

Question 4

DDx:

Answer 4

1. Medication-induced erectile dysfunction.
2. Erectile dysfunction 2o to vascular disease.
3. Hypogonadism.
4. Depression.
5. Peyronie’s.

Question 5

Workup:

Answer 5

1. Genital exam + rectal exam.
2. Serum glucose.
3. Testo level.
4. Prolactin, TSH, LH/FSH.
5. Ferritin.
6. MRI brain.
7. Doppler U/S penis.
8. Dynamic cavernosography.
9. BUN/Cr, electrolytes, cholesterol, UA, ECG.