deck 3 Flashcards
workup of patients with decreased sex drive
assess testosterone in the morning (peaks in AM)
workup of erectile disorder
- obtain morning serum-free testosterone
- if low, order FSH, LH, and prolactin
ED workup
obtain a FSH, LH, and prolactin level. If the FSH and LH are low, but the prolactin is normal, the diagnosis is pituitary or hypothalamic failure. If the FSH and LH are high and the prolactin is normal, the diagnosis is testicular failure. If the FSH and LH are low, but the prolactin is high, there is up to a 40% chance that the patient has a pituitary adenoma and a CT or MRI should be ordered. A penile brachial index can be performed to evaluate for significant vascular disease in patients with ED, but it would not help you in following up for a low testosterone level. The nocturnal penile tumescence evaluation would be done to eliminate psychologic factors that inhibit arousal in the setting of ED, but would also not help follow up an abnormal testosterone level.
sexual arousal disorder
inability to maintain an adequate physiologic sexual excitement response
hypoactive sexual desire disorder
very little desire for sexual activity
most effective treatment for woman unable to get orgasm
directed self-stimulation
most specific lab test for alcohol use
elevated MCV
med most specific for reducing relapse from alcoholism
Acamprosate (greater effect and more long lasting than naltrexone)
quitting smoking
nicotine patches –> if failed, add nicotine gum
varenicline mechanism
selective nicotinic receptor partial agonist
SE’s of varenicline
nausea, insomnia, abnormal dreams
use nicotine replacement with caution with what condition?
unstable angina
first line therapies for smoking cessation
nicotine replacement, bupropion, varenicline
joint presentation in OA
mild swelling. warmth and effusion are rare. crepitus is common
gout attacks
- abrupt onset of monoarticular symptoms with pain at rest and with movement
- often occur overnight or after excessive alcohol or a heavy meal
- exquisite pain with even slight pressure on the joint being painful
problem with oral steroids
often lead to ulcer formation
fluid aspirate in RA vs. OA
distinguishing factor is PMN leukocytes. RA –> more than 50% are PMNs, while in OA, less than 50% are PMNs
extra-articular manifestations of RA
cough + dyspnea may signal interstitial disease
- also vasculitis, dry eyes.
most impt component in diagnosis of asthma
history. PFTs are usually confirmatory, not diagnostic.
mild intermittent asthma
Patients with symptoms less than twice a week, with brief exacerbations, and with night-time symptoms less than twice a month
mild persistent asthma
symptoms more than twice a week but less than once a day, with symptoms that sometimes affect usual activity. Night-time symptoms occur more than twice a month.
moderate persistent asthma
daily symptoms and use of short-acting inhaler, with exacerbations that affect activity and may last for days. Night-time symptoms occur at least weekly.
severe persistent asthma
continual symptoms that limit physical activities, with frequent exacerbations and night-time symptoms.
how to monitor asthma control
peak flow measurements, which parallel FEV1.
80-100 = doing well
50-80 = warning to consider step-up therapy
below 50 = immediate medical attention
if you need to step up from a SABA and inhaled corticosteroids are contraindicated then…
add leukotriene modifier
spondylolisthesis
anterior displacement of vertebra in relation to the one below
most common cause of low back pain in patients younger than 26, especially athletes
spondylolisthesis
mgmt of back strain
NSAIDS + return to normal activities
useful adjunct for chronic low back pain if NSAIDS fail
TCA
most important intervention in smokers with COPD
encourage smoking cessation
only drug that has shown to improve natural history of COPD progression
oxygen
most sensitive measure to diagnose COPD
FEV1:FVC ratio
first line for COPD
- ## ipratropium (inhaled anticholinergic) (longer duration of action than beat-agonists and no sympathomimetic effects)
antibiotics for acute COPD exacerbations?
azithromycin, ciprofloxacin, amoxicillin-clavulanate
most cases of chronic renal failure are caused by…
diabetes and hypertension
best indicator of renal failure in elderly?
GFR (serum creatinine can be normal in elderly people with chronic renal insufficiency because they have less muscle mass)
first lab indication of chronic renal failure
anemia (kidney is source of erythropoietin and kidney is good at preserving role at concentrating and diluting urine and thus maintaining sodium, potassium, phosphate)
with moderate renal failure pt needs
nephrology referral
chronic pain definition
more than 3 months
pins and needles pain medical term
paresthesia
how to manage chronic nonmalignant pain with failing response to opioids
- ## change to a lower dose of a different opioid (evidence that continued escalating opioid doses results in worsened analgesic response. NMDA receptors are unregulated and lead to tolerance while pain receptors become increasingly more sensitive to stimuli)
tests of hepatic function suggestive of chronic disease
- albumin, bilirubin, PT
most common cause of death in cirrhotic patients
varices (secondary to chronic high pressure in portal veins)
absolute contraindications to liver transplantation
- portal vein thrombosis, severe medical illness, malignancy, hepatobiliary sepsis
relative contraindications to liver transplantation
- active alcoholism, HIV or hepatitis B surface antigen positivity, extensive previous abdominal surgery, and a lack of a personal support system
Class I NYHA classification
No limitation of activity
Class II NYHA classification
slight limitations to activity, comfortable at rest but have fatigue, palpitations, dyspnea, or angina with ordinary activity
Class III NYHA classification
Comfortable at rest but less-than-ordinary activity causes symptoms
Class IV NYHA classification
symptoms at rest and increased symptoms with minor activity
