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Family med > deck 3 > Flashcards

deck 3 Flashcards

1
Q

workup of patients with decreased sex drive

A

assess testosterone in the morning (peaks in AM)

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2
Q

workup of erectile disorder

A
  • obtain morning serum-free testosterone

- if low, order FSH, LH, and prolactin

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3
Q

ED workup

A

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.

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4
Q

sexual arousal disorder

A

inability to maintain an adequate physiologic sexual excitement response

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5
Q

hypoactive sexual desire disorder

A

very little desire for sexual activity

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6
Q

most effective treatment for woman unable to get orgasm

A

directed self-stimulation

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7
Q

most specific lab test for alcohol use

A

elevated MCV

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8
Q

med most specific for reducing relapse from alcoholism

A

Acamprosate (greater effect and more long lasting than naltrexone)

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9
Q

quitting smoking

A

nicotine patches –> if failed, add nicotine gum

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10
Q

varenicline mechanism

A

selective nicotinic receptor partial agonist

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11
Q

SE’s of varenicline

A

nausea, insomnia, abnormal dreams

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12
Q

use nicotine replacement with caution with what condition?

A

unstable angina

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13
Q

first line therapies for smoking cessation

A

nicotine replacement, bupropion, varenicline

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14
Q

joint presentation in OA

A

mild swelling. warmth and effusion are rare. crepitus is common

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15
Q

gout attacks

A
  • 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
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16
Q

problem with oral steroids

A

often lead to ulcer formation

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17
Q

fluid aspirate in RA vs. OA

A

distinguishing factor is PMN leukocytes. RA –> more than 50% are PMNs, while in OA, less than 50% are PMNs

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18
Q

extra-articular manifestations of RA

A

cough + dyspnea may signal interstitial disease

- also vasculitis, dry eyes.

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19
Q

most impt component in diagnosis of asthma

A

history. PFTs are usually confirmatory, not diagnostic.

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20
Q

mild intermittent asthma

A

Patients with symptoms less than twice a week, with brief exacerbations, and with night-time symptoms less than twice a month

21
Q

mild persistent asthma

A

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.

22
Q

moderate persistent asthma

A

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.

23
Q

severe persistent asthma

A

continual symptoms that limit physical activities, with frequent exacerbations and night-time symptoms.

24
Q

how to monitor asthma control

A

peak flow measurements, which parallel FEV1.
80-100 = doing well
50-80 = warning to consider step-up therapy
below 50 = immediate medical attention

25
Q

if you need to step up from a SABA and inhaled corticosteroids are contraindicated then…

A

add leukotriene modifier

26
Q

spondylolisthesis

A

anterior displacement of vertebra in relation to the one below

27
Q

most common cause of low back pain in patients younger than 26, especially athletes

A

spondylolisthesis

28
Q

mgmt of back strain

A

NSAIDS + return to normal activities

29
Q

useful adjunct for chronic low back pain if NSAIDS fail

A

TCA

30
Q

most important intervention in smokers with COPD

A

encourage smoking cessation

31
Q

only drug that has shown to improve natural history of COPD progression

A

oxygen

32
Q

most sensitive measure to diagnose COPD

A

FEV1:FVC ratio

33
Q

first line for COPD

A
  • ## ipratropium (inhaled anticholinergic) (longer duration of action than beat-agonists and no sympathomimetic effects)
34
Q

antibiotics for acute COPD exacerbations?

A

azithromycin, ciprofloxacin, amoxicillin-clavulanate

35
Q

most cases of chronic renal failure are caused by…

A

diabetes and hypertension

36
Q

best indicator of renal failure in elderly?

A

GFR (serum creatinine can be normal in elderly people with chronic renal insufficiency because they have less muscle mass)

37
Q

first lab indication of chronic renal failure

A

anemia (kidney is source of erythropoietin and kidney is good at preserving role at concentrating and diluting urine and thus maintaining sodium, potassium, phosphate)

38
Q

with moderate renal failure pt needs

A

nephrology referral

39
Q

chronic pain definition

A

more than 3 months

40
Q

pins and needles pain medical term

A

paresthesia

41
Q

how to manage chronic nonmalignant pain with failing response to opioids

A
  • ## 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)
42
Q

tests of hepatic function suggestive of chronic disease

A
  • albumin, bilirubin, PT
43
Q

most common cause of death in cirrhotic patients

A

varices (secondary to chronic high pressure in portal veins)

44
Q

absolute contraindications to liver transplantation

A
  • portal vein thrombosis, severe medical illness, malignancy, hepatobiliary sepsis
45
Q

relative contraindications to liver transplantation

A
  • active alcoholism, HIV or hepatitis B surface antigen positivity, extensive previous abdominal surgery, and a lack of a personal support system
46
Q

Class I NYHA classification

A

No limitation of activity

47
Q

Class II NYHA classification

A

slight limitations to activity, comfortable at rest but have fatigue, palpitations, dyspnea, or angina with ordinary activity

48
Q

Class III NYHA classification

A

Comfortable at rest but less-than-ordinary activity causes symptoms

49
Q

Class IV NYHA classification

A

symptoms at rest and increased symptoms with minor activity

Family med (48 decks)

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