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PRIMARY CARE EXAM 2 > LGBTQ > Flashcards

LGBTQ Flashcards

1
Q

What is sex?

a. The physical form of an individual’s body
b. An individual’s feeling of alignment with the different sexes–physical, social, psychological
c. Used to describe what type of person an individual is attracted to

A

a. The physical form of an individual’s body

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2
Q

What is gender?

a. The physical form of an individual’s body
b. An individual’s feeling of alignment with the different sexes–physical, social, psychological
c. Used to describe what type of person an individual is attracted to

A

b. An individual’s feeling of alignment with the different sexes–physical, social, psychological

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3
Q

What is sexuality?

a. The physical form of an individual’s body
b. An individual’s feeling of alignment with the different sexes–physical, social, psychological
c. Used to describe what type of person an individual is attracted to

A

c. Used to describe what type of person an individual is attracted to

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4
Q
  • Sex is _______ defined

- Gender + sexuality is _______ defined

A
  • sex = medically defined

- gender + sexuality = personally defined

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5
Q

This is defined as the distressing feeling of being uncomfortable in one’s body due to sex-linked physical attributes

A

gender dysphoria

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6
Q

What are the 2 types of feminizing therapies?

A
  • estrogen

- antiandrogen

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7
Q

Which of the following is NOT an effect of estrogen/ antiandrogen therapy?

a. breast growth
b. decreased sperm production
c. increased muscle mass
d. slow growth of body/facial hair

A

c. increased muscle mass

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8
Q

Which of the following is NOT an effect of testosterone therapy?

a. facial and body hair growth
b. scalp hair loss
c. clitoral enlargement
d. deepened voice
e. decreased muscle mass

A

e. decreased muscle mass

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9
Q

T/F: It is considered sexual harassment to intentionally misgender people

A

True

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10
Q

Which of the following is NOT a red flag for increased HIV risk.

a. MSM who engage in receptive anal sex
b. IVDU
c. transactional sex
d. cocaine use with sex
e. same partner for life

A

e. same partner for life

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11
Q

MSM are recommended to screen annually for these 5 conditions.

A
  • HIV
  • Syphillis
  • Gonorrhea/chlamydia
  • Hep C
  • Anal Pap
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12
Q

Which of the following is NOT a health concern for MSM?

a. eating disorders
b. drug use
c. suicide
d. obesity

A

d. obesity

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13
Q

Who SHOULD prescribe gender-affirming hormones?

A

primary care providers

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14
Q

What are the 4 requirements to begin gender-affirming hormones?

A
  • Persistent, well-documented gender dysphoria
  • Capacity to make a fully informed decision and to consent for treatment
  • Age of majority in a given country
  • If significant medical or mental health concerns are present, they must be reasonably well-controlled
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15
Q

What is the main goal with the initial visit?

A

assess readiness for transition

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16
Q

What is the ICD-10 code for gender identity disorder?

A

F64: Gender identity disorder

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17
Q

What are the 3 feminizing hormones?

A
  • estrogen
  • antiandrogen
  • progesterone
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18
Q

What are the 3 permanent effects of feminizing therapy?

A
  • breast growth
  • decreased testicular volume
  • decreased sperm production
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19
Q

Most effects of feminizing therapy start within _____ months of starting therapy

A

3-6 months

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20
Q

Which of the following is NOT an increased risk of feminizing therapy?

a. VTE
b. gallstones
c. elevated LFTs
d. cardiac disease
e. breast cancer
f. weight gain

A

e. breast cancer

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21
Q

What are the baseline labs we get for all patients for feminizing therapy?

A
  • lipid panel

- comprehensive metabolic panel

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22
Q

What is the protocol for estradiol for feminizing therapy?

A
  • start at lowest dose
  • double after 4-12 weeks
  • increase as needed if inadequate response in 3-6 months
23
Q

How to we measure the efficacy of spironolactone (antiandrogen) for feminizing therapy?

A

serum testosterone levels and/or titrate to feminization

24
Q

How do we measure the efficacy of finasteride (antiandrogen) for feminizing therapy?

A

titrate to feminization

testosterone levels will stay at physiologic male levels

25
Q

If using spironolactone what labs do you want to measure and how often?

*for feminizing therapy

A
  • BUN/Cr and K+

- every 3 months for first year, then annually

26
Q

What is the goal for testosterone and estradiol levels with hormone therapy for feminizing therapy?

A
  • testosterone = <55 ng/dL

- estradiol = 100-200 pg/mL

27
Q

When should lipids and BMP be done for monitoring hormone therapy?

*for feminizing therapy

A

at 6 months then every 6-12 months

28
Q

If a patient complains of galactorrhea, headache, vision changes what lab do you want to get?

*for feminizing therapy

A

prolactin

29
Q

When drawing labs you should recommend the patient wait ____ hours after they’ve taken their medication

A

8-12 hours

30
Q

What are the permanent effects of masculinizing therapy? (4)

A
  • facial and body hair growth
  • scalp hair loss
  • clitoral enlargement
  • deepened voice
31
Q

Which of the following is not an increased risk of masculinizing therapy?

a. polycythemia
b. weight gain
c. acne
d. balding
e. gynecologic cancers
f. sleep apnea

A

e. gynecologic cancers

32
Q

This type testosterone increases the risk of anaphylaxis and pulmonary oil microembolism.

a. injectable testosterone
b. topical testosterone
c. testosterone pellets (Testopel)
d. testosterone undecanoate (Aveed)

A

d. testosterone undecanoate (Aveed)

33
Q

This adjunctive therapy for masculinization can be used for vaginal dryness or uncomfortable Pap testing.

a. vaginal estrogen
b. topical testosterone
c. finasteride
d. progesterone

A

a. vaginal estrogen

34
Q

This adjunctive therapy for masculinization can help with clitoral enlargement.

a. vaginal estrogen
b. topical testosterone
c. finasteride
d. progesterone

A

b. topical testosterone

35
Q

This adjunctive therapy for masculinization can help with managing scalp hair loss and slowing other hair growth.

a. vaginal estrogen
b. topical testosterone
c. finasteride
d. progesterone

A

c. finasteride

36
Q

This adjunctive therapy for masculinization can help with cessation of menses.

a. vaginal estrogen
b. topical testosterone
c. finasteride
d. progesterone

A

d. progesterone

37
Q

When should testosterone labs be drawn for masculinizing therapy?

A

3, 6, 12 months; 2-6 weeks after dose change

38
Q

What is the goal testosterone level for masculinizing therapy?

A

350-700 ng/dL

39
Q

If a patient is on masculinizing therapy but complains of prolonged bleeding or slow masculinization what hormone do you want to check?

A

estradiol

*should be <50 pg/mL

40
Q

Before beginning puberty suppression in adolescents they need to be in what stage of puberty?

A

Tanner stage II or greater

41
Q

What medication is used to suppress puberty?

A

GnRH Agonist

42
Q

After suppressing puberty, at what age do you have a discussion on what their decision is?

A

16 years or older

43
Q

What is the main reason for puberty suppression?

A

prevent progress of irreversible hormonal effects (e.g. hair growth)

44
Q

What are the 3 GnRh agonist medications used for puberty suppression?

A
  • Leuprolide (Lupron)
  • Histrelin (Supprelin LA)
  • Goserelin (Zoladex)
45
Q

What are the 3 reasons for stopping suppression medications?

A
  • gonadectomy (removal of gonads)
  • at start of hormone therapy
  • achievement of adult hormone levels/puberty completion
46
Q

Most transfeminine people only require what 2 medications?

A
  • anti androgen

- estradiol

47
Q

What are the 3 responses to trauma?

A
  • fight
  • flight
  • freeze
48
Q

How can cervical cancer screening for transgender men be optimized to prevent the likelihood of suboptimal Paps?

A

2 weeks of vaginal estrogen beforehand

49
Q

If you are performing a physical exam and a patient is in distress. What do you do?

A
  • stop the exam
  • do not engage in or ask about the trauma
  • focus on the current distress!
50
Q

During an initial visit for pre-exposure prophylaxis (PrEP) what are the 3 things you need to do?

A
  • confirm HIV negative status
  • screen for STIs + Hep B/C
  • check renal function
51
Q

What is the preferred first line agent for PrEP?

A
  • emtricitabine/tenofovir disoproxil (TDF)
52
Q

What are the adverse effects of - emtricitabine/tenofovir disoproxil (TDF)?

A
  • GI side effects at startup
  • renal toxicity
  • bone toxicity
53
Q

What are the adverse effects of - emtricitabine/tenofovir alafenamide (TAF)?

A
  • weight gain

- dyslipidemia

54
Q

What is the post-exposure prophylaxis (PEP) for HIV?

A

TDF + raltegravir for 30 days

PRIMARY CARE EXAM 2 (5 decks)

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