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MS3 - Adult Ambulatory Care / Rural & Community Care > PreTest Family Medicine: "Chronic Complaints" > Flashcards

PreTest Family Medicine: "Chronic Complaints" Flashcards

1
Q

The most common cause of failure to achieve an erection in a man who has an intact sexual desire is ____________.

A

vascular problems

Mood disorders, stressors, and alcohol can play a role, but vascular disorders are more common.

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2
Q

When should you test the levels of testosterone in a man with sexual complaints?

A

If the man complains of decreased sexual interest and has a normal physical exam and no risk factors for other causes of sexual dysfunction in his history (e.g., no bitemporal hemianopsia, no headaches, no history of head trauma or irradiation).

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3
Q

Test ____________ when evaluating testosterone deficiency.

A

free testosterone in the morning (when it peaks)

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4
Q

True or false: beta-blockers can treat premature ejaculation.

A

False

Beta-blockers can cause erectile dysfunction, but they do not affect the ejaculation threshold.

SSRIs can be used to treat erectile dysfunction.

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5
Q

What test can confirm a vascular source of erectile dysfunction?

A

Penile-brachial index

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6
Q

How should low testosterone be managed?

A

•First, test the FSH, LH, and prolactin levels. If all three levels are low, then it is hypothalamic/pituitary failure. If the FSH and LH are low but the prolactin is high, then it is a prolactinoma. IF the FSH and LH are high, then it is testicular failure.

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7
Q

The best therapy for women with primary orgasmic disorder is _______________.

A

directed self-stimulation

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8
Q

What is the most sensitive test for detecting long-term alcohol abuse?

A

Gamma-glutamyl transferase

Ethyl glucuronide is the most sensitive test for detecting recent intoxication, but it does not tell you if the person drank a lot or has drunk alcohol for a long time. GGT will be elevated in those who abuse alcohol long-term.

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9
Q

An elevated _______________ is 96% specific for alcohol abuse.

A

MCV

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10
Q

_____________ has been shown to be the best treatment for preventing relapse in recovering alcoholics.

A

Acamprosate

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11
Q

If a person fails to quit smoking with one form of nicotine replacement, then _______________.

A

add a second form (e.g., gum + patch)

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12
Q

List the side effects of varenicline.

A
  • Nausea
  • Insomnia
  • Abnormal dreams
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13
Q

Varenicline is metabolized in the ____________.

A

urine

“Urinicline.”

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14
Q

The most supported therapies for smoking cessation are ________________.

A

nicotine replacement, varenicline, and bupropion

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15
Q

Nicotine replacement should be used with caution in those with ______________.

A

unstable angina

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16
Q

What is the role of PCPs in treating rheumatoid arthritis?

A

It used to be recommended that PCPs manage RA symptoms with NSAIDs until no longer effective, but with the advent of disease-modifying antirheumatic agents (DMARDs), it is now recommended that PCPs refer RA patients to rheumatologists.

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17
Q

How often can steroid injections be done?

A

No more than two per year

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18
Q

Describe the crystals seen in pseudogout.

A

Positively birefringent, rhomboid-shaped crystals

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19
Q

A joint aspirate shows elevated WBCs that are 20% PMNs. What is the likely diagnosis?

A

Osteoarthritis

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20
Q

List the three medicines that can treat acute gouty attacks and what order they should be used.

A

1) NSAIDs
2) Colchicine
3) Corticosteroids

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21
Q

The most common extra-articular manifestation of RA is _______________.

A

interstitial lung disease

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22
Q

The strongest predictor of future asthma development is _________________.

A

history of atopy (even more than family history of asthma!)

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23
Q

Why is methacholine rarely used to diagnose asthma?

A

It can induce life-threatening bronchospasm in some cases.

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24
Q

Asthma daytime attacks more than twice a month but less than once a day is classified as ____________.

A

mild persistent

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25
Q

What are “peak flow” levels?

A

They are an easy and inexpensive way for patients to monitor asthma status. Peak expiratory flow parallels FEV. Patients should compare their current peak flow to their personal best.

  • 80% to 100% = green zone = ok
  • 50% to 79% = yellow zone = review medication regimen
  • Below 50% = red zone = patient needs immediate medical attention
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26
Q

Describe the movement of spondylolisthesis.

A

The superior moves anterior in relation to the inferior.

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27
Q

How can you differentiate low back strain from spondylolisthesis?

A
  • Low back strain usually occurs after an inciting event. (“I was putting the groceries in the trunk and suddenly my back ‘gave out’.”)
  • Spondylolisthesis is more common in those who are younger than 26 and athletic, while low back strain is more common in older people.
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28
Q

True or false: low back strain should be treated with NSAIDs and bed rest.

A

False.

While NSAIDs are a key component of therapy, bed rest has not been shown to be helpful. Return to activity is the best recommendation.

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29
Q

Which antidepressants have been shown to help treat chronic pain?

A

SNRIs and TCAs

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30
Q

What two interventions have been shown to improve the prognosis of COPD?

A
  • Smoking cessation

* Supplemental oxygen

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31
Q

What is the best first-line agent in COPD?

A

Ipratropium

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32
Q

If a person with chronic COPD has an acute exacerbation, treat them with ________________.

A

azithromycin, ciprofloxacin, or Augmentin

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33
Q

The best predictor of renal failure in a diabetic is ______________.

A

estimated GFR

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34
Q

What lab abnormality is the first sign of chronic renal failure?

A

Anemia

Electrolytes are not usually affected until the GFR is less than 30 mL/min, so those remain normal well into kidney failure. Anemia, however, can present when GFR is 60 mL/min.

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35
Q

Those with chronic kidney disease are most likely to die from ___________.

A

cardiovascular causes

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36
Q

For a person who’s on the max dose of NSAIDs and opioids for pain and who still reports worsening pain, a good option is to _____________.

A

switch to a different kind of opioid at a lower dose

37
Q

The best test for evaluating longterm liver disease is __________.

A

low albumin

38
Q

The most common cause of death in those with chronic liver disease is ________________.

A

bleeding varices

39
Q

List the absolute contraindications to liver transplant.

A
  • Hepatobiliary sepsis
  • Severe medical illness
  • Malignancy
  • Portal vein thrombosis
40
Q

What tests are routinely done in the initial evaluation of heart failure?

A
  • Echocardiography (to look for structural causes like valve defects)
  • Urinalysis and creatinine (to evaluate for renal failure as a cause)
  • Thyroid function tests (because hyperthyroidism can cause heart failure)
  • Albumin levels (as chronic liver disease can induce heart failure)
  • Potassium
41
Q

Go through the four NYHA classes.

A
  • I: no symptoms
  • II: no symptoms at rest but symptoms with ordinary activity
  • III: no symptoms at rest but symptoms with “less than ordinary” activity
  • IV: symptoms at rest
42
Q

What lifestyle intervention is extremely helpful in improving the functionality of heart failure?

A

Cessation of alcohol

Alcohol can induce cardiomyopathy, so it is important to have heart failure patients stop drinking.

43
Q

What chronic drug is first-line in treating CHF?

A

ACE inhibitors

Beta-blockers are also helpful, but have less evidence. d

44
Q

A person has refractory edema even when taking furosemide and lisinopril. What two medications could you add to enhance diuresis?

A
  • Spironolactone

* Metolazone

45
Q

Describe what research shows about adding an ARB to an ACEi in a person with CHF.

A

Adding valsartan to ACEi use has been shown to reduce hospitalizations for CHF but not change long-term outcomes.

46
Q

What is the best predicting factor of Alzheimer disease?

A

Advancing age

47
Q

Which usually goes first in Alzheimer disease, social skills or visuospatial skills?

A

Visuospatial

Social skills are usually preserved until late in the disease.

48
Q

What tests should you do to confirm the diagnosis of Alzheimer’s?

A

MMSE

Note: you should do other things to rule out medical causes (like TSH, B12, RPR, LFTs), but Alzheimer’s is diagnosed by history.

49
Q

What drug has been shown to have a statistically significant benefit in those with severe dementia?

A

Memantine

50
Q

What is the best test for screening for diabetes?

A

The best is technically the two-hour glucose challenge, but because that is more expensive and time-consuming, the fasting glucose is usually done.

51
Q

True or false: the random and two-hour glucoses are positive if greater than 180.

A

False

They are positive if greater than 200.

52
Q

Diabetics should be given ACE inhibitors if their systolic BP is greater than _____________.

A

100

53
Q

A ___________ diet has been shown to improve glycemic control.

A

high-fiber

54
Q

When doing basal-bolus insulin, what percent should each be?

A

Roughly 50% should be basal and 50% bolus

55
Q

If a type 2 diabetic maximizes their oral agents and lifestyle efforts, what form and dose of insulin should you start them on?

A

0.1 U/kg of long-acting insulin at night

56
Q

The ATP-3 task force used to recommend that LDL be below 100 or 70 depending on risk factors. What are the new recommendations?

A

No target

Now, just treat with high-intensity statins based on risk factors and avoid treating to a target.

57
Q

What lifestyle factors can raise HDL?

A
  • Exercise: Can raise HDL by 15 points!
  • Weight loss: 5-10 points
  • Smoking cessation: 5-10 points
  • Decreasing lifestyle stress: 5 points
  • Increased fiber intake: 5 points
58
Q

Triglycerides can increase by about _________ after eating.

A

50

59
Q

What non-lipid serum value correlates with a high MI risk?

A

High CRP (particularly above 3.0)

60
Q

Which lipid value puts you at the highest risk of a negative outcome?

A

Low HDL

61
Q

Which lipid is affected by smoking?

A

HDL

62
Q

List three lipid medications that can decrease triglycerides.

A
  • Statins: mild
  • Fibrates: moderate
  • Fish oil: moderate
63
Q

How often should HIV-positive women get Pap tests?

A

6 months after the baseline test

12 months repeating

64
Q

Go through the three tiers of PPD interpretation.

A
  • 15 mm: people with no known risk factors
  • 10 mm: healthcare workers; recent immigrants; injection drug users
  • 5 mm: HIV-positive individuals; immunocompromised individuals; people with known TB contacts
65
Q

Prophylaxis against ________ should be done in those with CD4s less than 65.

A

MAC

66
Q

Those with PCP pneumonia should be treated with ____________.

A

Bactrim and steroids

67
Q

Go through the lifestyle modifications that can lower SBP and how much each does so by.

A
  • Weight loss: 15 mm Hg
  • DASH diet: 10 mm Hg
  • Sodium reduction, alcohol moderation, and exercise: 5-10 mm Hg
68
Q

True or false: always start with one drug in treating essential hypertension.

A

False

If the patient’s BP is more than 20/10 mm Hg greater than the goal BP, then you should consider starting with two.

69
Q

True or false: those with coarctation of the aorta will not need to take antihypertensives after correction of the defect.

A

False

If they have the defect for many years, the RAA system can produce hypertension even after the defect is corrected.

70
Q

What workup should you do in newly diagnosed hypertension?

A
  • CBC (looking for anemia)
  • BMP (looking for renal failure)
  • Urinalysis (also looking for renal failure)
  • Echocardiogram (looking for negative remodeling)
  • Lipid profile (to assess heart disease risk)
  • Calcium
  • Glucose

Note: only do a renal ultrasound if they have abdominal bruits or other indications of renal vascular anomalies.

71
Q

What test can identify renal vascular causes of hypertension?

A

An ACE-inhibitor scan

72
Q

What antihypertensive treatment regimen has been shown to decrease the risk of recurrent stroke?

A

ACEi and thiazide

73
Q

List the four initial antihypertensives recommended by the JNC 8.

A
  • ACEi (ARBs if untolerated)
  • CCB
  • Thiazides

Caveats:

  • CCBs and thiazides seem to work better in African Americans
  • ACEis or ARBs in those with CKD
74
Q

What is the difference between atypical angina and angina equivalent?

A
  • Atypical angina is angina that does not occur with exertion.
  • Angina equivalent is exertional dyspnea without chest pain.
75
Q

What are poor prognostic indicators in an exercise stress test?

A
  • Max HR less than 120 bpm
  • ST elevation at less than 120 bpm
  • ST depression in multiple leads
  • ST changes persisting for greater than 6 minutes
  • Max stage of Bruce protocol II
76
Q

Beta-blockers should be targeted to what in treating angina?

A

HR between 50 and 60

77
Q

What is the success rate of using diet alone to lose and maintain 20 lbs for two years?

A

20%

20 lbs 20% 20 months

78
Q

Gastric bypass is officially reserved for those in what BMI range?

A
  • Greater than 40 without comorbid conditions

* Greater than 35 with comorbid conditions

79
Q

The complication rate for Roux-en-Y bypass is _________.

A

40%

80
Q

Describe the utility of weight-loss medications.

A
  • Most can help people lose up to 9% of their weight
  • All show weight regain after discontinuation
  • Many work by stimulating the adrenergic system (phentermine, sibutramine)
81
Q

True or false: hyperthyroidism can accelerate osteoporosis.

A

True

82
Q

True or false: history and physical can sufficiently detect osteoporosis.

A

False

While a patient’s history can tell you about increased risk factors, DEXA or bone density imaging are needed for diagnosis of osteoporosis.

83
Q

Which osteoporosis medication also had an analgesic effect in those with osteoporotic fractures?

A

Calcitonin

“CALCitonin makes the patient change the CALCulation of pain scores.”

84
Q

Explain how the attitude toward eating is different in bulimia and anorexia.

A
  • In anorexia, the person feels a strong sense of control over eating.
  • In bulimia, the person feels no control over eating.
85
Q

Which ADHD symptoms is most likely to persist into adulthood?

A

Inattention

86
Q

What labs should you screen in a suspected ADHD case?

A

TSH

87
Q

Hashimoto’s disease is also called _______________.

A

chronic lymphocytic thyroiditis

88
Q

What are the two most common symptoms of hyperthyroidism?

A
  • Tachycardia

* Fatigue

89
Q

Describe subclinical hypothyroidism.

A

When the TSH is high but the T4 is normal

Monitor at yearly intervals due to a 2% yearly progression to hypothyroidism.

MS3 - Adult Ambulatory Care / Rural & Community Care (55 decks)

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