deck 3

Question 1

workup of patients with decreased sex drive

Answer 1

assess testosterone in the morning (peaks in AM)

Question 2

workup of erectile disorder

Answer 2

• obtain morning serum-free testosterone

- if low, order FSH, LH, and prolactin

Question 3

ED workup

Answer 3

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.

Question 4

sexual arousal disorder

Answer 4

inability to maintain an adequate physiologic sexual excitement response

Question 5

hypoactive sexual desire disorder

Answer 5

very little desire for sexual activity

Question 6

most effective treatment for woman unable to get orgasm

Answer 6

directed self-stimulation

Question 7

most specific lab test for alcohol use

Answer 7

elevated MCV

Question 8

med most specific for reducing relapse from alcoholism

Answer 8

Acamprosate (greater effect and more long lasting than naltrexone)

Question 9

quitting smoking

Answer 9

nicotine patches –> if failed, add nicotine gum

Question 10

varenicline mechanism

Answer 10

selective nicotinic receptor partial agonist

Question 11

SE’s of varenicline

Answer 11

nausea, insomnia, abnormal dreams

Question 12

use nicotine replacement with caution with what condition?

Answer 12

unstable angina

Question 13

first line therapies for smoking cessation

Answer 13

nicotine replacement, bupropion, varenicline

Question 14

joint presentation in OA

Answer 14

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

Question 15

gout attacks

Answer 15

• 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

Question 16

problem with oral steroids

Answer 16

often lead to ulcer formation

Question 17

fluid aspirate in RA vs. OA

Answer 17

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

Question 18

extra-articular manifestations of RA

Answer 18

cough + dyspnea may signal interstitial disease

- also vasculitis, dry eyes.

Question 19

most impt component in diagnosis of asthma

Answer 19

history. PFTs are usually confirmatory, not diagnostic.

Question 20

mild intermittent asthma

Answer 20

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

Question 21

mild persistent asthma

Answer 21

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.

Question 22

moderate persistent asthma

Answer 22

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.

Question 23

severe persistent asthma

Answer 23

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

Question 24

how to monitor asthma control

Answer 24

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

Question 25

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

Answer 25

add leukotriene modifier

Question 26

spondylolisthesis

Answer 26

anterior displacement of vertebra in relation to the one below

Question 27

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

Answer 27

spondylolisthesis

Question 28

mgmt of back strain

Answer 28

NSAIDS + return to normal activities

Question 29

useful adjunct for chronic low back pain if NSAIDS fail

Answer 29

TCA

Question 30

most important intervention in smokers with COPD

Answer 30

encourage smoking cessation

Question 31

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

Answer 31

oxygen

Question 32

most sensitive measure to diagnose COPD

Answer 32

FEV1:FVC ratio

Question 33

first line for COPD

Answer 33

- ipratropium (inhaled anticholinergic) (longer duration of action than beat-agonists and no sympathomimetic effects) -

Question 34

antibiotics for acute COPD exacerbations?

Answer 34

azithromycin, ciprofloxacin, amoxicillin-clavulanate

Question 35

most cases of chronic renal failure are caused by...

Answer 35

diabetes and hypertension

Question 36

best indicator of renal failure in elderly?

Answer 36

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

Question 37

first lab indication of chronic renal failure

Answer 37

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

Question 38

with moderate renal failure pt needs

Answer 38

nephrology referral

Question 39

chronic pain definition

Answer 39

more than 3 months

Question 40

pins and needles pain medical term

Answer 40

paresthesia

Question 41

how to manage chronic nonmalignant pain with failing response to opioids

Answer 41

- 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) -

Question 42

tests of hepatic function suggestive of chronic disease

Answer 42

- albumin, bilirubin, PT

Question 43

most common cause of death in cirrhotic patients

Answer 43

varices (secondary to chronic high pressure in portal veins)

Question 44

absolute contraindications to liver transplantation

Answer 44

- portal vein thrombosis, severe medical illness, malignancy, hepatobiliary sepsis

Question 45

relative contraindications to liver transplantation

Answer 45

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

Question 46

Class I NYHA classification

Answer 46

No limitation of activity

Question 47

Class II NYHA classification

Answer 47

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

Question 48

Class III NYHA classification

Answer 48

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

Question 49

Class IV NYHA classification

Answer 49

symptoms at rest and increased symptoms with minor activity