Su 12 Ambulatory Medicine 3-8

Front 1

632. Chronic Fatigue syndrome?

Back 1

a. CFS is profound fatigue for longer than 6 months that is not due to a medical or psychiatric cause. More common in women.

Front 2

633. Chronic Fatigue syndrome cause and overview?

Back 2

a. Cause is unknown.
b. A flu-like illness may act as the triggering event, but infection has not been established as the proven cause.
c. Other theories point to immunologic disturbance or endocrine dysfunction as possible causes.
d. CFS is a diagnosis of exclusion- R/o other causes before making a diagnosis of CFS.

Front 3

634. Prognosis of Chronic Fatigue syndrome?

Back 3

a. Most pts experience partial recovery w/in 2 yrs, but relapses can occur at any time.

Front 4

635. Chronic Fatigue syndrome specific criteria for diagnosis?

Back 4

a. New or definite onset of unexplained fatigue, not alleviated by rest, not due to exertion, and significantly affecting quality of life.
b. 4 or more of the following symptoms (for at least 6 months):
1. Diminished short-term memory or concentration
2. Muscle pain
3. Sore throat
4. Tender lymph nodes
5. Unrefreshing sleep
6. Joint pain (w/o redness/swelling)
7. Headaches
8. Post-exertional malaise for longer than 24 hours.

Front 5

636. Common comorbidity w/ Chronic Fatigue syndrome?

Back 5

a. Depression.

Front 6

637. Diagnosis of Fatigue?

Back 6

a. Basic lab tests to exclude other causes- consider CBC, LFTs, serum electrolytes, calcium, TSH, ESR, and HIV (if indicated).
b. Fasting glucose
c. Extensive testing other than the above is not indicated.

Front 7

638. Tx of fatigue?

Back 7

a. Tx the underlying disorder, if known.
b. Treat CFS and pts w/idiopathic fatigue as follows:
1. Cognitive behavior therapy, including exercise, social and psychological behaviour modifications.
2. Antidepressants, as appropriate.
3. NSAIDs for relief of HA, arthralgias.

Front 8

639. Aetiology of Chronic Fatigue?

Back 8

a. Only 5% of cases are diagnosed as Chronic Fatigue syndrome.
b. Most cases of chronic fatigue are due to depression, anxiety, or both (up to 2/3).
c. Between 20-25% of cases are idiopathic yet do not fit criteria for Chronic Fatigue syndrome.
d. < 5% are due to unidentified medical illness.

Front 9

640. Prevalence of Erectile dysfunction?

Back 9

a. It is thought that up to half of all men in the US between the ages of 40-70 have some form of erectile dysfunction.
b. Prevalence increases with age.

Front 10

641. Pathophys of erectile dysfunction?

Back 10

a. Once thought to be psychogenic in origin, it is now known that most cases (80%) are organic.
b. A normal erection is largely dependent on the healthy penile and systemic vasculature.
c. Some cases of erectile dysfunction are psychogenic.

Front 11

642. Risk factors for erectile dysfunction?

Back 11

a. Most important are those that contribute to atherosclerosis: HTN, smoking, hyperlipidemia, diabetes.
b. Meds- Antihypertensives (may indirectly lower intracavernosal pressure by virtue of lowering systemic BP).
c. Haematologic- sickle cell
d. Hx of pelvic surgery of perineal trauma
e. Alcohol abuse
f. Any cause of hypogonadism/low testosterone state, including hypo-thyroidism
g. Congenital penile curvature.

Front 12

643. Diagnosis of Erectile dysfunction?

Back 12

a. Detailed H&P, including a digital rectal examination and neurologic exam. Assess for signs of PVD.
b. Lab tests: CBC, chem, fasting glucose, lipid profile. If there is hypogonadism or loss of libido, order serum testosterone, prolactin levels, and thyroid profile.
c. Nocturnal penile tumescence- If normal erections occur during sleep, a psychogenic cause is likely. If not, the cause is probably organic.
d. Consider vascular testing- evaluate arterial inflow and venous trapping of blood.
e. Tests include intracavernosal injection of vasoactive substances, duplex U/S, and arteriography.

f. Psychologic testing may be appropriate in some cases.

Front 13

644. Tx of Erectile dysfunction?

Back 13

a. Tx the underlying cause. Address atherosclerotic risk factors.
b. Hormonal replacement (e.g., testosterone) in pts w/hypogonadism.
c. Sildenafil citrate (Viagra)
d. Tadalafil
e. Intracavernosal injections of vasoactive agents (pt learns to self-administer).
f. Vacuum constriction devices
g. Psychologic therapy may be indicated to reduce performance anxiety and address underling factors that may be causing or contributing to erectile dysfunction.

Front 14

645. MOA of Sildenafil citrate (Viagra)?

Back 14

a. Oral phosphodiesterase inhibitor the promotes penile smooth muscle relaxation.
b. It can be taken 30-60 minutes before anticipates intercourse.

Front 15

646. Sildenafil citrate (Viagra) contraindications?

Back 15

a. Nitrates- because together they can cause profound hypotension.

Front 16

647. Vacuum constriction devices for erectile dysfunction?

Back 16

a. Vacuum constriction devices are rings placed around the base of the penis that enhance venous trapping of blood.
b. They may interfere with ejaculation.