Medex Winter BS Final Review Page

MEDEX Objectives Home: http://faculty.washington.edu/alexbert/MEDEX/

WE’RE ALL IN THIS TOGETHER

Adult Sexuality

Fertilizer

Sexual Minorities

Lesbians

Don’t deny any feelings – gay, love etc.

            Don’t tell tem they’re wrong

            Their feelings are real!

Lesbian

Asdfa-how you ask your questions.

-Lesbian women do need paps.

Spoken maybey assumption

•      On why Buch let people go

•      That straight MD’s don’t make referrals, Rx’s etc

•      Our of 500 people only 5 are lesbian – maybe they were

•      Survesys are 10 years old – not valid – not lesbian health survey; Michigian Lesbian Health Survey.

•      Assessing why reports/research aren’t published in magazines – how does she know?

•      Assessing have increasing CA rates – nothing to back it up

Health Risks for Lesbians

•      CA – lung, breast, cervical (HPV), ovarian and endometrial

•      Cardiovascular – smokers, overweight

•      Disordered substance uses – etoh – still drinking until then,    drugs old, straight women stop about 45

•      Psychosocial and mental health – been told they have to be sore they their not

•      STDs – HPV, CT/GC, HIV BV (bacterial vaginitis), HSV type I and II  If are woman has BV – 82% chance partner does to.

Tell them

•      Accessing the septen (health care activists) – becoming a aelltably expert provider

•      Nutrition and exercise

•      Smoking cessation – etoh moderation

•      Stress management – where can they make positive ideals from lesbian research center

What can we do

•      Antidiscrimination statement – age,  sex, race, sexual minorities

•      Inclusive on seutral art – people of of races

•      Varity of magazines – good housekeeping ebony jet local gay lesbian newspapers for all people races lifestyles

•      Husbands aren’t the only spouse

•      Health education brochures – STDs breast CA for all populations

“do you have sex with men women or both”

“this is a safe place to talk:  we treat gay/lesbians/straight and thoses who don’t’ knew; so if you ever need help or have questions, please come see me.  If I don’t know I’ll find out or find a resources for you!!!”

Parents of G/L kids

•      Americans friends service – for parent

•      Parents and friends of gays and lesbians PFLAG – have book in office – corversations from straight parents with G/L kids

Toys

Use toys – sharing – use condoms for them.

Gay men

Don’t put your moral values on the pt.

•      Certification is an honor

•      Society gives you the priveldge to use it

Sincerity toward sexual minority care (nice)

Sdfasfd knowledge basif a providey adequate care to gay men (sinart)

Ilts not only about sex…

Know your pt

•      Is self identification

•      Is sexual and social behavior

•      Is culutural, ethnic, psychosocial background

•      Personal sexual hx is important

•      Avoid making generalizations

Take a good sexual history

Knowledge of common gay sex practices – reduce transmission of HIV and Aids

Knowledge of common gay sex venues

            Substance abuse

            Psychosocial needs – stigma – “comegait” self esteem depression substance abuse body language isolation aging

            Medical legal issues

Medical legal

•      Parenting

•      Living wills – your decisions in a bad health setulinon

•      Durable power of attorney for health care – desgenerate another person to make your decisions

•      Wills

APA – do support same sex adoptions

Healthcare decisions about the end of life - $4 a piece

Sexual hx

•      Best done at the appropriate time and place

•      Take advantage of hints pt gives

•      Give the pt room – put the chart pen down uncross legs look relaxed even if you’re not

•      Of sexual behavior

•      Gender and frequency of sex partners

•      Venues activities associated with sex

•      Safer sex practices

Can be in a privay relationship but have multiple sex partners

Don’t say “ are you faithful” to judgmental

Do say – do you have any other sex partners besides your primary partner?

Take cues from pt on verbage

Vocabulary

Top – the giver

Bottom – the receiver

Rimming – tonguing the anus – oral anal contact

Water sports – sex involving urine

MSM – men who have sex with men

Barebacking – anal sex without a condom

Crystal – meth – popular – ice not used by gay

Poppers – amal nitrate – inhale to enhance sex

The baths – where gay men go to have sex

In Seattle – club z, basic plumbing – oral sex only club

Fuck buddies – sexual friends

Bath houses – legal for sex

Parks, restrooms – not legal for sex

Arranging for gay sex

Bars –traditional but probably not for long term relationships

Internet – non-threatening

Monogamy –

•      If truly monogamous – not at a risk for HIV, STDs

•      But rial can still pass – partner can be a carrier of HIV HPH Hep B HCV

Substance abuse

•      Etoh, tobacco, crystal meth, Viagra alone or with crystal

•      Amyl nitrate (poppers)

•      Viagra/poppers = nitrate so contraindicated with Viagra drops down BP!!

•      Substance use is associated with sexual/social lifestyles need culturally appropriate treatment

•      Store wall – a gay/lesbian detox program – closed

•      Lakeside nlylerdin   fivedish   gay/lesbian counslees at these centers

“Push” – liquid incense = poppers

screening guidelines

sex with men in past 12 months

•      Hiv serology

•      Serological test for syphilis

•      Pharyngeal GC culture

Receptive anal sex in past 12 months

•      Rectal GC culture

•      Rectal Chlamydia sulture

•      Urethral/urine GC/CT testing not recommended (<1% prevalence in asymptomatic men)

•      Frequency of testing – every 3-6 months

•      Multiple or anonymous partners

•      Use of crystal meth or inhaled nitrates (poppers)

•      Men whose sex partners do these things

Hep A & B

HSV – herpes

No connection with anal sex and prostate cancer

Trauma – anal fissure – treat – no anal sex- treat then ok

Assertive partner – recurrent utis

HIV prevention

•      Start meds with a few hours from exposure not a few days later or else its to late.

•      Receptive anal penetration – not ejaculation ( + HIV partner) – treat prophylaxis HIV meds

pshalit@u.washington.edu

Anxiety Disorders

75% have anxiety and a 2^nd other diagnosis

Some self med ETOH and drugs and miss work

GAD generalized anxiety disorder

MDD  major repressive disorder

Fam Hx Environmental transfer from living with their parent with PTST not genetic

Panic attack  - a discrete period of intense fear or discomfort in which four (or more) symptoms developed abruptly and reached a peak within 10 minuts

Agroaphobia  - descripteal term goes with another disorder  - intense anxiety about being in a situation where escape is difficult help may not be abailable

Social phobias – marked and persisten fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation. – the person recognixes that the fear is excessive or unreasonable

            Self medicate with etoh to decrease social anxiety

OCD – obsessions or compulsions – not psychotic – not delushala

GAD – excessive worry for more days that not    Lasts at least 6 months    Looks like depression symptoms

Anxiety disorder due to a general medical condition   ex – increased thyroid  tx medical condition before treat psych condition

Separation anxiety disorder  - childhood disorder

Anxiety disorder NOS  - catch all group  - not otherwise specified

Pain

Nociceptor = pain receptors

Fingers (MS) and skin – largest # of px receptors in the body

Gut – worse # px receptors

Pain-

Cognition leads to fear and avoidance

Pain has to be communicated verbal and nonverbal

Brain-

            Cognition – you understand the px

            Location site quality – what do you feel

            Suffering response that produces avoidance response fear

Pain behavior-

What the pt shows us as px limping etc

Expressed-

Verbal

Nonverbal

Check for inconstitely

  Fellins thoughts – have to be expressive

-gender – female/male

-culture – different generations (ages)

-up bringing

malingering – do what they do knowingly

depression – extragerated pain levels and behaviors – normally severe symptoms

increased anxiety person extagerated pain levels and behaviors

sepresed – fixed visit insleall fprax visits

pain

chronic – rare but sere

increased recurrent inflammlery exibiits

px can be very ston

oppiods 

nsaids –gi problems

sz drugs

tricyclic

Sexual Assault

HIV/AIDS Panel

Jerry

Scared to know

Do you have a good support system

Before test results give

I have a capacity for denial

Getting depressed

Darlene

Didn’t’ fit the protocol according to MD so she was never tested

White pill – blue band horse on the side AZT drug

Trusted partner – asked him and trusted his answer

Kept asking who support group was – manes, phone #s, what did she do for fun, daughter names?  Pre-counseling appt. – but pt didn’t know it.

When told – pt cried for an hour – couldn’t remember name of herself on daughters.  Good thing she asked frist.  Cried in car for a hour coun’t remember how to get home.

Tonya

Asian Female  I never give up

Tired study work – getting worse

Was admitted for 6 days – before told (+)

I never think it happen to me, in a student

Is so smart yet is so stupid

Paula

Dx 1988 40 now

Run away at 16y/o in LA heroin addict

Though she had “dope sick”

Growth on side of face – thought maybe tooth abcess fever – huge

Nobody goes into the hospital unless you almost dead

Strect person – no counseling in hosp

You have AIDS you have 2 months – 2 years away and walked out.  No counseling – no anything

I shut my mind down

The disease was a blessing  I could get out of my hell – hole life

I got pregnant – now it was my life and someone else’s

They all know the exact dates

When they were told where

Past hospitalization

Exact counts – t-cells # and dates

Was scared family would say “you gotta go”

Its going to be around – learn to live with it

Stress - #1 factor to effect side effects of drugs

Women’s group, grandkids – helps with daily activity

Look at for yourself and enforce it

Chicken soup – meals on wheels

Pokaeaes – chemical dependency self and family members HIV support for people affected and not affected

            Can bring family member to for support

Shante – hot line #

Have list of resources ready for pt when give diagnosis

Support groups and what they each offer

Just listen

Its [relationships] not like what the doctors say

Safe sex is masturbation

When I miss it is seciores –(medieise)

I just hope we don’t have a lot of AIDS people here

Psychotherapy in Primary Care

“Not testable”

Updated 7 Dec 2003