Feature Archive

Clinical Challenge Case Study: Sore throat and bruises

Case Study: Sore throat and bruises

A 32-year-old woman presents to an urgent care clinic with a sore throat, subjective fever, and abnormal bruising.

Features Assessing and treating disorders of primary hemostasis

Assessing and treating disorders of primary hemostasis

An evaluation begins with a focused history and physical examination, CBC count with platelet trend, and examination of the peripheral smear.

Alternative Meds Update Copper: A metal for osteoarthritic pain management

Copper: A metal for osteoarthritic pain management

Oral copper supplements are not recommended unless extensive metabolic testing shows a true copper deficiency.

Features Preventing suicide in US veterans

Preventing suicide in US veterans

Greater awareness and enhancing communication between patients and primary care providers can help lower the risk of suicide among US veterans.

Clinical Challenge Case Study: Cardiac conditions of rheumatoid arthritis

Case Study: Cardiac conditions of rheumatoid arthritis

A 69-year-old man with no prior medical history presents over the course of several months with new-onset nonspecific joint pain and swelling without evidence of erosions.

Stat Consult Stat consult: Head lice

Stat consult: Head lice

Approximately 6 to 12 million head lice cases are diagnosed in the United States per year, primarily affecting elementary school children.

Features Breast cancer screening: a review of current mammography guidelines

Breast cancer screening: a review of current mammography guidelines

Consensus regarding mammography screening varies, and conflicting guidelines from medical organizations can cause confusion for patients and providers.

Features Preventing sudden death in young athletes

Preventing sudden death in young athletes

Hypertrophic cardiomyopathy, myocarditis, valvular heart disease, and dilated cardiomyopathy are among the most common causes.

Alternative Meds Update Kefir: A natural probiotic with vitamins, minerals, and proteins

Kefir: A natural probiotic with vitamins, minerals, and proteins

Commercially prepared kefir is considered to be safe, mainly as a result of the pasteurization process that is required for dairy products.

Clinical Challenge Case Study: Headache, neck stiffness, and fever

Case Study: Headache, neck stiffness, and fever

A 55-year-old man with a history of hypertension and migraines is sent by his primary care provider to the emergency department for a spinal tap to rule out meningitis.

Clinical Challenge Case Study: A subdural hematoma after a fall

Case Study: A subdural hematoma after a fall

A 65-year-old Hispanic man presents to the emergency department via EMS after an unwitnessed fall from a presumed standing height.

Clinical Challenge Case Study: Abdominal pain, distention, and constipation

Case Study: Abdominal pain, distention, and constipation

A 64-year-old man presents to the emergency department with abdominal pain and distention, as well as constipation of 8 days' duration.

Features Opioids and naloxone for pain management

Opioids and naloxone for pain management

Co-prescribing naloxone and opioids in primary care is recommended for patients who have a high risk for opioid overdose.

Alternative Meds Update Cod liver oil: An antibacterial, antifungal agent

Cod liver oil: An antibacterial, antifungal agent

Cod liver oil is rich in omega-3 fatty acids as well as eicosapentaenoic acid and docosahexaenoic acid and has high concentrations of vitamins A and D.

Clinical Challenge Case Study: Leg pain, nausea, and malaise

Case Study: Leg pain, nausea, and malaise

A 39-year-old man presents to the emergency department with 3 days of progressive bilateral leg pain, nausea, and malaise.

Features Hand-foot-and-mouth disease in adults

Hand-foot-and-mouth disease in adults

The disease may often go undiagnosed in adults because clinicians may be relatively inexperienced in identifying childhood illnesses in adults.

Clinical Challenge A faster heart rate and numbness: Is the patient having a heart attack?

A faster heart rate and numbness: Is the patient having a heart attack?

A 30-year-old woman presents with an increased heart rate, shortness of breath, and tingling in her right arm.

Alternative Meds Update Boron: a water-soluble element found in the earth's surface

Boron: a water-soluble element found in the earth's surface

Boron is found in small amounts in the earth's surface and is thought to be produced by the collection of particulate matter of meteorites.

Clinical Challenge Shaky, jerky eyes in an 8-week-old infant

Shaky, jerky eyes in an 8-week-old infant

An 8-week-old infant, presents to primary care with bilateral "shaky, jerky eyes."

Features Managing systolic heart failure

Managing systolic heart failure

Primary care providers can help significantly reduce heart failure exacerbations and improve their patients' overall quality of life.

Stat Consult Stat consult: Minor burns

Stat consult: Minor burns

The most common causes of minor superficial burns are sunburns and minor thermal injuries.

Features Necrotizing myopathy: muscle weakness

Necrotizing myopathy: muscle weakness

Clinicians in all settings are in a position to identify patients with potential myopathic processes and complete an initial diagnostic work-up.

Clinical Challenge Case Study: Fever and low platelets

Case Study: Fever and low platelets

A 66-year-old woman with a history of sarcoidosis and hypertension presents to the emergency department for 4 days with right-sided abdominal pain, vomiting, fever, and mild diarrhea without blood.

Features Photosensitivity diseases: a review of sun-exposed skin rashes

Photosensitivity diseases: a review of sun-exposed skin rashes

An overview of porphyrias, lupus erythematosus, rosacea, drug-induced photosensitivity, polymorphous light eruption, and solar urticaria.

Alternative Meds Update Coal tar: an anti-inflammatory treatment for psoriasis

Coal tar: an anti-inflammatory treatment for psoriasis

Coal tar products are commonly used as a treatment for psoriasis.

Clinical Challenge Case Study: Hyperglycemia, concern for diabetic ketoacidosis, and type 1 diabetes

Case Study: Hyperglycemia, concern for diabetic ketoacidosis, and type 1 diabetes

A 36-year-old man with type 1 diabetes presents to the emergency room with hyperglycemia and possible diabetic ketoacidosis after not taking his insulin for 3 days.

Features Genetic testing: an overview for clinicians

Genetic testing: an overview for clinicians

Understanding genetic testing allows providers to make the most of this resource in patient care.

Alternative Meds Update Alfalfa: weighing the risks and benefits

Alfalfa: weighing the risks and benefits

Long-term use of alfalfa has an immune-stimulating effect and can worsen autoimmune conditions such as lupus and multiple sclerosis.

Features Developmental trauma disorder: the effects of child abuse and neglect

Developmental trauma disorder: the effects of child abuse and neglect

Developmental trauma disorder, not yet officially recognized, results from child maltreatment and has many neurobiologic consequences.

Clinical Challenge Case Study in Urgent Care: Head injury

Case Study in Urgent Care: Head injury

A 71-year-old man is brought to the emergency department by his family after he tripped and fell in his backyard 30 minutes before presentation.

Clinical Challenge An unusual pelvic mass in a 43-year-old woman

An unusual pelvic mass in a 43-year-old woman

A woman who is in generally good health presents with a visibly enlarged abdomen with left-sided dominance and increased pelvic pressure that had worsened.

Features Rheumatoid arthritis: risk factors, clinical signs, and treatment

Rheumatoid arthritis: risk factors, clinical signs, and treatment

Early diagnosis and aggressive treatment are essential to mitigate the cascading events that lead to irreversible joint erosion in rheumatoid arthritis.

Clinical Challenge Case Study: Chest pain radiating into the neck

Case Study: Chest pain radiating into the neck

A 44-year-old man presents to his local urgent care clinic for chest pain radiating up into his neck that is gradually getting worse.

Global Health Rounds Canadian physician assistants: A new profession with new educational insight

Canadian physician assistants: A new profession with new educational insight

Canada's educational training programs are some of the most innovative in the world and use techniques that promote the skills that future clinicians need.

Features Thoracic outlet syndrome: A review

Thoracic outlet syndrome: A review

The condition has one fundamental pathophysiology but multiple distinct clinical presentations, including venous and neurogenic.

Clinical Challenge Case Study in Urgent Care: Leg edema and shortness of breath

Case Study in Urgent Care: Leg edema and shortness of breath

A 44-year-old man presents to an urgent care clinic with leg edema and shortness of breath.

Alternative Meds Update Frankincense: a rediscovered botanical product

Frankincense: a rediscovered botanical product

Frankincense is one of a multitude of rediscovered botanical products being studied for use in a variety of diseases and conditions.

Features Could disrupted homeostasis cause headaches?

Could disrupted homeostasis cause headaches?

Dysfunction of the endocrine system may lead to various neurologic manifestations, including headaches.

Clinical Challenge Case Study in Diabetes: Use of DPP-4 inhibitors with GLP-1 agonists

Case Study in Diabetes: Use of DPP-4 inhibitors with GLP-1 agonists

A 63-year-old man with type 2 diabetes was admitted to the hospital to undergo right robotic partial nephrectomy.

Clinical Challenge Fever and sore throat in a child

Fever and sore throat in a child

A 4-year-old girl presents to the emergency department after 3 days of worsening sore throat with a fever.

Features Managing bipolar disorder: pharmacologic options for treatment

Managing bipolar disorder: pharmacologic options for treatment

Lithium has been the mainstay of treatment for decades, but several other classes of medication have recently been used with varying degrees of success.

Alternative Meds Update Holy basil

Holy basil

Holy basil's protective mechanisms are thought to be due to the increase in antioxidant activity and alteration in gene expression.

Evidence-Based Medicine Antenatal steroids may improve respiratory outcomes for late preterm births

Antenatal steroids may improve respiratory outcomes for late preterm births

The decreased rate of respiratory complications with betamethasone suggests antenatal steroids may improve the respiratory status in late preterm infants.

Evidence-Based Medicine Regular proton pump inhibitor use associated with an increased risk of dementia in the elderly

Regular proton pump inhibitor use associated with an increased risk of dementia in the elderly

Regular proton pump inhibitor use in the elderly was associated with an increased risk of incident dementia compared with no proton pump inhibitor use, according to researchers.

Global Health Rounds Clinical officers improve health care in Kenya

Clinical officers improve health care in Kenya

Clinical officers outnumber physicians working in Kenya, and tend to work in rural areas where the need for health care is greatest.

Clinical Challenge Abnormal Pap test follow-up in a 30-year-old woman

Abnormal Pap test follow-up in a 30-year-old woman

A 30-year-old Caucasian woman reports a history of abnormal Pap test results with no other complaints.

Alternative Meds Update Kratom: The new alternative to opioids

Kratom: The new alternative to opioids

Kratom's legal future is uncertain, pending further review from the DEA and FDA.

Features Palliative care: a guide for clinicians

Palliative care: a guide for clinicians

By initiating a conversation, primary care providers can identify specific end-of-life needs and goals, manage symptoms, and coordinate care.

Alternative Meds Update Cloves effective for treating oral cavity pain

Cloves effective for treating oral cavity pain

Cloves, most commonly known in foods, are also excellent sources for treating pain in the oral cavity.

Clinical Challenge Vision changes after bariatric surgery

Vision changes after bariatric surgery

A patient notes concerns with vision difficulty 4 years after undergoing a laparoscopic biliopancreatic diversion with a duodenal switch.

Stat Consult Celiac disease

Celiac disease

In celiac disease, the surface pattern of the jejunal mucosa becomes flattened.

Alternative Meds Update Vitamin K

Vitamin K

Foods are the preferred source of vitamin K; however, supplements are widely available in many subtypes.

Global Health Rounds Starting a physician assistant program in Liberia

Starting a physician assistant program in Liberia

Steve Trexler, an American PA with over 30 years of experience, discusses the development of a physician assistant program in Liberia.

Evidence-Based Medicine Resumption of antithrombotic therapy after gastrointestinal bleeding in patients with atrial fibrillation

Resumption of antithrombotic therapy after gastrointestinal bleeding in patients with atrial fibrillation

Resuming antithrombotic therapy with in patients with atrial fibrillation and a serious gastrointestinal bleed results in better overall mortality outcomes.

Evidence-Based Medicine Risk of Alzheimer dementia after androgen deprivation therapy

Risk of Alzheimer dementia after androgen deprivation therapy

A recent cohort study evaluated the risk of developing Alzheimer dementia after ADT in 16,888 men with prostate cancer, 14.2% of whom were treated with ADT.

Evidence-Based Medicine Screening and treating pregnant women with asymptomatic bacteriuria may not be helpful

Screening and treating pregnant women with asymptomatic bacteriuria may not be helpful

Screening for asymptomatic bacteriuria may not lead to better outcomes among pregnant women and exposes them to unnecessary antibiotics.

Alternative Meds Update Restorative applications of spider web silk

Restorative applications of spider web silk

Spider web silk has been used for fabric, wound care, and is now the topic of some amazing research.

Stat Consult Stat consult: Allergic rhinits

Stat consult: Allergic rhinits

Allergic rhinitis is the twelfth most common diagnosis made at family physician visits.

Alternative Meds Update Inulin as a nutritional supplement

Inulin as a nutritional supplement

Inulin is a collective term for a large group of complex, natural carbohydrates.

Clinical Challenge Weak and dizzy spells in a patient after gastric bypass surgery

Weak and dizzy spells in a patient after gastric bypass surgery

A patient came to the clinic to discuss her dizzy spells 4 years after her Roux-en-Y gastric bypass surgery.

Alternative Meds Update Gold may possess anti-inflammatory agents

Gold may possess anti-inflammatory agents

The use of gold therapy as an anticancer agent appears promising, as does its more common use as a DMARD.

Alternative Meds Update D-mannose: an effective antibiotic alternative

D-mannose: an effective antibiotic alternative

D-mannose is a simple sugar that can be used as an effective alternative to antibiotics in a number of conditions.

Stat Consult Stat consult: Lyme disease

Stat consult: Lyme disease

The Lyme disease spirochete, Borrelia burgdorferi, is an obligate parasite and the most common tick-borne infection in North America and Europe.

Alternative Meds Update Bromelain as a proteolytic enzyme

Bromelain as a proteolytic enzyme

Found in pineapple, bromelain is a well known proteolytic enzyme.

Clinical Challenge Cultural considerations in diabetes: controlling HbA1c in a patient observing Ramadan

Cultural considerations in diabetes: controlling HbA1c in a patient observing Ramadan

A patient with type 2 diabetes is undergoing dialysis and needs to control his HbA1c levels while fasting during Ramadan.

Features Domestic minor sex trafficking: missed clinical opportunities

Domestic minor sex trafficking: missed clinical opportunities

An awareness of the risks and red flags among adolescent patients who are being trafficked for sex is key to intervention in this vulnerable population.

Clinical Challenge An unusual cause 
of respiratory distress in an infant

An unusual cause 
of respiratory distress in an infant

A congenital condition is found in an infant with respiratory and gastrointestinal symptoms.

Alternative Meds Update Slippery elm: an effective anti-inflammatory agent

Slippery elm: an effective anti-inflammatory agent

Slippery elm may be beneficial for patients with GI complaints.

Features Pesticides and 
Parkinson's disease

Pesticides and 
Parkinson's disease

Increasing evidence has shown a link between pesticide exposure and the risk for Parkinson's disease. How real is this link on the golf course?

Stat Consult Stat consult: Zika virus

Stat consult: Zika virus

Between 75% and 80% of Zika virus infections are asymptomatic.

Clinical Challenge Odorous stools, laboratory abnormalities after gastric bypass surgery

Odorous stools, laboratory abnormalities after gastric bypass surgery

A patient comes to her yearly nutrition check-up 11 years after undergoing gastric bypass surgery with reports of loose stools with significant odor several times per day.

Features Osteoarthritis: conservative treatment options

Osteoarthritis: conservative treatment options

Osteoarthritis is one of the most common problems encountered in primary care, and conservative treatment can improve patients' quality of life.

Features Medical nutrition
 therapy in diabetes

Medical nutrition
 therapy in diabetes

Developing personalized nutrition goals with a registered dietitian
can be effective in managing non-insulin-dependent diabetes.

Alternative Meds Update Chromotherapy as treatment for medical conditions

Chromotherapy as treatment for medical conditions

Chromotherapy focuses on rebalancing patients' chakras.

Features Current and emerging medications for psoriasis

Current and emerging medications for psoriasis

A number of therapeutic options exist for patients with psoriasis, including phototherapy and systemic and biologic agents.

Clinical Challenge Managing nephropathy in a patient with type 2 diabetes

Managing nephropathy in a patient with type 2 diabetes

A patient with type 2 diabetes presents with elevated microalbumin levels and a recent history of elevated glucose due to bedtime snacking.

Features Infantile hemangiomas: benign lesions with potential complications

Infantile hemangiomas: benign lesions with potential complications

Although usually benign, some infantile hemangiomas have complications that are potentially fatal or physically debilitating if untreated.

Features Cryptogenic organizing pneumonia

Cryptogenic organizing pneumonia

Patients with COP generally have positive outcomes following a definitive diagnosis and the initiation of appropriate treatment.

Stat Consult Stat Consult: Acute sinusitis in children and adolescents

Stat Consult: Acute sinusitis in children and adolescents

Acute sinusitis is common, affecting 6% to 7% of children presenting with respiratory symptoms.

Alternative Meds Update Bright light therapy effectively treats psoriasis, acne

Bright light therapy effectively treats psoriasis, acne

Bright light therapy may be safe and effective in children and adolescents.

Features Signs and symptoms of hepatitis C virus infection

Signs and symptoms of hepatitis C virus infection

Education of high risk populations and regular testing are crucial steps clinicians can take to stem the spread of hepatitis C infection.

Global Health Rounds In the wake of the Ebola crisis, PAs in Liberia face professional challenges

In the wake of the Ebola crisis, PAs in Liberia face professional challenges

Physician assistants in Liberia have played a key role in their country's health care during times of crisis, but they still face professional challenges.

Clinical Challenge Wrist pain after a fall: a simple fracture?

Wrist pain after a fall: a simple fracture?

After a fall on an outstretched hand, wrist injuries are common, but ligament tears should also be considered in adults.

Features Crohn disease: diagnosis and treatment

Crohn disease: diagnosis and treatment

A condition prone to recurrence, Crohn disease has a complicated presentation and pathophysiology, but multiple treatment options are available.

Alternative Meds Update Insufficient evidence exists for clinical recommendation of medical marijuana

Insufficient evidence exists for clinical recommendation of medical marijuana

Although small studies show potential efficacy of medical marijuana in treatment of specific conditions, insufficient evidence exists for clinicians to recommend or prescribe to patients.

Evidence-Based Medicine Glasgow Coma Scale may underestimate severity of isolated traumatic brain injury in patients aged ≥65 years

Glasgow Coma Scale may underestimate severity of isolated traumatic brain injury in patients aged ≥65 years

Study results suggest that GCS may be less accurate in predicting the extent of injury in elderly adults.

Evidence-Based Medicine In patients with first unprovoked venous thromboembolism, adding CT to limited cancer screening may not lead to statistically higher rate of cancer detection

In patients with first unprovoked venous thromboembolism, adding CT to limited cancer screening may not lead to statistically higher rate of cancer detection

Unprovoked venous thromboembolism has been associated with the presence of occult malignancies.

Clinical Challenge Markedly elevated serum transaminase levels

Markedly elevated serum transaminase levels

An incidental finding in an asymptomatic woman is followed by rapid deterioration of her condition.

Evidence-Based Medicine In patients without 
CVD or diabetes, pooled cohort equations may underestimate risk for CV event if other risk factors are present

In patients without 
CVD or diabetes, pooled cohort equations may underestimate risk for CV event if other risk factors are present

Accurate prediction of cardiovascular disease risk is crucial for the success of preventive measures.

Stat Consult Stat Consult: Norovirus 
infection

Stat Consult: Norovirus 
infection

Norovirus is the leading cause of both sporadic and epidemic gastroenteritis worldwide.

Features Primary care clinician risk assessment for hereditary breast cancer

Primary care clinician risk assessment for hereditary breast cancer

Primary care clinicians should be proficient at assessing the potential for hereditary breast cancer risk in their patients.

Global Health Rounds In Uganda, clinical officers rise to the challenge of meeting public health needs

In Uganda, clinical officers rise to the challenge of meeting public health needs

In Uganda, clinical officers are addressing public health needs by training to work in rural areas and treating the country's growing population.

Features A clinician's guide for managing patient perceptions of the flu vaccine

A clinician's guide for managing patient perceptions of the flu vaccine

By presenting research on the safety and efficacy of the flu vaccine, clinicians can successfully promote vaccination to patients in their care.

Features Personalizing anticoagulant treatments for nonvalvular atrial fibrillation

Personalizing anticoagulant treatments for nonvalvular atrial fibrillation

Multiple considerations come into play when choosing anticoagulant therapy for a patient with atrial fibrillation, a condition that greatly increases the risk for stroke.

Evidence-Based Medicine Palliative chemotherapy may reduce quality of life in some patients with end-stage cancer

Palliative chemotherapy may reduce quality of life in some patients with end-stage cancer

Palliative chemotherapy in the last month of life may increase the patient's risk of intensive medical treatment and death in an ICU.

Evidence-Based Medicine Denosumab may reduce the risk of fracture in women with breast cancer on aromatase inhibitor therapy

Denosumab may reduce the risk of fracture in women with breast cancer on aromatase inhibitor therapy

Denosumab has been shown to reduce fracture risk in women with breast cancer with bone metastases.

Evidence-Based Medicine Initiating antiretroviral therapy in HIV patients with CD4 T-cell counts >500 cells/mcL

Initiating antiretroviral therapy in HIV patients with CD4 T-cell counts >500 cells/mcL

Recommendations for initiation of antiretroviral therapy (ART) in asymptomatic adults with HIV are generally based on CD4 T-cell counts.

Evidence-Based Medicine Vitamin D supplementation does not improve functional outcomes in postmenopausal women

Vitamin D supplementation does not improve functional outcomes in postmenopausal women

Vitamin D deficiency is especially prevalent in postmenopausal women, and recommendations from current guidelines are inconsistent regarding vitamin D use.

Beyond Rx: OTC Corner Cold and cough 
symptom relief

Cold and cough 
symptom relief

Safe and effective over-the-counter and herbal treatments are available for patients with viral upper respiratory infections.

Stat Consult Stat Consult: Influenza 
in children

Stat Consult: Influenza 
in children

Learn how to diagnose and treat influenza in children.

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