Feature Archive

20th Anniversary Clinical Pearl Giveaway Internet "Challenges" and Teenagers: a Guide for Primary Care Providers

Internet "Challenges" and Teenagers: a Guide for Primary Care Providers

Discussions involving Internet challenges with children and adolescents should be as sensitive as those about sexuality and drug or alcohol use.

Stat Consult Stat Consult: Chronic Low Back Pain

Stat Consult: Chronic Low Back Pain

Chronic low back pain (LBP) defined as persistent or fluctuating musculoskeletal pain of lower back and lumbar spine lasting >3 months.

Neurology Information Center Hormonal Contraceptives and Migraine: Is It Time to Revisit Stroke Risk?

Hormonal Contraceptives and Migraine: Is It Time to Revisit Stroke Risk?

Current oral contraceptive products contain lower doses of estrogen than those used in the past, prompting reconsideration of risks and benefits.

Vaccine Information Center Platform Manufacturing May Speed Pandemic Vaccine Development

Platform Manufacturing May Speed Pandemic Vaccine Development

With the advent of platform manufacturing technology, vaccines can be developed quickly to stop the spread of outbreaks.

Asthma Information Center Obstructive Sleep Apnea in Asthma: Gaining Control by Losing Weight

Obstructive Sleep Apnea in Asthma: Gaining Control by Losing Weight

Poor control of asthma and obstructive sleep apnea can feed off one another, according to Michelle Zeidler, MD, pulmonologist at the University of California, Los Angeles, and director of the UCLA Sleep Fellowship Program.

Practice Management Information Center Should Clinicians Treat Family and Friends? Three Experts Weigh In

Should Clinicians Treat Family and Friends? Three Experts Weigh In

Although all of the guidelines acknowledge that there are emergent situations in which providing care for a family member or friend is not only permissible but also essential, other situations are frowned upon.

Legal Advisor Patient Test Results Never Received

Patient Test Results Never Received

A clinician fails to follow up after ordering diagnostic tests for a patient.

Clinical Challenge Case Study: Sudden Abdominal Pain

Case Study: Sudden Abdominal Pain

A 90-year-old woman with a history of coronary disease and gallstones presents to the emergency department with generalized abdominal pain that started suddenly about 7 hours prior.

Practice Management Information Center Does Political Affiliation Influence Patient Care? An Interview With Anupam B. Jena, MD

Does Political Affiliation Influence Patient Care? An Interview With Anupam B. Jena, MD

To shed further light on the study's implications, MPR interviewed lead author Anupam B. Jena, MD, PhD, Ruth L. Newhouse Associate Professor, Harvard Medical School, Boston, MA.

Features Social Media and Adolescents: What Are the Health Risks?

Social Media and Adolescents: What Are the Health Risks?

Primary care providers should screen for depression and other health-related risks associated with the use of social media by adolescents.

Features A History of Race and the Emerging Role of Genetics in Primary Care

A History of Race and the Emerging Role of Genetics in Primary Care

In 2003, the Human Genome Project became the culmination of the history of genetics research, allowing us to understand the role of genetics in human health and disease. As part of The Clinical Advisor's 20th Anniversary, this article explores the influence of race and genetics in clinical practice.

Pediatrics Information Center Managing Pediatric Migraine: Current Therapies and Future Directions

Managing Pediatric Migraine: Current Therapies and Future Directions

Migraine is highly prevalent in children and adolescents, affecting almost 10% of children between 5 and 15 years old and 30% of adolescents between 15 and 19 years old.

Legal Advisor Liability After a Missed Diagnosis

Liability After a Missed Diagnosis

A patient dies after a clinician fails to act on signs of a potential case of deep vein thrombosis.

Features Amyotrophic Lateral Sclerosis: Update for the Primary Care Clinician

Amyotrophic Lateral Sclerosis: Update for the Primary Care Clinician

Patients with ALS require multidisciplinary care and rehabilitative interventions; maximizing independent function and quality of life are the goals.

Clinical Challenge Case Study: Cardiovascular Complications of Chronic Obstructive Pulmonary Disease

Case Study: Cardiovascular Complications of Chronic Obstructive Pulmonary Disease

A 55-year-old man with chronic obstructive pulmonary disease reports having some mild chest pain.

Stat Consult Stat Consult: Parenteral Nutrition Issues

Stat Consult: Parenteral Nutrition Issues

Some include mechanical complications, central vascular access complications, and compatibility issues.

Features Oral Anticoagulation: Reversing the Current View in Bleeding Events

Oral Anticoagulation: Reversing the Current View in Bleeding Events

Advances in new reversal agents will be key for managing patients treated with DOACs to prevent major bleeding events.

Neurology Information Center Hans Asperger, Leading Autism Researcher, Tied to Nazi Child Euthanasia Program

Hans Asperger, Leading Autism Researcher, Tied to Nazi Child Euthanasia Program

Medical records of 48 children examined by Asperger show that he specifically called for 12 of the children to be transferred to the Am Spiegelgrund facility, the 'euthanasia' institution founded in 1940.

Endocrinology Information Center Updated Clinical Practice Guidelines on Testosterone Therapy in Men With Hypogonadism

Updated Clinical Practice Guidelines on Testosterone Therapy in Men With Hypogonadism

Testosterone therapy is recommended in men with hypogonadism to correct symptoms of testosterone deficiency. Men who are otherwise healthy do not need to be screened for hypogonadism.

Clinical Challenge Case Study: Mottling and Infection in an Adult

Case Study: Mottling and Infection in an Adult

A 44-year-old woman presents to her local emergency department after 5 days of persistent fever, productive cough, and worsening dyspnea on exertion.

Legal Advisor Voiding a Noncompete Clause

Voiding a Noncompete Clause

A clinician attempts to void a restrictive noncompete clause that she had signed before beginning her current job as an NP.

Clinical Challenge Case Study in Diabetes: Fungal Infections

Case Study in Diabetes: Fungal Infections

A 68-year-old patient with type 2 diabetes presents to a urologist to evaluate funguria, and a CT scan showed right hydroureteronephrosis.

Features Deep Vein Thrombosis: History and Evolution of Treatment

Deep Vein Thrombosis: History and Evolution of Treatment

Deep vein thrombosis is a significant source of morbidity and mortality, so it is imperative that clinicians understand how to recognize and treat patients with the disorder.

Clinical Challenge Case Study: Headache, Back Pain, and Fever

Case Study: Headache, Back Pain, and Fever

A 25-year-old woman presents to the emergency department with a chief complaint of headache, back pain, and fever, while also experiencing some vaginal itching and discharge.

Stat Consult Stat consult: Sudden cardiac death

Stat consult: Sudden cardiac death

Described as death within an hour of onset of any symptom

Clinical Challenge Case Study: Worsening Dyspnea in a Pregnant Woman

Case Study: Worsening Dyspnea in a Pregnant Woman

A 32-year-old woman, diagnosed several months earlier with pulmonary arterial hypertension, presented to the emergency department with dyspnea and near syncopal episodes.

Legal Advisor A Patient Is Mistakenly Told He Is Dying

A Patient Is Mistakenly Told He Is Dying

A clinician shares a patient's incorrect diagnosis with another government agency.

Clinical Challenge Case Study: Chest Pain and Shortness of Breath in a Patient with Colorectal Cancer

Case Study: Chest Pain and Shortness of Breath in a Patient with Colorectal Cancer

A 64-year-old woman who was recently diagnosed with colorectal cancer is brought to the emergency department with substernal chest pain and shortness of breath.

Features Acute infectious diarrhea: a clinical approach

Acute infectious diarrhea: a clinical approach

The first step for managing a patient with diarrhea is to determine the severity of dehydration according to the estimated volume loss and the symptoms and signs noted on physical examination.

Stat Consult Stat consult: Intimate partner violence

Stat consult: Intimate partner violence

Intimate partner violence was reported in over 30% of female psychiatric patients.

Clinical Challenge Case Study: Syncope, Dizziness, and Fatigue on a Camping Trip

Case Study: Syncope, Dizziness, and Fatigue on a Camping Trip

A 52-year-old man presents to the emergency department with dizziness and fatigue after a syncopal episode on a camping trip.

Pain Information Center Assessing lidocaine efficacy for chronic pain management

Assessing lidocaine efficacy for chronic pain management

Intravenous, patch lidocaine might be effective in treating, preventing chronic pain.

Clinical Challenge Case Study: A gradually progressive rash after a URI

Case Study: A gradually progressive rash after a URI

A 33-year-old man presents to the emergency department for 6 small spots on his chest, arms, and legs that gradually grew in diameter after using a topical cream and cephalexin.

Practice Management Information Center Sex and drugs: An interview about discussing sensitive patient topics

Sex and drugs: An interview about discussing sensitive patient topics

Dr Windel Stracener, a family practitioner for 22 years, discusses substance abuse, sexual activity, and other sensitive topics many clinicians do not ask their patients.

Legal Advisor Sexual Harassment at Work

Sexual Harassment at Work

A nurse in a VA facility files a complaint against a clinician, which ends with a criminal conviction.

Features Coronary artery disease: primary prevention measures

Coronary artery disease: primary prevention measures

Primary prevention efforts such as exercise, weight control, cessation of smoking, and alcohol intake can greatly affect the development of CAD.

Features Managing acute UTIs in postmenopausal women

Managing acute UTIs in postmenopausal women

UTIs present clinically as dysuria, with symptoms of frequent and urgent urination secondary to irritation of the urethral and bladder mucosa.

Clinical Challenge Case Study: Dizziness in a 42-year-old man

Case Study: Dizziness in a 42-year-old man

A 42-year-old man presents to the emergency department with vertigo that is worse with head motion as well as vomiting, but has no headache or abdominal pain.

Influenza Information Center The race to develop a universal influenza vaccine

The race to develop a universal influenza vaccine

NIH's National Institute of Allergy and Infectious Diseases is researching ways to develop a universal influenza vaccine against multiple strains.

Influenza Information Center The flu pandemic of 1918: 100 years later

The flu pandemic of 1918: 100 years later

In 1918, between 50 and 100 million people are thought to have died from the great influenza pandemic, representing as much as 5% of the world's population.

Clinical Challenge Case Study: Lower extremity edema and heart failure in a middle-aged woman

Case Study: Lower extremity edema and heart failure in a middle-aged woman

A 55-year-old obese woman with hypertension, diabetes, and scleroderma is referred for follow-up after a recent admission for new-onset heart failure.

Legal Advisor A dosage change over the phone

A dosage change over the phone

A clinician makes a dosage change for a patient during a telephone call, which leads to a lawsuit.

Features Long-acting reversible contraceptives: a review

Long-acting reversible contraceptives: a review

Because of the high number of unintended pregnancies and the effectiveness of LARCs, they should be a first-line contraceptive option for most women.

Obesity Resource Center Case Study: Shortness of breath in a COPD patient with obesity

Case Study: Shortness of breath in a COPD patient with obesity

A middle-aged patient with morbid obesesity and COPD complains about having shortness of breath at rest and dyspnea on exertion.

Features Noninvasive colorectal cancer screening

Noninvasive colorectal cancer screening

The FIT and the MT-sDNA are evidence-based tests that should be considered for CRC screening when a colonoscopy cannot be performed.

Mood Disorder Information Center Analyzing differences in illness and outcomes for anxious depression

Analyzing differences in illness and outcomes for anxious depression

Ranging definitions of anxiety associated with depression have caused variations in findings.

Clinical Challenge Case Study: Foot pain after jogging

Case Study: Foot pain after jogging

A 64-year-old woman presents to an urgent care clinic with 24 hours of left foot pain. She states that she tweaked it while jogging. The pain is localized to the lateral portion of her foot.

Legal Advisor Clinicians in a contract dispute

Clinicians in a contract dispute

Two NPs in practice together end up in court after one loses her license.

Mood Disorder Information Center Modest changes in level of exercise may prevent new cases of depression

Modest changes in level of exercise may prevent new cases of depression

Relatively modest changes in population levels of exercise may have important public mental health benefits and prevent a substantial number of new cases of depression.

Features Human papillomavirus in males

Human papillomavirus in males

The importance of male vaccination cannot be overemphasized, because the risk of male-to-female HPV transmission is significant.

Clinical Challenge Case Study: Diarrhea and rash

Case Study: Diarrhea and rash

A 60-year-old man with a history of gastroesophageal reflux disease presents to the emergency department with 2 to 3 days of fever, non-bloody diarrhea, and a worsening non-pruritic rash.

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.

Legal Advisor A patient commits murder

A patient commits murder

A nurse practitioner is sued by her patient's children after their mother is murdered.

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.

Mood Disorder Information Center Patients with various dermatologic disorders have greater depression risk

Patients with various dermatologic disorders have greater depression risk

Common psychiatric comorbidities such as depression, suicidal ideation, and body dysmorphic disorder are found in up to 30% of dermatologic patients.

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.

Legal Advisor Fired after violating a patient's privacy

Fired after violating a patient's privacy

A nurse notifies other clinicians that a patient is positive for hepatitis C.

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.

Practice Management Information Center Divergent views on the ACP position statement on physician-assisted suicide

Divergent views on the ACP position statement on physician-assisted suicide

The ACP proposes that efforts should focus on improving end-of-life care, as through palliative and hospice care.

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.

Mood Disorder Information Center Limited evidence available for augmentation therapy in treatment-resistant depression

Limited evidence available for augmentation therapy in treatment-resistant depression

Clinicians prescribing antidepressants may need to consider augmenting monotherapy with another agent.

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.

Legal Advisor The importance of good notetaking

The importance of good notetaking

Taking good notes is one of the most important steps a clinician can take to reduce the risk of a lawsuit.

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.

Infectious Diseases Information Center Diagnosis of hospital-acquired pneumonia still a challenge

Diagnosis of hospital-acquired pneumonia still a challenge

Clinicians must rely on the combination of clinical examination, signs and symptoms, microbiologic testing, and radiographic findings to diagnose hospital-acquired pneumonia.

Legal Advisor Birth control leads to a blood clot

Birth control leads to a blood clot

A patient presents with chest pain 6 weeks after beginning use of a contraceptive device.

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.

Practice Management Information Center Accountable Care Organizations: Do they save money?

Accountable Care Organizations: Do they save money?

ACOs have potential for success in improving the quality of and access to care, and these models promise to provide sustainable reform of healthcare costs for the future.

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."

Legal Advisor Fired for refusing vaccination

Fired for refusing vaccination

A clinician files a lawsuit against her employer after being fired for refusing Tdap immunization.

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.

Legal Advisor A nurse fired for falling asleep on the job

A nurse fired for falling asleep on the job

After a nurse is fired for falling asleep at her job at a hospital, she claims that it was in retaliation for taking time off under the FMLA.

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.

Legal Advisor Lab results never given to a patient

Lab results never given to a patient

An NP does not inform her patient about his lab results, which showed extensive kidney damage. He collapsed 2 months later.

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.

Legal Advisor A suspicious mole

A suspicious mole

A clinician's failure to follow up on a patient's mole results in a delayed diagnosis of cancer.

Diabetes Resource Center Using information technology to tailor diabetes care

Using information technology to tailor diabetes care

A study of one tracking system's effect finds improvement in the management of diabetes.

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.

Legal Advisor When a referral goes wrong

When a referral goes wrong

A clinician misses a differential diagnosis when she refers a patient to a specialist for rectal bleeding.

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