RSS 1.0Clinical Inquiries, 2008
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Which patients undergoing noncardiac surgery benefit from perioperative beta-blockers?
(Family Physicians Inquiries Network, 2008)Patients with moderate to high cardiac risk (a Revised Cardiac Risk Index [RCRI] score of 2 or higher [Table]) have a reduced risk of in-hospital death following perioperative beta-blocker therapy (strength of recommendation ... -
Which lab tests are best when you suspect hypothyroidism?
(Family Physicians Inquiries Network, 2008)Thyroid-stimulating hormone (TSH) level is the preferred test for initial evaluation of suspected primary hypothyroidism (strength of recommendation [SOR]: C, expert opinion). If TSH is abnormal, a free thyroxine (T4) level ... -
Which clinical features and lab findings increase the likelihood of temporal arteritis?
(Family Physicians Inquiries Network, 2008)Jaw claudication, diplopia, or a temporal artery abnormality on physical exam increase the likelihood of temporal arteritis. A finding of thrombocytosis in a patient with suspected temporal arteritis moderately increases ... -
Which drugs are safest for moderate to severe depression in adolescents?
(Family Physicians Inquiries Network, 2008)Selective serotonin-reuptake inhibitors (SSRIs) appear to be the safest, given current data. Major safety concerns--prompting a US Food and Drug administration (FDA) black box label warning--have been raised about increased ... -
Which drugs are most effective for moderate to severe depression in adolescents?
(Family Physicians Inquiries Network, 2008)Fluoxetine is the only selective serotonin-reuptake inhibitor (SSRI) approved by the US Food and Drug Administration (FDA) to treat depression in children 8 years of age and older; it also has the most favorable benefit-to-risk ... -
When should you admit a patient with suspected CAP?
(Family Physicians Inquiries Network, 2008)When the patient has 2 or more of the following CURB-65 criteria: respiratory rate ≥30, acute confusion, low blood pressure (systolic blood pressure <90 or diastolic BP ≤60 mm H g), blood urea nitrogen [BUN ] >19.6 mg/dL, ... -
What is the best workup for hypocalcemia?
(Family Physicians Inquiries Network, 2008)Unexplained hypocalcemia can usually be diagnosed by a limited number of serum tests when the cause isn't obvious from the history (recent neck surgery or renal failure): calcium corrected for serum albumin); creatinine; ... -
What's the best way to treat Achilles tendonopathy?
(Family Physicians Inquiries Network, 2008)Rest and ice are considered first-line therapy for acute Achilles tendonopathy (strength of recommendation [SOR]: C, expert opinion), as is nonsteroidal anti- inflammatory drugs (NSAIDs) (SOR: B, systematic review). Chronic ... -
What are the most effective ways you can help patients stop smoking?
(Family Physicians Inquiries Network, 2008)Brief counseling, nicotine replacement therapy, antidepressants, and varenicline all work well. Physician intervention should begin with routine assessment of smoking status for all patients. Brief (3 minutes or less) ... -
What is the best way to screen for breast cancer in women with implants?
(Family Physicians Inquiries Network, 2008)Mammography is best. It is considered as effective for screening women who have undergone augmentation mammoplasty as those who have not (strength of recommendation [SOR]: B, limited number of retrospective and prospective ... -
What's the best way to manage athletes with amenorrhea?
(Family Physicians Inquiries Network, 2008)Ruling out secondary causes of amenorrhea is, of course, the first step. Once that's done, you can make a presumptive diagnosis of hypothalamic amenorrhea and advise the patient to increase caloric intake or decrease energy ... -
What is the best way to evaluate an acute traumatic knee injury?
(Family Physicians Inquiries Network, 2008)The Ottawa Knee Rules can guide the use of radiography in adults who present with isolated knee pain. However, information on use of these rules in the pediatric population is limited (strength of recommendation [SOR ]: ... -
What is the best treatment for oral thrush in healthy infants?
(Family Physicians Inquiries Network, 2008)Nystatin oral suspension is a safe first-line therapy; fluconazole is more effective (strength of recommendation [SOR ]: B, 1 small randomized controlled trial [RCT]) but has not been approved by the Food and Drug ... -
What screening tests should you use to evaluate a man with low testosterone?
(Family Physicians Inquiries Network, 2008)Obtain a repeat morning testosterone level, as well as levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin to help understand the cause of low testosterone when there is a lack of adequate ... -
What's the best drug treatment for premature ejaculation?
(Family Physicians Inquiries Network, 2008)Antidepressants--specifically clomipramine, fluoxetine, paroxetine, and sertraline--are best and have been shown to improve symptoms of premature ejaculation (strength of recommendation [SOR]: A, meta-analysis of randomized ... -
What is the differential diagnosis of chronic leg edema in primary care?
(Family Physicians Inquiries Network, 2008)The differential diagnosis, in descending order, includes: elevated pulmonary artery pressure (often due to obstructive sleep apnea), congestive heart failure, idiopathic causes, venous insufficiency, use of nonsteroidal ... -
What is the clinical workup for failure to thrive?
(Family Physicians Inquiries Network, 2008)The clinical evaluation of failure to thrive (FTT) includes a thorough history and physical examination; observation of parent-child interactions; observation and documentation of the child's feeding patterns; and a home ... -
What are the causes of elevated TSH in a newborn?
(Family Physicians Inquiries Network, 2008)Congenital hypothyroidism is a critical cause of elevated thyroid-stimulating hormone (TSH) in newborns; evaluate all neonates with an elevated TSH for congenital hypothyroidism (strength of recommendation [SOR]: A). Other ... -
What is the best test for peripheral vascular disease?
(Family Physicians Inquiries Network, 2008)An ankle-brachial index is best for evaluating patients with symptoms of claudication (strength of recommendation [SOR]: B, multiple cohort studies). That said, duplex ultrasonography or magnetic resonance angiography may ... -
What could be behind your elderly patient's subjective memory complaints?
(Family Physicians Inquiries Network, 2008)Depression, anxiety, and dementia, as well as older age, female gender, lower education level, and decreased physical activity, have all been associated with memory loss reported by patients or family members (strength of ...