Ear Pain: Diagnosing Common and Uncommon Causes

Otalgia, or ear pain, presents as primary (ie, originating from the ear) or secondary (ie, referred from nonotologic sources). Evaluation should include a focused history and physical examination, with further assessment for concerning or persistent findings.

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Physical Therapy: Rehabilitation Principles, Coordination, and Collaboration

Family physicians can coordinate and collaborate with physical therapists by identifying patients for referral, using core rehabilitation principles to bridge care, and understanding the effectiveness of modalities used by physical therapists to augment neuromuscular re-education and therapeutic exercise.

Spondyloarthropathies

Spondyloarthropathies are inflammatory syndromes that share genetic predisposition (HLA-B27) and clinical findings such as inflammatory back pain, peripheral arthritis, dactylitis, and enthesitis.

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Healthy Dietary Advice in Clinical Practice: Recommendations for Family Physicians

Family physicians should counsel patients to prioritize whole, plant-based foods; limit ultra-processed products; and promote culturally flexible dietary patterns, referring to dietitians when needed.

Crohn's Disease: Diagnosis and Management

Crohn's disease is a chronic inflammatory condition that affects the gastrointestinal tract and often causes extraintestinal manifestations. Evaluation includes endoscopy, imaging, and fecal calprotectin testing. Management is guided by disease severity, complications, and…

Aortic Stenosis: Diagnosis and Treatment

Most patients with aortic stenosis are asymptomatic initially, but as the disease progresses to severe stenosis, symptoms may develop, leading to the need for valve replacement. Management is dependent on many factors, including symptoms, severity, rate of progression, and left…

Discontinuation of Buprenorphine for Opioid Use Disorder: Methods and Risks

Patient-initiated discontinuation of buprenorphine should involve shared decision-making, flexible tapering plans, and overdose prevention. For some patients, sustained dose reduction may be a more feasible end point than complete cessation.

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Atypical Moles

Atypical moles are associated with increased risk of melanoma and should prompt periodic, systematic skin examination. Management includes clinical assessment with dermoscopy, excisional biopsy, and postbiopsy monitoring.

Climate-Smart Health Care: Role of the Family Physician

Climate change caused by humans continues to accelerate, causing more frequent and severe weather events. Physicians can play a pivotal role in managing environmental health risks, such as heat and air pollution, and counseling patients on plant-forward diets and active…

Knee Pain in Adults and Adolescents: The Initial Evaluation

Knee pain is prevalent across age groups, commonly related to osteoarthritis in older adults and patellofemoral syndrome in younger adults. Assessment includes a detailed history, physical examination (inspection, palpation, range of motion, strength testing, and specialized…

Evaluation of the Painful Eye

The evaluation of patients presenting with eye pain should focus on identifying potentially emergent causes that require prompt evaluation and treatment. Most causes of eye pain can be diagnosed by history and physical examination, including functional and anatomic assessment.

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Gambling Disorder: Diagnosis and Treatment

Gambling disorder is often underdiagnosed. Case-finding using a direct question about gambling in patients at increased risk is recommended. Pharmacotherapy, psychotherapy, and self-help groups, such as Gamblers Anonymous, may help reduce gambling severity.

Type 2 Diabetes: Outpatient Insulin Management

Insulin treatment remains a significant but complex aspect of managing type 2 diabetes. To optimize insulin use in the outpatient setting, family physicians must consider strategies for initiation, titration, and adherence.

Pacemaker Therapy: Indications and Recommendations

Pacemakers are indicated to improve symptoms of bradycardia, prevent high-degree atrioventricular block from degenerating into complete heart block, and promote ventricular synchrony and improve survival in select patients.

Nausea and Vomiting During Pregnancy

For mild or moderate cases of nausea and vomiting in pregnancy, first-line treatment is vitamin B6 with or without doxylamine. If it is ineffective, or in more severe cases, treatment can be advanced to alternative agents, taking care to balance patient-specific risk factors…

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