AFP Clinical Answers
Testicular Cancer, Onset of Labor, Respiratory Tract Infection, Thyroid Cancer, Running Injuries
Am Fam Physician. 2019 Apr 1;99(7):424.
How should testicular cancer be diagnosed?
Routine screening for testicular cancer in asymptomatic men is not recommended. Scrotal ultrasonography is the preferred initial imaging study for evaluating a testicular mass. Confirmation of an alternative diagnosis is required to exclude testicular cancer in patients with a scrotal mass.
Does the time between contractions help predict when a pregnant woman at term should present for labor evaluation?
Women at term who have at least 12 contractions per hour are more likely to be diagnosed with active labor within 24 hours. A reduction in the interval between contractions is associated with the onset of active labor.
Are broad-spectrum antibiotics the preferred treatment in children with acute respiratory tract infections?
A retrospective cohort study found that broad-spectrum antibiotics are no more effective than narrow-spectrum antibiotics for treating acute respiratory tract infections in infants and children, and that adverse events are significantly more common in children treated with broad-spectrum antibiotics.
Should we screen for thyroid cancer?
The U.S. Preventive Services Task Force (USPSTF) recommends against screening for thyroid cancer in asymptomatic adults. It found inadequate direct evidence on the benefits of screening but determined that the magnitude of overall benefits of screening and treatment can be bounded as no greater than small, given the relative rarity of thyroid cancer, the apparent lack of difference in outcomes between treatment and surveillance (for the most common tumor types), and observational evidence showing no change in mortality over time after introduction of a mass screening program. Similarly, the USPSTF found inadequate direct evidence on the harms of screening but determined that the magnitude of overall harms of screening and treatment (i.e., permanent hypoparathyroidism, recurrent laryngeal nerve palsy, and subsequent vocal cord paralysis) can be bounded as at least moderate, given that overdiagnosis and overtreatment are likely to be substantial with population-based screening.
How should common running injuries be managed?
Eccentric exercises are primary therapy for patellar and Achilles tendinopathies. Eccentric exercises should be considered for treatment of hamstring tendinopathy. Exercise therapy for patellofemoral pain should consist of core and leg strengthening, as well as leg flexibility exercises. Exercise therapy for iliotibial band syndrome should consist of hip abductor strengthening and hamstring and iliotibial band stretching. Foot orthoses are beneficial for plantar fasciopathy. There is no evidence that custom orthoses are superior to commercially available products.
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