AFP Clinical Answers

Nerve Injury, Survivors of Sexual Assault, Obstructive Sleep Apnea, Bipolar Disorder, Meningitis


Am Fam Physician. 2021 Nov ;104(5):453.

How should peripheral nerve entrapment and injury be diagnosed and managed?

Electrodiagnostic testing should be used as an adjunct to physical examination and imaging to help confirm the diagnosis of peripheral nerve injury, establish the severity of the injury, and monitor the progression of nerve damage. Ultrasonography and magnetic resonance imaging should be used for diagnosing anatomic causes of nerve entrapment. In the absence of traumatic injury, initial treatment of nerve injuries should be conservative and include patient education, physical therapy, and activity modification.

What therapies are recommended for survivors of sexual assault?

A survivor-centered and trauma-informed approach should be used when caring for a survivor of sexual assault. All sexual assault survivors should be treated for the prevention of sexually transmitted infections. All sexual assault survivors of childbearing potential with a negative pregnancy test result should be offered emergency contraception within the appropriate time frame.

How should obstructive sleep apnea be diagnosed and treated?

The shorter STOP tool (snoring, tiredness, observed apnea episodes, pressure/hypertension history) for evaluating obstructive sleep apnea is easier to administer than the STOP-BANG criteria, which includes body mass index, age, neck size, and gender, and is equally sensitive. During a home sleep apnea test, diagnosis is based on 15 or more events per hour on the respiratory disturbance index, respiratory event index, or apnea-hypopnea index. Positive airway pressure is the most effective treatment for obstructive sleep apnea; however, mandibular advancement devices are easier for patients to use.

How should bipolar disorder be treated?

Lithium, quetiapine (Seroquel), or a combination of quetiapine and lithium or valproic acid (Depakote) is effective for the maintenance



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