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 remission goals.

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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.

Herpes Zoster and Postherpetic Neuralgia: Common Questions and Answers

Herpes zoster (ie, shingles) is caused by the reactivation of the varicella-zoster virus and commonly presents with a painful, vesicular skin rash that resolves within weeks. Treatment involves antiviral medications and pain management. The most frequent complication is postherpetic neuralgia, a chronic pain syndrome, especially affecting older adults and immunocompromised individuals.

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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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Injections of the Foot and Ankle

Foot and ankle injections are commonly performed by family physicians for the management of several musculoskeletal conditions. If symptoms persist despite conservative measures, injections may improve function and reduce pain. Ultrasound guidance improves accuracy of injection…

Skin and Soft Tissue Infections

Skin and soft tissue infections are clinical diagnoses. They are classified as mild, moderate, or severe, depending on the structures involved and presence or absence of systemic symptoms. Treatment depends on severity and includes oral and intravenous antibiotics

Botulinum Toxin Procedures: A Practical Approach to Cosmetic Injections

Botulinum toxin injection offers predictable results, has few adverse effects, and is associated with high patient satisfaction. A review of facial anatomy, injection techniques, and complications for cosmetic botulinum toxin treatment, with a focus on glabellar lines, is…

Severe Hypertension: Evaluation and Treatment

Severe hypertension is defined as a blood pressure of 180/110 to 120 mm Hg or greater in the absence of new or worsening target organ damage. Multiple trials have shown no short-term benefit of treatment, which has been associated with increased risk of cardiovascular events…

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