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Am Fam Physician. 2021;103(11):659

In what population is screening for abdominal aortic aneurysm appropriate based on USPSTF recommendations?

The U.S. Preventive Services Task Force (USPSTF) recommends one-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men 65 to 75 years of age who have ever smoked. The USPSTF recommends that clinicians selectively offer AAA screening with ultrasonography in men 65 to 75 years of age who have never smoked instead of routinely screening all men in this group. The USPSTF recommends against screening women who have never smoked and have no family history of AAA. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA in women 65 to 75 years of age who have ever smoked or have a family history of AAA.

What are the first-line medications used to treat acute migraines in children?

First-line acute migraine treatment in children is ibuprofen; adolescents may benefit from sumatriptan/naproxen (Treximet) tablets, zolmitriptan (Zomig) nasal spray, sumatriptan (Imitrex) nasal spray, rizatriptan (Maxalt), or almotriptan (Axert).

Are oral mucolytics effective at reducing the number of acute exacerbations, days of disability, and hospital admissions in patients with chronic bronchitis or COPD?

Oral mucolytic agents may reduce the number of acute exacerbations in patients with chronic bronchitis or chronic obstructive pulmonary disease (COPD; number needed to treat [NNT] = 8, over an average of nine months). Although mucolytics do not appear to impact lung function or quality of life, they are associated with a small reduction in days of disability per month (mean difference = −0.43 days) and decreased hospital admissions (NNT for 17 months = 19). Mucolytics are not associated with an increase in adverse effects.

What medication is recommended for the treatment of bone pain associated with Paget disease?

Nitrogen-containing bisphosphonates are recommended for the treatment of bone pain associated with Paget disease. The treatment of choice is a single 5-mg dose of zoledronic acid (Reclast) administered intravenously.

What changes are recommended in tidal volume and positive end-expiratory pressure values for patients with ARDS on mechanical ventilation?

When mechanical ventilation is required, patients with acute respiratory distress syndrome (ARDS) should be started at lower tidal volumes (6 mL per kg) instead of traditional volumes (10 to 15 mL per kg). Higher positive end-expiratory pressure values (12 cm H2O) should be considered for initial mechanical ventilation in patients with ARDS.

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