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Am Fam Physician. 2021;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 of bipolar disorder. Lithium, valproic acid, and some antipsychotics are effective single agents for acute mania. Effective combination therapies for acute mania include lithium or valproic acid with quetiapine or risperidone (Risperdal). Single-agent treatment for acute bipolar depression includes quetiapine and cariprazine (Vraylar), or lurasidone (Latuda) can be used in combination with lithium or valproic acid.

What testing is indicated for patients with suspected meningitis?

Gram stain testing of cerebrospinal fluid should be performed in all patients with suspected meningitis. In addition to routine testing of cerebrospinal fluid components, polymerase chain reaction testing should be used to evaluate for viral infections in all patients with suspected meningitis to minimize unnecessary antibiotic use.

Additional Online Only AFP Clinical Answers

How should patients recently discharged from the intensive care unit be evaluated in the outpatient setting?

Patients should be screened for weakness and referred to physical rehabilitation when appropriate. Patients should be screened for cognitive impairment. Patients discharged from the intensive care unit and their family members and partners should be screened for depression, anxiety, and posttraumatic stress disorder.

What are some important recommendations for preventive health in women of reproductive age?

Screening pelvic examinations are not recommended for women who are asymptomatic. Screen for depression in adolescents and women when systems are in place for diagnosis, follow-up, and treatment. Screen for intimate partner violence in women of reproductive age. Screen for gonorrhea and chlamydia in sexually active women younger than 25 years. Screen adults for tobacco use, unhealthy alcohol use, and unhealthy drug use.

How should frailty be identified and managed?

A validated frailty assessment tool, such as the Fried frailty phenotype, should be used to diagnose frailty. Frailty management should be individualized for each patient based on their degree of frailty, goals of care, and life expectancy. Patients diagnosed as prefrail or frail who have no contraindications to physical activity should be offered a multicomponent physical activity program.

Editor's Note: Several of the answers above first appeared in the new AFP Clinical Answers email, which is sent each month to recipients of the AFP email table of contents. Sign up to receive AFP emails.

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