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Am Fam Physician. 2023;108(2):134

What is the initial treatment recommendation for allergic rhinitis?

Continuous or as-needed intranasal corticosteroids are the first-line treatment for allergic rhinitis.

How should a young child with an acute limp be evaluated?

In children younger than five years with an acute limp, no localizing pathology on examination, and no concern for infection, anteroposterior and lateral radiography of both lower extremities should be performed, starting with the tibia and fibula. Imaging of both femurs may be appropriate if radiography of the tibia and fibula is unrevealing.

When is surgery for anterior shoulder dislocation beneficial?

Surgical treatment should be considered in first-time anterior shoulder dislocation in active patients younger than 25 years because of the high recurrence rate.

How should neonatal hyperbilirubinemia be diagnosed?

All newborns should be examined for jaundice and signs of acute bilirubin encephalopathy at least every 12 hours from birth until hospital discharge. Visual assessment alone should not be used to diagnose hyperbilirubinemia. Objective bilirubin measurements should be obtained in newborns who appear jaundiced or have symptoms of bilirubin toxicity. The American Academy of Pediatrics recommends universal screening of newborns 35 weeks' and older gestational age with total serum bilirubin or transcutaneous bilirubin at 24 to 48 hours of life or before hospital discharge if occurring earlier.

Which treatments are recommended for benign paroxysmal positional vertigo?

Repositioning maneuvers are helpful in treating benign paroxysmal positional vertigo. Benign paroxysmal positional vertigo should not routinely be treated with vestibular suppressant medications such as antihistamines or benzodiazepines.

When can patients with chronic lymphocytic leukemia be monitored without treatment?

Asymptomatic, early-stage chronic lymphocytic leukemia (i.e., absence of anemia and thrombocytopenia and less than three areas of lymph node involvement) may be monitored without treatment.

Additional Online Only AFP Clinical Answers

What can be used in risk stratification of incidentally discovered pulmonary nodules?

A validated clinical decision tool should be used in patients with pulmonary nodules to determine the probability of malignancy (high risk, greater than 65%; intermediate risk, 5% to 65%; and low risk, less than 5%) and guide management. A list of validated risk prediction models can be found in Table 4.

What initial medical treatment is recommended for patients with Bell Palsy?

Patients with Bell palsy should be prescribed oral corticosteroids. Combination therapy with oral corticosteroids and antivirals should be considered in patients with Bell palsy to reduce rates of synkinesis, which is misdirected regrowth of facial nerve fibers manifesting as involuntary co-contraction of certain facial muscles.

What is the preferred treatment for all patients with systemic lupus erythematosus?

Hydroxychloroquine is recommended for all patients with systemic lupus erythematosus.

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