American family physician
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Jaundice is an indication of hyperbilirubinemia and is caused by derangements in bilirubin metabolism. It is typically apparent when serum bilirubin levels exceed 3 mg/dL and can indicate serious underlying disease of the liver or biliary tract. A comprehensive medical history, review of systems, and physical examination are essential for differentiating potential causes such as alcoholic liver disease, biliary strictures, choledocholithiasis, drug-induced liver injury, hemolysis, or hepatitis. ⋯ Measuring fractionated bilirubin allows for determination of whether the hyperbilirubinemia is conjugated or unconjugated. Ultrasonography of the abdomen, computed tomography with intravenous contrast media, and magnetic resonance cholangiopancreatography are first-line options for patients presenting with jaundice, depending on the suspected underlying etiology. If the etiology of jaundice is unclear despite laboratory testing and imaging, liver biopsy may be required to establish the diagnosis, prognosis, and management of the disease.
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Vision loss affects more than 7 million Americans and impacts quality of life, independence, social functioning, and overall health. Common and dangerous conditions causing sudden vision loss include acute angle-closure glaucoma, retinal detachment, retinal artery occlusion, giant cell arteritis, and optic neuritis. Acute angle-closure glaucoma features ocular pain, headache, and nausea; treatment includes pilocarpine eye drops, oral or intravenous acetazolamide, and intravenous mannitol. ⋯ This condition requires immediate initiation of empiric steroids to prevent vision loss in the unaffected eye, as well as referral for a temporal artery biopsy. Optic neuritis is a demyelinating condition that features color desaturation, relative afferent pupillary defect, and pain with extraocular muscle movements. Treatment requires high-dose steroids, and patients should be evaluated for multiple sclerosis.
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American family physician · Jan 2025
ReviewEarly Childhood Concerns: Counseling on Sleep Issues, Thumb-Sucking, Picky Eating, School Readiness, and Oral Health.
Common early childhood concerns and behaviors include sleep issues, thumb-sucking, pacifier use, picky eating, school readiness, and oral health. Family physicians must recognize when these indicate an underlying disorder and offer constructive and evidence-based strategies to support healthy child development and family well-being. Behavioral interventions and education to address sleep issues can alleviate stress and decrease fatigue for the whole family. ⋯ Readiness to begin school depends on child, family, and societal factors, and needs an individualized approach that emphasizes inclusion while ensuring person-centered success. Reading and participation in early childhood educational programs improve literacy and classroom preparation. Oral health is an important part of childhood well-being; preventive care, including fluoridation, should begin when the first tooth has erupted.
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American family physician · Jan 2025
ReviewDysuria: Evaluation and Differential Diagnosis in Adults.
Dysuria, a feeling of pain or discomfort during urination, is often caused by urinary tract infection but can also be due to sexually transmitted infection, bladder irritants, skin lesions, and some chronic pain conditions. History is most often useful for finding signs of sexually transmitted infection, complicated infections, lower urinary symptoms in males, and noninfectious causes. Most patients presenting with dysuria should have a urinalysis performed. ⋯ Clinical decision rules may increase the accuracy of diagnosis with and without laboratory analysis. Evaluation and treatment of dysuria through a virtual encounter without laboratory testing may increase recurrent symptoms and antibiotic courses. Persistent symptoms after initial evaluation and treatment require further workup for infectious and noninfectious causes.
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Acute rhinosinusitis causes more than 30 million patients to seek health care per year in the United States. Respiratory tract infections, including bronchitis and sinusitis, account for 75% of outpatient antibiotic prescriptions in primary care. Sinusitis is a clinical diagnosis; the challenge lies in distinguishing between the symptoms of bacterial and viral sinusitis. ⋯ Most episodes of rhinosinusitis are self-limited, lasting 7 to 10 days. Complications of rhinosinusitis are rare but may include orbital cellulitis, meningitis, and abscess. Computed tomography and referral to an otolaryngologist should be considered for patients with recurrent rhinosinusitis or concern about complications.