The Medical clinics of North America
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Disease processes involving the ear, nose, and throat account for millions of office visits to primary care physicians per year. Because of their proximity to the airway as well as critical neurologic and vascular structures, the disease process in each individual case carries the potential for significant complications. Fortunately, improvements in medical care have significantly reduced the prevalence of these complications. ⋯ The physician should seek to rule out the presence of the aforementioned complications in each patient who presents with an otolaryngologic complaint. Any suggestion of their presence should prompt an immediate referral to a subspecialist or an emergency department. It is hoped that continued familiarization with these' disease processes will maintain them as rare entities of medical practice.
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Orthopedic injuries are common reasons for visits to primary care physicians. Careful history and physical examination with intelligent use of imaging technology will arrive at the correct diagnosis in most patients. ⋯ Nondisplaced fractures, tendon injuries, sprains, and overuse syndromes are entities within the purview of the primary care physician. Familiarity and confidence with diagnosis and management of these conditions in the office is optimal for the care of the adult patient.
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The patient who presents with headache can be diagnosed quickly and efficiently once the correct pattern has been identified. Most patients will have migraine, and treatment is based on the severity and disability. ⋯ Patients who have an acute new onset headache problem that requires immediate attention can be triaged and treated once their pattern and history are clear. Hopefully, increasing comfort levels with diagnosing headaches will allow the primary care practitioner to treat headache patients more effectively and efficiently.
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Dizziness and vertigo present in patients of all ages. Particularly in older patients, dizziness is associated with a variety of cardiovascular, neurosensory, and psychiatric conditions and with the use of multiple medications. For the patient, the symptoms can be debilitating. ⋯ Appropriate diagnosis and treatment can significantly improve quality of life. Most causes of dizziness are benign, but early recognition of serious or life-threatening disease is important. Management of these patients includes referral for neuroimaging and further evaluation in an emergency department.