The 5-Minute Clinical Consult Standard RD EDITION

Transcription

1

2 2

3 The 5-Minute Clinical Consult Standard RD EDITION 3

4 The 5-Minute Clinical Consult Standard RD EDITION Includes 30-Day Free Trial to 5minuteconsult.com Editor-in-Chief Frank J. Domino, MD Professor Director of Predoctoral Education Department of Family Medicine and Community Health University of Massachusetts Medical School Worcester, Massachusetts Associate Editors Robert A. Baldor, MD, FAAFP Professor and Vice-Chairman, Educational Affairs Department of Family Medicine and Community Health University of Massachusetts Medical School Worcester, Massachusetts Jeremy Golding, MD, FAAFP Professor of Family Medicine and Obstetrics & Gynecology University of Massachusetts Medical School Quality Officer Department of Family Medicine and Community Health University of Massachusetts Memorial Health Care Hahnemann Family Health Center Worcester, Massachusetts Jill A. Grimes, MD, FAAFP Clinical Instructor Department of Family Medicine University of Massachusetts Medical School 4

5 Worcester, Massachusetts Attending Physician University of Texas Health Services Austin, Texas 5

6 Acquisitions Editor: Rebecca Gaertner Product Development Editor: Leanne Vandetty Production Project Manager: Priscilla Crater Senior Manufacturing Coordinator: Beth Welsh Strategic Marketing Manager: Stephanie Manzo Design Coordinator: Teresa Mallon Production Service: Aptara, Inc Wolters Kluwer Health Two Commerce Square 2001 Market Street Philadelphia, PA USA LWW.com All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in China Library of Congress Cataloging-in-Publication Data eisbn-13: eisbn-10: Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check 6

7 the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) or fax orders to (301) International customers should call (301) Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6 pm, EST

8 As I sat down to write this, the radio announced the passing of Nelson Mandela. Imagine being imprisoned for your beliefs for 27 years! Nelson Mandela stood quietly and soundly on his beliefs, knowing the world would be a better place for his personal turmoil. History s high points occur when someone comes forward to take an unpopular stand, believing the world will be a better place for their su ering. Is the world of medicine ready to step up? Choosing Wisely ( These two words made a huge impact this past year, as most every medical specialty and health care-related group (over 60!) found consensus on what tests and treatments were of use and bene cial to society. and which were wasteful and harmful. Despite each group s involvement, many called this heresy. It is not. This e ort is the beginning of applying evidencebased medicine and a cost effective approach to care of our patients. Like it or not, the A ordable Care Act, complete with aws and technological blunders, was brought forward in an e ort to bring health insurance to 47 million US citizens who were previously uninsured; that is 1 in 6 people. President Obama voluntarily addressed something most Americans believe to be necessary health insurance coverage for all. The Congressional Budget O ce, a nonpartisan group that provides the US Congress with real numbers, continues to report lower than expected costs, with signi cant patient bene ts ( Other changes are rapidly occurring in health care. In some, solid, evidence-based medical research has yielded results that shake up the status quo, directing us toward changes that will prevent long term morbidity and mortality: Head trauma from sports-related activities during adolescence and early adulthood causes permanent damage. Concussion prevention is the priority. Will football soon be a sport played only in college and after? Prescription narcotics had a rough year: First, a call for training in appropriate use of long-term agents for nonmalignant pain and a systematic review of data showing no bene t of opioids for chronic low back pain. Accidental prescription opioid death is the most common 8

9 cause of death in those under the age of 50 in the US and is our responsibility. Pulling back on prescribing these agents will be a challenge we must accept with the grace and strength of Mandela. Curing hepatitis C can be at hand, and doing so will move cirrhosis and hepatoma from their leading role as causes of cancer death worldwide. Screen those born between 1945 and 1965 once and all who practice high-risk behaviors (blood transfusion before 1992, longterm hemodialysis, born to an HCV-infected mother, incarceration, intranasal drug use, getting an unregulated tattoo, and other percutaneous exposures). HIV has become a chronic disease and like hepatitis C should now be part of our universal routine adult health screening; the new guidelines recommend screening all adolescents and adults ages 15 to 65 years, all pregnant women, and those younger adolescents and older adults who are at increased risk. Bacteria in our gut may play a huge role in our degree of health, in uencing illness from viral URIs to coronary artery disease and even maybe obesity! In our efforts to overcome obesity, we will need to advocate a more vegetarian-based diet as an intervention to alter the gut microbiome and prevent illness. Prevention of cardiovascular morbidity and mortality is clearly bene ted by use of statins where cardiovascular risk is high but is not achieved by reaching a simple LDL goal. Again, we will need to prioritize helping patients to stop smoking and to start exercising. The bene t of medications to prevent heart disease hinges on these interventions, not just a pill. Mandela said resentment is like drinking poison and then hoping it will kill your enemies. Clinicians in all disciplines should remember that our di erences in opinion are so much smaller than our common goal of helping others. This year s 5-Minute Clinical Consult is dedicated to those who have su ered long and risked much to make our patients better. Let s make certain their efforts were just the beginning of a better future. 9

10 PREFACE Any man may easily do harm but not every man can do good to another. PLATO Born in the 3rd century BC, Plato understood the essential role of providing care to those in need. And when you hold this book, you too have enormous potential to serve humanity, one person at a time. Welcome to The 5-Minute Clinical Consult Our editorial team has collaborated with hundreds of authors so that you may deliver your patients the best care. Each topic provides you with quick answers you can trust, where and when you need them most, either in print or online at This highly organized content provides you with: Differential diagnosis support from an accessible, targeted search, delivering the answers you need quickly Current evidence-based designations highlighted in each topic A revised and updated Health Maintenance section 880+ commonly encountered diseases and disorders in print, and more than 1,200 additional topics online, including 500 topics from The 5- Minute Pediatric Consult and over 620 topics from The 5-Minute Emergency Medicine Consult FREE Point of Care CME and CE: 1/2 hour credit for every digital search 200+ diagnostic and treatment algorithms Color images and videos for procedures, treatment, and physical therapy A to Z Drug Database from Facts & Comparisons More than 1,250 patient handouts in English and Spanish from the AAFP ICD-10 Codes and DSM-V criteria; in addition, ICD-9 and SNOMED codes are available online. 10