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Mildly Elevated Liver Transaminase Levels: Causes and Evaluation - American Family ...

Dec 1, 2017 - Mild, asymptomatic elevations (less than five times the upper limit of normal) of alanine transaminase and aspartate transaminase levels are common in primary care. It is estimated that approximately 10% of the U.S. population has elevated transaminase levels. An approach based on the ...

American Family Physician : Article

https://www.aafp.org/afp/2017/1201/p709.html

Pleuritic Chest Pain: Sorting Through the Differential Diagnosis - American Family ...

Sep 1, 2017 - Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. Pulmonary embolism is the most common serious cause, found in 5% to 21% of patients who present to an emergency department with pleuritic chest pain. A ...

American Family Physician : Article

https://www.aafp.org/afp/2017/0901/p306.html

Ear Pain: Diagnosing Common and Uncommon Causes - American Family Physician

Jan 1, 2018 - Otalgia (ear pain) is a common presentation in the primary care setting with many diverse causes. Pain that originates from the ear is called primary otalgia, and the most common causes are otitis media and otitis externa. Examination of the ear usually reveals abnormal findings in ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0101/p20.html

Dizziness: Approach to Evaluation and Management - American Family Physician

Feb 1, 2017 - Dizziness is a common yet imprecise symptom. It was traditionally divided into four categories based on the patient’s history: vertigo, presyncope, disequilibrium, and light-headedness. However, the distinction between these symptoms is of limited clinical usefulness. Patients have ...

American Family Physician : Article

https://www.aafp.org/afp/2017/0201/p154.html

Exercise Stress Testing: Indications and Common Questions - American Family Physician

Sep 1, 2017 - Exercise stress testing is a validated diagnostic test for coronary artery disease in symptomatic patients, and is used in the evaluation of patients with known cardiac disease. Testing of asymptomatic patients is generally not indicated. It may be performed in select deconditioned ...

American Family Physician : Article

https://www.aafp.org/afp/2017/0901/p293.html

Syncope: Evaluation and Differential Diagnosis - American Family Physician

Mar 1, 2017 - Syncope is an abrupt and transient loss of consciousness caused by cerebral hypoperfusion. It accounts for 1% to 1.5% of emergency department visits, resulting in high hospital admission rates and significant medical costs. Syncope is classified as neurally mediated, cardiac, and ...

American Family Physician : Article

https://www.aafp.org/afp/2017/0301/p303.html

Secondary Hypertension: Discovering the Underlying Cause - American Family Physician

Oct 1, 2017 - Most patients with hypertension have no clear etiology and are classified as having primary hypertension. However, 5% to 10% of these patients may have secondary hypertension, which indicates an underlying and potentially reversible cause. The prevalence and potential etiologies of ...

American Family Physician : Article

https://www.aafp.org/afp/2017/1001/p453.html

Depression: Screening and Diagnosis - American Family Physician

Oct 15, 2018 - Depression affects an estimated 8% of persons in the United States and accounts for more than $210 billion in health care costs annually. The U.S. Preventive Services Task Force (USPSTF) and American Academy of Family Physicians recommend screening for depression in the general adult ...

American Family Physician : Article

https://www.aafp.org/afp/2018/1015/p508.html

Well-Child Visits for Infants and Young Children - American Family Physician

Sep 15, 2018 - The well-child visit allows for comprehensive assessment of a child and the opportunity for further evaluation if abnormalities are detected. A complete history during the well-child visit includes information about birth history; prior screenings; diet; sleep; dental care; and medical,...

American Family Physician : Article

https://www.aafp.org/afp/2018/0915/p347.html

Hemolytic Anemia: Evaluation and Differential Diagnosis - American Family Physician

Sep 15, 2018 - Hemolytic anemia is defined by the premature destruction of red blood cells, and can be chronic or life-threatening. It should be part of the differential diagnosis for any normocytic or macrocytic anemia. Hemolysis may occur intravascularly, extravascularly in the reticuloendothelial ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0915/p354.html

Urine Drug Tests: Ordering and Interpreting Results - American Family Physician

Jan 1, 2019 - Urine drug testing is an essential component of monitoring patients who are receiving long-term opioid therapy, and it has been suggested for patients receiving long-term benzodiazepine or stimulant therapy. Family physicians should be familiar with the characteristics and capabilities ...

American Family Physician : Article

https://www.aafp.org/afp/2019/0101/p33.html

Evaluating Medical Decision-Making Capacity in Practice - American Family Physician

Jul 1, 2018 - Medical decision-making capacity is the ability of a patient to understand the benefits and risks of, and the alternatives to, a proposed treatment or intervention (including no treatment). Capacity is the basis of informed consent. Patients have medical decision-making capacity if they...

American Family Physician : Article

https://www.aafp.org/afp/2018/0701/p40.html

Chronic Kidney Disease: Detection and Evaluation - American Family Physician

Dec 15, 2017 - Chronic kidney disease affects 47 million people in the United States and is associated with significant health care costs, morbidity, and mortality. Because this disease can silently progress to advanced stages, early detection is critical for initiating timely interventions. Multiple ...

American Family Physician : Article

https://www.aafp.org/afp/2017/1215/p776.html

Knee Pain in Adults and Adolescents: The Initial Evaluation - American Family Physician

Nov 1, 2018 - Knee pain affects approximately 25% of adults, and its prevalence has increased almost 65% over the past 20 years, accounting for nearly 4 million primary care visits annually. Initial evaluation should emphasize excluding urgent causes while considering the need for referral. Key ...

American Family Physician : Article

https://www.aafp.org/afp/2018/1101/p576.html

Amenorrhea: A Systematic Approach to Diagnosis and Management - American Family Physician

Jul 1, 2019 - Menstrual patterns can be an indicator of overall health and self-perception of well-being. Primary amenorrhea, defined as the lifelong absence of menses, requires evaluation if menarche has not occurred by 15 years of age or three years post-thelarche. Secondary amenorrhea is ...

American Family Physician : Article

https://www.aafp.org/afp/2019/0701/p39.html

Chronic Cough: Evaluation and Management - American Family Physician

Nov 1, 2017 - Although chronic cough in adults (cough lasting longer than eight weeks) can be caused by many etiologies, four conditions account for most cases: upper airway cough syndrome, gastroesophageal reflux disease/laryngopharyngeal reflux disease, asthma, and nonasthmatic eosinophilic ...

American Family Physician : Article

https://www.aafp.org/afp/2017/1101/p575.html

First Trimester Bleeding: Evaluation and Management - American Family Physician

Feb 1, 2019 - Approximately one-fourth of pregnant women will experience bleeding in the first trimester. The differential diagnosis includes threatened abortion, early pregnancy loss, and ectopic pregnancy. Pain and heavy bleeding are associated with an increased risk of early pregnancy loss. ...

American Family Physician : Article

https://www.aafp.org/afp/2019/0201/p166.html

Anemia in Older Adults - American Family Physician

Oct 1, 2018 - Anemia is associated with increased morbidity and mortality in older adults. Diagnostic cutoff values for defining anemia vary with age, sex, and possibly race. Anemia is often asymptomatic and discovered incidentally on laboratory testing. Patients may present with symptoms related to ...

American Family Physician : Article

https://www.aafp.org/afp/2018/1001/p437.html

The Adult Well-Male Examination - American Family Physician

Dec 15, 2018 - The adult well-male examination should provide evidence-based guidance toward the promotion of optimal health and well-being. The medical history should focus on tobacco and alcohol use, risk of human immunodeficiency virus and other sexually transmitted infections, and diet and ...

American Family Physician : Article

https://www.aafp.org/afp/2018/1215/p729.html

Geriatric Assessment: An Office-Based Approach - American Family Physician

Jun 15, 2018 - Family physicians should be proficient in geriatric assessment because, as society ages, older adults will constitute an increasing proportion of patients. Geriatric assessment evaluates medical, social, and environmental factors that influence overall well-being, and addresses ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0615/p776.html

Evaluation of Jaundice in Adults - American Family Physician

Feb 1, 2017 - Jaundice in adults can be an indicator of significant underlying disease. It is caused by elevated serum bilirubin levels in the unconjugated or conjugated form. The evaluation of jaundice relies on the history and physical examination. The initial laboratory evaluation should include ...

American Family Physician : Article

https://www.aafp.org/afp/2017/0201/p164.html

Evaluation of Suspected Dementia - American Family Physician

Mar 15, 2018 - Dementia is a significant and costly health condition that affects 5 million adults and is the fifth leading cause of death among Americans older than 65 years. The prevalence of dementia will likely increase in the future because the number of Americans older than 65 years is expected ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0315/p398.html

Recurrent Abdominal Pain in Children - American Family Physician

Jun 15, 2018 - Recurrent abdominal pain (RAP) in children is defined as at least three episodes of pain that occur over at least three months and affect the child’s ability to perform normal activities. RAP is most often considered functional (nonorganic) abdominal pain, but an organic cause is found ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0615/p785.html

Colorectal Cancer Screening and Surveillance in Individuals at Increased Risk - ...

Jan 15, 2018 - Individuals at increased risk of developing colorectal cancer include those with a personal or family history of advanced adenomas or colorectal cancer, a personal history of inflammatory bowel disease, or genetic polyposis syndromes. In general, these persons should undergo more ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0115/p111.html

Hearing Loss in Adults: Differential Diagnosis and Treatment - American Family Physician

Jul 15, 2019 - More than 30 million U.S. adults have hearing loss. This condition is underrecognized, and hearing aids and other hearing enhancement technologies are underused. Hearing loss is categorized as conductive, sensorineural, or mixed. Age-related sensorineural hearing loss (i.e., ...

American Family Physician : Article

https://www.aafp.org/afp/2019/0715/p98.html

Neuropsychological Evaluations in Adults - American Family Physician

Jan 15, 2019 - Neuropsychologists provide detailed assessments of cognitive and emotional functioning that often cannot be obtained through other diagnostic means. They use standardized assessment tools and integrate the findings with other data to determine whether cognitive decline has occurred, to ...

American Family Physician : Article

https://www.aafp.org/afp/2019/0115/p101.html

Vitamin D Screening and Supplementation in Community-Dwelling Adults: Common Questions ...

Feb 15, 2018 - Measurement of vitamin D levels and supplementation with oral vitamin D have become commonplace, although clinical trials have not demonstrated health benefits. The usefulness of serum 25-hydroxyvitamin D levels to assess adequate exposure to vitamin D is hampered by variations in ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0215/p254.html

Tremor: Sorting Through the Differential Diagnosis - American Family Physician

Feb 1, 2018 - Tremor is an involuntary, rhythmic, oscillatory movement of a body part. It is the most common movement disorder encountered in primary care. The diagnosis of tremor is based on clinical information obtained from the history and physical examination. The most common tremors in patients ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0201/p180.html

Cervical Cancer Screening - American Family Physician

Apr 1, 2018 - Screening in women has decreased the incidence and mortality of cervical cancer. Precancerous cervical lesions (cervical intraepithelial neoplasias) and cervical carcinomas are strongly associated with sexually-transmitted high-risk human papillomavirus (HPV) infection, which causes ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0401/p441.html

Health Maintenance in School-Aged Children: Part I. History, Physical Examination, ...

Aug 15, 2019 - The goals of the health maintenance visit in school-aged children (five to 12 years) are promoting health, detecting disease, and counseling to prevent injury and future health problems. During the visit, the physician should address patient and parent/caregiver concerns and ask about ...

American Family Physician : Article

https://www.aafp.org/afp/2019/0815/p213.html

Colorectal Cancer Screening and Prevention - American Family Physician

May 15, 2018 - Colorectal cancer is a common cause of morbidity and mortality in the United States. Most colorectal cancers arise from preexisting adenomatous or serrated polyps. The incidence and mortality of colorectal cancer can be reduced with screening of average-risk adults 50 to 75 years of ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0515/p658.html

Allopurinol Hypersensitivity Assay HLA-B*58:01 Genotyping - American Family Physician

Nov 1, 2019 - The allopurinol hypersensitivity assay, or HLA-B*58:01 test, is a blood test to detect the presence of a human leukocyte antigen B (HLA-B) genetic variant that increases the risk of life-threatening, severe cutaneous adverse reactions in patients taking allopurinol.

American Family Physician : Article

https://www.aafp.org/afp/2019/1101/p530.html

Primary Care for Persons Who Inject Drugs - American Family Physician

Jan 15, 2019 - More than 750,000 persons in the United States inject opioids, methamphetamine, cocaine, or ketamine, and that number is increasing because of the current opioid epidemic. Persons who inject drugs (PWID) are at higher risk of infectious and noninfectious skin, pulmonary, cardiac, ...

American Family Physician : Article

https://www.aafp.org/afp/2019/0115/p109.html

Acute Coronary Syndrome: Diagnostic Evaluation - American Family Physician

Feb 1, 2017 - Myocardial infarction (MI), a subset of acute coronary syndrome, is damage to the cardiac muscle as evidenced by elevated cardiac troponin levels in the setting of acute ischemia. Coronary artery disease is the leading cause of mortality in the United States. Chest pain is a common ...

American Family Physician : Article

https://www.aafp.org/afp/2017/0201/p170.html

Noninfectious Penile Lesions - American Family Physician

Jan 15, 2018 - Noninfectious penile lesions are classified by clinical presentation as papulosquamous (e.g., psoriasis), inflammatory (e.g., lichen sclerosus, lichen nitidus, lichen planus), vascular (e.g., angiokeratomas), or neoplastic (e.g., carcinoma in situ, invasive squamous cell carcinoma). ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0115/p102.html

Rheumatologic Tests: A Primer for Family Physicians - American Family Physician

Aug 1, 2018 - Patients with a suspected connective tissue disorder should undergo serologic testing to confirm the diagnosis and, in some cases, to monitor disease activity and predict flares. Patients with suspected systemic lupus erythematosus should be tested for antinuclear antibodies. However, ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0801/p164.html

Preoperative Assessment in Older Adults: A Comprehensive Approach - American Family ...

Aug 15, 2018 - Surgical outcomes are significantly influenced by patients’ overall health, function, and life expectancy. A comprehensive geriatric preoperative assessment of older adults requires expanding beyond an organ-based or disease-based assessment. At a preoperative visit, it is important to ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0815/p214.html

Prolaris Test for Prostate Cancer Risk Assessment - American Family Physician

Sep 1, 2019 - The Prolaris test improves the accuracy of prognosis for patients with prostate cancer, especially those with low- or intermediate-grade disease who may be deciding between interventional and noninterventional treatment approaches.

American Family Physician : Article

https://www.aafp.org/afp/2019/0901/p311.html

Developmental Delay: When and How to Screen - American Family Physician

Jul 1, 2017 - An estimated 15% of children in the United States have at least one developmental delay, yet less than one-fifth of those children receive early intervention services before three years of age. Many barriers exist to implementing initial screening and referral, but screening tools can ...

American Family Physician : Article

https://www.aafp.org/afp/2017/0701/p36.html

mSEPT9 (Epi proColon) Blood Test for Colorectal Cancer Screening - American Family ...

Jul 1, 2019 - Epi proColon is a blood test used for the detection of the methylated septin 9 (mSEPT9) gene. It is approved by the U.S. Food and Drug Administration for colorectal cancer screening in people at average risk who have declined first-line screening tests.

American Family Physician : Article

https://www.aafp.org/afp/2019/0701/p10.html

Hoarseness in Adults - American Family Physician

Dec 1, 2017 - Hoarseness is a common presentation in primary care practices. Combined with other voice-related changes, it falls under the umbrella diagnosis of dysphonia. Hoarseness has a number of causes, ranging from simple inflammatory processes to less common psychiatric disorders to more ...

American Family Physician : Article

https://www.aafp.org/afp/2017/1201/p720.html

Allergy Testing: Common Questions and Answers - American Family Physician

Jul 1, 2018 - An estimated 10% to 30% of the global population has an allergic disease. Clinical presentations of allergic diseases, respiratory infections, and autoimmune conditions have similar features. Allergy and immunologic testing can help clarify the diagnosis and guide treatment. Immediate ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0701/p34.html

Palpitations: Evaluation in the Primary Care Setting - American Family Physician

Dec 15, 2017 - Palpitations are a common problem in the ambulatory primary care setting, and cardiac causes are the most concerning etiology. Psychiatric illness, adverse effects of prescription and over-the-counter medications, and substance use should also be considered. Distinguishing cardiac from ...

American Family Physician : Article

https://www.aafp.org/afp/2017/1215/p784.html

Proteinuria in Children: Evaluation and Differential Diagnosis - American Family Physician

Feb 15, 2017 - Although proteinuria is usually benign in the form of transient or orthostatic proteinuria, persistent proteinuria may be associated with more serious renal diseases. Proteinuria may be an independent risk factor for the progression of chronic kidney disease in children. Mechanisms of ...

American Family Physician : Article

https://www.aafp.org/afp/2017/0215/p248.html

Health Maintenance in Postmenopausal Women - American Family Physician

May 1, 2017 - Cardiovascular disease is the leading cause of death and disability in postmenopausal women older than 50 years. Clinicians should use the pooled cohort risk assessment equations or another risk calculator every three to five years to estimate a woman’s 10-year risk of atherosclerotic ...

American Family Physician : Article

https://www.aafp.org/afp/2017/0501/p561.html

Preventive Health Care for Women Who Have Sex with Women - American Family Physician

Mar 1, 2017 - Despite recent shifts in societal attitudes toward same-sex relationships, women who have sex with women face a variety of barriers to optimal health, including a history of negatively perceived interactions in clinical settings that lead them to delay or avoid health care. Women who ...

American Family Physician : Article

https://www.aafp.org/afp/2017/0301/p314.html

Expanded Newborn Screening: Information and Resources for the Family Physician - ...

Jun 1, 2017 - Each year, 4 to 5 million newborns receive state-mandated screening. Although the Advisory Committee on Heritable Disorders in Newborns and Children has identified 34 core conditions that should be incorporated into screening programs, each state manages, funds, and maintains its own ...

American Family Physician : Article

https://www.aafp.org/afp/2017/0601/p703.html

Diagnosing VTE: Guidelines from the American Society of Hematology - Practice ...

Dec 1, 2019 - The American Society of Hematology has published recommendations for determining the optimal diagnostic strategy based on pretest risk.

American Family Physician : Practice Guidelines

https://www.aafp.org/afp/2019/1201/p716.html

General Health Checks in Adults for Reducing Disease-Related Morbidity and Mortality - ...

Dec 1, 2019 - General health check visits have no benefit on cardiovascular morbidity or on total, cardiovascular, or cancer-related mortality. There is also no evidence that they cause patient harm.

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2019/1201/p676.html

Attention Deficit/Hyperactivity Disorder: Screening and Evaluation - FPIN's Help Desk ...

Jun 1, 2019 - The Conners Abbreviated Symptom Questionnaire has the best combination of positive and negative likelihood ratios.

American Family Physician : FPIN's Help Desk Answers

https://www.aafp.org/afp/2019/0601/p712.html

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