Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
How have you integrated the new HPV self-swab collection into your routine cervical cancer screening, particularly in those with prior abnormal results?
Unfortunately, the new HPV self-swab collection is not currently available in my institution, but I would definitely incorporate this into my routine cervical cancer screening if it were an option! I think the HPV self-swab option is ideal for patients who are either not amenable to a pelvic exam or...
Would you consider anabolic osteoporosis therapy in a young adult male with multiple non-traumatic vertebral compression fractures and low bone density for age (Z-score -2.6)?
I think a young male with multiple minimal trauma vert fractures and low BMD is appropriate to consider anabolic therapy. Of course, a thorough workup needs to be done to determine if there are any treatable causes of bone loss. If it is determined that he has “idiopathic osteoporosis” then treatmen...
What are your criteria for starting tolvaptan in adult patients diagnosed with autosomal dominant polycystic kidney disease?
This question is probably a bit too broad to answer in detail here, but in broad strokes, depending on the age, imaging criteria (Mayo class / total kidney volume), and kidney function of the patient, as well as other clinical factors, you assess the patient's risk of rapid disease progression to ma...
How do you counsel an otherwise healthy patient on how soon they can go back to moderate exercise after a bilateral pulmonary embolism?
Generally, the approach is to have the patient start their exercise regimen at a lower intensity and gradually increase it based on their tolerance.
Would you continue Forteo treatment past the recommended 2 years if T scores remain low and procollagen (P1NP) is elevated and if so, how would you monitor response?
I would offer a third year of a PTH analogue if the BMD response is less than a -2.5 T Score. I would follow quarterly serum calcium levels and a BMD for 1 year to assess the effects.
What criteria do you utilize in deciding when to treat or not treat frequent VPC’s?
Symptoms (burden and severity) PVC burden (>15-20% may lead to a cardiomyopathy) Presence of LV dysfunction Interference with bi-ventricular pacing PVCs triggering VT or VF
What is your approach to further work-up and management of neutropenia in patients with SLE/RA overlap?
This is an interesting situation that comes up in the routine evaluation of patients with rheumatoid arthritis and other autoimmune syndromes. The normocellular bone marrow suggests a peripheral destruction, in general, and raises some concerns for antibodies directed against neutrophils. These are ...
How does trimethoprim-sulfamethoxazole's efficacy against S. pyogenes influence your empirical treatment of skin infections in regions with high resistance rates?
I am a little confused by the question. Why would you use TMP/SMX monotherapy for SSTI? During the emergence of CA-MRSA, cephalexin with or without TMP/SMX had the same efficacy rates (Pallin). I agree with Dr. @Dr. First Last; linezolid is a great choice if MRSA is a concern. Cephalexin or cefadrox...
In patients with iron deficiency due to history of gastric bypass or IBD, would you consider oral iron therapy if the iron deficiency anemia is mild?
Oral iron can often be effective in iron deficiency, as long as absorption is intact. If you are concerned about absorption, performing an oral iron challenge can be useful in allowing you to avoid long trials of oral iron that will be ineffective. Simply check an iron panel at baseline, then admini...
Do you recommend patients temporarily hold cilostazol prior to and after a kidney biopsy?
Kidney biopsy is considered a high-risk bleeding procedure by SIR (Society of Interventional Radiology).Cilostazol is a PDE inhibitor leading to the inhibition of platelet aggregation. The Drug has a half-life of 10 hours. In the past, it was recommended to stop the drug at least 24 hours before a p...