Influenza Season 2018-2019

The flu season is predicted to start in October and last until May in the United States. This year’s trivalent flu vaccine covers H1N1, H3N2, and the Victoria-lineage strains of influenza.

Management of Migraine Headaches

When you start clinic this morning, you see your first patient is a new patient with a chief complaint of “headaches.” Upon entering the exam room, you see a young man in no apparent distress, scrolling through his phone. He stands up to greet you and introduces himself. Carlos is a 25-year-old man who describes himself as very healthy. He comes to the clinic today because he has been having frequent headaches, and they are interfering with his work.

Current Management of Back Pain

As October gets underway, your schedule fills up with sports physicals for the local schoolchildren. But after a morning of catching up with healthy kids and teenagers you only see once or twice a year, you see the name of an adult you know well on your schedule. Rebecca is a 27-year-old elementary school teacher who lives down the street from you. She is coming in to be seen for back pain.

Ear Pain with a Normal Ear Exam

Ear pain with a normal ear exam can be caused by a number of sources. These include TMJ, dental causes (including cavities and ulcers), cervical spine arthritis, pharyngitis, tonsillitis, neuropathic pain, and Eustachian tube dysfunction. Significantly less common reasons for ear pain and no obvious defect include tumors, Bells’ palsy, temporal arteritis, referred pain from cranial nerve IX or X, and cardiovascular events.

Primary Sclerosing Cholangitis

Primary sclerosing cholangitis is an idiopathic liver disease involving inflammation and fibrosis of bile ducts. The primary type of primary sclerosing cholangitis involves inflammation and fibrosis of the entire biliary tree. Most patients are asymptomatic and initially diagnosed because of incidentally discovered elevated LFTs.

Primary Biliary Cholangitis

Primary biliary cholangitis (PBC) is an autoimmune disease involving cholestasis that produces intrahepatic scarring of small bile ducts. As the disease progresses, the scarring may lead to periportal inflammation, fibrosis, possibly cirrhosis and liver failure. Most patients present with symptoms of pruritus and fatigue.

Seasonal Affective Disorder

Seasonal Affective Disorder is a mood disorder that affects approximately 5% of people in the United States per year. It is more common in Northern climates, among people with a history of depression, and in people with a first-degree relative who suffers from depression.

The Management of Animal Bites

Your next patient in clinic has arrived with a chief complaint of “animal bite”. Steve is a long-time patient of yours. He is retired and spends his time volunteering at the animal shelter. This is not the first time he has been bitten by an animal. When you walk into the examination room, you see an older gentleman in minimal distress. He is holding his right arm, and his forearm has a piece of gauze covering it.

Respiratory Infection in an Infant

You walk into your family practice clinic and see a post-it note on your schedule that your first appointment has been bumped for an infant whose parents called in last night and spoke with the cross-covering physician at your practice. The note says that the infant had a low-grade fever, cough, and wheezing.

Practical Advice for the “Healthy” Patient

For many of us in primary care, the typical patient is “healthy-ish.” She might be overweight but not morbidly obese. He might be diabetic but manages his disease with a single medication. She might have high cholesterol and hypertension but otherwise has a negative medical history.