ACE Inhibitors Top Choice for Hypertension in Diabetes
They should be the first-line treatment in patients with hypertension who have DM when cost is not a concern, according to a new study. (Source: Consultant Live)
Source: Consultant Live - November 19, 2013 Category: Primary Care Source Type: news

Cholesterol Management 2013 and Beyond: Two Roads Diverged
The ACC and AHA provide the map for a road not yet traveled in the assessment and treatment of cardiovascular disease. The new 2013 guidelines parse risk in new ways and shift away from the statin-centric prevention model we know so well. What's different? Is anything the same? Here, a closer look. (Source: Consultant Live)
Source: Consultant Live - November 18, 2013 Category: Primary Care Source Type: news

Use ABPM to Assess Diabetes Cardiovascular Risk
Patients with type 2 diabetes mellitus should be monitored with ABPM if they are at high risk for cardiovascular complications, according to the results of a new study. (Source: Consultant Live)
Source: Consultant Live - November 18, 2013 Category: Primary Care Source Type: news

In Workup for New-Onset AF, What and What Not to Order?
In evaluating a patient with new-onset atrial fibrillation for cardiac or embolic risk, there are several essential elements in a thorough workup. See if you know which of the tests here you can forgo. (Source: Consultant Live)
Source: Consultant Live - November 15, 2013 Category: Primary Care Source Type: news

Vaccine-Preventable Infection?
From lacy and reticular and limited to the cheeks, this rash quickly covered the child's body and transformed into a solid rash. Your dx? (Source: Consultant Live)
Source: Consultant Live - November 15, 2013 Category: Primary Care Source Type: news

New Guidelines Rethink Cardiovascular Risks
Prevention guidelines focus on assessment of CV risk, lifestyle modifications to reduce CV risk, and management of elevated blood cholesterol and body weight in adults. (Source: Consultant Live)
Source: Consultant Live - November 14, 2013 Category: Primary Care Source Type: news

The 23-Valent Pneumoccocal (Pneumovax) Vaccine: For Which Patients?
For which of these patients would you give the 23-valent pneumococcal vaccine? (Source: Consultant Live)
Source: Consultant Live - November 14, 2013 Category: Primary Care Source Type: news

Quiz for a Clinical Polymath
The topics this week range from superficial to visceral, and from head to spleen. See if you can answer all 5 questions. (Source: Consultant Live)
Source: Consultant Live - November 14, 2013 Category: Primary Care Source Type: news

The 23 Valent Pneumoccocal (Pneumovax) Vaccine: For Which Patients?
For which of these patients would you give the 23 valent Pneumococcal vaccine? (Source: Consultant Live)
Source: Consultant Live - November 14, 2013 Category: Primary Care Source Type: news

Folliculitis: Part II
In part II, a close-up look at fungal, eosinophilic pustular, and steroid-induced types. (Source: Consultant Live)
Source: Consultant Live - November 13, 2013 Category: Primary Care Source Type: news

The FDA and Hydrocodone
Hydrocodone-acetaminophen combinations are moved to Schedule II from Schedule III while single-agent extended release hydrodocone is approved without a tamper-resistant mechanism. Here, pain specialist Dr Steven King opines on both FDA decisions. (Source: Consultant Live)
Source: Consultant Live - November 13, 2013 Category: Primary Care Source Type: news

In HIV/HCV Co-infected Patients, How Avoid Hepatic Decompensation?
Patients co-infected with HCV and HIV can develop rapidly progressive liver fibrosis. End-stage liver disease is the most common cause of death in these patients even when they are undergoing antiretroviral therapy. (Source: Consultant Live)
Source: Consultant Live - November 11, 2013 Category: Primary Care Source Type: news

Folliculitis: Part I
Here: a close-up look at gram positive and negative cases of folliculitis. (Source: Consultant Live)
Source: Consultant Live - November 10, 2013 Category: Primary Care Source Type: news

Unsightly, perhaps & mdash;but dangerous?
The location is unusual, but the appearance is characteristic. Your dx? (Source: Consultant Live)
Source: Consultant Live - November 8, 2013 Category: Primary Care Source Type: news

Folliculitis: Part I
Here: a close-up look at gram positive and negative cases of folliculitis. (Source: Consultant Live)
Source: Consultant Live - November 8, 2013 Category: Primary Care Source Type: news

Is There a Best Regimen for Initial Antiretroviral Therapy?
With more than 2500 possible drug combinations to treat the HIV infection, HIV-AIDS expert Dr Rodger MacArthur starts the answer with another question: What exactly do we mean by "the best"? (Source: Consultant Live)
Source: Consultant Live - November 8, 2013 Category: Primary Care Source Type: news

Unsightly, perhaps—but dangerous?
The location is unusual, but the appearance is characteristic. Your dx? (Source: Consultant Live)
Source: Consultant Live - November 8, 2013 Category: Primary Care Source Type: news

Why “ Physician Wellness ” Is Such a Struggle
Hospitals and management groups are working to prevent physician burnout by creating " wellness " programs. Sounds good, right? Not really. Here, a family physician and burnout prevention coach explains what's wrong with the initial premise. (Source: Consultant Live)
Source: Consultant Live - November 7, 2013 Category: Primary Care Source Type: news

Why “Physician Wellness” Is Such a Struggle
Hospitals and management groups are working to prevent physician burnout by creating "wellness" programs. Sounds good, right? Not really. Here, a family physician and burnout prevention coach explains what's wrong with the initial premise. (Source: Consultant Live)
Source: Consultant Live - November 7, 2013 Category: Primary Care Source Type: news

Dark Mole & mdash;Dark Harbinger?
Would you worry about this asymptomatic lesion? What are the symptoms of achalasia? Test your clinical mettle against this week's 5 questions. (Source: Consultant Live)
Source: Consultant Live - November 6, 2013 Category: Primary Care Source Type: news

Persistent Pain in the Toes After Hiking
(Source: Consultant Live)
Source: Consultant Live - November 6, 2013 Category: Primary Care Source Type: news

Episodic Flank Pain With Urinary Frequency in an HIV-Positive Man
The 46-year-old man had presented 3 times with similar symptoms in the past year, was given a diagnosis of pyelonephritis and treated with antibiotics each time. He improved each time, but the symptoms returned. What else is going on? (Source: Consultant Live)
Source: Consultant Live - November 6, 2013 Category: Primary Care Source Type: news

Dark Mole—Dark Harbinger?
Would you worry about this asymptomatic lesion? What are the symptoms of achalasia? Test your clinical mettle against this week's 5 questions. (Source: Consultant Live)
Source: Consultant Live - November 6, 2013 Category: Primary Care Source Type: news

Cognitive Concerns in Primary Care: 10 Things You Should Know
This just in: Medicare reimburses physicians 3 to 5 times more for common procedural care than for cognitive care. (Source: Consultant Live)
Source: Consultant Live - November 5, 2013 Category: Primary Care Source Type: news

Does Rivaroxaban in Patients With AF Differ in Those With Prior MI?
A subgroup analysis of patients in the ROCKET-AF trial found rivaroxaban is equally effective in AF patients with prior MI as in those without. Read more here on results of the safety analysis and other data. (Source: Consultant Live)
Source: Consultant Live - November 5, 2013 Category: Primary Care Source Type: news

Direct Thrombin Inhibitors May Pose Increased Risk of MI
Dabigatran became more widely prescribed for patients with non-valvular AF after initially showing superiority to warfarin in the RE-LY trial. Results of subsequent analyses, however, dictate caution. (Source: Consultant Live)
Source: Consultant Live - November 5, 2013 Category: Primary Care Source Type: news

Chilblains (Pernio)
is typically caused by an abnormal vascular response to non-freezing cold exposure. (Source: Consultant Live)
Source: Consultant Live - November 4, 2013 Category: Primary Care Source Type: news

Mite and Other Bites—Debugging the Diagnosis
Bites from various bugs can resemble one another and cause symptoms similar to those of a variety of disorders. Test your knowledge in this week's photo quiz. (Source: Consultant Live)
Source: Consultant Live - November 1, 2013 Category: Primary Care Source Type: news

Black Hairy Tongue Associated with Treatment for Bipolar Disorder
Black hairy tongue is a benign and self-limited condition. It is caused by abnormal hypertrophy and elongation of filiform lingual papillae with associated discoloration, typically brownish or black. Certain medications are causative agents. (Source: Consultant Live)
Source: Consultant Live - November 1, 2013 Category: Primary Care Source Type: news

Mite and Other Bites—Debugging the Diagnosis
Bites from various bugs can resemble one another and cause symptoms similar to those of a variety of disorders. Test your knowledge in this week's photo quiz. (Source: Consultant Live)
Source: Consultant Live - November 1, 2013 Category: Primary Care Source Type: news

Skin and GI Lesions: What’s the Connection?
Cutaneous hyperpigmentation and papules coupled with active GI bleeding and a submucosal mass. What’s the diagnosis—and the chief clinical concern? (Source: Consultant Live)
Source: Consultant Live - November 1, 2013 Category: Primary Care Source Type: news

Beware Before Prescribing: Direct Thrombin Inhibitors Pose Increased Risk of MI
Dabigatran became more widely prescribed for patients with non-valvular AF after initially showing superiority to warfarin in the RE-LY trial. Results of subsequent analyses, however, dictate caution. (Source: Consultant Live)
Source: Consultant Live - November 1, 2013 Category: Primary Care Source Type: news

Racial Differences in Response to Antiretroviral Therapy
A recent study sought to separate psychosocial influences from biological factors at work in the higher rates of virologic failure among black Americans vs whites. (Source: Consultant Live)
Source: Consultant Live - November 1, 2013 Category: Primary Care Source Type: news

Diabetes, Intussusception, Celiac Disease: Take the Weekly Quiz
Among the disorders in the spotlight this week: intussusception, Celiac disease, sickle cell disease. See how well you do. (Source: Consultant Live)
Source: Consultant Live - November 1, 2013 Category: Primary Care Source Type: news

Black Hairy Tongue: What Cause?
The condition is characterized by an abnormal hypertrophy and elongation of filiform lingual papillae with an associated “brown” or “black” discoloration. Can you name the causes? (Source: Consultant Live)
Source: Consultant Live - October 30, 2013 Category: Primary Care Source Type: news

Obstructive Sleep Apnea Causes Myocardial Injury
OSA is associated with subclinical myocardial injury as indicated by increased high-sensitivity troponin T levels, according to this study. (Source: Consultant Live)
Source: Consultant Live - October 30, 2013 Category: Primary Care Source Type: news

Peripheral Nerve Stimulation for Chronic Headache
Electric stimulation of peripheral nerves shows promise as a long-term treatment for patients with chronic headache. (Source: Consultant Live)
Source: Consultant Live - October 30, 2013 Category: Primary Care Source Type: news

Lower Blood Glucose Levels May Stop Cognitive Decline
Lowering blood sugar levels is a promising strategy for preventing memory problems and cognitive decline as persons age, even for those whose blood sugar levels fall within the normal range. (Source: Consultant Live)
Source: Consultant Live - October 30, 2013 Category: Primary Care Source Type: news

Multiple Conditions Lower Seniors’ Quality of Life
In a recent study, both baseline and new multiple chronic conditions led to worse health in older patients. (Source: Consultant Live)
Source: Consultant Live - October 29, 2013 Category: Primary Care Source Type: news

Pearls From the Emergency Medical Literature
Here: tips from top articles culled from the emergency medical literature, with take-home messages for primary care. (Source: Consultant Live)
Source: Consultant Live - October 29, 2013 Category: Primary Care Source Type: news

Drug Offers Novel Approach for Airway Diseases
For patients with asthma or COPD, PL554 has the potential to both reverse bronchodilation and reduce inflammation more quickly and with fewer adverse effects. (Source: Consultant Live)
Source: Consultant Live - October 29, 2013 Category: Primary Care Source Type: news

Medication Errors in Adults—Case #4: Chemotherapy Drug Interactions
This case highlights medication errors that can result from drug interactions noted with the use of tamoxifen or other chemotherapeutic agents. (Source: Consultant Live)
Source: Consultant Live - October 27, 2013 Category: Primary Care Source Type: news

The Rapid, High-Yield Ortho Exam: A Systematic Approach
Attention to detail and a systematic approach combined with the knowledge and use of specific diagnostic exam tests will help minimize missing common orthopedic soft tissue injuries. (Source: Consultant Live)
Source: Consultant Live - October 24, 2013 Category: Primary Care Source Type: news

Treatment-Resistant Annular Rash
Antifungal creams haven’t made a dent in this intermittent rash. What is this lesion? (Source: Consultant Live)
Source: Consultant Live - October 24, 2013 Category: Primary Care Source Type: news

Mostly GI, with Pain and CAP for Good Measure
This week: 3 questions on GI disorders, 1 Pneumonia, and the link between the brain and pain. Can you answer all 5 questions? (Source: Consultant Live)
Source: Consultant Live - October 24, 2013 Category: Primary Care Source Type: news

Parents of Overweight Children Do Not Perceive the Health Risks
If a parent does not perceive their child to be obese, food choices for meals or snacks can be affected—or encouraging more exercise may not seem important. But parents in this study did not seem to worry even after they'd been told by a physician that their child's weight placed the child at risk. (Source: Consultant Live)
Source: Consultant Live - October 23, 2013 Category: Primary Care Source Type: news

Use Peanut Butter to Sniff Out Early Alzheimer Disease?
Peanut butter and a ruler may turn out to be tools that offer an inexpensive, sensitive, and specific olfactory means of screening for Alzheimer disease. Details here. (Source: Consultant Live)
Source: Consultant Live - October 23, 2013 Category: Primary Care Source Type: news

Strategies for Protecting and Treating Immunosuppressed Patients
Here: tips for optimal care for patients with medical disorders that suppress their immune systems or who are taking immunosuppressant medications. (Source: Consultant Live)
Source: Consultant Live - October 23, 2013 Category: Primary Care Source Type: news

Basal Cell Carcinoma: Looks Can Be Deceiving
Basal cell carcinoma often has a distinct appearance: a waxy bump that is pearly or translucent, with a rolled border is classic. But its appearance can raise suspicion for other conditions—mainly melanoma. Here are some examples of typical and atypical BCCs. (Source: Consultant Live)
Source: Consultant Live - October 23, 2013 Category: Primary Care Source Type: news

Rapid Opioid Detoxification
The use of general anesthesia to speed opioid detox without the discomforts of withdrawal has no scientific support. It can also be more dangerous than even a cold-turkey stop. Here, evidence of the hazards and support for time-tested dose reduction. (Source: Consultant Live)
Source: Consultant Live - October 22, 2013 Category: Primary Care Source Type: news