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Cardiovascular Signs and Symptoms: Syncope and Presyncope. 心血管体征和症状：晕厥和晕厥前期。
FP essentials Pub Date : 2026-03-01
Anna Laurie, Jenna Greenberg, Joshua Greenberg
{"title":"Cardiovascular Signs and Symptoms: Syncope and Presyncope.","authors":"Anna Laurie, Jenna Greenberg, Joshua Greenberg","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Syncope is an abrupt, transient, and complete loss of consciousness associated with an inability to maintain postural tone, followed by rapid and spontaneous recovery. Syncope is caused by temporary cerebral hypoperfusion. Presyncope describes symptoms such as lightheadedness and vision changes that may or may not precede syncope. Syncope can be classified by its mechanism: reflex (neurally mediated), orthostatic hypotension, or cardiac. Initial evaluation of loss of consciousness should include a careful history and detailed physical examination with orthostatic vital signs and 12-lead electrocardiography. The history should evaluate whether the episode was a true loss of consciousness and clarify whether it has a syncopal or nonsyncopal etiology. Although there is no evidence-based standard for the diagnosis of syncope, consensus suggests diagnostic criteria concordant with the three syncope mechanisms. The treatment of syncope is specific to its mechanism. Multiple risk stratification tools exist; however, these do not outperform clinician judgment in predicting serious outcomes of syncope in the short term. When evaluating and treating syncope, additional consideration should be given to special populations including children and adolescents, older adults, athletes, and patients with postural orthostatic tachycardia syndrome.</p>","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"562 ","pages":"27-35"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Musculoskeletal Treatments. 肌肉骨骼治疗。
FP essentials Pub Date : 2026-02-01
Kate Rowland
{"title":"Musculoskeletal Treatments.","authors":"Kate Rowland","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"561 ","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Musculoskeletal Treatments: Fracture Management. 肌肉骨骼治疗：骨折管理。
FP essentials Pub Date : 2026-02-01
Kana Maeji Carter, Bradlee Sako
{"title":"Musculoskeletal Treatments: Fracture Management.","authors":"Kana Maeji Carter, Bradlee Sako","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Primary care physicians often serve as the initial point of contact for patients presenting with potential fractures. Initial evaluation with plain radiography or ultrasonography can confirm the diagnosis. If clinical suspicion remains high despite negative imaging, the joint should be immobilized with protected weight-bearing. Then, reassessment should include repeat radiography in 10 to 14 days or advanced imaging with computed tomography or magnetic resonance imaging without intravenous contrast based on location and risk. For fractures that can be managed nonoperatively, the joint should be immobilized with a brace or cast, with short-interval follow-up and repeat radiography. Common indications for referral to an orthopedic surgeon include fractures that are open, displaced, intra-articular, unstable, fracture-dislocations, and those with neurovascular compromise. Fractures with nonunion or malunion should be managed surgically. Rehabilitation is supported by some evidence but requires further research to define optimal protocols for specific fracture types. Special populations, including older adults and athletes, require tailored care plans. Multidisciplinary care has been shown to improve outcomes in patients with complex fractures and in older adults. Racial and ethnic disparities in morbidity and mortality rates associated with fractures highlight the need for improved access to quality care.</p>","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"561 ","pages":"7-13"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Musculoskeletal Treatments: Injection Therapies. 肌肉骨骼治疗：注射疗法。
FP essentials Pub Date : 2026-02-01
Bradlee Sako, Kana Maeji Carter
{"title":"Musculoskeletal Treatments: Injection Therapies.","authors":"Bradlee Sako, Kana Maeji Carter","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Musculoskeletal conditions are often managed conservatively, and injection therapies can serve as a diagnostic and therapeutic adjunct in their management. Corticosteroids are commonly injected into joints and soft tissues for their anti-inflammatory properties in pain reduction. Although these injections are widely used, their potential long-term risks, including chondrotoxicity, require careful evaluation of their role in short-term pain relief. Based on current research, hyaluronic acid and prolotherapy may offer pain relief with a potentially lower risk profile compared with corticosteroids, but they are not typically covered by health insurance. Platelet-rich plasma has shown mixed but generally promising results for multiple indications, although its use is limited by out-of-pocket expense. Stem cell therapy remains largely experimental. Compared with landmark-guided techniques, ultrasound guidance offers clinicians increased injection accuracy, safety, and the ability to perform injections that previously required specialty referral.</p>","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"561 ","pages":"14-22"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Musculoskeletal Treatments: Physical Modalities. 肌肉骨骼治疗：物理模式。
FP essentials Pub Date : 2026-02-01
Liana Kobayashi, Kana Maeji Carter
{"title":"Musculoskeletal Treatments: Physical Modalities.","authors":"Liana Kobayashi, Kana Maeji Carter","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Chronic musculoskeletal pain disorders account for 70% to 80% of chronic pain diagnoses in the United States. T he most common conditions are low back pain, neck pain, headache disorders, and knee and hip osteoarthritis. Most evidence suggests that treatments for chronic pain are best used in combination, such as in multidisciplinary rehabilitation programs. Evaluation of individual treatments in isolation is limited by small sample sizes, high risk of bias, lack of standardization in clinician delivery and treatment dosage or intensity, and inconsistent categorization of treatment techniques. Moderate-certainty evidence supports the effectiveness of exercise-based therapies, whereas low- to moderate-certainty evidence supports the use of osteopathic manipulative treatment for pain management across multiple body regions. Additional available therapies include other types of manual therapy (eg, spinal manipulative therapy, chiropractic care), massage therapy, Rolfing, traction, transcutaneous electrical nerve stimulation, therapeutic ultrasound, laser therapy, dry needling, shockwave therapy, and kinesio taping.</p>","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"561 ","pages":"22-29"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Musculoskeletal Treatments: Psychological and Integrative Therapies. 肌肉骨骼治疗：心理和综合疗法。
FP essentials Pub Date : 2026-02-01
Cynthia L Kim, Kana Maeji Carter
{"title":"Musculoskeletal Treatments: Psychological and Integrative Therapies.","authors":"Cynthia L Kim, Kana Maeji Carter","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>T he relationships between prolonged or chronic musculoskeletal pain and psychological factors are complex and multifactorial. The relationships can be characterized as neurobiopsychological in etiology and manifestation. Mental health influences the experience and perception of pain, treatment adherence, and functional outcomes. T hus, patients with chronic pain should be screened for comorbid mental health conditions. Accurate diagnosis helps determine which integrative modalities are most likely to be effective for treatment of musculoskeletal pain and dysfunction. Pharmacologic treatment can reduce or alleviate mental health symptoms that negatively interact with pain and dysfunction. Integrative modalities include psychological therapies such as cognitive behavior therapy, mindfulness-based stress reduction, acceptance and commitment therapy, and cognitive functional therapy. Physicians should engage their patients in open and nonjudgmental discussion about beliefs regarding pain and dysfunction and the use of integrative therapies. They can educate patients on how to identify accurate information about these modalities, allowing patients to make informed decisions regarding their use. Health insurance will typically pay for short courses of psychotherapies and some somatic therapies, but access to licensed clinicians is limited in many areas. Insurance rarely covers supplements and other integrative, nonmainstream therapies.</p>","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"561 ","pages":"31-35"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Abdominal Pain Syndromes: Small Bowel Obstruction and Ileus. 腹痛综合征：小肠梗阻和肠梗阻。
FP essentials Pub Date : 2026-01-01
Katie L Buel, Paul T Mingo
{"title":"Abdominal Pain Syndromes: Small Bowel Obstruction and Ileus.","authors":"Katie L Buel, Paul T Mingo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Small bowel obstruction and ileus are common surgical concerns that family physicians may encounter in a consultative role with surgical specialties. The most common cause of small bowel obstruction in adults and children is adhesions, followed by internal and external hernias. Postoperative ileus is a common complication that can occur after any abdominal surgery; however, with the implementation of enhanced recovery after surgery protocols, the incidence is decreasing. For small bowel obstruction, treatment focuses on gastric decompression, fluid resuscitation, electrolyte replacement, and pain control, which may include opioid therapy initially. Use of oral contrast medium studies for small bowel obstructions managed nonoperatively is now considered the standard of care after appropriate decompression and fluid resuscitation in the low-risk patient. Operative management is recommended for patients with hemodynamic instability, surgery in the previous 6 weeks, or signs of peritonitis, and for those in whom the condition does not resolve with an initial nonoperative approach. Treatment of postoperative ileus is largely supportive, entailing electrolyte correction, intravenous fluids as needed, and pain control.</p>","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"560 ","pages":"30-35"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Abdominal Pain Syndromes: Acute Appendicitis. 腹痛综合征：急性阑尾炎。
FP essentials Pub Date : 2026-01-01
Paul T Mingo, Katie L Buel
{"title":"Abdominal Pain Syndromes: Acute Appendicitis.","authors":"Paul T Mingo, Katie L Buel","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Acute appendicitis is one of the most common causes of emergency abdominal surgery in adults and children. Although tenderness at the McBurney point is the most specific symptom, diagnosing appendicitis clinically is challenging. Diagnosis should include the use of laboratory testing, including white blood cell count with differential, C-reactive protein level, and neutrophil-to-lymphocyte ratio, in addition to use of clinical prediction tools such as the Appendicitis Inflammatory Response score and diagnostic imaging. Although ultrasonography is a reasonable first-line imaging modality, its outcomes are user-dependent and studies are often nondiagnostic (ie, unable to rule out appendicitis). Computed tomography is commonly used in the United States to diagnose acute appendicitis and has the additional benefit of being able to evaluate for multiple etiologies of abdominal pain. Based on imaging findings, acute appendicitis can be subcategorized as uncomplicated (ie, inflammatory changes without signs of necrosis or abscess) or complicated (ie, signs of necrosis with perforation or abscess formation). Patients with appendicolith on imaging and pregnant patients should be managed surgically. The standard of care for uncomplicated acute appendicitis remains laparoscopic appendectomy, whereas complicated appendicitis in stable patients may initially be managed nonoperatively with antibiotic therapy and percutaneous abscess drainage before consideration of interval appendectomy.</p>","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"560 ","pages":"7-14"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Abdominal Pain Syndromes. 腹痛综合征。
FP essentials Pub Date : 2026-01-01
Ryan D Kauffman
{"title":"Abdominal Pain Syndromes.","authors":"Ryan D Kauffman","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"560 ","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Abdominal Pain Syndromes: Gallstone Disease. 腹痛综合征：胆石症。
FP essentials Pub Date : 2026-01-01
Paul T Mingo, Katie L Buel
{"title":"Abdominal Pain Syndromes: Gallstone Disease.","authors":"Paul T Mingo, Katie L Buel","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cholelithiasis, characterized by the presence of gallstones, is a common condition in the United States, with 80% of affected individuals having no symptoms. Symptomatic gallstone disease encompasses symptomatic cholelithiasis, biliary dyskinesia, acute cholecystitis, choledocholithiasis, gallstone pancreatitis, and acute cholangitis. It often manifests as sharp, stabbing right upper quadrant or epigastric pain as well as nausea and vomiting. History, physical examination, and laboratory evaluation alone are insufficient to make an accurate diagnosis. Ultrasonography should be the first-line imaging modality for evaluating right upper quadrant pain. Symptomatic cholelithiasis is diagnosed with the confirmation of gallstones on imaging in patients presenting with classic symptoms. Clinical prediction tools such as the 2018 Tokyo guidelines for acute cholecystitis or pretest probability calculation for choledocholithiasis should be used to aid diagnosis and determine the need for further imaging. Laparoscopic cholecystectomy is the standard treatment for most forms of symptomatic gallstone disease. In cases of choledocholithiasis, intraoperative common bile duct exploration at the time of cholecystectomy or endoscopic retrograde cholangiopancreatography performed before, during, or after cholecystectomy is needed.</p>","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"560 ","pages":"15-21"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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