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March 2010 Issue of JAAPA

Editorial

Yes, I'm his daughter—and I'm also a physician assistant

The author explores what happens as the roles of medical professional and daughter coincide when her elderly father is hospitalized with pneumonia.

Dermatology Digest

Does this young girl have the same rash as her mother?

The daughter of a woman with psoriasis vulgaris develops an alarming rash after exposure to several possible aggravating factors.

Clinical Watch

Pain management: Opioid use in chronic noncancer pain

Concerns about prescribing controlled substances and the potential for addiction should not prevent PAs from adequately managing chronic noncancer pain.

CME

Use of mild therapeutic hypothermia to treat cardiac arrest

Induced hypothermia, used to prevent brain ischemia during cardiac surgery, can also effectively treat out-of-hospital cardiac arrest.

How to approach the physical examination of a shoulder injury

Key factors from the history help with establishing a differential diagnosis and selecting proper tests for assessing a shoulder injury.

CME Posttests

CME Posttest: Examination of the shoulder; Mild therapeutic hypothermia

March 2010

Case Reports

A rare presentation of metastatic breast cancer in a woman with apparent cholangiocarcinoma

Jaundice and intermittent abdominal pain were the only clues to a primary breast cancer that manifested without the usual symptoms.

The Surgical Patient

Drain placement with antibiotics provides effective therapy for appendicitis in pregnancy

Conservative management is used effectively to treat a woman with a ruptured appendix at 32 weeks' gestation.

Critically Appraised Topic

Should patients at low-to-moderate cardiac risk receive beta-blockers before undergoing noncardiac surgery?

A search of the literature does not support using beta-blocker therapy in patients at lower risks for cardiac events prior to noncardiac surgery.

Quick Recertification Series

Polycystic kidney disease (PKD) and nephrotic syndrome

The clinical features, assessment of, diagnosis, and treatment of PKD and nephrotic syndrome are outlined in a quick review format.

POEMs

One in four obese children with acanthosis nigricans have impaired glucose control

Clinical question: How often do obese children with acanthosis nigricans (AN) have diabetes or other impairments of glucose control?

Daily aspirin has limited benefit in patients with diabetes

Clinical question: In patients with diabetes but no cardiovascular disease, does daily aspirin treatment reduce the risk of cardiovascular events?

Acute-onset visual floaters and flashes is linked to retinal detachment

Clinical question Are adults with acute-onset visual floaters and flashes at risk for retinal detachment?

H1N1 pandemic flu symptoms are generally mild, brief

Clinical question What are the clinical features of the H1N1 pandemic influenza?

Elderly with higher BMI have lower mortality risk

Clinical question: What is the relationship between body mass index (BMI) and mortality in the elderly?

Maternal blood testing can accurately identify fetal sex

Clinical question: Is maternal blood testing late in the first trimester accurate to determine fetal sex?

When the Patient Asks

What do I do about treatment-resistant depression?

Patients who don't respond to their antidepressant should be evaluated carefully for compliance, substance abuse, bipolar disorder, and social stressors. Switching drugs or combination therapy ...

Diagnostic Imaging Review

Imaging helps to diagnose an uncommon disease in a man with painless hematuria

This patient's condition is rarely diagnosed by history and physical examination alone; CT with and without contrast is essential to detection.

Genomics in PA Practice

The genetics encounter: Not the typical clinic visit

The author explains the detail-oriented work of a pediatric geneticist working at a genetics clinic to help children and families dealing with rare disorders.

Case of the Month

Disfiguring and disabling growth is seen in an existing mass

A patient presents with a large cutaneous mass on her buttock. It was first noticed years earlier but had recently grown significantly.

Ask a Librarian

Ask a Librarian!—March 2010

Need more information about genetics or about patient assessment instruments and tests? This month's column discusses resources that can help.

Eliminating Health Disparities: What Works?

Eliminating health disparities: What works?—March 2010

This column examines recent literature on health disparities, emphasizing tools that can help clinicians to assess and address disparities in their own practices. This month's ...