Evaluation of primary care residents' knowledge of pharmacotherapy.

BACKGROUND: The study objective was to determine primary care residents' knowledge of pharmacotherapy. METHODS: Eighty primary care residents at five Family Medicine residencies completed a pharmacotherapy survey used to assess their knowledge of drug interactions, adverse drug reactions, and new medications. Residents were asked whether they could benefit from more formal pharmacotherapy instruction. RESULTS: Seventy-seven residents (96%) completed the survey. Scores ranged from 11 to 43 (22% to 86%) out of a possible 50. Scores showed no significant difference on the basis of sex or residency. The only statistically significant difference was between first and third year residents' scores. Third year residents' mean score was 32.39 +/- 8.23 (64.8%). Ninety-one percent of residents believed they could benefit from more formal instruction in pharmacotherapy. CONCLUSIONS: Results suggest that primary care residents' pharmacotherapy knowledge may need improvement. Residents affirmed the need for formal instruction. Therefore, comprehensive pharmacotherapy curricula in primary care residencies should be considered.

Paresthesias: a practical diagnostic approach.

Paresthesias may be caused by central or peripheral nervous system abnormalities. Central nervous system-induced paresthesias are most commonly caused by ischemia, structural or compressive phenomena, infection, inflammation or degenerative conditions. Peripherally induced paresthesias can be caused by entrapment syndromes, metabolic disturbances, trauma, inflammation, connective tissue diseases, toxins, hereditary conditions, malignancies, nutritional deficiencies and miscellaneous conditions. Confirming the diagnosis and establishing an etiology may require appropriate laboratory and radiologic studies, or other studies. In most cases, the specific clinical syndromes associated with the paresthesias, coupled with the presenting neurologic findings, provide the physician with a framework for the diagnosis.

Secondary hypertension: a practical diagnostic approach.

Secondary hypertension is a relatively uncommon, potentially reversible condition for which physicians should maintain a high index of suspicion. When a patient is found to have elevated blood pressure, a through history should be obtained and a complete physical examination should be performed. Depending on the findings, additional screening and diagnostic studies may be necessary. The most common causes of secondary hypertension are renal parenchymal disease, renovascular disease, coarctation of the aorta, pheochromocytoma, primary hyperaldosteronism, thyroid dysfunction and Cushing's syndrome.

Screening for prostate cancer: a comparison of urologists and primary care physicians.

Prostate cancer screening has assumed increased importance with increasing mortality from this cancer. Newer diagnostic tests such as measurement of prostate-specific antigen (PSA) have improved detection of early prostate cancer. To determine practice patterns of prostate cancer screening, surveys were sent to 487 urologists (231 responses) and 542 family physicians (205 responses) in the Southeast inquiring about actual screening practices. In screening asymptomatic patients, the digital rectal examination was used by 99% of the urologists and 98% of the family physicians, with the mean age of screening initiation being 45 +/- 7 years for the urologists and 43 +/- 7 years for the family physicians. Serum PSA was used for screening asymptomatic patients by 98% of the urologists and 87% of the family physicians, with 49 +/- 4 years being the mean age of screening initiation for both specialties. Although differences in screening emerged, both physician groups approximated the recommended screening guidelines.

Ampicillin-specific rashes.

Ampicillin is one of the most common drugs to elicit a rash, with an overall incidence of 3% to 8%. "Ampicillin-specific" rashes are thought to be nonhypersensitivity reactions and cause maculopapular erythema with minimal irritation or pruritus. If the rash is indeed an ampicillin-specific one, then discontinuation of ampicillin is not mandatory, and subsequent use of ampicillin or other beta-lactam antibiotics is tolerated. On the other hand, true hypersensitivity reactions with urticarial and anaphylactic properties demand prompt discontinuation of the drug and warrant supportive care. Unfortunately, there is no immediate definitive scientific method to differentiate between the two.