Special Issues of Family Medicine

Annotation: ➢ Identify and understand the pecularities of patients with low back pain in family doctor practice and be able to apply existing knowledge in patient care (diagnostics, differential diagnosis, tactics of care). Main tasks: ➢ To consider and analyze the most frequent reasons of low back pain in primary care. ➢ To understand the specifics of taking the anamnesis and clinical examination to patients with low back pain in primary care. ➢ To understand indications for laboratory, radiological examination tools, specialists’ consultation in primary care in low back pain differential diagnosis. ➢ To recognize warning symptoms and indications for hospitalization to patient with low back pain. Topics covered during the class: Homework: ➢ Strengthen theoretical knowledge about the lesson’s topic according to required prior knowledge description and selfcontrol questions, using previous study years’ educational material about peripheral nerves’ anatomy, respiratory/abdominal/urogenital diseases’ symptoms. The necessary background knowledge: ➢ Anatomy of peripheral nerves. ➢ Muscle innervation, dermatomes, myotomes. ➢ Neurological examination practical techniques. ➢ Radiographic testing in low back pain differential diagnosis. ➢ Non-pharmacologic and pharmacologic treatment of low back pain. ➢ Rehabilitation in case of low back pain. Self-control questions: 1. What is the definition of acute, subacute and chronic low back pain? 2. Give definition and examples to four clinical groups of low back pain: a. Non-specific pain - ... b. Specific pain - ... c. With nervous system damage associated pain - ... d. Irradiating pain - ... 3. What are the signs of low back pain with nervous system damage: a. Nerve root damage symptoms b. Cauda equina symptoms c. Lumbar myelopathy symptoms 4. What are “red flag” symptoms? 5. What accompanying symptoms can be in case of low back pain? 6. How we can objectively evaluate patient’s pain intensity? 7. What is Lasegue’s sign? Crossed Lasegue test? What is the interpretation of the examination results? 8. What is Schober’s test? What is the interpretation of the examination results? 9. Which screening laboratory tests can be used to low back pain differential diagnosis? 10. What are the indications for radiographic testing (RTG, CT, MRI etc.) in differential diagnosis? 11. Tactics in primary care unit in case of acute low back pain? 12. Tactics in primary care unit in case of chronic low back pain? 13. What is non-specific low back pain non-pharmacological treatment? 14. What is non-specific low back pain pharmacological treatment? 15. What is low back pain prophylaxis? Literature: BOOKS/CHAPTERS 1. Bates’, Guide to physical examination and history taking, 12th ed., chapter 9. 2. Davidson’s Principles & Practice of Medicine, 21st ed., chapters 22, 23. GUIDELINES Guideline for the evaluation and management of low back pain, evidence review https://www.mccofaz.com/media/3741/evaluation-and-management-of-low-back-pain.pdf Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians https://annals.org/aim/fullarticle/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice Low back pain EBM guidelines https://www.ebm-guidelines.com/ebmg/ltk.free?p_artikkeli=ebm00435 Clinical guidelines for low back pain: A critical review of consensus and inconsistencies across three major guidelines https://www.researchgate.net/publication/317507418_Clinical_guidelines_for_low_back_pain_A_critical_review_of_consensus_and_inconsistencies_across_three_major_guidelines Updated Guidelines for Treatment of Low Back Pain https://www.neurologyadvisor.com/topics/pain/updated-guidelines-for-treatment-of-low-back-pain/ Low back pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy

Annotation: ➢ Identify and understand the pecularities of patients with abdominal pain in family doctor practice and be able to apply existing knowledge in patient care (diagnostics, differential diagnosis, tactics of care). Topics covered during the class: Homework: ➢ Strengthen theoretical knowledge about the lesson’s topic according to required prior knowledge description and selfcontrol questions, using previous study years’ educational material about abdominal examination and the most frequent abdominal pathologies. The necessary background knowledge: ➢ The most frequent reasons of acute and chronic abdominal pain. ➢ Pathophysiology of abdominal pain, character, site and it’s connection to ethiology. ➢ Evaluation of general state and dangerous symptoms (“red flag”). ➢ Clinical, laboratory and radiological patients’ examination methods in differential diagnosis. ➢ Sympthomatic therapy in case of abdominal pain. ➢ Acute and chronic abdominal pain in children. Tactics. Literature: Recommended literature: BOOKS/CHAPTERS 1. Bates’, Guide to physical examination and history taking, 12th ed., chapter 9. 2. Davidson’s Principles & Practice of Medicine, 21st ed., chapters 22, 23. Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain https://www.karger.com/Article/FullText/371583 The Practice Guidelines for Primary Care of Acute Abdomen 2015 https://onlinelibrary.wiley.com/doi/pdf/10.14442/jgfm.17.1_5 Infants and children: Acute Management of Abdominal Pain (second edition) https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2013_053.pdf Abdominal Pain: A Synthesis of Recommendations for Its Correct Management https://www.italjmed.org/index.php/ijm/article/view/itjm.2015.515/645#toc Pediatric Functional Abdominal Pain Treatment and Referral Guidelines https://www.communitycarenc.org/media/files/ped-ab-pain-guidelines-rome-iii.pdf VADLĪNIJAS Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain https://www.karger.com/Article/FullText/371583 The Practice Guidelines for Primary Care of Acute Abdomen 2015 https://onlinelibrary.wiley.com/doi/pdf/10.14442/jgfm.17.1_5 Infants and children: Acute Management of Abdominal Pain (second edition) https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2013_053.pdf Abdominal Pain: A Synthesis of Recommendations for Its Correct Management https://www.italjmed.org/index.php/ijm/article/view/itjm.2015.515/645#toc Pediatric Functional Abdominal Pain Treatment and Referral Guidelines