AFP: American Family Physician Podcast Episode 238 -- September 2025 -- Part 2 AFP: American Family Physician
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Sep 30, 2025 Dive into the complexities of lymphadenopathy, where doctors pinpoint signs that may signal serious issues. Explore the role of galantamine in treating Alzheimer’s patients and its mixed outcomes. Discover effective parenteral treatments for migraines, and learn about the innovative EpiSwitch prostate cancer screening test. Unpack vitamin B12 deficiency risks and symptoms, along with diagnostic recommendations. Plus, hear how fezolinetant shows promise for managing menopause symptoms with minimal side effects.
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Lymphadenopathy: Wide Differential, Key Red Flags
- Lymphadenopathy has a broad differential ranging from self-limited viral infections to malignancy and autoimmune disease.
- Chronic nodes can still be benign, but certain features (hard, >2 cm, fixed, systemic symptoms) raise concern for malignancy.
Workup And When To Biopsy
- For generalized lymphadenopathy without clear cause, order inflammatory, infectious, and autoimmune testing; consider imaging as needed.
- If high-risk features or a persistent localized node >1 month, obtain needle or excisional biopsy rather than steroids masking diagnosis.
Galantamine: Benefits Come With Harms
- Galantamine slows cognitive decline at six months in mild-to-moderate Alzheimer's with an NNT ~10, but increases nausea and discontinuation.
- In mild cognitive impairment it shows no ADL benefit and raises harms including increased discontinuation and mortality signals.