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SPECIFIC OBJECTIVES FOR THIS COURSE: DAY 1 - THYROID NODULES – Incidence of thyroid nodules in the primary care setting. Features from history and physical examination that increase the likelihood of malignancy. Diagnostic approach to a thyroid nodule. Common cytologic findings from fine needle aspirate and their clinical significance. DIZZINESS – Common causes of dizziness. Central and peripheral causes of vertigo. Physical examination maneuvers used to diagnose and treat vertigo. IMPORTANT DRUG INTERACTIONS, SIDE EFFECTS – Common mechanisms for drug interactions. Most frequent culprit drugs. Frequent side-effects seen with commonly used medications. APPROACH TO SYNCOPE – Etiologies of syncope. Clues in the history and physical as well as simple office testing to risk-stratify patients. Use of additional testing in syncope. Role of lifestyle measures, medication, and more invasive measures to prevent recurrent syncope. DAY 2 - PERIPHERAL ARTERIAL DISEASE (PAD) – Pathophysiology of arteriosclerosis, the most common cause of PAD. Patients at increased risk for PAD. Focused history and physical examination to assess for PAD. Role of ancillary testing. Management of PAD utilizing evidence-based guidelines for exercise, medications and revascularization. OUTPATIENT ANTICOAGULATION ISSUES – Outpatient warfarin using current guidelines. When and how to reverse the effects of warfarin. Evaluate for hypercoagulable states and the implications. Appropriate duration and intensity of anticoagulation in a variety of clinical scenarios. ABNORMAL LIVER TESTS: CASE STUDIES – Approach to assess patients with asymptomatic elevations in liver studies. Common causes of asymptomatic elevations in transaminase levels. Natural history of hepatitis B infection, including serologic markers and indications for treatment. Eepidemiology, evaluation and potential treatment options for nonalcoholic steatohepatitis. DYSLIPIDEMIA – Recent changes to ATP III lipid management guidelines to their clinical practice. Secondary causes of dyslipidemia. Treatment strategies for various dyslipidemic states. DAY 3 - PAINFUL KNEE – Historical features to help distinguish between common causes. Physical examination skills utilized in the diagnosis of common causes. Treatment of common knee injuries and which injuries require orthopedic consultation. PAINFUL SHOULDER – Anatomy of the shoulder in relation to common mechanisms of injury. Key historical and physical examination skills needed to diagnose common causes. Initial management of common injuries. DIAGNOSIS OF PRIMARY HEADACHE SYNDROMES – Historical features of migraine, tension-type, cluster headache. Which historical features best discriminate between migraine and tension-type headache. Triggers for migraine. TREATMENT OF PRIMARY HEADACHE SYNDROMES – Role of abortive therapy for migraine, tension-type, cluster headache. Range of options for pharmacologic preventive therapy for migraine, tension-type, cluster headache. Non-pharmacologic treatment strategies for migraine. DAY 4 - PREVENTION OF TYPE 2 DIABETES – Identify patients with pre-diabetes. Recommendations of professional organizations regarding diabetes prevention. Treat CVD risk factors in patients with pre-diabetes. TREATMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES – Glucose targets in T2DM. Pharmacological treatment options. Develop individualized regimens to optimize glycemic control. PREOPERATIVE CARDIAC EVALUATION – Risk stratification for perioperative cardiac risk. Preoperative cardiac risk guidelines; revised cardiac risk index. Beta-blockers and statins for patients at risk for perioperative cardiac complications. PREOPERATIVE PULMONARY EVALUATION – Patient and procedure-related risk factors for postoperative pulmonary complications. The limited role of preoperative spirometry. Strategies to reduce the risk of postoperative pulmonary complications. DAY 5 - APPROACH TO HYPERTENSION – Appreciate that all antihypertensive medications do not equally reduce cardiovascular risk. Apply the JNC-7 guidelines to clinical care of hypertensive patients. Indications for selection of initial antihypertensive therapy. Which drugs most effectively reduce the risk of cardiovascular disease. NEW DRUGS FOR THE PRIMARY CARE PHYSICIAN – Important advances in pharmacotherapy. Efficacy and side effects for each drug. Compare key new drugs with previously available medications for similar indications. COMMON THYROID DISORDERS – Common causes of thyroid hyper-function and hypo-function. Treat common thyroid function abnormalities. Evaluation of thyroid nodules. COMMON ENDOCRINE DISORDERS – Recognize, evaluate and treat common endocrine abnormalities including hypoglycemia, hypercalcemia, low testosterone, adrenal masses.
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