Learning Objectives for

Case 1: 45-year-old female annual exam

  1. Principles of screening and the characteristics of a good screening test.
  2. Risk factors for breast and cervical cancer based on family history, age, gender and exposure.
  3. Current recommendations for mammography.
  4. Current recommendations for Papanicolaou testing and the different types of testing available.
  5. Risk factors for osteoporosis and appropriate preventative measures.
  6. Recommended immunizations for adults.
  7. Recognize symptoms of menopause.
  8. Cancer screening appropriate for a woman's yearly health exam.
Case 2: 55-year-old male annual exam
  1. Individualize the recommendation for cancer screening for common cancers for an adult male patient (e.g., lung, colorectal, and prostate).
  2. State the significance of nutrition and obesity in health promotion and disease prevention.
  3. Prescribe an exercise program for a sedentary patient.
  4. Recommend timely vaccinations based on age, medical conditions, lifestyle, and environment.
  5. Perform smoking cessation counseling for patients who smoke.
  6. State principles that guide behavior change counseling.
Case 3: 65-year-old female with insomnia
  1. Common causes of insomnia in the elderly.
  2. Diagnostic criteria for major depressive disorder (MDD).
  3. Use history, physical, and tests to rule out medical causes of depressive symptoms.
  4. Understand the effects of depression on the patient's family.
  5. Common therapeutic options for MDD and their side effects.
  6. Risk factors for elder abuse.
  7. Understand the importance of inquiring about the use of complementary and alternative therapies.
  8. Understand how culture can affect the evaluation and treatment of conditions.
Case 4: 19-year-old female with sports injury
  1. Create a differential diagnosis for ankle pain.
  2. Perform a focused history and physical appropriate for painful joints.
  3. Signs and symptoms of life/limb-threatening injuries.
  4. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) for strains/sprains.
  5. Utilize evidence-based medicine indications for radiologic evaluation of ankle injury.
  6. Construct a treatment plan for ankle pain, including RICE (Rest, Ice, Compression, Elevation).
  7. Provide counseling to the patient regarding injury prevention.
  8. Understand the role of the family medicine physician in treating ankle injuries
Case 5: 30-year-old female with palpitations
  1. Create a differential diagnosis of palpitations.
  2. Common presentations of hyperthyroidism.
  3. Common physical findings in hyperthyroidism: Lid lag, tremor, and hyperreflexia.
  4. Common causes of hyperthyroidism.
  5. Initial evaluation of a patient with suspected hyperthyroidism.
  6. Usual course of a patient with Graves' disease after radioactive iodine (RAI) treatment.
  7. Treatment of hypothyroidism after RAI treatment.
Case 6: 57-year-old female presents for diabetes care visit
  1. Incorporate appropriate psychosocial, cultural, health literacy, and family data into the management plan of a patient with type 2 diabetes.
  2. Apply evidence-based standards of care in the management of a patient with type 2 diabetes mellitus.
  3. Make informed decisions about diagnosis, monitoring, and pharmacologic management of type 2 diabetes patients using scientific evidence and clinical judgment.
  4. Recognize the barriers to coordination of diabetes care and envision system-wide improvements that could improve coordination of diabetes care.
  5. Recognize the importance of an inter-professional team approach in the care of patients with diabetes.
  6. Use of the electronic medical record in the care of your practice population and in the reporting of quality of care measures.
  7. Educate the patient about type 2 diabetes with attention to and respect for the patient's own disease model.
Case 7: 53-year-old male with leg swelling
  1. Differential diagnosis of unilateral leg swelling.
  2. Differentiate between deep venous thrombosis (DVT), leg ulcer, and peripheral arterial disease (PAD).
  3. The importance of smoking as a risk factor of vascular disease in the diabetic patient.
  4. Impact of socio-cultural factors on the management of chronic disease.
  5. Impact of obesity on health.
  6. Implications of DVT, its diagnosis, and management.
  7. The value of a team-based approach to chronic disease management.
Case 8: 54-year-old male with elevated blood pressure
  1. Nationally accepted guidelines for screening, diagnosing, and staging the severity of hypertension (i.e., pre-hypertension, essential hypertension, and resistant hypertension).
  2. Appropriate elements of the hypertensive patient history to identify lifestyle and other cardiovascular risk factors, and assess concomitant disorders that affect prognosis and guide treatment.
  3. Appropriate elements of a comprehensive physical examination in hypertensive patients, including proper techniques in blood pressure measurement.
  4. Order recommended laboratory studies on an uncomplicated new hypertensive patient on initial visits.
  5. Basic management plans for the longitudinal care of patients with hypertension.
  6. Elements of lifestyle modification (including health education and behavioral change strategies) for hypertensive patients.
  7. Importance of providing socio-culturally sensitive and responsive education, counseling, and care to patients and their families.
  8. Awareness of improved patient care outcomes through effective communication with all members of the primary care team, including nutritionists, social workers, and nurses.
  9. Awareness of practicing cost-effective health care and resource allocation that does not compromise quality of care.
Case 9: 50-year-old female with palpitations
  1. Risk factors for coronary heart disease (CHD).
  2. Elicit a clear history characterizing chest pain and the predictive value of these symptoms in diagnosing the underlying cause.
  3. Differential diagnosis for palpitations based on an organ system approach.
  4. Conduct a directed physical to search for findings to support or exclude differential diagnoses of atypical chest pain.
  5. Target goals for cholesterol and lipoproteins.
  6. Role of exercise stress testing for CHD in men and women.
Case 10: 45-year-old male presenting with low back pain
  1. Differential diagnosis for low back pain.
  2. Develop physical exam skills in evaluating low back pain.
  3. Develop the skills in the diagnosis and treatment of low back pain.
  4. Red flags or alarming symptoms for serious causes for low back pain.
  5. Order imaging studies when indicated.
  6. Appropriate treatment for back pain.
  7. Refer refractory back pain for consultation and surgical intervention.
Case 11: 74-year-old female with knee pain
  1. Obtain thorough history for the chief complaint of knee pain.
  2. Components of a thorough knee exam.
  3. Differential diagnosis for knee pain in an adult.
  4. Appropriate treatment plan for osteoarthritis, including medications and lifestyle modifications.
  5. Recognize when imaging and referral to specialists are appropriate.
  6. Classes of medications useful for the treatment of chronic pain, and their common side effects.
  7. USPSTF recommendations for appropriate screenings in adults, including musculoskeletal recommendations.
Case 12: 16-year-old female with vaginal bleeding and UCG
  1. Essential features of a preconception consultation and how to incorporate this content into any visit.
  2. Chlamydia screening.
  3. Use of the HEEADSS adolescent interviewing technique.
  4. Diagnose pregnancy: intrauterine, ectopic, and miscarriage.
  5. Options during an unplanned pregnancy.
  6. Order initial prenatal labs.
  7. Counsel pregnant patient for healthy behavior, folic acid supplementation, and immunizations.
  8. Normal progression of symptoms and physical exam findings during pregnancy.
  9. Workup of first trimester vaginal bleeding.
  10. Management of a miscarriage, including the medical and social follow-up.
Case 13: 40-year-old male with a persistent cough
  1. Differential diagnosis for a patient who presents with a persistent cough and wheezing.
  2. Important features of the history and physical examination that support the diagnosis of asthma.
  3. Key features of the history and physical examination that will determine the severity of asthma in the patient.
  4. Comorbid conditions of asthma that must be addressed to help the patient control his asthma (Comorbid conditions are those which may also require treatment in order for asthma control to improve).
  5. Medications available to treat asthma.
  6. Appropriate treatment and written asthma action plan for the patient based on his stage of severity.
  7. Educate the patient on how to use a peak flow meter, inhaler, and spacer device.
Case 14: 35-year-old female with missed period
  1. Establish diagnosis and timing of pregnancy, including week of gestation and estimated delivery date.
  2. Common symptoms of pregnancy, from diagnosis through the post-partum period.
  3. Appropriate responses to common problems that arise during pregnancy, including nausea, back pain, mood changes, and fatigue.
  4. Appropriate preventive measures and follow-up during pregnancy, including diet, exercise, immunizations, and diagnostic testing.
  5. Appropriate screening tests during and after pregnancy, including genetic, infectious, blood, hypertension, diabetes, domestic violence, and depression screening.
  6. Types of hypertension in pregnancy and common complications of hypertension in pregnancy.
  7. Gestational diabetes and common complications of gestational diabetes.
  8. Appropriate history, exam, and diagnostic work-up for vaginal discharge in pregnancy.
  9. Common etiologies of vaginal bleeding, including placenta previa and placental abruption
  10. Appropriate contraceptive options and preventive care in the post-partum period
  11. Family-centered, longitudinal perinatal care.
Case 15: 42-year-old male with right upper quadrant pain
  1. Adequate history on a patient with RUQ abdominal pain.
  2. Perform a diagnostic abdominal exam on a patient with RUQ abdominal pain.
  3. Differential diagnosis for someone with right upper quadrant abdominal pain.
  4. Order and interpret laboratory and radiologic tests as they relate to RUQ abdominal pain.
  5. Screening for substance abuse.
  6. Manage someone with biliary tract disease
  7. Counsel patient with alcohol abuse.
Case 16: 68-year-old male with skin lesion
  1. Accurately describe skin lesions
  2. Terms which describe the morphology, shape, and pattern of skin lesions.
  3. Treatment principles of topical corticosteroid and local and systemic antifungal agents.
  4. ABCDE criteria for the evaluation of hyperpigmented lesions as possible melanoma.
  5. Common biopsy procedures including shave biopsy, punch biopsy, incisional and excisional biopsies.
  6. Treatment modalities for squamous cell carcinoma.
  7. Importance and methods of prevention of skin cancers.
  8. Initial workup and management of benign prostatic hyperplasia (BPH).
Case 17: 55-year-old, post-menopausal female with vaginal bleeding
  1. Menopause and common symptoms and treatment options.
  2. Differential for postmenopausal bleeding.
  3. Counsel a patient about the differential, work-up, and follow-up plan for postmenopausal bleeding.
  4. Risk factors for osteoporosis and the recommended screening for osteoporosis.
  5. Recommended cancer screening for a 50+ year-old female.
  6. Risks/benefits of hormone therapy in the postmenopausal female.
  7. Counsel patients regarding osteoporosis prevention/treatment.
Case 18: 24-year-old female with headaches
  1. Typical presenting signs and symptoms of migraine headache and contrast these with the typical signs and symptoms of the most common and most serious causes of headache (tension, cluster, brain tumor, intracranial hemorrhage, medication use).
  2. Appropriately focused history on a patient who presents with headache.
  3. Focused neurologic exam on a patient who presents with headache.
  4. Indications for ordering imaging tests on a patient who presents with headache.
  5. Counsel a patient who presents with headache on the appropriate prevention and treatment of the headache.
  6. Importance of continuity of care when treating a patient who presents with chronic headache.
  7. Use of point-of-care technology when uncertainty regarding diagnosis, appropriate evaluation, and/or treatment of a patient arises during the course of an office visit.
Case 19: 39-year-old male with epigastric pain
  1. Differential diagnosis for a male patient who presents with epigastric abdominal pain.
  2. Key features of the history and physical examination that support the diagnosis of peptic ulcer disease.
  3. Differences in diagnostic workup and treatment for peptic ulcer disease due to Helicobacter pylori (H. pylori) versus gastroesophageal reflux disease (GERD).
  4. Differences between ulcer and non-ulcer (functional) dyspepsia.
  5. Evidence-based treatment strategies for H. pylori gastritis.
  6. Appropriateness of follow-up and testing for eradication in patients with H. pylori gastritis.
  7. Potential risks and adverse events associated with non-judicious use of proton pump inhibitors (PPIs).
  8. Cultural competency and respect for patients who will require interpreter services.
Case 20: 28-year-old female with abdominal pain
  1. Conduct a culturally sensitive, empathic history.
  2. Ways in which victims of violence may manifest symptoms and be alert to clues a patient may give that he/she has been a victim of intimate partner violence.
  3. Ways to assist the patient in developing a safety plan.
  4. Mandatory reporting requirements for the relevant state.
  5. Local resources available to survivors of violence.
  6. Survivorís perspective in an abusive relationship and the barriers to his/her seeking help.
  7. Differential diagnosis of abdominal and pelvic pain in evaluating the patient.
Case 21: 12-year-old female with fever
  1. Take a thorough history and perform an appropriate physical exam in the setting of an acute respiratory illness.
  2. Order appropriate diagnostic studies, if necessary, to determine cause of illness and severity of illness, and have the knowledge to treat acute respiratory infection.
  3. Accurately identify common positive findings on physical exam for pneumonia and acute respiratory infection.
  4. Calculate a body mass index, and determine the diagnosis of obesity.
  5. Counsel a pediatric patient and his/her family regarding appropriate treatment of obesity including diet and exercise.
  6. The changing pattern of obesity and three complications of obesity.
Case 22: 70-year-old male with new-onset unilateral weakness
  1. Signs and symptoms of transient ischemic attack (TIA) and stroke.
  2. Interpret laboratory data related to patients with new onset neurological symptoms, particularly numbness or weakness in an extremity with or without accompanying speech difficulty.
  3. Assess and interpret target goals for cholesterol and lipoproteins using the best available guidelines (e.g., National Cholesterol Education Program Adult Treatment Panel [NCEP ATP] III guidelines).
  4. Appropriate therapy for acute stroke and primary and secondary prevention of stroke.
  5. Evidence for the role of lifestyle changes in prevention of stroke.
  6. Side effects and costs of commonly used medications for stroke prevention and treatment.
  7. Importance of effective communication between physicians, students, patients, and families in the management of atherosclerotic cardiovascular disease
  8. Care for patients with coronary artery disease from diverse patient backgrounds and at different points in their illness.
  9. Appropriately discuss depression with a patient.
  10. Commonly used tests to determine the functional ability of an elderly patient, e.g., the "Timed Up and Go" (TUG) test, and the MiniĖMental State Examination (MMSE).
Case 23: 5-year-old female with sore throat
  1. Evaluate a patient with pharyngitis, including appropriate history and physical examination, use of clinical prediction rules and appropriate antibiotic use.
  2. Suppurative and non-suppurative complications of Group A beta-hemolytic streptococcal pharyngitis (strep throat).
  3. Health maintenance visit for a 5-year- old.
  4. Use CDC/ACIP chart in order to determine what immunizations are required based on age of the patient.
  5. Contraindications to immunizations.
  6. Diagnose Attention Deficit Hyperactivity Disorder (ADHD).
  7. Recommendations for screening of anemia in children.
  8. Calculate BMI in a child and be able to identify a child at risk for obesity.
Case 24: 4-week-old female with fussiness
  1. Fundamental components of an appropriate newborn and infant history.
  2. Differential for fussiness in a young infant and the pathophysiology of colic in infants.
  3. Physical exam techniques for a newborn and the basics of growth charting.
  4. Normal newborn and young infant behavioral norms, deviations from them, and signs and symptoms of concern in evaluating a young infant.
  5. Fundamentals of screening and assessment of postpartum blues and postpartum depression.
  6. Fundamental precepts of family systems thinking and practice supportive counseling skills which will empower parents to develop autonomy and mastery as parents.
  7. Health risk assessment of the young infant and the fundamentals of screening for such in the newborn period.
Case 25: 38-year-old male with shoulder pain
  1. Respect for the patient, physician preceptor, and office staff.
  2. Be a motivated and integral member of the office healthcare team, partnering effectively with the patient, preceptor, and office staff.
  3. Capacity for self-reflection and mindfulness concerning the patientís agenda, perspective and comprehension.
  4. Elicit the patientís chief complaint/concern --"shoulder pain"-- in an open-ended fashion.
  5. Elicit the patientís related story/narrative/HPI about their "shoulder pain" in a fashion that is appropriately detailed and inclusive of appreciating the functional impact of the patientís concern.
  6. Physical examination pertaining to the patient's chief complaint of "shoulder pain" that includes and is guided by the information gained in the clinical interview.
  7. Communicate to the physician preceptor the pertinent interview and examination findings and a related differential diagnosis pertaining to the patient's chief complaint of "shoulder pain" in the presence of the patient using patient-centered language.
  8. Assessment and treatment plan pertaining to the patient's chief complaint of "shoulder pain" that is subject to physician preceptor review and patient partnership, providing an opportunity for ongoing learning and application.
Case 26: 55-year-old male with fatigue
  1. Differential diagnosis for a patient presenting with fatigue.
  2. Cost-effective strategy when selecting a laboratory evaluation of a patient with fatigue.
  3. U.S. Preventive Services Task Force guidelines regarding screening for common cancers among adult men and women.
  4. Principles of clinical epidemiology relevant to screening and screening guidelines.
  5. Patient-centered approach to counsel patients on recommended preventive services.
  6. Develop an evaluation and management plan for an adult male with iron deficiency anemia.
  7. Articulate a compassionate approach to delivering bad news to a patient.
  8. Primary care physicianís role in maintaining a longitudinal therapeutic relationship with a patient during the process of consultation and referral.
Case 27: 17-year-old male with groin pain
  1. Elicit focused history of patients presenting with scrotal pain.
  2. Proficient testicular examination and elicit signs specific to identify or exclude testicular torsion.
  3. Differential diagnosis for adolescent male presenting with scrotal pain.
  4. Appropriate laboratory and radiological studies as it relates to the differential diagnosis of scrotal pain.
  5. Algorithmic approach to testicular pain.
  6. Management of testicular torsion.
  7. STIs as a cause of testicular pain among adolescent males.
  8. Importance of counseling to prevent STIs.
  9. Epidemiology and USPSTF recommendations for screening for common testicular cancers.
Case 28: 58-year-old male with shortness of breath
  1. Differential diagnosis for a patient who presents with shortness of breath and cough.
  2. Key features of the history and physical exam that support the diagnosis of chronic obstructive pulmonary disease (COPD).
  3. Organized, effective approach for smoking cessation counseling.
  4. Interpret pulmonary function test (PFT) results.
  5. Treatment plan for a patient with COPD.
  6. Counsel a patient on the use of an inhaler.
Case 29: 79-year-old male with dementia
  1. Differentiate among the presentations of delirium, dementia, and depression in an older adult patient.
  2. Interpret at least one standardized instrument (e.g., MiniCog, Mini-Mental State Examination [MMSE] or Folstein) to screen for cognitive loss in an older adult patient for whom there are concerns regarding memory or function.
  3. Baseline functional abilities (instrumental activities of daily living, activities of daily living) in an older adult patient with altered mental status
  4. Differential diagnosis for acute change in mental status for a patient with dementia.
  5. Caregiver stress and its impact on the care of a patient with dementia.
  6. Management options, including pharmacological, non-pharmacological, complementary therapies and caregiver support for an older adult patient with dementia.
  7. Therapeutic interventions to prevent or treat delirium in the hospital setting.
  8. Role of social service, healthcare agencies, hospice, and other community organizations to provide care and assistance to older adult patients with dementia and their families.
Case 30: Labor and delivery
  1. Advantages of group prenatal care.
  2. Diagnose active labor. 
  3. Interpret fetal monitoring strips using the National Institute of Child Health and Human Development (NICHD) guidelines.
  4. Affect of culture and health beliefs on pregnancy management.
  5. Evaluation and diagnosis of preclampsia, and the health disparities related to preclampsia.
  6. Role of the family physician in the management of prenatal care, labor, delivery, postpartum and newborn care.
  7. Effective counseling of patients and families regarding breastfeeding and newborn anticipatory guidance related to breastfeeding.
Case 31: 66-year old female with shortness of breath
  1. Nationally accepted guidelines for assessing risk of developing Coronary Artery Disease (CAD). Risk assessment to the individual patient. 
  2. Elements of the History of Present Illness (HPI) and Past Medical History (PMHx) in a patient having a high risk of CAD and presenting with symptoms and signs consistent with new onset Congestive Heart Failure (CHF).
  3. Psycho-social events/stressors that have had an impact on the patient's recent behaviors, affecting the management of health problems. Model the interviewing approach to establishing an empathic connection with the patient, and delineate the advantages of this approach.
  4. Elements of the physical exam (PE) in a patient with suspected CAD/CHF. Explain the significance of positive findings.
  5. Differential diagnosis of the most likely precipitating factors of CHF, considering the history and presentation of the identified patient.
  6. Diagnostic testing strategy for a patient at risk of CAD, presenting with shortness of breath, and interpret the test results.
  7. Patient-centered strategy for counseling a patient about lifestyle changes and management goals to reduce the risk of CAD.
  8. Reflect on your own personal reactions to the patient during the interview.  Consider the benefits of self-knowledge to future patient interactions. Model the exploration of problem-solving solutions which will be acceptable to the provider and the patient, for use when the patient has not been adherent to treatment plans.
Case 32: 33-year-old female with painful periods
  1. Risk factors for dysmenorrhea.
  2. Appropriate history and physical and laboratory work up of a patient with dysmenorrhea.
  3. Normal and abnormal physical examination findings on a pelvic exam.
  4. Appropriate differential diagnosis for a patient with dysmenorrhea.
  5. Treatment of dysmenorrhea.
  6. Definition of menorrhagia.
  7. Evaluation of a patient with possible premenstrual syndrome (PMS).
  8. Treatment options for a patient with PMS.
  9. Use and insertion for the progestin only intrauterine device (IUD) in a patient with dysmenorrhea.
Case 33: 28-year-old female with dizziness
  1. Recognize and identify common causes of upper respiratory infections (URI).
  2. Appropriate use of antibiotics in the treatment of URI.
  3. Counsel patients regarding appropriate therapeutic measures for URI.
  4. Effective and empathic strategies for communicating with patients and families with stressors and from diverse cultural backgrounds.
  5. Incorporate knowledge about culture and its impact on the health of patients and families into the treatment plans.
  6. Identify, differentiate, and discuss the common causes and treatment options for vertigo, presyncope and disequilibrium.
  7. History and physical characteristics that correlate with different causes of dizziness.
  8. Exam maneuvers and the significance of physical exam findings for the diagnosis vertigo.
  9. Recognize signs and symptoms of dizziness that may indicate serious disease.
  10. Indications for use of neuroimaging in evaluation of dizziness.
  11. Recommend cause-specific treatment for common causes of vertigo.
Case 34: Evaluation and Care of the Newborn Infant
  1. Benefits of feeding human breast milk to infants.
  2. Important elements of a prenatal history as they relate to the health of the unborn child, including the importance of maternal age.
  3. Factors in the perinatal and newborn history that may put a neonate at risk for medical problems.
  4. Intrauterine factors that affect the growth of the fetus.
  5. Indication for newborn screening for TORCH infections, including human immunodeficiency virus (HIV).
  6. Factors that affect maternal-to-fetus HIV transmission and those that play a role in the prevention of vertical HIV transmission.
  7. Key concepts used in the clinical evaluation of gestational age and stability at birth (e.g., the Ballard score and Apgar score). Use weight and gestational age to categorize potential clinical problems.
  8. Medications that are routinely given to all newborns (e.g., vitamin K, hepatitis B vaccine, eye infection prophylaxis).
  9. Common etiologies for small-for-gestational-age (SGA) infants.
  10. Salient physical findings of congenital cytomegalovirus (CMV) infection and potential long-term complications associated with this condition.
Case 35: Infant Well Child (2, 6 and 9 Months)
  1. Appropriate growth patterns in infants up to 9 months of age using standard growth charts.
  2. Nutritional requirements for appropriate growth for infants at ages 2, 6, and 9 months, including caloric requirements, differences between formula and breast milk, and how and when to add solid foods to the diet.
  3. Difference between expected developmental milestones (surveillance) and standardized tools (screening). Use the Parents' Evaluation of Developmental Status (PEDS) or other screening test to evaluate the developmental milestones of the patient at 2, 6, and 9 months.
  4. Importance of prevention and anticipatory guidance during the well visits, including behavior, development, safety and immunizations.
  5. Differential diagnosis for an asymptomatic abdominal mass and formulate a plan for evaluation.
Case 36: 3-Year-old Well Child Check
  1. Key components of a toddler well-child visit, including:
  2. Developmental milestones for children between the ages of 3 and 5 years old.
  3. Eczema and first-line therapy.
  4. Common causes and work-up of anemia in an otherwise healthy child, as well as first-line therapy of iron-deficiency anemia.
Case 37: 8-Year-Old Well Child Check
  1. Factors that contribute to childhood obesity.
  2. Health implications of childhood obesity.
  3. Typical presentation of attention-deficit hyperactivity disorder (ADHD) in children.
  4. Conditions that contribute to a child's failure in school.
  5. Initial evaluation of childhood hypertension.
  6. Routine components of a health maintenance visit for a school-aged child.
Case 38: 6-Year-Old with Chronic Cough
  1. Obtain a focused and relevant history for a chief complaint of chronic cough.
  2. Relevant physical exam findings in a complete pulmonary examination.
  3. Relevant differential diagnosis for chronic cough in a school-aged child.
  4. Atopic diathesis and its relationship to allergies and asthma.
  5. Basics of management of allergic rhinitis.
  6. Work-up for a patient suspected of having asthma.
  7. Apply the National Institutes of Health/National Asthma Education and Prevention Program (NIH/NAEPP) asthma severity criteria and stepwise management to a patient newly diagnosed with asthma.
  8. Fundamentals of an asthma action plan, including commonly used medications, peak flow monitoring, and asthma education.
  9. Be familiar with Web-based asthma resources for children with asthma and their families.
Case 39: 60-year-old woman with chest pain on exertion
  1. Symptoms and signs of chest pain characteristic of angina pectoris.
  2. Categorize the patientsí symptoms as angina pectoris, atypical angina, or non-cardiac chest pain.
  3. Complete medical history that differentiates among the common etiologies of chest pain.
  4. Clinical characteristics that is typical of angina pectoris, including risk factors of coronary heart disease.
  5. Perform a physical exam that includes identifying the presence of dyspnea and anxiety, obtaining accurate vital signs, and performing heart, lung, and vascular exams.
  6. Appropriate laboratory and diagnostic studies based on patient demographics and the most likely etiologies of chest pain.
  7. Recommend primary and secondary prevention of ischemic heart disease through the reduction of cardiovascular risk factors (e.g. controlling hypertension and dyslipidemia, aggressive diabetes management, avoiding tobacco, and aspirin prophylaxis).
  8. Prescribe appropriate anti-anginal medications when indicated and communicate potential adverse reactions.
Case 40: 45-year-old man who is overweight
  1. Be aware of health implications of obesity.
  2. Risk factors for obesity-related changes.
  3. Physical findings of hypercholesterolemia.
  4. Etiologies of primary and secondary dyslipidemias.
  5. Screening recommendations for dyslipidemias in adults.
  6. Basic management of common dyslipidemias, including therapeutic lifestyle changes.
  7. Calculate daily caloric requirement to maintain weight and daily caloric requirement for weight loss.