Hospital Medicine Comprehensive Review Series

Title: HMid-Hospital Medicine – Infectious Diseases: Bloodstream Infections/Endocarditis; Multi-Drug Resistant; Skin/Soft Tissue

Faculty: John K. Crane, M.D., PhD., Blair Weikert, M.D.

Original Release Date: July 1, 2020  Expiration Date: July 1, 2023

TOPIC 1: Bloodstream Infections and Endocarditis.

Upon completion of this session, the participant should be able to: ^{GL, COMP}

1. Analyze the epidemiology and risk factors for bloodstream infections and endocarditis in patients presenting to a primary care practice.
2. Employ the diagnosis and management skills for bloodstream infections and infective endocarditis as per the current IDSA guidelines.
3. Recognize post-infection patient management issues and apply appropriate endocarditis prophylaxis measures as per the AHA guidelines

TOPIC 2: Multi-Drug Resistant Infections.

Upon completion of this session, the participant should be able to: ^{EBM, COMP}

1. Assess to identify and avoid or minimize the urgent and serious threats of drug resistance as identified by the CDC and IDSA.
2. Apply the most effective and appropriate treatment and strategy for each infection.
3. Determine when specialist referral will result in an improved outcome.

TOPIC 3: Skin and Soft Tissue infections.

Management of skin and soft tissue infections continues to be common in primary care.  They can range from uncomplicated which is managed in the outpatient setting to problematic requiring inpatient care, An evidence-based approach to diagnosis and treatment from JAMA dermatology, Clinical Infectious Diseases, CDC guidance published in the MMWR, and NEJM will be reviewed. Upon completion of this session, the participant should be able to: ^{COMP, EBM, GL}

1. Differentiate between skin and soft tissue infections that require antibiotic coverage for anaerobes and those that do not.
2. Accurately diagnose venous stasis dermatitis as a non-infectious entity.
3. Correctly formulate treatment plans for animal and human bites.
4. Identify 2 or more non-infectious diagnoses that resemble “bilateral cellulitis”

Title: HMne-Hospital Medicine - Neurology: Headaches; Stroke; Syncope/Vertigo

Faculty:Gerald W. Smetana, M.D., M.A.C.P,. Kendal Williams, M.D., M.P.H.

Original Release Date: July 1, 2020  Expiration Date: July 1, 2023

TOPIC 1 Treatment of Primary Headache Syndromes.

Upon completion of this session, the participant should be able to: ^{EBM, GL, COMP}

1. Appreciate the role of abortive therapy for migraine, tension-type, and cluster headaches.
2. Recognize the range of options for pharmacologic acute and preventive therapy, as recommended by the AHS 2015 Evidence-Based recommendations for migraine, as well as options for tension-type, and cluster headaches.
3. Develop non-pharmacologic treatment strategies for migraine as per the most recent Cochrane Systematic Review.

TOPIC 2 Update on the Management of Stroke and Transient Ischemic Attack.

Upon completion of this session, the participant should be able to: ^{GL, COMP}

1. Assess common presentations of cerebrovascular insufficiency.
2. Prescribe the initial management of patients with a suspected acute CVA.
3. Apply cutting edge strategies and therapies for the management of hemorrhagic and thrombotic strokes.
4. Distinguish between stroke and TIA and appropriately assess the patient with TIA for early risk of stroke.
5. Formulate an effective post-stroke secondary prevention plan as per the AHA/ASA guidelines.

TOPIC 3: The Evaluation and Management of Syncope and Vertigo.

Upon completion of this session, the participant should be able to: ^{GL, COMP}

1. Appropriately evaluate patients with syncope or vertigo.
2. Formulate a diagnostic evaluation strategy of syncope or vertigo that is based on best practices and the 2017 ACC/AHA/HRS guidelines.
3. Debate the value of the various diagnostic approaches to the workup of syncope.
4. Prescribe an effective therapeutic strategy for the management of both syncope and vertigo per the 2017 ACC/AHA/HRS guidelines.

Title: Hospital Medicine - Endocrinology: Diabetes; Adrenal Insufficiency; Cushing's Syndrome

Faculty: David A. Horowitz, M.D., Stephen J. Winters, M.D.

Original Release Date: July 1, 2019  Expiration Date: July 1, 2022

TOPIC 1: Practical Approach to the Patient with Diabetes.

Upon completion of this session, using multiple research trials as well as recommendations from the ADA, EASN, AGA, CDA, AACE, ACP, and the AAFP, the participant should be able to: ^{GL, COMP}

1. Consider this primer on management.
2. Distinguish the patient who is likely to go on to develop complications and appreciate the potential long-term course.
3. Apply the current guidelines for therapy and access the anticipated outcome goals.

TOPIC 2: Adrenal Insufficiency- Primary and Secondary.

Upon completion of this session, the participant should be able to: ^COMP

1. Apply principles learned to evaluate the diagnostic tests used to confirm the diagnosis or primary or secondary adrenal insufficiency.
2. Employ therapeutic options for patients with primary or secondary adrenal insufficiency.

TOPIC 3: Cushing’s Syndrome and other Functional Disorders of the Adrenal.

Upon completion of this session, the participant should be able to: ^COMP

1. Outline the etiology of Cushing’s syndrome.
2. Evaluate a patient with an adrenal tumor.
3. Evaluate a patient for suspected hyperaldosteronism.
4. Recognize when to refer patients for more advanced cardiac care.

Title: Hospital Medicine - Radiology: Back Pain Imaging; Pelvic Imaging; Non-Invasive Vascular Imaging

Faculty: Adam R. Guttentag, M.D., Ryan J. Smith, M.D.

Original Release Date: July 1, 2019  Expiration Date: July 1, 2022

TOPIC 1: Back Pain Imaging.

Upon completion of this session, the participant should be able to: ^{EBM, COMP}

1. Use evidence based guidelines to help decide which patients require immediate imaging for evaluation of back pain.
2. Discuss the utility of various forms of imaging for specific lumbar pathologies.
3. Analyze a radiologist’s report of lumbar imaging with respect to the patient’s specific symptoms.

TOPIC 2: Pelvic Imaging.

Upon completion of this session, the participant should be able to: ^{GL, COMP}

1. Order appropriate radiologic studies for evaluating patients with dysfunctional uterine bleeding, according to the American College of Radiology Appropriateness Criteria.
2. Utilize the most appropriate imaging studies for evaluating female patients with pelvic pain, according to the American College of Radiology Appropriateness Criteria.
3. Determine which studies are most appropriate for evaluating patients with post-menopausal bleeding using the American College of Radiology Appropriateness Criteria

TOPIC 3: Non-Invasive Vascular Imaging: Aorta, Carotids and More.

Upon completion of this session, the participant should be able to: ^{EBM, COMP}

1. Design an evidence based algorithm for integrating imaging into evaluation of patients with suspected carotid stenosis.
2. Select appropriate tests to order for patients with suspected acute aortic syndromes.
3. Integrate modern non-invasive techniques into evaluation of suspected visceral and peripheral artery disease.

Title: Hospital Medicine - EKG: AV Block/Dissociation; Inferior/Posterolateral MIs; Lethal Dysrhythmias/Heart Disease

Faculty: Jerry W. Jones, M.D., F.A.C.E.P., F.A.A.E.M

Original Release Date: July 1, 2019  Expiration Date: July 1, 2022

TOPIC 1: 3rd Degree AV Block and AV Dissociation.

Upon completion of this session, the participant should be able to: ^COMP

1. Distinguish a 3rd degree AV block from a simple AV dissociation.
2. Discuss capture beats and fusion beats and demonstrate their utility in the diagnosis of AV dissociation and its differentiation from 3rd degree AV block.
3. Relate the differences between a junctional escape pacemaker and a ventricular escape pacemaker.
4. Illustrate the differences between a 3rd degree AV block in the AV node and one in the infranodal regions.

TOPIC 2: Inferior MIs and Posterolateral MIs.

Upon completion of this session, the participant should be able to: ^COMP

1. Detect ST elevations indicating acute inferior epicardial ischemia
2. List two other areas of the heart commonly affected when inferior epicardial ischemia is evident
3. Distinguish between anterior subendocardial ischemia and posterolateral epicardial ischemia
4. Recommend a preferred approach to a patient with chest pain and a non-diagnostic admission 12-lead ECG

TOPIC 3: Two Signs of Potentially Lethal Dysrhythmias and Two Signs of Potentially Lethal Heart Disease.

Upon completion of this session, the participant should be able to: ^{GL, COMP}

1. Detect the ECG changes of Brugada Syndrome
2. Detect changes suggestive of hyperkalemia
3. Detect the changes of Wellens Syndrome
4. Detect de Winter T wave changes and relate their importance