Internal Medicine Comprehensive Review Series

Title: IMcd-Internal Medicine - Cardiology: ECGs; Hypertension; Peripheral Vascular Disease

Faculty: Gregary D. Marhefka, M.D., F.A.C.C., F.A.C.P., Nicholas J. Ruggiero II, M.D., F.A.C.P., F.A.C.C., F.S.C.A.I., F.S.V.M., F.C.P.P

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

TOPIC 1: ECGs that Primary Care Practitioners Cannot Miss.

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

1. Detect and identify subtle tachyarrhythmias.
2. Detect and distinguish subtle bradyarrhythmias.
3. Recognize and manage as per the AHA/AHF and ESC Guidelines for potentially life-threatening ECG morphologies.
4. Recognize and appropriately disposition patients with subtle STEMI patterns.

TOPIC 2: Hypertension

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

1. Incorporate latest JNC VIII guidelines on hypertension into clinical practice.
2. Incorporate latest ASH guidelines on hypertension into clinical practice.
3. Select appropriate therapies and work-up for hypertensive urgency and emergency.
4. Identify patients for secondary work-up of hypertension.

TOPIC 3: Peripheral Vascular Disease

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

1. Recognize the indications for ordering ABIs as per the ACCF/AHA Guidelines.
2. Apply as per the current ACCF/AHA Guidelines, the indications for screening abdominal aortic aneurysms.
3. Discriminate indications, strengths and weaknesses of different surgical techniques for abdominal aortic aneurysm repair.
4. Employ non-surgical therapies for peripheral vascular disease.
5. Identify when renal artery interventions may be indicated.

Title: IMgi-Internal Medicine – Gastroenterology: Irritable Bowel Syndrome; Dyspepsia; GI Bleeds

Faculty: Bryant Allen, M.D., Michael A. Malone, M.D.

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

TOPIC 1: Irritable Bowel Syndrome.

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

1. Appraise possible etiologies for Irritable Bowel Syndrome.
2. Select and utilize diagnostic criteria to identify IBS, based on the current medical evidence and expert recommendations.
3. Use the current medical literature to assess and screen for other conditions that can present with similar IBS symptoms.
4. Detect “red flag” signs and symptoms that should make one question the diagnosis of IBS.
5. Formulate an EBM diagnostic evaluation for patients with signs and symptoms of IBS.
6. Use the current medical literature to develop an EBM treatment plan for Irritable Bowel Syndrome.

TOPIC 2: Dyspepsia.

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

1. Appraise symptoms and common etiologies for dyspepsia.
2. Use EBM to detect “alarm symptoms” that are suspicious for GI malignancy.
3. Apply current medical evidence and expert guidelines to construct a diagnostic evaluation for Dyspepsia.
4. Determine appropriate treatment for Dyspepsia based on current medical evidence and the likely etiology.

TOPIC 3: GI Bleeds: Upper & Lower.  Upon completion of this session, the participant should be able to:  ^COMP,EBM

1. Describe the gastrointestinal tract anatomy and pathophysiologic changes that result in presentation with bleeding.
2. Determine the emergency department "essentials" for the assessment of the patient with GI bleeding.
3. Develop a rational framework for the ED treatment of acute gastrointestinal bleeding, both upper and lower using evidence-based medicine.

Title: IMid-Internal Medicine - Infectious Diseases: Skin/Soft Tissue Infections; Tuberculosis; Infection Prevention

Faculty:John K. Crane, M.D., PhD., Blair Weikert, M.D., Kendal Williams, M.D., M.P.H.

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

TOPIC 1: Overview of the Inpatient Management of Skin and Soft Tissue Infections.

Upon completion of this session, the participant should be able to: EBM, COMP Review the clinical presentation and categorization of common skin and soft tissue infections. 1. Differentiate common non-infectious conditions that can mimic skin and soft tissue infections. 2. Based on evidence from the CDC and standard of care publications, recognize and incorporate the changing epidemiology and resistance patterns impacting skin and soft tissue infections into therapeutic plans. 3. Recognize the types of drug-associated rashes and formulate an effective treatment plan for each.

TOPIC 2: Tuberculosis Update.

Upon completion of this session, the participant should be able to: EBM, GL, COMP 1. Appraise how the changing epidemiology of tuberculosis has impacted the incidence of the disease in the U.S. 2. Detect and manage latent tuberculosis infection, including appropriate use of gamma-interferon release assays as per the CDC recommendations and Guidelines. 3. Apply the principles of treatment of TB disease, specify how to increase medication adherence, and detect adverse drug reactions. 4. Differentiate patient characteristics to anticipate multi-drug resistance.

TOPIC 3: Infection Prevention and Antibiotic Stewardship.

Antimicrobial resistance continues to be a very prominent concern in all aspect of medicine. Antibiotic stewardship is extremely important to reduce the continued development of resistance and improve patient outcomes.

Upon completion on this session, using an evidencebased approach, based on guidelines from IDSA, the participant should be able to: GL, EBM, COMP 1. Incorporate “Diagnostic Stewardship” into action plans toward Antibiotic Stewardship. 2. Use a Hospital or Health-System Antibiogram to avoid unwise use of antibiotics. 3. Distinguish between antibiotics carrying the highest risk of triggering C. difficile infection vs. lower-risk antibiotics. 4. Describe how antibiotic stewardship in the hospital can be extended to nursing homes, outpatient clinics, and the wider community.

Title: IMwo-Internal Medicine - Women’s Health: Coronary Artery Disease, Parts 1 & 2; Anemia

Faculty: Herbert L. Muncie, Jr., M.D.., Alyson N. Owen, M.D

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

TOPIC 1: Women and CAD, Part 1: Risk Factors

Upon completion of this session, the participant should be able to: EBM, COMP 1. Distinguish the different effects of risk factors on women and risk factors that are unique to women 2. Appropriately assess cardiovascular risk and order appropriate screening tests 3. Recognize the differences in the presentation of acute coronary syndromes in women 4. Utilize evidence-based therapies for the treatment of ACS in women

TOPIC 2: Women and CAD, Part 2: The Woman with Chest Pain and MI

Upon completion of this session, the participant should be able to: COMP,EBM 1. Recognize the different ways that coronary artery disease may manifest in women 2. Use appropriate testing strategies for women with chest pain using evidence-based medicine 3. Distinguish the etiologies of chest pain in women without obstructive coronary artery disease 4. Apply appropriate strategies for the counseling and treatment of women with chest pain

TOPIC 3: Anemia – A Finding, Not Yet a Diagnosis.

Upon completion of this session, using the Cochrane Abstract Database and AAFP Guidelines, the participant should be able to: GL, COMP 1. Distinguish the etiologies for the common anemias.
2. Construct the diagnostic evaluation to determine the etiology of each anemia. 3. Develop the therapeutic options for each identified anemia. 4. Formulate the appropriate follow-up evaluations for assessing the treatment efficacy.

Title: IMcp-Internal Medicine - Common Problems: Atrial Fibrillation; Chest Pain; Depression

Faculty:Vandana Y. Bhide, M.D., David A. Horowitz, M.D., Gerald Smetana, M.D.

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

TOPIC 1: Atrial Fibrillation in the Hospitalized Patient.

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

1. Assess and evaluate treatment options for atrial fibrillation with rapid ventricular response, as per the 2010 HFSA Guidelines.
2. Employ appropriate anticoagulation strategies for atrial fibrillation.
3. Distinguish the advantages of rhythm versus rate control treatment strategies, 2014 ACC/AHA Guidelines for atrial fibrillation management.
4. Determine the possible underlying causes of CHF exacerbations

TOPIC 2: Approach to the Management of Chest Pain.

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

1. Evaluate the complaint in the context of history, physical exam, and EKG findings.
2. Develop a strategy to use cardiac biomarkers in the evaluation of ACS.
3. Use recent research studies and guidelines to develop an approach to the patient with chest pain

TOPIC 3: Rational Management of Depression in Primary Care.

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

1. Employ an appropriate initial approach to use of the updated USPSTF Guidelines for screening of the patient with depression.
2. Determine the proper role of second generation antidepressants as per the ACP Guideline.
3. Assess the effectiveness of augmentation and switching strategies.
4. Specify the most common side effects, as per the 2016 ACP Guidelines, of commonly used antidepressants.