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by Valerianna Amorosa, M.D. - University of Pennsylvania School of Medicine; Assistant Professor of Clinical Medicine; Chief of Infectious Diseases and Clinic Director, HIV and Infectious Diseases Clinic, Philadelphia VA Medical Center, Philadelphia, PA; by Christopher V. Chambers, M.D. - Jefferson Medical College, Thomas Jefferson University; Professor and Director, Clinical Trials, Department of Family and Community Medicine; Philadelphia, PA; by Kevin S. Ferentz, M.D. - University of Maryland School of Medicine; Associate Professor and Director of Clinical Operations, Department of Family Medicine, Baltimore, MD; by David A. Horowitz, M.D. - University of Pennsylvania School of Medicine; Assistant Professor of Clinical Medicine; Senior Medical Director for Quality, University of Pennsylvania Health System; Chief Medical Officer, PennCare at Home, Home Care Division of UPHS, Philadelphia, PA; by Keith S. Kaye, M.D., M.P.H. - Duke University School of Medicine; Associate Professor of Medicine, Division of Infectious Diseases; Chair, Hospital Infection Control Committee and Hospital Epidemiologist, Duke University Medical Center, Durham, NC; by Kenneth Kaye, M.D., F.A.C.P. - Harvard Medical School; Associate Professor of Medicine; Attending Physician, Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA; by Laurence J. Kinsella, M.D., F.A.A.N. - Saint Louis University Medical School; Professor of Neurology; Chief, Division of Neurolog y and Neurophysiology, Forest Park Hospital, St. Louis, MO; by Gary H. Oberlender, M.D., F.A.C.P. - Consultant in Geriatric Medicine; by Merri Lou Pendergrass, M.D., Ph.D. - Harvard Medical School; Associate Professor of Medicine; Associate Clinical Chief and Director of Clinical Diabetes, Division of Endocrinology, Metabolism and Hypertension, and Interim Chief, Diabetes Section, Brigham and Women's Hospital, Boston, MA; by Neil S. Skolnik, M.D. - Temple University School of Medicine; Professor of Family and Community Medicine; Associate Director, Family Practice Residency Program, Abington Memorial Hospital, Abington, PA; by Gerald W. Smetana, M.D. - Harvard Medical School; Associate Professor of Medicine; Director of CME, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA; and by C. Christopher Smith, M.D. - Harvard Medical School; Assistant Professor of Medicine; Associate Director, Internal Medicine Residency Training Program, Associate Firm Chief, Blumgart Medical Firm, and Co-Director, Rabkin Fellowship in Medical Education, Beth Israel Deaconess Medical Center of Harvard Medical School, Boston, MA.

OVERALL OBJECTIVES: The overall objective is to provide the participant with practical and clinically relevant information. Upon completion of this CME activity, the physician or healthcare provider should be able to describe the current approach to formulating differential diagnoses, diagnostic, therapeutic, and preventive management of the various disciplines presented.

EDUCATIONAL GAP AND NEEDS ANALYSIS STATEMENT: There is a need to maintain a breadth of knowledge to effectively care for the variety of patient presentations in the PCP’s office. There is also a need for an annual review and update of many practical issues in Primary Care Medicine which are provided by this CME activity. Needs analysis identifies the commonly seen disorders of Infections and Antibiotics, DM-Type 2, Dizziness, HA, HTN, Dementia, Delirium and other common Neurologic conditions as being fundamental to the daily knowledge and skills necessary for Primary Care Practitioners today. Educational gap analysis has identified two areas that must be addressed: increased knowledge and increased confidence on the part of Primary Care Physicians. To address these needs and close these gaps, this annual update will present current thinking and new information to help Primary Care physicians obtain additional knowledge and provide them with the confidence to educate, diagnose and treat their patients with these disorders to achieve improved outcomes.

SPECIFIC OBJECTIVES
TOPIC 1	Infections and Antibiotic Choices in Primary Care - Upon completion of this session, the participant should be able to: 1. Describe the changes in the incidence and presentations of methicillin-resistant Staphylococcus aureus (MRSA) infections in primary care. 2. Develop a strategy for management and presumptive antibiotic choice in primary care patients with soft tissue infections. 3. Describe the changes in incidence in Clostridium difficile diarrhea and the role of over-prescribing of broad spectrum antibiotics. 4. Develop a strategy for evaluation and presumptive antibiotic choice for suspected C. difficile diarrhea. 5. Discuss the role of probiotics in the treatment and prevention of C. difficile diarrhea. 6. Apply the new recommendations for SBE prophylaxis in primary care.
TOPIC 2	Treatment of Hyperglycemia in Type 2 Diabetes - Upon completion of this session, the participant should be able to: 1. Understand the pathogenesis and natural history of hyperglycemia in T2DM. 2. Describe current pharmacological treatment options. 3. Develop individualized regimens to optimize glycemic control.
TOPIC 3	Preoperative Cardiac Evaluation - Upon completion of this session, the participant should be able to: 1. Develop risk stratification for perioperative cardiac risk. 2. Demonstrate knowledge of preoperative cardiac risk guidelines and the revised cardiac risk index. 3. Properly use beta-blockers and statins for patients at risk for perioperative cardiac complications.
TOPIC 4	Dizziness - Upon completion of this session, the participant should be able to: 1. Differentiate between the most common causes of dizziness. 2. Distinguish between central and peripheral causes of vertigo. 3. Describe physical examination maneuvers used to diagnose and treat vertigo.
TOPIC 5	Practical Approach to the Patient with Dementia - Upon completion of this session, the participant should be able to: 1. Review a practical approach to screening for dementia. 2. Discuss medication management to include Polypharmacy, drug-drug interactions, as well as new drugs and their potential efficacy and side effects. 3. Develop a long-term follow-up and referral process that considers cost effective and resource management.
TOPIC 6	Hypertension - Upon completion of this session, the participant should be able to: 1. Describe the current approach to the treatment of hypertension. 2. Describe the important aspects of the Joint National Committee recommendations for the individualized treatment of Hypertension. 3. Identify which patients need further evaluation for secondary forms of hypertension. 4. List the advantages and disadvantages of home blood pressure monitoring.
TOPIC 7	Delirium in the Elderly: Current Concepts - Upon completion of this session, the participant should be able to: 1. List diagnostic features and common causes of delirium. 2. Distinguish between delirium and dementia. 3. Appreciate causes of persistent delirium. 4. Describe non-pharmacologic and pharmacologic treatment approaches to the delirious patient.
TOPIC 8	Helicobacter pylori Infection - Upon completion of this session, the participant should be able to: 1. Describe the clinical manifestations of H. pylori infection. 2. Relate the methods of diagnosing H. pylori infection. 3. Summarize the treatment of H. pylori infection.
TOPIC 9	Neurologic Emergencies - Upon completion of this session, the participant should be able to: 1. Recognize spinal cord compression, Guillain-Barré Syndrome, Myasthenic Crisis. 2. Develop an approach to examination and diagnosis. 3. Incorporate cost-effective testing. 4. Apply principles to treatment and rehabilitation.
TOPIC 10	Pharmacotherapy of Depression and Other Mood Disorders: Incorporating Newer Agents and Strategies in Primary Care - Upon completion of this session, the participant should be able to: 1. Discuss the epidemiology of depression and anxiety in primary care. 2. Recognize the varied presentations of depression and anxiety in primary care. 3. Develop a treatment plan using newer anti-depressant medications. 4. Develop a treatment plan for patients who do not respond to the initial anti-depressant agent.
TOPIC 11	Meningitis and Meningoencephalitis - Upon completion of this session, the participant should be able to: 1. Describe the epidemiology of meningitis and the different types of meningitis. 2. Identify clinical signs and symptoms of different types of meningitis. 3. Describe indications for lumbar puncture (LP) and interpretations of LP results. 4. Summarize treatment options and the need for hospitalization and public health notification.
TOPIC 12	Soft Tissue and Bone Infections - Upon completion of this session, the participant should be able to: 1. Identify an approach to making the diagnosis of common skin and soft tissue infections. 2. Recognize common infections to include streptococcal and staphylococcal infections and necrotizing fasciitis, diabetic foot infections, bite wound infections and bone and joint infections. 3. Apply appropriate treatment and management of these commonly seen infections and decide when specialist referral is indicated.
TOPIC 13	Treatment of Primary Headache Syndromes - Upon completion of this session, the participant should be able to: 1. Appreciate the role of abortive therapy for migraine, tension-type, and cluster headache. 2. Recognize the range of options for pharmacologic preventive therapy for migraine, tension-type, and cluster headache. 3. Develop non-pharmacologic treatment strategies for migraine.
TOPIC 14	Smoking Cessation - Upon completion of this session, the participant should be able to: 1. Recognize the role of smoking in disease etiology. 2. Identify smoking cessation techniques which can be utilized in their practice setting.
TOPIC 15	Advanced Nutritional Assessment and Therapy - Upon completion of this session, the participant should be able to: 1. Utilize readily available clinical data to make accurate and comprehensive nutritional assessments. 2. Identify common vitamin and mineral deficiencies in seniors. 3. Identify a range of therapeutic nutritional approaches for acutely ill, chronically ill, and frail patients. 4. Apply nutritional therapies towards improved wellness.
TOPIC 16	Vitamin B-12 Deficiency in the Elderly - Upon completion of this session, the participant should be able to: 1. Describe the normal physiology and the pathophysiology of B-12 deficiency and its causes. 2. Describe the use of metabolic markers in B-12 deficiency. 3. Define work-up of B-12 deficiency in clinical practice.

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