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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 Glenn Eiger, M.D., F.C.C.P. - Jefferson Medical College, Thomas Jefferson University; Associate Professor of Medicine; Director, Internal Medicine Residency Program and Associate Chairman, Department of Medicine, Albert Einstein Medical Center, 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 Marc H. Gorelick, M.D., M.S.C.E., F.A.A.P., F.A.C.E.P. - Medical College of Wisconsin; Professor of Pediatrics and Population Health; Jon E. Vice Chair, Emergency Medicine, Children's Hospital of Wisconsin, Milwaukee, WI; by Donald Kaye, M.D., M.A.C.P. - Drexel University, College of Medicine; Professor of Medicine, Philadelphia, PA; by Laurence J. Kinsella, M.D., F.A.A.N. - Saint Louis University Medical School; Professor of Neurology; Chief, Division of Neurology and Neurophysiology, Forest Park Hospital, St. Louis, MO; by John M. Loiselle, M.D., F.A.A.P. - Jefferson Medical College, Thomas Jefferson University; Associate Professor of Pediatrics; Director, Department of Emergency Medicine and the Urgent Care Center, Alfred I. duPont Hospital for Children, Wilmington, DE; by Herbert L. Muncie, Jr., M.D. - Louisiana State University Health Sciences Center School of Medicine; Professor of Family Medicine and Director, Predoctoral Education, Department of Family Medicine, New Orleans, LA; 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 Albert J. Peters, D.O., F.A.C.O.G. - Sher Institute for Reproductive Medicine (SIRM) of the Greater Lehigh Valley; Medical Director, Lehigh Valley, PA; and by Gregory Tino, M.D., F.C.C.P. - University of Pennsylvania School of Medicine; Associate Professor of Medicine; Chief, Pulmonary Clinical Service, Hospital of the University of Pennsylvania, Philadelphia, PA.

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. Therefore, there is a need for an annual review and update of many practical issues in General Adult, Gynecologic and Pediatric Medicine which are provided by this CME activity. Needs analysis specifically identifies Routine Adult Care, Stroke Risk and Prevention and Visual Diagnosis as being fundamental to the knowledge and skills necessary for Primary Care Practitioners today. In addition, the ability to confidently diagnose and treat common disorders such as Asthma, Diarrhea, Thyroid Disease, Chronic Cough, Hemoptysis, Disorders of Sleep, Anemia and New and Changing Infectious Diseases are practical issues for the Primary Care Provider. There is also a “gap” in care of the Adolescent patient that needs to be communicated and filled. Finally, there are common Gynecologic and Pediatric disorders that also need to be taught. 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, presenting current thinking and new information, will help Primary Care physicians obtain additional knowledge and provide them with the confidence to educate, diagnose and treat their patients with their presenting disorders.

SPECIFIC OBJECTIVES
TOPIC 1	Routine Adult Care - Upon completion of this session, the participant should be able to: 1. Identify the current primary care guidelines for recommended screening tests for adults. 2. List the various recommended immunizations for adults.
TOPIC 2	Stroke - Risk Factors and Prevention - Upon completion of this session, the participant should be able to: 1. Discuss risk factors and modification. 2. Apply principles of localization to classify stroke subtypes. 3. Recognize when to refer patients for carotid endarterectomy. 4. Review use of aspirin, clopidogrel, dipyridamole, warfarin, heparin and carotid endarterectomy.
TOPIC 3	Infective Diarrhea - Upon completion of this session, the participant should be able to: 1. Differentiate the presentation of toxigenic and invasive diarrhea. 2. Identify food-borne pathogens. 3. Explain when to use fecal WBC, stool cultures, and stool O&P examinations. 4. Summarize the indications for antibiotic therapy. 5. Identify appropriate antibiotic choices.
TOPIC 4	Common Thyroid Disorders - Upon completion of this session, the participant should be able to: 1. Diagnose common causes of thyroid hyper-function and hypo-function. 2. Treat common thyroid function abnormalities. 3. Perform an appropriate evaluation of thyroid nodules.
TOPIC 5	Hemoptysis - A common and occasionally life-threatening emergency. Upon completion of this session, the participant should be able to: 1. Characterize the causes for hemoptysis. 2. Characterize the severity of a bleeding episode. 3. Identify the diagnostic modalities available. 4. Outline acute basic therapy and understand indications for specialist referral.
TOPIC 6	Update on STDs in Primary Care: What’s New in HSV and HPV? - Upon completion of this session, the participant should be able to: 1. Describe the transmission patterns of HSV. 2. Develop diagnostic strategies for genital ulcers. 3. Apply an algorithm for managing patients with ASCUS Pap Smears. 4. Describe the role of HPV testing in reproductive age women. 5. Discuss the recommendations for use of the HPV vaccine.
TOPIC 7	New or Emerging Infectious Diseases - Upon completion of this session, the participant should be able to: 1. Explain the etiology and pathogenesis of these infections. 2. Describe the clinical approach and methods of diagnosing these infections. 3. Summarize the management of these infections.
TOPIC 8	Disorders of Sleep: Obstructive Sleep Apnea and Others - Sleep apnea is a common disorder seen in general practice. Upon completion of this session, the participant should be able to: 1. Describe the epidemiology of obstructive sleep apnea. 2. Identify the clinical presentation and how to take a thorough “sleep history.” 3. Characterize the diagnostic work-up including overnight polysomnography. 4. Differentiate treatment modalities including CPAP, dental appliances, surgery & others. 5. Review obesity hypoventilation syndrome, central sleep apnea, Cheyne Stokes breathing, narcolepsy and periodic leg movements of sleep.
TOPIC 9	Approach to the Patient with Chronic Cough - Cough is a very common outpatient problem, which can be difficult to manage. Upon completion of this session, the participant should be able to: 1. Characterize the pathophysiology and most common etiologies of cough. 2. Outline pertinent features of a focused history and physical. 3. Develop a cost effective approach to diagnosis and treatment.
TOPIC 10	Abnormal Uterine Bleeding - Upon completion of this session, the participant should be able to: 1. Define abnormal uterine bleeding. 2. Differentiate between functional and organic causes. 3. Manage most non-surgical etiologies of this problem.
TOPIC 11	: Anemia – A Finding, Not Yet a Diagnosis - Upon completion of this session, the participant should be able to: 1. List most common anemias in women and their usual etiology. 2. Compare the diagnostic evaluation needed to determine the etiology of the anemia. 3. Identify the therapeutic options for each of the identified anemias. 4. Describe the follow-up plans for assessing the efficacy of treatment for each anemia.
TOPIC 12	Chronic Anovulation - Upon completion of this session, the participant should be able to: 1. Discriminate between the hypothalamic, pituitary and ovarian causes of anovulation. 2. Investigate associated health risks. 3. Formulate an appropriate treatment regimen.
TOPIC 13	Hormonal Contraceptives: Good, Bad and Controversial - Upon completion of this session, the participant should be able to: 1. Describe clinical differences in oral contraceptives. 2. Decide the appropriate agent for specific patients. 3. Give attention to relative and absolute contraindications to oral contraceptives.
TOPIC 14	Acute Asthma in Children: An Update on Management - Upon completion of this session, the participant should be able to: 1. Summarize recent information regarding inhaled bronchodilator therapy for acute asthma. 2. Recognize the role of systemic and inhaled corticosteroids in the management of acute asthma exacerbations. 3. Discuss the appropriate use of additional therapies including magnesium sulfate and heliox. 4. Describe the important considerations for ventilator management for severe acute asthma.
TOPIC 15	Bronchiolitis - Upon completion of this session, the participant should be able to: 1. Discuss the benefits and limitations of the most recent recommendations for the treatment of bronchiolitis. 2. Identify features placing infants at risk for more serious disease.
TOPIC 16	Visual Diagnosis in the Pediatric Patient - Upon completion of this session, the participant should be able to: 1. Recognize common, uncommon and atypical presentations of childhood illnesses. 2. Formulate an initial approach to the management of certain childhood illnesses or injuries based on visual clues. 3. Ask appropriate questions to discriminate among similar appearing pediatric diagnoses.

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