Family Medicine Syllabus

1. Understand the principles of the PCMH, the three primary domains of care delivery, and the importance of self care
   
2. Understand the types of disciplinary teams in the PCMH
   
3. Describe types of health team models and the new team approach model
   

1. Define Primary, secondary, and tertiary prevention
   
2. Define the WHO criteria for screening tests
   
3. Define prevalence, incidence, and number needed to screen
   
4. Describe preventive services for the cancers: colon, breast, lung, ovarian and prostates cancer; be familiar with USPSTF recommendations
   
5. List the preventive service recommendations for the following cardiovascular diseases: hypertension, hyperlipidemia, abdominal aortic aneurysm, CHD and CVD;
   
6. List the preventive service recommendations for the following substance abuse and mental health issues: tobacco, alcohol, and depression
   

1. Identify viral and bacterial causes of acute pharyngitis
   
2. Describe treatment options and physical examination findings for GABHS
   
3. Recognize the Centor criteria for GABHS
   
4. Define the carrier state in GABHS
   
5. Understand the complications from acute glomerulonephritis
   
6. Define dysphagia, medication induced esophagitis, and globus hystericus
   
7. Name the elements of an obstructive sleep apnea (OSA) study, the symptoms of OSA, and the chronic illnesses associated with OSA.
   
8. Identify the causes of laryngitis and hoarseness, and treatment guidelines
   
9. Describe the symptoms and treatment of reflux laryngitis
   

1. Differentiate between blepharitis, stye, and chalazion
   
2. Describe the common pathogens of bacterial conjunctivitis and their treatment
   
3. Describe the potential serious effects of topical steroids on the eye
   
4. Differentiate between viral and allergic conjunctivitis, their diagnosis and treatment Identify the signs , symptoms and treatment of corneal herpetic infection
   
5. Differentiate preseptal from orbital cellulitis based on signs and symptoms and describe the treatment for orbital cellulitis
   
6. Describe the treatment for ocular chemical burns
   
7. Describe the risk factors and appearance of central retinal artery occlusion
   
8. Describe the symptoms and treatment of retinal detachment
   

1. Identify the four groups of diabetes and how DM is diagnosed; define prediabetes ; be able to identify other cause of DM
   
2. Describe the changing epidemiology of diabetes in the U.S.
   
3. Identify the morbidity and mortality (complications) associated with DM and preventive measures that lower morbidity
   
4. Define the two common pathogenic mechanisms associated with the development of DM and the characteristics of type 1 and type 2 DM
   
5. Describe latent autoimmune diabetes of adults (LADA) and maturity-onset diabetes of young (MODY)
   
6. What have the ACCORD and UKPDS trials shown in the treatment of type 2 DM
   
7. What impact does behavioral therapy have on the management of DM?
   
8. Identify the Dietary recommendations of the ADA and the effects of exercise on DM
   
9. Identify the classes of diabetic agents, mode of action and side effects; identify two agents that may promote weight loss
   
10. Describe the classes of insulin preparations
    
11. Define how to initiate insulin in the type 2 DM patient and when to consider the discontinuation of insulin
    
12. Describe basal bolus insulin dosing in type 1 DM
    
13. List 3 factors that influence the amount of insulin considered for pre prandial injections
    

1. Identify the common history, physical exam skills, and special techniques for evaluating back pain
   
2. List the percentage of patients with LBP, chronic LBP and the percent who return to work
   
3. Name the most common cause of back pain seen in Family Medicine, predisposing factors, and significance of psychosocial factors
   
4. What is the value of diagnostic testing, and describe routine treatment for LBP
   
5. Identify the clinical signs and symptoms associated with disc herniation syndromes and when to refer for surgical evaluation
   
6. Be able to describe the clinical signs, symptoms and treatment of thoracolumbar compression fractures, spinal stenosis, and scoliosis
   

1. Define angina and its signs and symptoms
   
2. List the treadmill stress test findings that are > or = to 90% positive predictive value for CAD
   
3. List 3 goals in the pharmacologic management of stable CAD
   
4. Describe the pharmacologic effects of nitrates, b-blockers, calcium channel blockers and ranolazine for the treatment of stable angina.
   
5. Define the methods of secondary prevention for the treatment of stable angina
   

1. Define the pathophysiologic mechanism in CHF
   
2. Describe the AHA/NYHA classification of angina
   
3. Identify the signs, symptoms, and pattern of viral cardiomyopathy
   
4. List methods of risk factor reduction in CHF
   
5. Describe the 4 general classes of pharmacologic therapy in CHF and their mechanism of action and outcomes
   

1. List the risk factors for the development of atherosclerosis
   
2. Define the LDL cholesterol goals based on risk assessment
   
3. Define coronary artery disease risk equivalents
   
4. List the primary and secondary goals of therapy for dyslipidemia
   
5. Identify therapeutic lifestyle changes
   
6. Describe the role of statins in primary and secondary therapy and their mechasnism of action and side effects
   
7. Describe the action, benefits, and side effects of niacin and fish oil
   

1. Be able to identify the morbidity and mortality associated with tobacco use
   
2. Be familiar with the pathologic basis of smoking and its effect on tissues
   
3. Describe the pharmacologic effects of Buproprion, nicotine , and varenicline for the treatment of smoking
   

1. Define metabolic syndrome NCEP ATP-III criteria and its associated medical conditions
   
2. Describe the incidence of metabolic syndrome and obesity in the U.S. and its prevalence in ethnic populations
   
3. Understand the pathological mechanism of increased abdominal adipose tissue and its effects on metabolism especially lipids and blood sugar
   
4. Describe the treatment for metabolic syndrome
   

1. Describe two hypotheses for the increase in allergic responses noted over the past few years
   
2. List the common physical signs and symptoms of allergies
   
3. Describe the most effective treatment for allergic rhinitis
   
4. Define “NARES” and its treatment
   
5. Identify the signs and symptoms of vernal conjunctivitis and its treatment
   
6. List the 3 key elements to the diagnosis of asthma; and be able to discuss common signs and symptoms
   
7. List the differential in the diagnosis of asthma
   
8. Describe the most useful test for the diagnosis of asthma in the primary care office and its relationship to the severity of disease
   
9. Be familiar with the classification scale for asthma and the step approach to treatment
   
10. List the risk factors for asthma related death
    

1. What key questions should be asked during the history pertaining to OLD
   
2. List the leading cause of death in OLD
   
3. Define the relationship between OLD and asthma
   
4. Define occupational pneumoconiosis and hypersensitivity pneumonitis
   
5. Describe the best prevention of OLD
   

1. Define how to distinguish obstructive from restrictive disease using PFT, FEV1, and FVC; be able to diagnose each using PFTs
   
2. Describe what makes an adequate PFT
   
3. Define what sign and symptoms suggest a cardiac cause for shortness of breath
   
4. List the most common causes of acute episodes of cough?
   
5. Describe the most common differential of cough in the non-smoking adult
   

1. List 3 of the most common obstructive lung diseases
   
2. Define asthma and its relationship to socioeconomic status
   
3. Describe the important history and physical findings in asthma
   
4. Identify how to diagnosis asthma and specifically how to use spirometry to diagnose obstructive lung disease.
   
5. Identify the stages in the stepwise approach to classification and treatment of asthma
   
6. List 3 classes of medications that decrease the frequency of exacerbations in chronic obstructive lung disease (COPD)
   
7. Define the risks of smoking and environmental pollutants in COPD
   
8. Define when to screen for alpha one antitrypsin deficiency
   
9. Identify the subsets of COPD and its clinical presentation
   
10. Identify the stages in the stepwise approach to classification and treatment of COPD
    
11. List the indications for antibiotic treatment in the exacerbation of COPD
    
12. Describe preventive measures in the treatment of COPD
    

1. Define who should receive an influenza and pneumococcal vaccine based on risks and age.
   
2. List the types of vaccine available
   
3. Define its effect on pneumonia prevention.
   

1. List the differential diagnosis of primary and secondary headache
   
2. Describe the components of the history and physical of the patient that presents with the complaint of HA
   
3. Define the diagnostic criteria for migraine HA
   
4. Describe the treatment of migraine HA preventive(prophylactic) and abortive(acute treatment)
   
5. List the diagnostic criteria for tension, cluster, and medication overuse HA
   
6. Describe the signs and symptoms of Giant cell Arteritis, and the causes of HA in the older adult
   

1. Describe the signs and symptoms of gout
   
2. Describe the presentation of gout in women and older adults
   
3. List the two most important factors in the development of acute gouty arthritis
   
4. Define the causes of secondary gout
   
5. Define the mechanism of action of Allopurinol; and the prophylaxis of gout
   
6. Identify the diseases associated with calcium pyrophosphate deposition disease ; the workup for new diagnosis and may diseases may be confused with its initial diagnosis
7. List the signs and symptoms of ankylosing spondylitis and the classic radiographic appearance
   
8. Define the classic triad of reactive arthritis and the suggested causes
   

1. Define Barret’s esophagitis, its incidence in western culture and risk factors
   
2. Describe the role of H pylori in the role of PUD, methods of testing for H. pylori, and treatment options
   
3. List the major causes of PUD
   
4. Discuss the side effects of PPI’s
   
5. Define the role of diagnostic testing in GERD, alarm symptoms, and lifestyle modifications
   
6. List the common causes of Upper GI bleeding ,
   
7. Define the traditional clinical picture of gallstones
   
8. Describe diagnostic testing in gall bladder disease
   

1. Describe the ages of peak incidence in the diagnosis of IBD and lifetime risk of developing IBD for 1st degree relatives
   
2. Define the areas of the GI tract most prone to the development of ulcerative colitis(UC) and crohn’s; define what is meant by a skip lesion
   
3. Identify the intestinal and extraintestinal symptoms of crohn’s and UC
   
4. Define the role of systemic steroids in the pharmacologic treatment of both UC and crohn’s
   
5. List 3 symptoms that characterize IBS
   
6. Describe the physical examination of the patient with IBS and the use of diagnostic screening tests(recommendations)
   
7. Define the ROME III criteria used to diagnose IBS
   
8. List the common signs and symptoms of diverticulitis and the diagnostic tests used for the initial evaluation
   
9. Describe conservative management of uncomplicated diverticulitis and who may be treated as an outpatient
   
10. Define the effects of long term fiber use after the first episode of diverticulitis
    
11. Describe the adult presentation of celiac disease
    
12. List the serologic tests to consider in the diagnosis of celiac disease
    
13. List the dietary items patients should avoid if diagnosed with celiac disease
    
14. Identify the overall mortality risks associated with Celiac disease
    

1. Describe the physical characteristics of seborrheic keratosis and the best way to differentiate it from melanoma
   
2. List the characteristics of a dermatofibroma and the clinical imlications of the “pinch” test
   
3. Describe the physical characteristics of actinic keratosis
   
4. Describe the physical characteristics of basal cell carcinoma and the indications for mohs surgery
   
5. Describe the physical characteristics of squamous cell carcinoma
   
6. Describe the physical characteristics of melanoma and risk factors for development
   
7. Define the most important prognostic indicator in the treatment of melanoma
   

The required reading for the third year OMM Curriculum is Somatic Dysfunction in Osteopathic Family Medicine 2007,
by Kenneth E. Nelson, DO. 

1. Chapter 25 – The Patient with Chronic Pain, Headache
   1. Review and understand the kinds of pain- nociceptive, neuropathic and psychogenic
   2. Review tension headaches and their associated areas of somatic dysfunction
   3. Review migraine headaches and osteopathic procedures and contraindications with acute onset
   4. Understand the symptoms and areas of treatment for cluster headaches
   5. Learn the areas of secondary somatic dysfunction with headaches due to organ disease
      
      
2. Chapter 26 – The Patient with Back Pain:  Short Leg syndrome and Postural Balance
   1. Recognize the chief subjective complaints of patients with symptomatic short legs
   2. Differentiate between a functional and anatomical short leg
   3. List possible etiologies of a functional short leg
   4. Recognize how to reestablish the functional balance of the sacrum in a patient with a short leg
   5. Recognize and list the possible muculoskeletal sequelae of a short leg
   6. Define cross over points in the axial skeleton
   7. Define spinal vertebral accommodations to a short leg as they would appear in the axial skeleton