CARDIOVASCULAR DISORDERS

Congestive Heart Failure

• Identify atrial fibrillation, and determine appropriateness for anticoagulation.
• Diagnose new onset congestive heart failure, and understand the most appropriate tests in the work up for heart failure.
• Identify indications and thresholds for transfusing packed red blood cells in the setting of congestive heart failure.
• Recognize the primary cause of sudden cardiac arrest and the associated EKG findings.
• Discuss contraindications to beta-blocker use in the setting of congestive heart failure.
• Recognize peripartum cardiomyopathy and understand its appropriate treatment.
• Recognize signs of advanced heart failure.
• Diagnose heart failure with preserved ejection fraction.
• Diagnose heart failure with preserved ejection fraction and understand associated medical treatment.
• Determine appropriate use of beta-blockers in heart failure with reduced ejection fraction.
• Understand significant physical examination findings in congestive heart failure.
• Identify medicines to be avoided in patients with heart failure.
• Recognize the risk factors for congestive heart failure.
• Compare risk factors between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).
• Treat acute decompensated heart failure.
• Treat for acute decompensated heart failure.
• Recognize signs and symptoms of respiratory failure.
• Assess pharmacologic treatment for heart failure with reduced ejection fraction in the African American population.
• Select the medication that provides the greatest mortality benefit in patients with HFrEF.
• Select the prognostic indicators for congestive heart failure.

Endocarditis

• Identify the most common pathogens responsible for acute prosthetic valve infective endocarditis.
• Discuss appropriate empiric antibiotic coverage of infective endocarditis.
• Recognize that neurologic complications of infective endocarditis may present before the diagnosis is established.
• List common etiologies of infective endocarditis in pediatric populations.
• Discuss the diagnostic utility and limitations of the modified Duke criteria.
• Classify a patient using the modified Duke criteria.
• Characterize the cardiac sequelae of rheumatic fever, echocardiographic characteristics of infective endocarditis, and limitations of echocardiography as an imaging modality in this setting.
• Define the indications for emergent cardiac surgery in the setting of infective endocarditis.
• Identify the preferred initial evaluation when infective endocarditis is suspected.
• Recognize that antibiotic prophylaxis for infective endocarditis (is reserved for high-risk procedures only in certain, high-risk patients.

Ischemic Heart Disease

• List the contraindications to stress testing.
• Recognize that folic acid and hormone replacement therapy are not indicated for primary and secondary coronary artery disease (CAD) prevention.
• Manage hypercholesterolemia according to treatment guidelines for high cholesterol.
• Recognize that a stress test is not indicated to screen for CAD in low-risk asymptomatic patients.
• Identify the benefits of smoking cessation on CAD risk.
• Recognize acute coronary syndrome, Prinzmetal angina, syndrome X, Wellens syndrome, an ST segment elevation myocardial infarction (STEMI), new left bundle branch block, and non-traditional CAD risk factors.
• Calculate Thrombolysis in Myocardial Infarction risk score.
• Identify patients who would benefit the most from coronary artery bypass grafting.
• Medically manage stable angina.
• Identify and manage unstable angina/non-STEMI.
• Describe the mechanical complications from myocardial infarction.
• List the contraindications to thrombolytics in patients with STEMI.
• Recognize the digitalis effect on electrocardiography.
• Identify the symptoms of Wellens syndrome.
• Describe the medical regimen for patients with non–ST elevation myocardial infarction (STEMI).
• Diagnose STEMI based on electrocardiographic findings.
• List the contraindications to thrombolytics.
• Record the treatment options for an elderly patient with cardiac problems and altered mental status.
• Recognize the symptoms of pulmonary embolism in elderly patients following surgery.
• Diagnose septal infarct in an elderly patient with comorbidities and shortness of breath.

Pediatric Cardiovascular Disorders

• Measure blood pressure in children.
• Evaluate patients with Kawasaki disease and identify the complications of the condition.
• Diagnose Kawasaki disease, ventricular septal defect, and myocarditis in pediatric patients.
• Recognize the sequelae of rheumatic fever.
• Evaluate pediatric patients for heart murmur, exertional syncope and causes of hypertension.
• Differentiate chest wall pain from cardiac chest pain in adolescents.
• Identify the symptoms of hypertrophic obstructive cardiomyopathy.
• Discuss blood pressure screening in children.
• Discuss the causes of pericarditis in children.
• Recognize the physical findings of endocarditis and the presentation of mitral valve prolapse in children.
• Describe mitral insufficiency in children with rheumatic heart disease.
• Manage lipids in children with type 1 diabetes mellitus.
• Characterize aortic root pathology in patients with Marfan syndrome.

Vascular Disease

• Determine first-line treatment for lower extremity deep venous thrombosis (DVT).
• Select the minimum duration of enoxaparin treatment in patients with DVT.
• Evaluate the cutoff for ankle-brachial index diagnostic of peripheral arterial disease (PAD)
• Identify supervised exercise as a first-line treatment for claudication from PAD.
• Diagnose high-risk limb ischemia and fibromuscular dysplasia.
• Distinguish neurogenic from vascular claudication.
• Identify neurogenic claudication from vascular claudication.
• Diagnose and provide medical treatment to patients with neurogenic claudication.
• Identify integumentary changes associated with PAD.
• Recognize the ethnic group with the highest genetic predisposition to thromboangiitis obliterans.

ALLERGY AND IMMUNOLOGY

Auto-Immune Collagen Vascular Disorders

• Identify and manage Raynaud phenomenon.
• Manage eosinophilic pneumonia and mastocytosis.
• Characterize and manage eosinophilic esophagitis.
• Identify allergic interstitial nephritis, vasculitic skin ulcers, and hypersensitivity pneumonitis.
• Recognize the most sensitive and specific tests for diagnosing systemic lupus erythematosus.
• Describe the drugs that can induce lupus.
• Identify eosinophilia granulomatosis with polyangiitis (Churg-Straus syndrome).

Food Allergy

• Identify the symptoms of lactose intolerance.
• Recognize the management of influenza vaccination in patients with a history of egg allergy.
• Describe the difference between IgE-mediated food reactions and non-IgE-mediated food reactions.
• Recognize that an egg allergy is a relative contraindication to receiving yellow fever vaccine.
• Recognize that it is safe to provide iodinated contrast media in patients with a history of anaphylaxis to shellfish.
• Characterize and manage anaphylaxis.
• List food allergies that may play a role in eosinophilic esophagitis.
• Recognize that food allergies can be associated with atopic dermatitis.
• Diagnose celiac disease and recognize that patients with celiac disease may benefit from a gluten-free diet. 

RHEUMATOLOGY, MUSCULOSKELETAL DISORDERS, AND SPORTS MEDICINE

Bone and Joint Infections

• Describe appropriate evaluation and testing in a patient with suspected discitis.
• Examine the emerging trends in osteomyelitis.
• Decide on the appropriate course of treatment in an immunocompromised patient with suspected septic olecranon bursitis.
• Describe clinically relevant testing for diabetic osteomyelitis.
• Identify the clinical features associated with trauma-related osteomyelitis.
• Describe the key factors associated with joint aspiration.
• Characterize appropriate strategies for joint fluid analysis.
• Select the most appropriate test for detecting early osteomyelitis.
• Describe the most effective site to culture for gonococcal septic arthritis.
• Define typical characteristics for the clinical presentation of septic arthritis.
• List the key factors involved with joint fluid analysis.
• Identify risk factors for Pseudomonas-associated osteomyelitis.
• Recognize causative organisms of osteomyelitis by age group.
• Examine the most common pathogen observed in osteomyelitis.

Deep Soft Tissue Infections

• Differentiate between periorbital/orbital cellulitis.
• Identify clinical presentation of necrotizing fasciitis.
• Manage clostridial myonecrosis.
• Differentiate diabetic muscle infarct from infections.

Rheumatoid Arthritis

• Correctly use lab techniques to help diagnose rheumatoid arthritis.
• Explain why anemia develops in rheumatoid arthritis.
• Know what disease-modifying antirheumatic drugs (DMARDs) can be used in monotherapy for any degree of rheumatoid arthritis.
• Recognize and treat side effects of methotrexate.
• Describe the implications for methotrexate use in pregnancy.
• Express the pathophysiology of rheumatoid arthritis and its treatments.
• Define the role of nonsteroidal anti-inflammatory drugs (NSAIDs) in rheumatoid arthritis.
• Explain the ramifications of obesity in rheumatoid arthritis.
• Know the risk factors for rheumatoid arthritis.

ENDOCRINOLOGY, DIABETES, AND METABOLISM

Pediatric Endocrine Disorders

• Diagnose acute adrenal insufficiency.
• Differentiate primary adrenal insufficiency (Addison disease) from secondary adrenal insufficiency.
• Recognize volume depletion and its correction as priorities in diabetic ketoacidosis.
• Develop a treatment plan for adolescents with type 2 diabetes mellitus.
• Employ all indicated vaccines in children with diabetes.
• Identify causes for early morning hyperglycemia.
• Diagnose diabetes.
• Discuss recommendations for the routine supplementation of vitamin D in infants.
• Evaluate and treat neonatal hypoglycemia.
• Advise patients with type 1 diabetes mellitus on their risk of hypoglycemia.
• Identify the manifestations of transient neonatal hypoglycemia.
• Recognize symptoms of pediatric hyperthyroidism.
• Interpret laboratory studies in a patient with hyperthyroidism.
• Assess laboratory data in a patient with hypothyroidism.
• Recognize and treat the female athlete triad.
• Implement screening for hyperlipidemia in children. 

PSYCHIATRIC DISORDERS 

Mood Disorders

• Diagnose major depression.
• Select the initial therapy for moderate depression.
• Recognize seasonal affective disorder.
• Discuss the role of light therapy in the treatment of seasonal affective disorder.
• Diagnose bipolar disorder II.
• Discuss the role of electroconvulsive therapy in the treatment of bipolar disorder I.
• Recognize that medical conditions can present with psychiatric manifestations in elderly patients.
• Recognize remission in patients with depression.
• Recognize the contraindications to treatment with lithium.
• Recognize the risks associated with antidepressant medication.
• Recognize the risks associated with pharmacotherapy for depression in suicidal patients.
• Recognize that there is a medication that has been shown to prevent suicide in patients with depression.

EYE, EAR, NOSE, AND THROAT

Pediatric Eye, Ear, Nose and Throat Disorders

• Recognize the manifestations of and treat Kawasaki disease.
• Diagnose and select appropriate treatment for otitis externa.
• Employ the optimal tooth-saving approach to the pediatric avulsion of permanent teeth.
• Recognize peritonsillar abscess and identify definitive treatment with aspiration or incision and drainage.
• Fully evaluate the eye for foreign bodies in cases of corneal abrasion.
• Treat corneal abrasions in pediatric patients.
• Accurately diagnose acute otitis media.
• Implement appropriate follow-up care for otitis media with effusion.
• Diagnose and manage dacryocystitis.
• Recognize and treat nasolacrimal duct obstruction.
• Apply current guidelines for the treatment of acute otitis media.
• Describe orbital cellulitis and differentiate it from other conditions.
• Differentiate between different types of conjunctivitis.
• Identify and appropriately refer patients with contact lens–associated keratitis.
• Describe the treatment of group A beta-hemolytic streptococcal pharyngitis and examine its rationale.
• Suspect infectious mononucleosis as a cause of pharyngitis.
• Differentiate sinusitis from viral upper respiratory infection.
• Use appropriate therapy for tympanostomy tube–associated otorrhea.

CHILD AND ADOLESCENT CARE

Childhood Immunizations

• Discuss the contraindications and reasons for deferring scheduled vaccinations.
• Explain which vaccinations are indicated and contraindicated in immunocompromised individuals and their caregivers.
• Describe the indications, administration schedule, and contraindications for meningococcal vaccine.
• Explain the indications, administration, and catch-up schedule for pneumococcal vaccine.
• Define the indications for a booster dose of tetanus vaccine.
• List the common and rare complications of vaccinations.
• Characterize the difference between attenuated vs inactivated vaccines and dosing schedule for polio vaccine.
• Explain the schedule of administration and contraindication of the measles, mumps, rubella, and varicella vaccines.
• Describe the postexposure prophylaxis for measles.
• Examine the indications, contraindications, and dosing administration schedule for rotavirus, human papillomavirus, hepatitis A to C virus, diphtheria, tetanus, and acellular pertussis, and Haemophilus influenzae type B vaccines.
• List the vaccinations that may be required for international travels.

Sexuality and Emotional Development

• Recognize the developmental markers of early, middle, and late adolescence.
• Distinguish between appropriate and inappropriate sexual behavior in preadolescents and adolescents.
• Describe appropriate parental counseling during adolescence.
• Discuss expected changes in brain anatomy among adolescents.
• Discuss the timing of and the factors influencing the development of concrete thinking and abstract reasoning in adolescents.
• Characterize the role of puberty in the psychosocial development of adolescents. 

GERIATRIC SYNDROMES

Common Issues in the Elderly

• List the adverse events of alprostadil.
• Recognize the appropriate checking testosterone levels.
• Appropriately treat erectile dysfunction.
• Evaluate and improve nutritional status.
• Describe the indications and contraindications for vitamin supplementation.
• Identify the manifestations of acoustic neuroma.
• Advise elderly patients on sexual activity after myocardial infarction.
• List the contraindications for cataract surgery.
• Describe the measures necessary to help prevent age-related macular degeneration.
• Recognize food impaction as a cause of dysphagia.
• Describe the management of presbycusis.

Other Primary Geriatrics

• Characterize the appropriate management of osteoarthritis in the setting of obesity.
• Manage terminal delirium and restless leg syndrome.
• Recognize indications for hospice referral.
• Manage end-of-life care issues.
• Recognize and manage the signs and symptoms of Morton neuroma.
• Differentiate calluses from warts.
• Identify the signs and symptoms of obstructive sleep apnea.
• Examine commonly used antibiotics that interact with warfarin.
• Recognize the signs of elder abuse.
• Demonstrate how to manage a case of suspected elder abuse.
• Recognize and manage carotid stenosis. 

EMERGENT/URGENT CARE

Wound Management

• Characterize the process for wound preparation and suture closures of lacerations on the lower extremities.
• Describe appropriate management and treatment options for domestic animal and human bites.
• Describe the correct technique of incision and drainage.
• Recognize incision and drainage alone as adequate treatment for mild abscesses.
• Describe the appropriate staple techniques used in various types of skin lacerations.
• Identify the 3 methods of nail trephination.
• Describe the correct technique for trephination
• Describe the correct techniques for limb and chest escharotomy.

WOMEN'S HEALTH AND MATERNITY CARE

General Approach to the Pregnant Patient

• Discuss the development of human chorionic gonadotropin (hGC)
• Identify abnormal physical examination findings in pregnant patients
• Define anemia in pregnant patients

HEMATOLOGY AND ONCOLOGY 

Gynecologic Cancer

• Stage ovarian cancer according to the Federation of Gynecology and Obstetrics (FIGO) staging system.
• Counsel a patient regarding pregnancy and breastfeeding being associated with a lower risk for ovarian cancer.
• Identify the most effective screening tool for finding early-stage ovarian carcinomas.
• Treat invasive epithelial ovarian carcinoma.
• Recall the guidelines for surgical staging of ovarian cancer.
• Evaluate abnormal vaginal bleeding.
• Recall the guidelines for surgical staging of endometrial carcinoma.
• Stage endometrial cancer.
• Treat endometrial cancer with adjuvant radiotherapy.

Sickle Cell Disease

• Identify the genetics of sickle cell disease
• Vaccinate people with sickle cell disease against encapsulated organisms
• Recognize salmonella as a cause of osteomyelitis in sickle cell disease
• Recognize the indications for hydroxyurea in sickle cell disease
• Recognize acute aplastic crisis in sickle cell disease

NEPHROLOGY AND UROLOGY

Chronic Kidney Disease

• Recognize the most significant cause of morbidity and mortality in chronic kidney disease (CKD).
• Identify the most common cause of CKD.
• Recognize proteinuria as a marker of CKD.
• Summarize the role of angiotension-converting enzyme inhibitors in the preservation of kidney function in patients with CKD beyond the protection conveyed by lowering of blood pressure.
• Examine the risks of erythropoietin-stimulating agent use.
• Analyze the role that sodium-glucose cotransporter 2 inhibitors have in reducing the progression of diabetic renal disease.
• Appreciate metabolic acidosis in CKD and the importance of correcting it.
• Recognize uremic encephalopathy as a medical emergency requiring emergency dialysis.
• Diagnose peritonitis in patients receiving peritoneal dialysis.
• List the various complications of CKD.
• Account for renal function when managing diabetes with sulfonylureas.

NEUROLOGIC DISORDERS

Seizures

• Recognize medications which can precipitate withdrawal seizures
• Differentiating syncope versus seizures by clinical presentation
• Discuss the emergent management of pre-eclampsia and eclampsia

DERMATOLOGY

Pediatric Dermatology

• Characterize the presentations of infantile hemangioma, benign course of pityriasis rosea, and verruca vulgaris.
• Differentiate tinea faciei from other facial dermatologic conditions.
• Diagnose tinea capitis.
• Identify the risk associated with large congenital nevi.
• Describe the management of milia in a neonate.
• Describe the management of neonatal herpes simplex virus infection.
• Recognize the physical manifestations of erythema toxicum neonatorum, the course of action of nevus simplex (salmon patch), and the clinical presentation and natural history of Mongolian spots.
• Manage eczema in children.
• Summarize the effective management of moderate to severe inflammatory acne.

POPULATION-BASED CARE

Prevention of Cardiovascular Disease

• Assess the risk factors for and apply current guidelines to prevent cardiovascular disease (CVD).
• Recognize the effect and mechanism of action of aspirin in preventing CVD.
• Describe the role of new medications on the secondary prevention of CVD.
• Discuss the guidelines for the use of statins after a cardiac event.

Prevention of Infectious Disease

• Recognize which populations are appropriate for screening for chlamydia and gonorrhea.
• Discuss the benefits of early detection and treatment of gonorrhea and chlamydia.
• Describe the 2-step screening process for syphilis and identify which populations should be screened.
• Identify specific populations for which screening for hepatitis B and C viruses is recommended.
• Determine populations at risk for HIV infection.
• Discuss the primary modes of HIV transmission and know when to offer screening.