Rakel Textbook of Family Medicine 8ed 2011.
The recommended reading assignments in this textbook have been designed to correspond to the
core clinical topics for the rotation. Certain 3rd Year requirements are outlined in the specific
Medical School Curriculum, for example, VCOM.
1. PATIENT CENTERD MEDICAL HOME (PCMH)
a. Reading assignment: Rakel pages 17-23
b. Objectives:
i. Understand the principles of the PCMH, the three primary domains of care
delivery, and the importance of self care
ii. Understand the types of disciplinary teams in the PCMH
iii. Describe types of health team models and the new team approach model
2. PREVENTIVE HEALTH CARE
a. Reading assignment: Rakel pages 70-85
b. Objectives:
i. Define Primary, secondary, and tertiary prevention
ii. Define the WHO criteria for screening tests
iii. Define prevalence, incidence, and number needed to screen
iv. Describe preventive services for the cancers: colon, breast, lung, ovarian
and prostates cancer; be familiar with USPSTF recommendations
v. List the preventive service recommendations for the following
cardiovascular diseases: hypertension, hyperlipidemia, abdominal aortic
aneurysm, CHD and CVD;
vi. List the preventive service recommendations for the following substance
abuse and mental health issues: tobacco, alcohol, and depression
3. ORAL CAVITY AND ACUTE PHARYNGITIS
a. Reading assignment: Rakel pages 330-338
b. Objectives:
i. Identify viral and bacterial causes of acute pharyngitis
ii. Describe treatment options and physical examination findings for GABHS
iii. Recognize the Centor criteria for GABHS
iv. Define the carrier state in GABHS
v. Understand the complications from acute glomerulonephritis
vi. Define dysphagia, medication induced esophagitis, and globus hystericus
vii. Name the elements of an obstructive sleep apnea (OSA) study, the
symptoms of OSA, and the chronic illnesses associated with OSA.
viii. Identify the causes of laryngitis and hoarseness, and treatment guidelines
ix. Describe the symptoms and treatment of reflux laryngitis
4. RED EYE IN ADULTS AND CHILDREN
a. Reading assignment: Rakel pages 932-939
b. Objectives:
i. Differentiate between blepharitis, stye, and chalazion
ii. Describe the common pathogens of bacterial conjunctivitis and their
treatment
iii. Describe the potential serious effects of topical steroids on the eye
iv. Differentiate between viral and allergic conjunctivitis, their diagnosis and
treatment Identify the signs , symptoms and treatment of corneal herpetic
infection
v. Differentiate preseptal from orbital cellulitis based on signs and symptoms
and describe the treatment for orbital cellulitis
vi. Describe the treatment for ocular chemical burns
vii. Describe the risk factors and appearance of central retinal artery occlusion
viii. Describe the symptoms and treatment of retinal detachment
5. DIABETES MELLITUS
a. Reading assignment: Rakel pages 731-744
b. Objectives:
i. Identify the four groups of diabetes and how DM is diagnosed; define
prediabetes ; be able to identify other cause of DM
ii. Describe the changing epidemiology of diabetes in the U.S.
iii. Identify the morbidity and mortality (complications) associated with DM
and preventive measures that lower morbidity
iv. Define the two common pathogenic mechanisms associated with the
development of DM and the characteristics of type 1 and type 2 DM
v. Describe latent autoimmune diabetes of adults (LADA) and maturity-onset
diabetes of young (MODY)
vi. What have the ACCORD and UKPDS trials shown in the treatment of
type 2 DM
vii. What impact does behavioral therapy have on the management of DM?
viii. Identify the Dietary recommendations of the ADA and the effects of
exercise on DM
ix. Identify the classes of diabetic agents, mode of action and side effects;
identify two agents that may promote weight loss
x. Describe the classes of insulin preparations
xi. Define how to initiate insulin in the type 2 DM patient and when to
consider the discontinuation of insulin
xii. Describe basal bolus insulin dosing in type 1 DM
xiii. List 3 factors that influence the amount of insulin considered for pre
prandial injections
6. THORACOLUMBAR SPINE (low back pain- LBP)
a. Reading assignment: Rakel pages 636-647
b. Objectives:
i. Identify the common history, physical exam skills, and special techniques
for evaluating back pain
ii. List the percentage of patients with LBP, chronic LBP and the percent
who return to work
iii. Name the most common cause of back pain seen in Family Medicine,
predisposing factors, and significance of psychosocial factors
iv. What is the value of diagnostic testing, and describe routine treatment for
LBP
v. Identify the clinical signs and symptoms associated with disc herniation
syndromes and when to refer for surgical evaluation
vi. Be able to describe the clinical signs, symptoms and treatment of
thoracolumbar compression fractures, spinal stenosis, and scoliosis
7. CORONARY ARTERY DISEASE (CAD) STABLE ANGINA
a. Reading assignment: Rakel pages 499-503
b. Objectives:
i. Define angina and its signs and symptoms
ii. List the treadmill stress test findings that are > or = to 90% positive
predictive value for CAD
iii. List 3 goals in the pharmacologic management of stable CAD
iv. Describe the pharmacologic effects of nitrates, b-blockers, calcium
channel blockers for the treatment of stable angina.
v. Define the methods of secondary prevention for the treatment of stable
angina
8. CONGESTIVE HEART FAILURE (CHF)
a. Reading assignment: Rakel pages 508-512
b. Objectives:
i. Define the pathophysiologic mechanism in CHF
ii. Describe the AHA/NYHA classification of angina
iii. Identify the signs, symptoms, and pattern of viral cardiomyopathy
iv. List methods of risk factor reduction in CHF
v. Describe the 4 general classes of pharmacologic therapy in CHF and their
mechanism of action and outcomes
9. DYSLIPIDEMIA
a. Reading assignment: Rakel pages 479-485
b. Objectives:
i. List the risk factors for the development of atherosclerosis
ii. Define the LDL cholesterol goals based on risk assessment
iii. Define coronary artery disease risk equivalents
iv. List the primary and secondary goals of therapy for dyslipidemia
v. Identify therapeutic lifestyle changes
vi. Describe the role of statins in primary and secondary therapy and their
mechasnism of action and side effects
vii. Describe the action, benefits, and side effects of niacin and fish oil
10. CIGARETTE SMOKING/TOBACCO USE
a. Reading assignment: Rakel pages 498-499
b. Objectives:
i. Be able to identify the morbidity and mortality associated with tobacco
use
ii. Be familiar with the pathologic basis of smoking and its effect on tissues
iii. Describe the pharmacologic effects of Buproprion, nicotine , and
varenicline for the treatment of smoking
11. METABOLIC SYNDROME
a. Reading assignment: Rakel pages 492-496
b. Objectives:
i. Define metabolic syndrome NCEP ATP-III criteria and its associated
medical conditions
ii. Describe the incidence of metabolic syndrome and obesity in the U.S. and
its prevalence in ethnic populations
iii. Understand the pathological mechanism of increased abdominal adipose
tissue and its effects on metabolism especially lipids and blood sugar
iv. Describe the treatment for metabolic syndrome
12. ALLERGY AND ASTHMA
a. Reading assignment: Rakel pages 343-345
b. Objectives:
i. Describe two hypotheses for the increase in allergic responses noted over
the past few years
ii. List the common physical signs and symptoms of allergies
iii. Describe the most effective treatment for allergic rhinitis
iv. Define “NARES” and its treatment
v. Identify the signs and symptoms of vernal conjunctivitis and its treatment
vi. List the 3 key elements to the diagnosis of asthma; and be able to discuss
common signs and symptoms
vii. List the differential in the diagnosis of asthma
viii. Describe the most useful test for the diagnosis of asthma in the primary
care office and its relationship to the severity of disease
ix. Be familiar with the classification scale for asthma and the step approach
to treatment
x. List the risk factors for asthma related death
13. OCCUPATIONAL LUNG DISEASE(OLD)
a. Reading assignment: Rakel pages 292-294
b. Objectives:
i. What key questions should be asked during the history pertaining to
OLD
ii. List the leading cause of death in OLD
iii. Define the relationship between OLD and asthma
iv. Define occupational pneumoconiosis and hypersensitivity pneumonitis
v. Describe the best prevention of OLD
14. PULMONARY FUNCTION TESTING (PFT) /COMMON PULMONARY SYMPTOMS
a. Reading assignment: Rakel pages 263-268
b. Objectives:
i. Define how to distinguish obstructive from restrictive disease using PFT,
FEV1, and FVC; be able to diagnose each using PFTs;
ii. Describe what makes an adequate PFT
iii. Define what sign and symptoms suggest a cardiac cause for shortness of
breath
iv. List the most common causes of acute episodes of cough?
v. Describe the most common differential of cough in the non-smoking adult
15. OBSTRUCTUVE LUNG DISEASE
a. Reading assignment: Rakel pages 268-277
b. Objectives:
i. List 3 of the most common obstructive lung diseases
ii. Define asthma and its relationship to socioeconomic status
iii. Describe the important history and physical findings in asthma
iv. Identify how to diagnosis asthma and specifically how to use spirometry
to diagnose obstructive lung disease.
v. Identify the stages in the stepwise approach to classification and treatment
of asthma
vi. List 3 classes of medications that decrease the frequency of exacerbations
in chronic obstructive lung disease (COPD)
vii. Define the risks of smoking and environmental pollutants in COPD
viii. Define when to screen for alpha one antitrypsin deficiency
ix. Identify the subsets of COPD and its clinical presentation
x. Identify the stages in the stepwise approach to classification and treatment
of COPD
xi. List the indications for antibiotic treatment in the exacerbation of COPD
xii. Describe preventive measures in the treatment of COPD
16. INFLUENZA PREVENTION
a. Reading assignment: Rakel pages 281-282
b. Objectives:
i. Define who should receive an influenza and pneumococcal vaccine based
on risks and age.
ii. List the types of vaccine available
iii. Define its effect on pneumonia prevention
17. HEADACHE(HA)
a. Reading assignment: Rakel pages 962-965
b. Objectives:
i. List the differential diagnosis of primary and secondary headache
ii. Describe the components of the history and physical of the patient that
presents with the complaint of HA
iii. Define the diagnostic criteria for migraine HA
iv. Describe the treatment of migraine HA preventive(prophylactic) and
abortive(acute treatment)
v. List the diagnostic criteria for tension, cluster, and medication overuse HA
vi. Describe the signs and symptoms of Giant cell Arteritis, and the causes of
HA in the older adult
18. CRYSTAL ARHTROPATHIES/SPONDYLOARTHROPATHIES
a. Reading assignment: Rakel pages 668-674
b. Objectives:
i. Describe the signs and symptoms of gout
ii. Describe the presentation of gout in women and older adults
iii. List the two most important factors in the development of acute gouty
arthritis
iv. Define the causes of secondary gout
v. Define the mechanism of action of Allopurinol; and the prophylaxis of
gout
vi. Identify the diseases associated with calcium pyrophosphate deposition
disease ; the workup for new diagnosis and may diseases may be confused
with its initial diagnosis
vii. List the signs and symptoms of ankylosing spondylitis and the classic
radiographic appearance
viii. Define the classic triad of reactive arthritis and the suggested causes
19. COMMON ADULT GASTROINTESTINAL DISORDERS
a. Reading assignment: Rakel pages 847-855
b. Objectives:
i. Define Barret’s esophagitis, its incidence in western culture and risk
factors
ii. Describe the role of H pylori in the role of PUD, methods of testing for H.
pylori, and treatment options
iii. List the major causes of PUD
iv. Discuss the side effects of PPI’s
v. Define the role of diagnostic testing in GERD, alarm symptoms, and
lifestyle modifications
vi. List the common causes of Upper GI bleeding ,
vii. Define the traditional clinical picture of gallstones
viii. Describe diagnostic testing in gall bladder disease
20. GI CONT’D: Inflammatory Bowel Diseases (IBD), Irritable Bowel Syndrome(IBS),
DIVERTICULAR DISEASE (DD), CELIAC(CD)
a. Objectives:
i. Describe the ages of peak incidence in the diagnosis of IBD and lifetime
risk of developing IBD for 1st degree relatives
ii. 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
iii. Identify the intestinal and extraintestinal symptoms of crohn’s and UC
iv. Define the role of systemic steroids in the pharmacologic treatment of
both UC and crohn’s
v. List 3 symptoms that characterize IBS
vi. Describe the physical examination of the patient with IBS and the use of
diagnostic screening tests(recommendations)
vii. Define the ROME III criteria used to diagnose IBS
viii. List the common signs and symptoms of diverticulitis and the diagnostic
tests used for the initial evaluation
ix. Describe conservative management of uncomplicated diverticulitis and
who may be treated as an outpatient
x. Define the effects of long term fiber use after the first episode of
diverticulitis
xi. Describe the adult presentation of celiac disease
xii. List the serologic tests to consider in the diagnosis of celiac disease
xiii. List the dietary items patients should avoid if diagnosed with celiac
disease
xiv. Identify the overall mortality risks associated with Celiac disease
21. DERMATOLOGY
a. Reading assignment: Rakel pages 723-730
b. Objectives:
i. Describe the physical characteristics of seborrheic keratosis and the best
way to differentiate it from melanoma
ii. List the characteristics of a dermatofibroma and the clinical imlications of
the “pinch” test
iii. Describe the physical characteristics of actinic keratosis
iv. Describe the physical characteristics of basal cell carcinoma and the
indications for mohs surgery
v. Describe the physical characteristics of squamous cell carcinoma
vi. Describe the physical characteristics of melanoma and risk factors for
development
vii. 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, FAAO, FACOFP. During your
Family Medicine rotation you are required to read:
1. Family Practice
Ch 25 – The Patient with Chronic Pain, Headache
Ch 26 – The Patient with Back Pain: Short Leg syndrome and Postural