Family Practice Recertification | April 2015

Family Practice Recertification

Martin Quan, MD
For more than a decade, it has been an annual ritual to read headlines about a crisis brewing in Congress as it struggled to avert a looming Medicare disaster stemming from the imminent pay cut to Medicare physicians mandated by the "SGR". Like a broken record each time, spurred by warnings of physician groups of the dire consequences the slash in Medicare fees would have on medical practices and Medicare patients, Congress scrambled at the 12th hour to put off the mandated cuts for another year.
This study was a randomized, controlled trial of 240 adults with metabolic syndrome who were assigned to follow either the single-component dietary recommendation of increased fiber consumption (≥30g/d), or the multi-component American Heart Association (AHA) dietary guidelines. The primary outcome measure was weight loss at 12 months.
This is a randomized controlled study of 612 pregnant smokers of a low-income, inner city population in the west of Scotland, United Kingdom.
The prevalence of HPV infection in US females aged 14-19 is approximately 25% and in females aged 20-24 it is increased to approximately 45%. Despite this high risk, in 2013, only 38% of females aged 13-17 have received all three recommended HPV vaccine doses.
This was a systemic review and meta-analysis of randomized control trials regarding the relationship between dietary fat consumption, serum cholesterol levels, and subsequent coronary heart disease development.
This cluster randomized controlled trial evaluated whether a screening and referral system for social determinants of health (called WE CARE) at well child visits resulted in receipt of more community resources for families.
Shirah Vollmer, MD
A 38 year old female lab technician is seen for "being nervous all the time". She complains of being unable to relax. She relates to you that he has been a "worry wart" for as long as she can remember, always fearing that something is going to go wrong. Although her doctor has told her she is in excellent health, she relates that she sees him frequently for episodic stomach pains and palpitations.
James D. Collins, MD
A mother brought her 1-year-old daughter to the emergency department and reported that the child had swallowed a coin. She had vomited once without recovery of the coin. The mother said the baby had not been coughing or wheezing and had no respiratory distress, but she refused to eat.
This 76-year-old woman presented to clinic with 8 weeks of severe scalp itching. She had previously been treated with emollient lotion, baby oil, a dandruff shampoo containing pyrithione zinc, and hydroxyzine. Her past medical history includes eczema, hypertension, hyperlipidemia, paroxysmal SVT, GERD, and depression. She is retired, volunteers at an elementary school, and does not drink alcohol, smoke tobacco, or use recreational drugs.
In last month's Pain Perspectives, I discussed the importance of assessing patients with chronic pain for depression – as it is extremely prevalent in this population and has been found to interfere with physical treatment. This month, we will begin to look at what the primary care physician can do to ensure that their patients with chronic pain have their depression addressed adequately.
Daniel Schimmel, MD, MS
A 51 year-old man with a history of well-controlled hypertension presents to his primary physician's office for an acute care visit with chest discomfort that would come and go.

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Dermatology Quiz

Elderly Woman With an Itchy Scalp
This 76-year-old woman presented to clinic with 8 weeks of severe scalp itching. She had previously been treated with emollient lotion, baby oil, a dandruff shampoo containing pyrithione zinc, and hydroxyzine. Her past medical history includes eczema, hypertension, hyperlipidemia, paroxysmal SVT, GERD, and depression. She is retired, volunteers at an elementary school, and does not drink alcohol, smoke tobacco, or use recreational drugs.
Elderly Woman With an Itchy Scalp
What is Your Diagnosis?
Eczema
Seborrheic dermatitis
Neurodermatitis
Pediculosis capitis
Contact dermatitis

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