Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with the symptom of a cough and be able to do the following at the level of a Phase III medical student:

Discuss the DIFFERENTIAL DIAGNOSIS including:

• Acute (< 3wks): Common vascular (pulmonary embolism), infectious (viral URI, viral/bacterial bronchitis, bronchiolitis, croup, sinusitis, pneumonia), cardiac (pulmonary edema), trauma (pneumothorax), exposures (fumes, smoke, cold air). Less Common. Foreign body. vascular (pulmonary embolism), trauma (pneumothorax), cardiac, (pulmonary edema).
• Chronic (>3wks): Common. Inflammation/allergy (asthma, allergic rhinitis, post-nasal drip syndrome, chronic sinusitis), gastrointestinal (GERD), medications (ACE-I), post- infectious, substances (tobacco, fumes), respiratory. (COPD) Less Common.  Inflammation (bronchiectasis), gastrointestinal ( aspiration), medications, ( beta-blockers) neoplasm, (lung, mediastinal cancers) respiratory (ILD, cystic fibrosis), cardiac (CHF, mitral stenosis), psychogenic/anxiety, infectious.  (tuberculosis).

Generate a hypothesis for the patient utilizing the following:

Clinical Tasks

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, gather data regarding cough onset, frequency, aggravating/alleviating factors, duration, quality, associated symptoms (dyspnea, constitutional symptoms, and effect on sleep, heartburn, infectious or noxious exposures) allergy/asthma history and tobacco use.
• Physical Examination: Assess vital signs (HR, RR, temp), HEENT, CVS, lung and abdominal examination.

General Evaluation

• List and interpret appropriate diagnostic tests essential to the processes of exclusion, differentiation, and diagnosis (pulse ox, peak flow, CXR, spirometry).
• Identify indications for other testing including laboratory tests.
• In particular know how to distinguish pneumonia from other causes of cough. (Phase 1 & 2 Review)

General Management

• Describe the initial management plan for a patient with an acute cough.
• Describe the initial management plan for a patient with a chronic cough.
• List common over the counter and prescription medications used in the management of cough (along with their side effects).
• List indications for antihistamines, decongestants, cough suppressants, antibiotics, steroids and ß agonists.
• Counsel and educate patients about smoking cessation.

Basic Science Content

• Understand the physiology of the coughing mechanism: stimulation of mechanical or chemical afferent nerve receptors in the bronchial tree. Cough depends on an intact afferent-efferent reflex arc, adequate expiratory and chest wall muscle strength, and normal mucociliary production and clearance. Based on this outline the effects of therapy on specific elements of coughing.

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with family problems and be able to do the following at the level of a Phase III medical student:

Discuss the DIFFERENTIAL DIAGNOSIS including:

• Developmental transitions (family lifecycle stages) such as marriage, childbirth, child rearing, adolescence, leaving home, separation and divorce, remarriage, midlife, old age, dying and death can create stress and lead to physical problems.
• Patients who present with family difficulties may also be experiencing them because of a lack of coping skills, alcohol or substance abuse problems or there may be mental health disease within the family contributing to family dysfunction.

Generate a hypothesis for the patient utilizing the following:

Clinical Tasks

• Taking into consideration the patient’s literacy, culture and other contextual factors, elicit a history of social, sexual, school or family difficulties that include family of origin, complete family history and stage of Family Lifecycle.
• Understand the use of a family conference for information gathering purposes.
• Perform appropriate physical examination for patients presenting with physical complaints.

General Evaluation

• Perform an assessment to include depression screening, screening for substance abuse and screen for domestic violence. Utilize depression screening tools and the CAGE questionnaire.
• Understand family behavioral styles such as enmeshment, triangulation and disengagement.
• Be familiar with a multigenerational pedigree populated with relevant medical and psychosocial information. (Phase 1 & 2 Review)

General Management

• Determine how to suitably enlist family members in the care of a patient and provide support for caregivers.
• Determine appropriate family counseling programs, community agencies, school based programs for management of social and family difficulties.

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with the symptom of fatigue and be able to do the following at the level of a Phase III medical student:

Differential Diagnosis:

• Define fatigue and differentiate from other symptoms such as shortness of breath, dyspnea on exertion, weakness.
• Identify major causes of fatigue in adults including depression, anxiety, somatoform disorder, sleep disorders, medications, idiopathic, and underlying disease states.

Generate a hypothesis for the patient utilizing the following:

Key Findings

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, elicit a detailed history regarding onset and duration of symptoms, medication use, sleep history, functional levels, drug or alcohol use, psychiatric disorders.
• Physical examination: Perform appropriate physical examination including neurologic, endocrine, lymphatic, cardiovascular, and pulmonary.

Evaluation

• List and interpret appropriate laboratory tests in evaluation of fatigue.
• Identify indications for other diagnostic testing.
• List diagnostic criteria used for diagnosing chronic fatigue.
• Screen for depression.

Management

• Outline initial management plan for a patient with fatigue.
• Identify mutually agreed upon therapeutic goals.
• List possible treatment options for idiopathic fatigue including; exercise, behavioral therapy, SSRI antidepressants).

Basic Science Content

• Describe pathophysiology of fatigue in thyroid disorders. (Phase 1 & 2 Review)
• Describe pathophysiology of fatigue in anemia.

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with the symptom of headache and be able to do the following at the level of a Phase III medical student:

Discuss the DIFFERENTIAL DIAGNOSIS including:

• Describe differential diagnosis for primary headaches including migraine, tension, chronic daily (rebound) headache and cluster. (Phase 1 & 2 Review)
• Describe differential for secondary headaches, especially potentially serious causes including intracranial hemorrhage from aneurysm, intracranial mass, infection, concussion and temporal arteritis. (Phase 1 & 2 Review)

Generate a hypothesis for the patient utilizing the following:

Key Findings

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, obtain detailed history of headache including onset, duration, intensity, frequency, associated symptoms, alleviating and aggravating factors, personal and family history of headaches, neurologic symptoms, trauma, immunosuppression, medications and dietary history.
  1. List “Red Flags” suggesting a progressive or life-threatening disease.
• Physical Examination: Perform a detailed neurologic examination.

General Evaluation

• Identify indications for imaging of the brain.
• Identify indications for lumbar puncture.

General Management

• Outline initial treatment plan for benign headache including lifestyle changes and abortive medications. (triptans, ergot alkaloid, NSAIDs) (Phase 1 & 2 Review)
• Discuss indications for and medications used for prophylactic treatment of chronic headaches.(beta-blockers, [propranolol] calcium channel blockers, [verapamil] antidepressants, [amitriptyline] and anticonvulsants [topiramate]). (Phase 1 & 2 Review) 

Basic Science Content

• Describe the role of serotonin neuronal systems in the pathogenesis of migraine headache and identify the primary targets for therapeutic intervention. (Phase 1 & 2 Review)

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with the symptom of low back pain and be able to do the following at the level of a Phase III medical student:

Discuss the Differential Diagnosis including:

No nerve involvement (non-radicular)

• Mechanical low back or leg pain
  1. Idiopathic (lumbar strain or sprain)
  2. Disk herniation and facet degeneration
  3. Osteoporotic compression fracture
  4. Spondylolisthesis
  5. Congenital disease (kyphosis, scoliosis, transitional vertebrae)
• Non-mechanical spinal conditions
  1. Neoplasia (myeloma, metastases/primary, lymphoma/leukemia)
  2. Infections (osteomyelitis, septic discitis, abscess, shingles)
  3. Paget disease
  4. Inflammatory arthritis (associated with HLA-B27)
  • Ankylosing spondylitis
  • Psoriatic
  • Reactive arthritis (Reiter syndrome)
  • Inflammatory bowel disease

Common Sources of Referred Pain – visceral disease

• Pelvic organs (prostate, endometriosis, PID)
• Renal (stones, infection, abscess)
• Aortic aneurysm, retroperitoneal neoplasm/infection
• Gastrointestinal (pancreatitis, cholecystitis, penetrating ulcer)

Generate a hypothesis for the patient utilizing the following:

Clinical Tasks

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, gather data to categorize back pain as musculoskeletal or due to other local or other organ system disease. Determine whether psychosocial distress is amplifying the pain.
• Physical Examination: Perform examination of the back and other anatomic areas that could lead to back pain. Determine whether there is neurological deficit, abnormal bladder, bowel, or sexual function, an inciting event, pain location, radiation, and effect of rest or leg motion.

General Evaluation

List and interpret diagnostic tests key in the processes of exclusion, differentiation, and diagnosis of low back pain:

• Describe indications for diagnostic imaging when appropriate to confirm a clinical diagnosis.
• Determine whether there is loss of sphincter tone or urinary retention that may represent a surgical emergency. Determine if signs or symptoms of other emergencies such as leaking abdominal aortic aneurysm, or neoplastic spinal cord compression exist.

General Management

• Communicate an effective plan of management for a patient with pain in the lower back.
• Outline management of acute musculoskeletal back pain without neurological or other abnormality on examination.
• Outline basic management of renal, biliary, gynecological or vascular causes of back pain.
• Select patients in need of interdisciplinary/specialized care.

Basic Science Content

• Describe the nerve roots that affect reflexes in the lower extremities. (Phase 1 & 2 Review)
• Describe the dermatome innervation of the lower extremity. (Phase 1 & 2 Review)

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with oral pain or oral lesions and be able to do the following at the level of a Phase III medical student:

Differential Diagnosis:

• Identify common oral lesions such as bony torus, aphthous ulcer, mucocele, oral thrush, geographic tongue, leukoplakia and oral cancer.
• Identify major causes of oral pain in adults including dental trauma and caries, gingivitis, periodontal infection, oral thrush & B12 deficiency.

Generate a hypothesis for the patient utilizing the following:

Key Findings

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, elicit a detailed history regarding onset and duration of symptoms, last dental visit, medication use & smoking history or alcohol use. Identify if patient has a regular source of dental care.
• Physical examination: Perform appropriate physical examination of high risk areas including palpation of the floor of mouth and examination of the soft palate and lateral tongue. Identify white spots as a precursor to dental caries.

Evaluation

• List and interpret appropriate laboratory tests in evaluation of oral pain.

General Management

• Outline initial management plan for a patient with common oral lesions or oral pain.
• Identify mutually agreed upon therapeutic goals.
• Identify patients who require urgent dental/oral specialty care from those who need routine follow-up in a “dental home.”

Basic Science Content

• Describe basic oral/dental anatomy. (Phase 1 & 2 Review) 
• Understand the microbiology of dental caries.
• List the sites in the mouth most commonly affected by oral cancer.

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with a skin lesion and be able to do the following at the level of a Phase III medical student:

Differential Diagnosis:

• Identify skin lesions such as tinea corporis, impetigo, basal cell cancer, squamous cell cancer, malignant melanoma, seborrheic keratosis, contact dermatitis, herpes zster.

Differentiate lesions into the following categories:

Inflammatory

• acneform – Common: acne vulgaris. Less Common: acne rosacea, perioral dermatitis
• contact dermatitis – Common: allergic contact dermatitis ( i.e. poison ivy or nickel), irritant dermatitis
• eczematous dermatitis –Common: atopic, seborrheic. Less Common: nummular, stasis dermatitis
• photosensitivity – dermatomyositis, lupus erythematosus, photosensitive drug eruption
• Common: psoriasis
• Common: urticaria

Infectious

• bacterial – Common: cellulitis, folliculitis, impetigo
• fungal – Common: candidiasis, dermatophyte infections (tinea), tinea versicolor
• parasitic – Common: lice, scabies
• viral – Common: herpes simplex, herpes zoster, molluscum, wartst

Neoplastic

• benign – Common: nevi, skin tags, inclusion cyst, lipoma. Less Common:  dermatofibroma, sebaceous hyperplasia
• malignant – Common: basal cell carcinoma. Less Common:  squamous cell carcinoma, malignant melanoma

Vascular

• acquired – Common: spider veins, telangiectasias. Less Common:  cherry angiomas, spider angiomas
• congenital – Less Common:  hemangiomas, vascular malformations

Generate a hypothesis for the patient utilizing the following:

Clinical Tasks

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, perform thorough, efficient, focused data gathering to determine the evolution and progression of skin lesions including a history of significant contacts, sun exposure, and family history. Identify patients at high risk for skin cancer.
• Physical Examination: Accurately describe skin lesions and eruptions including morphology, location, and distribution. Perform a skin cancer screening exam.
• Co-Morbidities: Identify common dermatological manifestations of systemic disease.

General Evaluation

Appropriately select and interpret diagnostic tests key to the exclusion, differentiation and diagnosis of common skin conditions such as:

• Culture
• KOH prep
• Skin biopsy
• Name the characteristics of pigmented lesions that assist in the identification of a melanoma. (A,B,C,D,E)

General Management

Appropriately select and interpret diagnostic tests key to the exclusion, differentiation and diagnosis of common skin conditions such as:

• Communicate an effective plan of management to a patient/their family or caregivers for management of common skin conditions.
• Demonstrate knowledge of classes of topical corticosteroids including potency and vehicles.
• Know adverse effects of high potency/fluorinated topical corticosteroids.
• Demonstrate knowledge of common topical and systemic dermatological medications.
• Describe common dermatology procedures such as cryosurgery, shave/punch biopsies or elliptical excision.

Basic Science Content

• Demonstrate knowledge of the basic structure of the skin and recognize the adnexal structures including the hair, nails, sebaceous glands and sweat glands. (Phase 1 & 2 Review)

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with the symptom of weight loss/failure to thrive and be able to do the following at the level of a Phase III medical student:

Differential Diagnosis:

• Define clinically important involuntary weight loss as greater than 5% of body mass in 6-12 months.
• Identify differential diagnosis for involuntary weight loss in the adult patient including hyperthyroidism, diabetes mellitus, malabsorption, malignancy, COPD, chronic illness, depression, mania, drug or alcohol use, medications.

Generate a hypothesis for the patient utilizing the following:

Key Findings

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, elicit a detailed history regarding documentation of previous weight, dietary history, activity history, medications, comorbities, change in appetite and depressive symptoms.
• Physical examination: Perform appropriate physical examination including all systems.

Evaluation

• List and interpret appropriate laboratory tests in evaluation of weight loss (TSH, HIV, CBC, blood glucose).
• Identify and interpret other diagnostic tests which may be used for the evaluation of weight loss.
• Perform depression screening.

Management

• Outline initial management plan for a patient with weight loss.

Basic Science Content

• Describe pathophysiology of weight loss in hyperthyroidism and diabetes mellitus.
• Describe mechanisms of weight loss in associated with malignancy.

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with allergic rhinitis, conjunctivitis, or urticaria (Hives) and be able to do the following at the level of a Phase III medical student:

Clinical Tasks:

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, elicit a detailed history including timing of symptom/lesion onset/duration, and identification of precipitants.
• Identify common allergens and their possible effects on susceptible children and adults.
• Physical examination: Perform and appropriate exam of the conjunctiva, ENT chest and skin. Recognize nasal polyps and classic urticarial lesions.
• Comorbidities: Assess if patient is asthmatic. Determine if symptoms may be indicative of systemic disease. Identify serious allergic conditions such as anaphylaxis.

Evaluation

• List and interpret diagnostic tests which are key in the processes of exclusion, differentiation, and diagnosis of allergic conditions.
• Indicate those conditions where laboratory investigation is indicated.
• List indications for the use of tests designed to identify allergens. (prick skin testing and testing for IgE antibodies to specific allergens [RAST]).
• Interpret results so as to differentiate the allergic from the non-allergic individual.
• Define seasonal and perennial allergens/allergy.

Management

• Communicate an effective initial plan of management for a patient with allergies, including identification and discontinuation of offending trigger and pharmacological therapy.
• Outline the basic emergency management of a patient with anaphylaxis.
• Outline the immediate and long-term management of the child or adult with allergies including education and counseling for the patient, family, school, and the community.
• List common medications used in the management of allergies (along with their side effects).
• Contrast first generation and second generation H1 receptor antagonists
• List indications for steroids.
• Select patients in need of immunotherapy/multidisciplinary/specialist care.

Basic Science Content

• Outline the different cellular/immune mediators involved in early and late phase allergic reactions including mast cells, histamine, leukotrienes, cytokines and other mediators. (Phase 1 & 2 Review) 
• Outline the effects of therapy on specific elements of the allergic process.

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with asthma and be able to do the following at the level of a Phase III medical student:

Clinical Tasks:

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, elicit a detailed symptoms history about intermittency, seasonal waxing and waning, nocturnal episodes, exacerbation on exposure to exercise, cold air, allergens, air pollutants, smoking history, or upper respiratory tract infections.
• Physical: Perform an appropriate physical exam to assess evidence of degree of airflow obstruction and oxygenation.
• Comorbidities: Assess the patient for other atopic conditions and cardiovascular complications of airflow obstruction or concurrent cardiovascular disease.
• 
  

Evaluation

• List and interpret diagnostic tests which are important in the processes of exclusion, differentiation, and diagnosis of asthma.
• Utilize spirometry and FEV1 to quantify severity and reversibility of airway narrowing.
• Select and interpret diagnostic imaging to detect complications of asthma and to exclude alternative diagnoses.
• Demonstrate knowledge of National Asthma Guidelines.
• Discus the use of peak flow monitoring in the chronic care of asthma patients.
• List indications for allergy testing for asthma.
• Identify those patients in need of hospitalization.

Management

• Communicate an effective action plan for managing a patient with asthma.
• Utilize the concepts of chronic disease management to care for an asthmatic patient.
• List common medications used in asthma (along with their side effects).
• Outline an initial plan of management for a patient with an exacerbation of asthma in the ambulatory setting.
• Describe the use and benefits of a “spacer” device.
• Select patients in need of multidisciplinary/specialized care.

Basic Science Content

• Outline the role of different types of cells in the chronic inflammatory condition of the airways associated with asthma (mast cells, eosinophils, T cells). (Phase 1 & 2 Review)
• Explain how the pharmacological interventions used in this disease relate to the cells identified above.

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with depression or anxiety and be able to do the following at the level of a Phase III medical student:

Clinical Tasks:

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, perform a history to elicit the symptoms of depression (depressed mood, loss of interest in all activities, change in weight/appetite, sleep, energy, concentration, feeling of hopelessness, worthlessness or guilt, recurrent thoughts of suicide, increase in somatic complaints or withdrawal from others), anxiety (excessive worry about events which is out of proportion to the impact of the event, discrete period of intense fear, recurrent panic attacks, along with cardiopulmonary, neurological, psychiatric or other medical symptoms) and precipitating life stressors. Determine whether a general medical condition is present, use or abuse/dependence of alcohol, caffeine or drugs (or withdrawal) and gather family history of psychiatric disease. Determine how long these symptoms have been present.
• Physical Exam: Perform a focused exam to identify physical conditions that could present as depression or anxiety.
• Comorbidities: Identify those patients with chronic diseases at risk of depression. Identify coexisting thyroid or other health problems, alcohol or drug problems.

Evaluation

• Select patients who require further investigation for medical condition or drugs that affect mood (e.g., thyroid function, toxicology screen, electrolytes, etc.).
• Use screening tools to assist in the diagnosis and to document response to treatment/remission.
• Identify those patients who are suicidal or require hospitalization.

Management

• Communicate an effective initial plan of management for a patient with anxiety or a mood disorder.
• Use chronic disease management tools including re-administering screening tools to help evaluate attainment of remission.
• Outline and describe treatment under categories of medications, physical treatment, and psychological treatment and/or community mental health resources.
• Select patients in need of multidisciplinary/specialized care.
• Understand augmentation strategies with medications (bupropion).

Basic Science Content

• Explain current knowledge of the pathophysiology/neuro-physiology of anxiety/depression and how treatment affects these mechanisms.

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with diabetes mellitus and be able to do the following at the level of a Phase III medical student:

Clinical Tasks:

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, perform a history to uncover symptoms of diabetes mellitus and associated complications. Elicit a family history of DM.
• Physical exam: Perform a physical exam to determine if there are signs of DM complications or co morbid conditions.
• Comorbidities: Elicit a personal or family history of hypertension, hyperlipidemia, obesity or cardiovascular disease.

Evaluation

• Know ADA criteria and diagnostic tests for the diagnosis of diabetes mellitus.
• Select and interpret diagnostic tests for diagnosis of diabetes mellitus and its complications.
• Discuss HbA1c and glycemic monitoring.
• Discuss urine microalbumin (spot albumin to creatinine ratio) and nephropathy diagnosis. Diagnose diabetic ketoacidosis, severe hyperglycemia, and hyperosmolar state; determine the precipitating causes.
• Discuss criteria used to determine if hospitalization is indicated.

Management

• Communicate an effective initial plan of management for a patient/caregiver for hyperglycemia.
• Outline appropriate immediate and chronic disease management of diabetes mellitus, including exercise, diet, blood pressure control and primary and secondary prevention of complications, both micro and macrovascular.
• List oral drugs and insulin formulations used in the management of DM (including side effects).
• Conduct education and counseling in patients with diabetes mellitus and their families, including lifestyle modifications, and primary and secondary preventive strategies for the complications of the disease (role of ACEI and ARBs, lipid control, BP control, foot care and eye care).
• Select patients in need of multidisciplinary/specialized care.

Basic Science Content

• Contrast the mechanism of hyperglycemia in Type I & Type II diabetes mellitus.
• Compare the mechanism of action of insulin to that of various classes of oral hypoglycemic agents.

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) at risk of or experiencing domestic violence and be able to do the following at the level of a Phase III medical student:

Clinical Tasks:

• History: Through sensitive, focused, data gathering demonstrate competency in routine screening for family violence across the lifespan, including direct and indirect screening questions and instruments. Incorporate a recognition of cultural factors that influence the occurrence and patterns of and responses to family violence in individuals, families, and communities.
• Physical: Assess for physical and/or mental health effects persisting into adult life, after childhood experience of abuse or family violence.
• Co-morbidities: Assess for adverse health effects of present and past violence.

Evaluation

• Assess risk of severe injury or death in a patient presenting with family violence-related injuries and illnesses. Provide culturally competent assessment and intervention.
• Recognize the significant physical and mental health effects of both ongoing and prior family violence. Assist the patient with understanding the relationship of violence and abuse to their health problems.
• Recognize the effects of family violence across the lifespan, including the long-term effects on children who are exposed to family violence.
• Recognize intentional injury patterns.

Management

• Provide safety planning for a victim of intimate partner violence.
• Determine appropriate community agencies, social workers, or resource specialists in family violence, as indicated for victims and survivors of family violence.
• Document extent of current and prior injuries through written documentation, use of body maps, and/or photographs.
• Demonstrate, by acknowledging and intervening, the ability to communicate non-judgmentally and compassionately with victims and survivors, and perpetrators of family violence.

Basic Science Content

• Demonstrate knowledge of Colorado legal statutes that relate to the physicians role and responsibility in family violence. (Mandatory Reporting: Colo. Rev. Stat. § 12-36-135 requires physicians to report all injuries believed to have been caused by criminal acts, including domestic violence).

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with a lipid disorder and be able to do the following at the level of a Phase III medical student:

Clinical Tasks:

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, elicit a detailed history to identify a family history of lipid disorders and CVD and those patients with secondary causes for their lipid abnormalities.
• Physical exam: Conduct an appropriate exam to identify skin manifestations of lipid disorders and evidence of associated cardiovascular complications.
• Comorbidities: Identify patients with CVD.

Evaluation

• Select patients to test and interpret the results of a fasting lipid panel.
• Stratify patients by their risk for subsequent development of CAD for consideration of lifestyle/drug therapy.
• Use decision tools in the stratification process.

Management

• Communicate an effective plan of management for a patient with abnormal serum lipids.
• Identify threshold values for treatment and goal LDL cholesterol levels depending on a patient’s underlying risk.
• Conduct education and lifestyle modification for patients and their families.
• List common drugs used to treat lipid disorders (include side effects) and identify those that improve overall mortality.
• Select patients in need of multidisciplinary/specialized care.

Basic Science Content

• Describe dietary fat and cholesterol absorption, transport, and metabolism; list major circulating lipoproteins. (Phase 1 & 2 Review)
• Outline the basic aspects of the pathogenesis of atherosclerosis including factors such as endothelial dysfunction, dyslipidemia, inflammation, tissue factor, etc.
• Explain the antiatherogenic effect of HDL by reverse cholesterol transport.
• Describe the mechanism of action of drugs that have been shown to lower cholesterol levels (e.g., HMG CoA reductase inhibitors, fibrates, resins, niacin, cholesterol absorption inhibitors).

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) requiring End of Life Care and be able to do the following at the level of a Phase III medical student:

Clinical Tasks:

• Accompany a hospice provider on a clinical visit.

Evaluation

• Define palliative care.
• Describe the relationship between hospice and palliative care.
• List five common myths of hospice.
• Describe key features of the Medicare Hospice Benefit.
• List and describe the roles of the interdisciplinary hospice team members.

Management

• Define the terms addiction, physical dependence, tolerance and “pseudoaddiction”.
• Describe what “hope” might look like in terminally ill patients.
• Describe challenges in prognostication, artificial fluids and hydration, and cross-cultural communication at the end of life.
• Explore ones own thoughts and emotions around caring for the dying.

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with hypertension and be able to do the following at the level of a Phase III medical student:

Clinical Tasks:

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, elicit a personal and family history of hypertension and cardiovascular disease.
• Physical: Perform physical exam including blood pressure measurement.
• Comorbidities: Identify major CVD risk factors including obesity, dyslipidemia, diabetes, smoking, and physical inactivity.
• Assess compliance with treatment and barriers to compliance.

Evaluation

• Identify criteria for diagnosis of hypertension.
• Interpret results of blood pressure measurements.
• Identify secondary causes of hypertension.
• Stratify patients by their stage of hypertension.

Management

• Outline an effective plan of management for a patient with hypertension.
• Identify goal blood pressure levels for patient’s underlying risk. (e.g. diabetic vs. non-diabetic)
• Select appropriate medication, if indicated.
• List common adverse effects expected with usual anti-hypertensive medications.
• Outline plan for education and counseling with patients and their families regarding lifestyle modification. Review DASH diet guidelines, weight reduction, lowering sodium intake, tobacco cessations, increasing physical activity, and consuming alcohol in moderation.

Basic Science Content

• Explain current knowledge of the pathophysiology of hypertension and how treatment affects these mechanisms.

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with obesity and be able to do the following at the level of a Phase III medical student:

Clinical Tasks:

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, elicit a detailed personal and family history of obesity; elicit a diet and physical activity history.
• Physical: Perform a physical examination including Body Mass Index (BMI) and waist circumference.
• Comorbidities: Assess patient’s absolute risk status for the presence of CHD, other atherosclerotic diseases, type 2 diabetes, and sleep apnea. Identify other risk factors including physical inactivity and patient motivation.

Evaluation

• Diagnose overweight or obesity and disease risk utilizing BMI and waist circumference measurements.
• Select appropriate treatment options for BMI category. For BMI >30-39, discuss pharmacotherapy options. For BMI >40, discuss bariatric surgery options.
• Select appropriate diagnostic tests for presence of comorbidities.

Management

• Conduct an effective plan for weight management with the initial goal of weight loss therapy to reduce body weight by 10%.
• Outline an appropriate meal plan to reduce calorie intake by 500 kcals/day.
• Outline an appropriate physical activity plan to increase energy expenditure by 250 calories/day.
• Outline appropriate long-term management of obesity including primary and secondary prevention of complications.
• Conduct education and counseling with patients and their families, including lifestyle modification.
• Refer to other health care professionals or other reputable weight management resources within the community.

Basic Science Content

• Explain current knowledge of the pathophysiology of overweight and obesity and how treatment affects these mechanisms.

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) for preventive services and be able to do the following at the level of a Phase III medical student:

Clinical Tasks:

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, elicit an age appropriate history to develop a disease prevention plan in adults.
• Physical: perform an age appropriate physical examination for disease prevention in adults.
• Comorbidities: Identify risk factors for common diseases in adults.

Evaluation

• Describe the difference between diagnostic and screening tests.
• Identify age appropriate and gender appropriate screening tests for adults and immunization schedule recommendations.
• Recognize indications, levels of evidence supporting screening, recommended tests and frequency of testing.
• Describe cost associated with screening populations and individuals.
• List risk and benefits associated with each screening test.

Management

• Conduct an appropriate plan of management for male and female asymptomatic adults regarding disease prevention including risk assessment, screening, and immunizations.
• Describe rationale for testing or not testing to patient.
• Conduct smoking cessation counseling in appropriate patients.

Basic Science Content

• List the cancers for which there is a recognized genetic link.
• Discuss the time course for the progression of the following diseases from an asymptomatic stage to overt disease:
  • Breast cancer
  • Cervical cancer
  • Colon cancer
  • Prostate cancer
  • Cardiovascular disease
  • Cerebral vascular disease
  • Diabetes
• Discuss herd immunity from vaccination of large populations.
• Define sensitivity, specificity, positive predictive value and negative predictive value. (Phase 1 & 2 Review)

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with a skin infection and be able to do the following at the level of a Phase III medical student:

Clinical Tasks:

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, through efficient, focused data gathering identify the presenting features subsequent course of the infection, associated systemic complaints such as myalgias, fever chills. Identify symptoms of sepsis including lightheadedness and mental status changes.
• Physical exam: Conduct a physical exam to evaluate and monitor skin infections, determine if lymphangitis or lymphadenopathy is present, determine if mental status changes or hypotension are present.
• Comorbidities: Screen for patients with increased susceptibility such as diabetics and those who are immunocompromised.

Evaluation

• List and interpret critical clinical and diagnostic tests which are key in the processes of exclusion, differentiation, and diagnosis.
• Differentiate common skin infection from other conditions such as thrombophlebitis, necrotizing fasciitis, dermatitis and inflammatory conditions.
• Categorize skin infections as bacterial, viral, parasitic or fungal.
• Assess the severity of the condition to guide the setting most appropriate for management (Inpatient vs. Outpatient).
• Identify patients with necrotizing fasciitis.

Management

• Communicate an effective initial plan of management for a patient with a bacterial, fungal or viral skin infection.
• List antimicrobials of choice for common skin infections (include side effects).
• Outline the outpatient treatment of MRSA.
• Assess and update tetanus immunization status.
• Discuss indications for isolation in selected patients.
• Select patients in need of multidisciplinary/specialist care.

Basic Science Content

• Name the common pathogens in bacterial skin infections.
• Describe the pathophysiology of acne vulgaris.

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with a strain or sprain and be able to do the following at the level of a Phase III medical student:

Clinical Tasks:

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, through efficient, focused data gathering determine: occupation, repetitive motions, and precipitating events, mechanism of injury, and maneuvers which reproduce the pain, inflammatory changes, effusion or change in function.
• Physical examination: perform appropriate exam of upper & lower limbs including observation of limb movement, gait, examination and determination of range of motion of joints, assessing muscle mass, and palpation of peripheral arteries.
• Comorbidities: identify possible life/limb threatening associated conditions such as compartment syndrome or is there an associated bony injury.

Evaluation

• Differentiate between different causes of acute and chronic extremity pain.
• List and interpret critical clinical and laboratory findings and decision rules which were key in the processes of exclusion, differentiation, and diagnosis of common upper and lower extremity soft tissue injuries.
• Appropriately select and interpret diagnostic tests to evaluate acute or chronic upper or lower extremity pain.
• Determine if the extremity pain represents an emergency such as compartment syndrome or other vascular compromise.

Management

• Communicate an effective plan of management to a patient and/or their caregivers for an acute strain or sprain of the upper or lower extremity.
• Describe indications for RICE, NSAIDs and rehabilitation therapy.
• Outline management for common overuse injuries.
• Outline management for exercise-induced injuries which returns patient to physical activity.
• Describe effective strategies for injury prevention.
• Select patients in need of multidisciplinary/specialized care.
• Utilize decision rules such as the “Ottawa Ankle Rules” and “Ottawa Knee Rules” to guide management.

Basic Science Content

• Describe the functional anatomy of the ankle, knee and shoulder joints. (Phase 1 & 2 Review) 
• Relate the mechanism of injury to the anatomical injury.

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with an upper respiratory tract infection and be able to do the following at the level of a Phase III medical student:

Clinical Tasks:

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, perform a history to gather information from a patient presenting with possible upper respiratory tract symptoms including smoking history. Elicit historical features that differentiate streptococcal from viral sore throat, the common cold from influenza and bacterial sinusitis from non-bacterial reasons for sinus congestion.
• Physical: Perform an appropriate physical exam on a patient with URI symptoms and include sinus transillumination and nasal exam in patients with sinus symptoms. Recognize significant patterns of cervical lymphadenopathy and pharyngeal exudates in sore throat.
• Co-Morbidities: describe complications of untreated upper respiratory tract infections. Determine if a patient has potential serious conditions such as sepsis, pneumonia, peritonsillar abscess, epiglottis or other upper airway compromise.

Evaluation

• List and interpret diagnostic tests such as rapid streptococcal and influenza tests that are key in the diagnosis of URIs. Understand indications and interpretation on imaging studies in sinusitis.
• Identify serious causes/complications of URIs.
• Use decision tools in the clinical evaluation of sore throat and sinusitis.

Management

• Describe appropriate therapy for URIs, including antibiotics, symptomatic treatments and medications and lifestyle changes.
• Describe appropriate use of antivirals in influenza.
• Describe preventive strategies for decreasing URIs including smoking cessation hand washing and other measures.
• Use effective communication skills to foster adherence to recommendations and to respond to those patients who express different expectations of treatment for their illness.

Basic Science Content

• Describe the common pathogens in sore throat, sinusitis and other clinical syndromes of URI.

Objectives

At the conclusion of the AAC-RCC Block we expect students to see a patient (or discuss a case with your preceptor) with with a urinary tract infection and be able to do the following at the level of a Phase III medical student:

Clinical Tasks:

• History: Taking into consideration the patient’s literacy, culture and other contextual factors, elicit appropriate history including sexual history, estrogen deficiency, onset/duration of symptoms, prior history of UTIs.
• Physical: Perform and appropriate physical examination.
• Comorbidities: Identify risk factors for UTIs and occult pyelonephritis.

Evaluation

• Describe and interpret key laboratory tests used for diagnosis of UTI.
• Describe the difference between complicated and uncomplicated UTI.
• Describe risk factors, signs, and symptoms of pyelonephritis.

Management

• Conduct an appropriate initial management plan for uncomplicated and complicated UTIs.
• Describe rationale behind your treatment plan including antimicrobial resistance in your community and cost factors.
• Discuss indications for urine culture.
• Outline initial management plan for recurrent UTIs.
• Discuss indications for inpatient vs. outpatient management of pyelonephritis.

Basic Science Content

• Outline pathophysiology of development of UTIs in males and females.
• Describe microbiology of simple UTIs.