Under the impetus of the Human Genome Project, a rapidly growing number of genes and mutations are becoming targets for molecular testing in patients and whole populations affected with or at risk for genetic disorders. The rapid pace of gene discovery—and the ease with which modern molecular biologic technology enables translation of these findings into clinical tests and potential gene-targeted therapies—has placed unprecedented demands on both the clinical laboratory and the clinicians who must decide if and when a particular test is appropriate and informative. Given the relatively small size of the specialty of medical genetics and the small number of trained genetic counselors in the country, much of this test ordering and interpretive burden must fall on primary care clinicians. The situation becomes even more acute and complex as we move into the era of genome-level DNA sequencing and direct-to-consumer genetic testing, with all that it can reveal about the patient’s present and future risk factors. This presentation will provide a contemporary overview of the current state of this field, with consideration of which applications can be handled adequately in primary care and which would benefit from referral to a medical genetics center. In addition, the many thorny ethical dilemmas raised by this powerful technology will be discussed.

This session aims to refresh your knowledge and stimulate interest in performing a thorough and focused physical exam (PE), particularly in the geriatric population. Whether part of a Medicare evaluation or a routine office visit, the PE provides an opportunity to develop rapport, trust, and potentially to discover clinically significant findings that might otherwise have gone unrecognized. A series of brief scenarios will be used to illustrate important yet basic concepts such as differentiation between normal age-related findings versus indicators of worrisome disease processes and atypical presentation of disease. Now, Let’s Get Physical!

This presentation will use case-based scenarios to illustrate different patterns of liver test abnormalities. The faculty will discuss the difference between cholestatic versus hepatitis versus infiltrative liver diseases and their characteristic liver test patterns. You will learn about the workup of liver test abnormalities with subsequent supplemental serological testing, imaging, and in some cases, liver biopsy. After this session, you will know the difference between true “liver function tests,” tests of cholestasis, tests of inflammation, and tests of infiltration.

With the COVID-19 pandemic moving through the country, it is important for clinicians to have the most up-to-date information. Join this session with Dr. Peter Libby and Dr. Erin Bohula to learn about the cardiovascular complications of COVID-19 and how you can help patients facing these issues. Please note that any data, indications, and guidelines presented in this activity are current as of the recording on 05/08/2020 and they are subject to change as new information is published.

Growth is a fundamental process of childhood that is followed longitudinally by primary care. Poor growth velocity warrants an evaluation to identify an underlying pathology, whether endocrine or non-endocrine, whereas short stature refers to height below the normal spectrum of the population. You will learn more about common pathologies that may present with poor growth and contrast them with genetic mechanisms that contribute to variation in the population. Growth hormone—which was traditionally restricted to use in those with growth hormone deficiency—is the main intervention available to increase final adult height. As it commonly has efficacy to increase stature outside of the setting of growth hormone deficiency, the number of FDA-approved indications for its use have expanded over the past decades. The faculty in this lecture will also discuss considerations by pediatric endocrinologists in the prescription of growth hormone.

Providing safe and effective pain control can be achieved despite the serious public health crisis of the opioid overdose and misuse epidemic currently affecting the United States and other countries. This talk will review the evolution of the present-day opioid epidemic to better understand current risks. Terminology associated with addiction, currently referred to as substance use disorder, will be defined. Assessment of pain is imperative, with a shift away from intensity to functional ability. Risk factors for misuse must also be assessed. These findings inform the treatment regimen, including whether opioids are indicated, and if so, what mitigating strategies must be implicated to reduce the risk of misuse. Techniques such as harm reduction, weaning and safe handling will be addressed.

Unlike HIV with rates of mortality that decline yearly, TB remains the leading infectious cause of death worldwide, accounting for 1.3 million deaths in 2016. Approximately 2 billion people in the world and 10 to 15 million Americans have latent TB infection (LTBI). Although they are not infectious, up to 10% each year are at risk of progression to active disease, depending on their risk factors and co-morbidities. This presentation will compare modalities to diagnose LTBI: the tuberculin skin test (or PPD) and the interferon gamma release assay (e.g., the quantiferon gold blood test). The faculty will discuss which patients are at high risk for progression to TB disease and the role of preventive chemotherapy. Finally, you will learn more about the emerging global storm that awaits us as diabetes becomes epidemic and merges with TB, as there is a 2-4-fold increased risk for TB in patients with diabetes.

There are emerging epidemics of obesity, metabolic syndrome, and type 2 diabetes mellitus in the U.S. and around the world. In this session, you will receive valuable pharmacological and non-pharmacological tools to combat these conditions in the primary care setting. The faculty will share their experience in providing care with a multidisciplinary team, use of meal replacements, and personalized weight loss plans based on body composition and lifestyle.

Anemia is one of the commonest problems facing the primary care clinician. This session will outline a practical approach and show how it is possible to narrow down the possibilities. The clinical history—especially symptoms and duration of anemia—and history of the CBCs will often lead to a precision differential diagnosis. These points will be made through focused case examples.

This session, recorded on 5/8/2020, will describe the recent advances in treatment for severe asthma. Faculty will use patient case examples to describe a systematic approach for assessing patients with difficult-to-control asthma and review the stepwise treatment of asthma. They will also discuss how primary care clinicians can help to identify patients in their practice who would benefit from further subtyping of their asthma and treatment with biologic therapies. Please note that any data, indications, and guidelines presented in this activity are current as of the recording on 5/8/2020 and they are subject to change as new information is published.

Primary care clinicians commonly care for survivors of breast cancer. This session will review current recommendations for follow-up testing and secondary prevention after breast cancer diagnosis and initial treatment. The faculty will cover common clinical issues, including recommendations for genetic testing, management of side effects and complications of adjuvant hormonal therapies, and treatment of menopause symptoms.

Headache is one of the most common reasons for patients to visit primary care providers. Most patients can be well cared for in this setting, without the need for a specialty consultation. In this talk, the faculty will discuss lifestyle modification, complementary and alternative treatments, and both acute and preventive pharmacotherapy for primary headache disorders, including migraine and tension-type headache.