Issue

CASE PRESENTATION
A 68-year-old African-American woman with hypertension controlled with thiazide diuretics presents for her annual examination. She has had four previous vaginal deliveries and a hysterectomy 22 years before. On the genitourinary review of systems, she reports occasional involuntarily losses of urine 4-8 times per day when she coughs, lifts, bends over, or laughs, requiring the use of perineal pads. She also has daytime urinary frequency and nocturia 3-4 times per night, which was stated in a voiding diary. The physical examination reveals atrophic vaginitis and a small cysto

I was recently asked to participate in a panel discussion regarding the “future of primary care.” At first, I thought they asked me to discuss the future of internal medicine, and I had envisioned a lively discussion regarding new technology and procedures that are quickly becoming the standard of care in cardiology, pulmonology, and other subspecialty areas. Manpower issues were not forefront in my mind, since my residents are eagerly applying to fellowships in these areas and dreaming of future careers viewed as exciting and highly compensated.

When I was informed that this was to be

INTRODUCTION
Although eating is an activity everyone should know a great deal about, many persons fail to eat a nutritionally balanced diet and do not take advantage of the many natural food sources that not only can provide necessary nutrients, but can also help maintain health and promote a more successful aging process. Many persons eat to excess or fail to consume basic requirements necessary for health. Malnutrition is not something observed only in third-world countries. In addition to a necessary amount of proteins, carbohydrates, and fats, we

CASE PRESENTATION
Mr. D, a 51-year-old married male, accompanied by his wife and two teenage children, comes to the office of Dr. H, an internist and primary care physician. Mr. D has not seen a physician in over 10 years. Mrs. D describes a 3-month history of “strange behavior” by her husband, including getting up in the middle of the night and going to his office and eating meals at odd hours (eg, insisting it is dinnertime in the morning). He has been forgetful, calls his two children by a variety of different names, and last week was found banging on his neighbor’s door, insisting

CASE PRESENTATION
A 62-year-old functional but cachectic male, who was able to ambulate with a walker, presented to the emergency department (ED) with a temperature of 102.3 degrees F, and neck and low back pain. The patient reported having had subjective fever and chills at home starting 1 week prior to the hospital visit. He also reported generalized fatigue, occasional shortness of breath, and a 20-pound weight loss over 2 weeks. There were no reported changes in mental status. The patient did have a recent history of having had a left carotid sinus takedown with removal of the optic nerve

May 15, the end of the initial open enrollment period for Medicare Part D, is quickly approaching and, despite all the talk about the dangers of not making a decision, some 20 million Medicare beneficiaries have yet to enroll in a prescription plan. But how do people evaluate, select, and enroll in a prescription plan? The fact is that it is a complex process, but in most cases well worth it because the costs involved in not making a decision are high, and the benefits of joining are much greater. Those costs include a late enrollment penalty, being locked out until January 1, 2007 from any co

ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the

April 2006

This continuing medical education activity is presented by the Johns Hopkins University School of Medicine, Baltimore, Maryland. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

These examination questions are based on the article “Medical Care of the Hip Fracture Patient,” which appears on pages 40-45 in this issue of Clinical Geriatrics.

ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Educatio