1. National education programs risk assessment tool for 10 year risk of MI (from framingham heart study data). 
High risk: >20%, start baby aspirin, get LDL<70-100, consider stress test
Intermediate risk: 10-20%, get high specificity CRP levels or electron-beam CT for coronary calcium to further stratify into high vs low risk.
Low risk:<10%
2. Various USPSTF recommendations:
-One time abdominal u/s to look at aorta in males age 65-75 with a history of smoking. 2005, (B)
-One or two small polyps found with tubular adenoma with low grade dysplasia: next screening colonoscopy in 5-19 years
3. CBT for primary insomnia in older adults:
-Sleep restriction: restrict sleep to actual number of hours patient has slept in past 2 weeks, gradually increase time in bed to optimal (15-20 minute increments every 5 days)
-Sleep compression: gradually decrease time spent in bed to total sleep times.
-Evidence for effectiveness; more effective when combined with pharmacotherapy (Zolpidem, avoid benzos and antihistamines in elderly)
4. Sleep hygiene handout
5. Organic depression:
-Dementia
-Endocrine: cushings, hypothyroid, addisons, diabetes, hypoglycemia, hyperparathyroid
-Rheum: lupus, RA, temporal arteritis
-CNS pathology: tumor, parkinsons, MS, stroke, cerebral arteriolosclerosis, temporal lobe epilepsy.-Cardiovascular: CHF, MI
-Liver pathology (hepatitis)
-Renal failure
-Electrolyte abnormalities
-Infectious: AIDS, syphilis
-Cancer, esp pancreas
-Micronutrient deficiencies: folate, B12, thiamine
-Porphyria
6. Mini-cog mental exam is faster, more sensitive and specific than MMSE. 
Mini-cog: repeat 3 words (apple, watch, penny)
Clock face drawing (45 min past 10)
Recall the 3 words
7. SSRI for depression with anxiety component: 
-Paxil has strong antianxiety effects, but worse SSRI discontinuation syndrome. It (and prozac) are most studied in children, it may cause significant weight gain.
-Escitalopram (lexapro) is approved for GAD, and is a "neutral" SSRI
8. Medications linked to (causing) depression:

Cardiovascular drugs	Clonidine (Catapres) Digitalis Guanethidine (Ismelin) Hydralazine (Apresoline) Methyldopa (Aldomet) Procainamide (Pronestyl) Propranolol (Inderal) Reserpine (Serpasil) Thiazide diuretics
Chemotherapeutics	6-Azauridine Asparaginase (Elspar) Azathioprine (Imuran) Bleomycin (Blenoxane) Cisplatin (Platinol) Cyclophosphamide (Cytoxan) Doxorubicin (Adriamycin) Mithramycin (Mithracin) Vinblastine (Velban) Vincristine
Antiparkinsonian drugs	Amantadine (Symmetrel) Bromocriptine (Parlodel) Levodopa (Larodopa)
Antipsychotic drugs	Fluphenazine (Prolixin) Haloperidol (Haldol)
Sedatives and antianxiety drugs	Barbiturates Benzodiazepines Chloral hydrate Ethanol
Anticonvulsants	Carbamazepine (Tegretol) Ethosuximide (Zarontin) Phenobarbital Phenytoin (Dilantin) Primidone (Mysoline)
Anti-inflammatory/anti-infective agents	Ampicillin Cycloserine (Seromycin) Dapsone Ethambutol (Myambutol) Griseofulvin (Grisactin) Isoniazid (INH) Metoclopramide (Reglan) Metronidazole (Flagyl) Nalidixic acid (NegGram) Nitrofurantoin (Furadantin) Nonsteroidal anti-inflammatory agents Penicillin G procaine Streptomycin Sulfonamides Tetracycline
Stimulants	Amphetamines (withdrawal) Caffeine Cocaine (withdrawal) Methylphenidate (Ritalin)
Hormones	Adrenocorticotropin Anabolic steroids Glucocorticoids Oral contraceptives
Other drugs	Choline Cimetidine (Tagamet) Disulfiram (Antabuse) Lecithin Methysergide (Sansert) Phenylephrine (Neo-Synephrine) Physostigmine (Antilirium) Ranitidine (Zantac)

9. Depression handout
10. Testing for gonorrhea-- NAAT/PCR on vaginal swab in women (more sensitive than urine). In men, urethral swab and urine test have same (high) sensitivity.