JAAPA CME Post-Test November 2017
A Nonpharmacologic Approach to Managing Insomnia in Primary Care | Managing Chest Pain in Patients with Concomitant Left Bundle-Branch Block
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A Nonpharmacologic Approach to Managing Insomnia in Primary Care

Kelsey Taylor, PA-C; Nataliya Bilan, PA-C; Nadzeya Tsytsyna, PA-C; Ellen D. Mandel, DMH, MPA, PA-C

Insomnia, or inadequate or poor sleep leading to significant distress or impairment in functioning, is a prevalent disorder treated by primary care providers (PCPs). With millions of people across the United States suffering from insomnia, PCPs must understand the disorder’s pathophysiology, perpetuating factors, and treatment, as well as its effect on patient health and the economy. Although PCPs traditionally treat insomnia with pharmaceuticals, behavioral measures are effective and should be used whenever possible. This activity reviews clinically relevant principles of diagnosing and treating insomnia, highlighting nonpharmacologic treatments.

Learning Objectives

Upon completion of this activity, participants will be able to:

  • Differentiate insomnia from other sleep-wake disorders.
  • Diagnose insomnia using DSM-5 criteria or through the use of validated screening tools.
  • Prescribe an insomnia treatment regimen that uses a behavioral intervention suited to the patient’s particular needs.

Managing Chest Pain in Patients with Concomitant Left Bundle-Branch Block

Andrew Wyant, MD; Somu Chatterjee, MD, MPH; Tamara Bennett, MSPAS, PA-C

Diagnosis and timely management of acute myocardial infarction (MI) relies heavily on the ST-segment elevation sum. Presence of concomitant left bundle-branch block (LBBB) in patients presenting with possible acute MI presents a diagnostic dilemma. The LBBB pattern distorts STsegment changes, delaying or preventing accurate diagnosis. This activity reviews the Sgarbossa criteria and ST/S ratio and presents a treatment algorithm that may help improve patient care and reduce morbidity and mortality.

Learning Objectives

Upon completion of this activity, participants will be able to:

  • Describe the major differences between the 2004 and 2013 ACC/AHA guidelines for managing patients with concomitant STEMI and LBBB.
  • List the ECG characteristics of LBBB, ST-segment elevation or depression, and the ST/S ratio.
  • Use the Sgarbossa criteria to determine if a patient with symptoms of acute coronary syndrome and LBBB warrants emergent reperfusion, PCI, or further diagnostic evaluation.

Accreditation Statement


This activity has been reviewed and is approved for a maximum of 1.0 AAPA Category 1 CME credit by the AAPA Review Panel. PAs should only claim credit commensurate with their participation in the CME activity.  

Disclosure Policy Statement

It is the policy of AAPA to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member has with the commercial interest of any commercial product discussed in an educational presentation. The participating faculty reported the following:

Kelsey Taylor practices emergency medicine at NYC Health and Hospital-North Central Bronx in the Bronx, N.Y. Nataliya Bilan practices plastic surgery at Manhattan Eye, Ear, and Throat Hospital in New York City. Nadzeya Tsytsyna practices general surgery at New York University-Langone Hospital in Brooklyn, N.Y. At the time this article was written, Ms. Taylor, Ms. Bilan, and Ms. Tsytsyna were students in the PA program at Pace University-Lenox Hill Hospital in New York City. Ellen D. Mandel is a clinical professor in the Department of PA Studies at Pace University-Lenox Hill Hospital. Andrew Wyant, Somu Chatterjee, and Tamara Bennett are assistant professors in the PA program at the University of Kentucky in Lexington, Ky.The authors have disclosed no potential conflicts of interest, financial or otherwise.

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Type:     Journal-based CME
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