The GenerEhlist - CCFP Exam Prep, Low Risk Obstetrics & Canadian Primary Care Medicine

• written by: Chris Cochrane
• peer review: Caleb Dusdal

Caleb and Chris discuss the key topic of Dementia including the first three CCFP Board Exam topics.

Kyla Freeman, Patricia Massel and Caitlin Blewett review some of the key principles of postpartum hemorrhage, with an emphasis on medical management options.

This episode was expert reviewed by Dr. Nicole Ebert, an OSS trained family physician.

Join us to review your 4 T's : Tone, Tissue, Trauma, and Thrombin

Braedon Paul and Caleb Dusdal tackle the CCFP Key Topic Diarrhea

Written by Braedon Paul, the topics are covered in the form of three cases.

Caleb Dusdal introduces some new team members and a whole new podcast to the Generehlist line up!

The GenerEhlist: Low risk obstetrics with:

• Kyla Freeman,
• Patricia Massel, and
• Caitlin Blewett

Written By: Caleb Dusdal Peer Review By: Sarah Donnelly

https://thegenerehlist.ca/ccfp-exam-105-topics-podcast/

Objective One: In patients complaining of leg pain and/or swelling, evaluate the likelihood of deep venous thrombosis (DVT) as investigation and treatment should differ according to the risk.

Objective Two: In patients with high probability for thrombotic disease (e.g., extensive leg clot, suspected pulmonary embolism) start anticoagulant therapy if tests will be delayed.

Objective Three: Identify patients likely to benefit from DVT prophylaxis.

Objective Four: Utilize investigations for DVT allowing for their limitations (e.g., Ultrasound and D-dimer).

Objective Five: In patients with established DVT, use oral anticoagulation appropriately, (e.g., start promptly, watch for drug interactions, monitor lab values and adjust dose when appropriate, stop warfarin when appropriate, provide patient teaching).

Objective Six: Consider the possibility of an underlying coagulopathy in patients with DVT, especially when unexpected.

Objective Seven: Use compression stockings in appropriate patients, to prevent and treat post-phlebetic syndrome.

Written By: Dr. Vishalini Sivarajah Expert Review By: Dr. Darby Ewashina

https://thegenerehlist.ca/ccfp-exam-105-topics-podcast/

Objective One: In a patient with a diagnosis of depression: Assess the patient for the risk of suicide. Decide on appropriate management (i.e., hospitalization or close follow-up, which will depend, for example, on severity of symptoms, psychotic features, and suicide risk)

Objective Two: Identify patients who may be at a higher risk for depression (e.g., certain socio-economic groups, those who suffer from substance abuse, postpartum women, people with chronic pain) and assess appropriately.

Objective Three: In patients who have medically unexplained symptoms consider and assess for depression.

Objective Four: After a diagnosis of depression is made look for and diagnose other comorbid psychiatric conditions (e.g., anxiety, bipolar disorder, personality disorder).

Objective Five: In a patient diagnosed with depression: Manage appropriately (e.g., medications, psychotherapy, supported self-management) Monitor their response to therapy and modify appropriately (e.g., augmentation, dose changes, medication changes), Reassess the patient's safety, Set goals, including a return-to-work plan, Refer as necessary (including community resources)

Objective Six: In a patient presenting with symptoms consistent with depression consider and rule out serious organic pathology using a targeted history, physical examination, and investigations (especially in elderly or difficult patients).

Objective Seven: In patients presenting with depression inquire about abuse:

Objective Eight: In a patient with symptoms of depression differentiate major depression from adjustment disorder, dysthymia, and a grief reaction.

Objective Nine: Following failure of an appropriate treatment in a patient with depression consider other diagnoses (e.g., bipolar disorder, schizoaffective disorder, organic disease).

Objective Ten: In very young and elderly patients presenting with changes in behaviour consider the diagnosis of depression (as they may not present with classic features).

Objective Eleven: When treating a patient with antidepressants use them in a selective and careful manner, adapted to the presentation and the needs of the individual patient, by: Selecting the most appropriate antidepressant and dose for the patient based on patient factors and on pharmacological factors (e.g., possible drug interactions), Monitoring medication effectiveness, including adherence and the patient's possible self-medication using other substances (e.g., herbal and naturopathic remedies, alcohol, cannabis), Considering augmentation strategies when appropriate, Monitoring side effects carefully when initiating treatment, especially in young and elderly patients,

Objective Twelve: When developing a return-to-work plan for a patient who is being treated for depression: Assess the impact of residual symptoms on work hardiness, performance, and safety & Communicate with the patient and the workplace to ensure the plan is realistic and provides clear guidance

• Written By: Darrell Vandenbrink
• Peer Review By: Chris Cochrane
• Expert Review By: Dr. Adrienne Stedford

Objective One: When assessing the acutely ill patient, look for signs and symptoms of dehydration. (e.g., look for dehydration in the patient with a debilitating pneumonia).

Objective Two: In the dehydrated patient, assess the degree of dehydration using reliable indicators (e.g., vital signs) as some patients' hydration status may be more difficult to assess (e.g., elderly, very young, pregnant).

Objective Three: In a dehydrated patient, Determine the appropriate volume of fluid for replacement of deficiency and ongoing needs Use the appropriate route (oral if the patient is able; IV when necessary).

Objective Four: When treating severe dehydration, use objective measures (e.g., lab values) to direct ongoing management.

Objective Five: In a dehydrated patient Identify the precipitating illness or cause, especially looking for non-gastro-intestinal, including drug-related, causes Treat the precipitating illness concurrently.

Objective Six: Treat the dehydrated pregnant patient aggressively, as there are additional risks of dehydration in pregnancy.

Written By: Chris Cochrane

Expert Review By: Dr. Nabeela Waja (Paediatrician)

https://thegenerehlist.ca/2021/06/06/ccfp-key-topic-croup/

Objective 1: In patients with croup, Identify the need for respiratory assistance (e.g., assess ABCs, fatigue, somnolence, paradoxical breathing, in drawing) and provide that assistance when indicated.

Objective 2: Before attributing stridor to croup, consider other possible causes (e.g., anaphylaxis, foreign body (airway or esophagus), retropharyngeal abscess, epiglottitis).

Objective 3: In any patient presenting with respiratory symptoms, look specifically for the signs and symptoms that differentiate upper from lower respiratory disease (e.g., stridor vs. wheeze vs. whoop).

Objective 4: In a child presenting with a clear history and physical examination compatible with mild to moderate croup, make the clinical diagnosis without further testing (e.g., do not routinely X-ray).

Objective 5: In patients with a diagnosis of croup, use steroids (do not under treat mild-to-moderate cases of croup).

Objective 6: In a patient presenting with croup, address parental concerns (e.g., not minimizing the symptoms and their impact on the parents), acknowledging fluctuating course of the disease, providing a plan anticipating recurrence of the symptoms.

Written/Researched By: Braedon Paul

Peer Review By: Caleb Dusdal

STEP 1. [Objectives 1a/b/c, 8a] Provide reassurance and develop rapport through validation of the problem and use of active listening skills.

STEP 2. [Objective 3a] Evaluate the severity of the crisis and assess the patient's mental, psychiatric, suicidal or homicidal, and medical statuses.

STEP 3. [Objective 3a/b/c, 6] Ensure the safety of the patient and others through voluntary hospitalization, involuntary commitment, securing close monitoring by family and friends, or helping to remove the patient from a dangerous situation.

STEP 4. [Objective 2a/b/ , 4, 5] Stabilize the patient's emotional status, explore options for dealing with the crisis, develop a specific action plan, and obtain commitment from the patient to follow through.

STEP 5. [Objectives 2c/d] Follow up with the patient to provide ongoing support and to reinforce appropriate action.

Objective One: In a patient with a diagnosed chronic disease who presents with acute symptoms, diagnose: acute complications of the chronic disease acute exacerbations of the disease

Objective Two: Regularly reassess adherence (compliance) to the treatment plan (including medications)

Objective Three: In patients with chronic disease a) Actively inquire about pain. b) Treat appropriately by: titrating medication to the patient's pain, taking into account other treatments and conditions, considering non-pharmacologic treatment and adjuvant therapies

Objective Four: Patients with chronic disease, actively inquire about: the psychological impact of diagnosis and treatment, functional impairment, underlying depression or risk of suicide or underlying substance abuse.

Objective Five: Given a non-compliant patient, explore the reasons why, with a view to improving future adherence to the treatment plan.