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

Written & Researched By: Caleb Dusdal and Thomsen D'hont

The first of the new 105 CCFP Topics https://thegenerehlist.ca/2021/05/16/ccfp-key-topic-chronic-pain/

Objective One: In a patient with chronic pain: Establish the etiology, Reassess and periodically review the etiology and Periodically look for potential comorbidities or complications, particularly mental illness and addictions.

Objective Two: In a patient with chronic pain who complains of significantly increased pain, search for an alternative etiology as you cannot assume that the original cause of the pain is the reason for the exacerbation.

Objective Three: In a patient in whom you did not make the initial diagnosis of chronic pain: Establish an effective relationship, Verify the diagnosis, and clarify goals of treatment and plans for management

Objective Four: In managing a patient with chronic pain: Use shared decision-making, and engage other professionals in this care when appropriate

Objective Five: In a patient with chronic pain: Comprehensively document the assessment, plan, goals, and prescription details and Make the treatment plan appropriately accessible

Objective Six: When prescribing medications with abuse potential in a patient with chronic pain where you have no established relationship or insufficient records, be prudent in your prescribing. Do not simply provide or refuse to prescribe.

Objective Seven: Use a written treatment contract with realistic consequences when prescribing medications with abuse potential to a patient with chronic pain.

Objective Eight: When a patient with chronic pain has breached a contract: Manage your own emotions, Address the possible impact on your staff and team, and Apply or judiciously amend the contract

Written By: Chris Cochrane, FM Resident in Medicine Hat

Peer Review By: Kevin Duncan, EM Resident in Kelowna

Objective One: a) In a patient having a seizure: Ensure proper airway control (e.g., oropharyngeal airway or nasal trumpet, lateral decubitus to prevent aspiration). b) Use drugs (e.g., benzodiazepines, phenytoin) promptly to stop the seizure, even before the etiology is confirmed. c) Rule out reversible metabolic causes in a timely fashion (e.g., hypoglycemia, hypoxia, heat stroke, electrolytes abnormalities).

Objective Two: In a patient presenting with an ill-defined episode (e.g., fits, spells, turns), take a history to distinguish a seizure from other events.

Objective Three: In a patient presenting with a seizure, take an appropriate history to direct the investigation (e.g., do not over investigate; a stable known disorder may require only a drug-level measurement, while new or changing seizures may require an extensive work-up).

Objective Four: In all patients presenting with a seizure, examine carefully for focal neurologic findings.

Objective Five: In a patient with a previously known seizure disorder, who presents with a seizure or a change in the pattern of seizures: a) Assess by history the factors that may affect the primary seizure disorder (e.g., medication compliance, alcohol use, lifestyle, recent changes in medications [not just antiepileptic medications], other illnesses). b) Include other causes of seizure in the differential diagnosis. (Not all seizures are caused by epilepsy.)

Objective Six: In the ongoing care of a patient with a stable seizure disorder: a) Regularly inquire about compliance (with medication and lifestyle measures). side effects of anticonvulsant medication, and the impact of the disorder and its treatment on the patient's life (e.g., on driving, when seizures occur at work or with friends). b) Monitor for complications of the anticonvulsant medication (e.g., hematologic complications, osteoporosis). c) Modify management of other health issues taking into account the anticonvulsant medication (e.g., in prescribing antibiotics, pregnancy).

Researched By: Caleb Dusdal Expert Review By: Dr Todd Hill

Objective One: When counselling a patient: - Set clear therapeutic goals with the patient, - Allow adequate time, - Evaluate your own skills, - Recognize when you are approaching or exceeding boundaries, - Recognize when your beliefs or biases may interfere with counselling. - Remain aware of the risks of offering advice versus providing options and - Pay close attention to the quality of the therapeutic relationship and alliance.

Objective Two: For a patient who is considering or requesting referral for counselling/psychotherapy, clarify concerns and provide realistic information about the process and available resources (e.g., expectations, timing, frequency, costs, duration, homework, starting/ending the relationship if ineffective).

Plus some bonus counseling tools, resources and a review of motivational interviewing!

CCFP 105 Key Topic: Cough

Written & Researched By: Kajsa Heyes Peer Review By: Hermeen Dhillon

Objective One: In patients presenting with an acute cough: a) Include serious causes in the differential diagnosis. b) Diagnose a viral infection clinically, principally by taking an appropriate history. c) Do not treat viral infections with ant

Objective Two: In pediatric patients with a persistent (or recurrent) cough, generate a broad differential diagnosis

Objective Three: In patients with a persistent (e.g., for weeks) cough: a) Consider non-pulmonary causes, as well as other serious causes in the differential diagnosis. b) Investigate appropriately.

Objective Four: Do not ascribe a persistent cough to an adverse drug effect without first considering other causes.

Objective Five: In smokers with persistent cough, assess for chronic bronchitis and make a positive diagnosis when it is present.

Written/Researched By: Khash Farzam

Peer Review By: Caleb Dusdal

Objective One: In all patients presenting with symptoms of prolonged or recurrent cough, dyspnea, or decreased exercise tolerance, especially those who also have a significant smoking history, suspect the diagnosis of chronic obstructive pulmonary disease (COPD).

Objective Two: When the diagnosis of COPD is suspected, seek confirmation with pulmonary function studies (e.g., FEV1).

Objective Three: In patients with COPD, use pulmonary function tests periodically to document disease progression.

Objective Four:

Encourage smoking cessation in all patients diagnosed with COPD.

Objective Five:

Offer appropriate vaccinations to patients diagnosed with COPD (e.g., influenza/pneumococcal vaccination).

Objective Six:

In an apparently stable patient with COPD, offer appropriate inhaled medication for treatment (e.g., anticholinergics/bronchodilators if condition is reversible, steroid trial).

Objective Seven:

Refer appropriate patients with COPD to other health professionals (e.g., a respiratory technician or pulmonary rehabilitation personnel) to enhance quality of life.

Objective Eight:

When treating patients with acute exacerbations of COPD, rule out co-morbidities (e.g., myocardial infarction, congestive heart failure, systemic infections, anemia).

Objective Nine:

In patients with end-stage COPD, especially those who are currently stable, discuss, document, and periodically re-evaluate wishes about aggressive treatment interventions.

Written By: Kyla Freeman

Peer Review By: Thomsen D'hont

Expert Review By: Dr. Vanessa Rogers

Objective One: With all patients, especially adolescents, young men, postpartum women, and perimenopausal women, advise about adequate contraception when opportunities arise.

Objective Two: In patients using specific contraceptives, advise of specific factors that may reduce efficacy (e.g. delayed initiation of method, illness, medications, specific lubricants)

Objective Three: In aiding decision-making to ensure adequate contraception: - Look for and identify risks (relative and absolute contraindications) - Assess (look for) STI exposure - Identify barriers to specific methods (e.g. cost, cultural concerns) - Advise of efficacy and side effects, especially short-term side effects that may result in discontinuation

Objective Four: In patients using hormonal contraceptives, manage side effects appropriately (i.e. recommend an appropriate length of trial, discuss estrogens in medroxyprogesterone acetate [Depo-Provera].

Objective Five: In all patients, especially those using barrier methods or when efficacy of hormonal methods is decreased, advise about post-coital contraception

Objective Six: In a patient who has had unprotected sex or failure of the chosen contraceptive method, inform about time limits in post-coital contraception (emergency contraceptive pil, intrauterine device)

Written By: Caleb Dusdal - PGY-1 FM Calgary Reviewed By: Chris Cochrane - PGY-1 FM Medicine Hat

Objective Four: Given an appropriate history of chest pain suggestive of herpes zoster infection, hiatal hernia, reflux, esophageal spasm, infections, or peptic ulcer disease: a) Propose the diagnosis. b) Do an appropriate work-up/follow-up to confirm the suspected diagnosis.

Objective Five: Given a suspected diagnosis of pulmonary embolism: a) Do not rule out the diagnosis solely on the basis of a test with low sensitivity and specificity

Written and Researched By: Caleb Dusdal Peer Review By: Chris Cochrane

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

Objective One Given a patient with undefined chest pain, take an adequate history to make a specific diagnosis (e.g., determine risk factors, whether the pain is pleuritic or sharp, pressure, etc.).

Objective Two Given a clinical scenario suggestive of life-threatening conditions (e.g., pulmonary embolism, tamponade, dissection, pneumothorax), begin timely treatment (before the diagnosis is confirmed, while doing an appropriate work-up).

Objective Three In a patient with unexplained chest pain, rule out ischemic heart disease

CCFP Key Topic "Cancer"

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

Written & Researched By: Sarah Donnelly IM PGY-1 University of Alberta

Objective One In all patients, be opportunistic in giving cancer prevention advice even when it is not the primary reason for the encounter.

Objective Two In all patients, provide the indicated evidence-based screening (according to age group, risk factors, etc.) to detect cancer at an early stage (e.g., with Pap tests, mammography, colonoscopy, digital rectal examinations, prostate-specific antigen testing).

Objective Three In patients diagnosed with cancer, offer ongoing follow-up and support and remain involved in the treatment plan, in collaboration with the specialist cancer treatment system. (Don't lose track of your patient during cancer care.)

Objective Four In a patient diagnosed with cancer, actively inquire, with compassion and empathy, about the personal and social consequences of the illness (e.g., family issues, loss of job), and the patient's ability to cope with these consequences.

Objective Five In a patient treated for cancer, actively inquire about side effects or expected complications of treatment (e.g., diarrhea, feet paresthesias), as the patient may not volunteer this information.

Objective Six In patients with a distant history of cancer who present with new symptoms include recurrence or metastatic disease in the differential diagnosis.

Objective Seven In a patient diagnosed with cancer, be realistic and honest when discussing prognosis. (Say when you don't know.)