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.)

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

1 Given a well woman with concerns about breast disease, during a clinical encounter (annual or not): a) Identify high-risk patients by assessing modifiable and non- modifiable risk factors b) Advise regarding screening (mammography, breast self- examination) and its limitations. c) Advise concerning the woman's role in preventing or detecting breast disease (breast self-examination, lifestyle changes).

2 Given a woman presenting with a breast lump: a) Use the history, features of the lump, and the patient's age to determine if aggressive work-up or watchful waiting is indicated. b) Ensure adequate support throughout investigation of the breast lump by availability of a contact resource. c) Use diagnostic tools (e.g., needle aspiration, imaging, core biopsy , referral) in an appropriate manner (i.e., avoid over- or under-investigation, misuse) for managing the breast lump.

3 In a woman who presents with a malignant breast lump and knows the diagnosis: a) Recognize and manage immediate and long-term complications of breast cancer. b) Consider and diagnose metastatic disease in the follow-up care of a breast cancer patient by appropriate history and investigation.c) Appropriately direct (provide a link to) the patient to community resources able to provide adequate support (psychosocial support).

CCFP Key Topic 11 - Behavioural Problems

https://thegenerehlist.ca/2021/01/17/ccfp-exam-key-topic-eleven-behavioural-problems/(opens in a new tab)

Written By: Chris Cochrane

Reviewed By: Kajsa Heyes

Objective One:In all patients, when working up a behavioural problem:

a) Ensure a thorough assessment of medical and mental health conditions and psychosocial factors before offering a diagnosis or definitive adviceb) Use a validated assessment tool if availablec) Use multiple sources of information (e.g., workplace, family, school) with consentd) Explore the patient's own perspective, not just that of the caregiver

Objective Two:In assessing behavioural problems in adolescents specifically look for substance use, peer issues, abuse, and other stressors.

Objective Three:While assessing behavioural problems in a patient,

a) Evaluate the impact of the behaviour

b) Explore any underlying emotional distress with the patient

c) Destigmatize embarrassing behaviours

Objective Four:When making a diagnosis of a behavioural problem in a patient,

a) Avoid premature labelling of a behaviour as a disorder

b) Follow up with support and regular visits until the situation is clearer and any therapeutic requirements are more evident

Objective Five:When managing behavioural problems:

a) Assess and address immediate risk for the patient and others

b) Do not limit treatment to medication; address other dimensions (e.g., do not just use amphetamines to treat ADD, but add social skills teaching, time management, etc.) and match to available community resources

Objective Six:When there is a challenging relationship with a patient with behavioural problems maintain a continuous, therapeutic, and non-judgmental relationship with the patient and family.

Written and Researched: Kajsa Heyes Reviewed by: Chris Cochrane

https://thegenerehlist.ca/ccfp-topics-page/

Step 1: “S” for Setting up the interview

Step 2: “P” is for Perception of patient

Step 3: “I” is for Invitation from the patient

Step 4: “K” is for Knowledge and information for the patient

Step 5: “E” is for Empathy and responding to patient emotions

Step 6:”S” is for Strategy and Summary

Written/Researched: Caleb Dusdal Peer Review: Sophia Park

https://thegenerehlist.ca/ccfp-topics-page/episode-nine-anxiety

Objective One For a patient with multiple unexplained symptoms or behaviours, look for anxiety as a primary or contributing cause.

Objective Two When a patient presents with symptoms of anxiety, clearly distinguish between distress (e.g. fear, nervousness, worry) and an anxiety disorder.

Objective Three In a patient presenting with acute symptoms of panic (e.g., shortness of breath, palpitations, hyperventilation), do not attribute the symptoms to anxiety without first excluding serious medical pathology (e.g., pulmonary embolism, myocardial infarction) from the differential diagnosis, especially in patients with established anxiety disorder.

Objective Four When working up a patient with symptoms of anxiety, and before making the diagnosis of an anxiety disorder, a) Exclude serious medical pathology b) Identify - other co-morbid psychiatric conditions - abuse - substance use c) Assess the risk of suicide d) Discuss functional impact with the patient

Objective Five When an anxiety disorder is suspected, assess and classify according to established diagnostic criteria, as treatment will vary according to the classification.

Objective Six In patients with known anxiety disorders, do not assume all new symptoms are attributable to the anxiety disorder.

Objective Seven When planning management of anxiety, offer appropriate treatment, which may include one or a combination of the following: • Self-management techniques • Regular office follow-up • Community resources • Structured therapies (Cognitive Behavioral Therapy, psychotherapy) • Judicious use of pharmacotherapy

Objective Eight When managing anxiety or an anxiety disorder do not use medication as a sole treatment.

Objective Nine: When assessing and managing anxiety, discuss the use of alcohol and substances as harmful self-medication.

Written By: Hermeen Dhillon

Reviewed By: Dr. Brandie Walker

Objective 1: In patients of all ages with respiratory symptoms (acute, chronic, recurrent): - Include asthma in the differential diagnosis. - Confirm the diagnosis of asthma by appropriate use of: - History - Physical examination - Spirometry

Objective 2: In a child with acute respiratory distress, distinguish asthma or bronchiolitis from croup and foreign body aspiration by taking an appropriate history and doing a physical examination.

Objective 3: In a known asthmatic, presenting either because of an acute exacerbation or for ongoing care, objectively determine the severity of the condition physical examination, spirometry. Do not underestimate severity.

Objective Four: In a known asthmatic with an acute exacerbation: - Treat the acute episode - Rule out co-morbid disease - Determine the need for hospitalization or discharge

Objective Five: For the ongoing (chronic) treatment of an asthmatic, propose a stepwise management plan including: - Self-monitoring. - Self-adjustment of medication - When to consult back

Objective Six: For a known asthmatic patient, who has ongoing or recurrent symptoms: - Assess severity and compliance with medication regimens. - Recommend lifestyle adjustments (e.g., avoiding irritants, triggers) that may result in less recurrence and better control.