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

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.

Written By: Caleb Dusdal, FM PGY1 Calgary

Reviewed By: Kirstin Dawson, IM PGY1 - Ottawa

https://thegenerehlist.ca/2020/12/13/episode-seven-atrial-fibrillation/

Objective One: In a patient who presents with new onset atrial fibrillation, look for an underlying cause

Objective Two: In a patient presenting with atrial fibrillation, look for haemodynamic instability, and intervene rapidly and appropriately to stabilize the patient.

Objective Three: In an individual presenting with chronic or paroxysmal atrial fibrillation, a.    Explore the need for anticoagulation based on the risk of stroke with the patient and b.    Periodically reassess the need for anticoagulation.

Objective Four: In patients with atrial fibrillation, when the decision has been made to use anticoagulation, institute the appropriate therapy and patient education, with a comprehensive follow-up plan.

Objective Five: In a stable patient with atrial fibrillation, identify the need for rate control.

Objective Six: In a stable patient with atrial fibrillation, arrange for rhythm correction when appropriate.

Written and Researched by: Chris Cochrane Reviewed by: Sarah Donnelly

Objective 1a. In patients requiring antibiotic therapy, make rational choices first-line therapies for common bacterial infections: - Simple Cystitis - Complicated Cystitis/Pyelonephritis - STI: Gonorrhea/Chlamydia - Cellulitis and Erysipelas (non-purulent skin infections) - Abscess (purulent skin infection) - Impetigo - Bacterial Community Acquired - Pneumonia - Sinusitis - Acute Otitis Media - Acute Conjunctivitis - Hyper-Acute Conjunctivitis

Objective 1b. Make rational choices regarding knowledge of local resistance patterns: Objective 1c. Make rational choices with respect to patient’s medical and drug history:

Objective 1d. Make rational choices regarding patient’s context:

Objective 2. In patients with a clinical presentation suggestive of a viral infection, avoid prescribing antibiotics.

Objective 3. In a patient with a purported antibiotic allergy, rule out other causes (e.g., intolerance to side effects, non-allergic rash) before accepting the diagnosis.

Objective 4. Use a selective approach in ordering cultures before initiating antibiotic therapy (usually not in uncomplicated cellulitis, pneumonia, urinary tract infections, and abscesses; usually for assessing community resistance patterns, in patients with systemic symptoms, and in immunocompromised patients).

Objective 5: In urgent situations (e.g., cases of meningitis, septic shock, febrile neutropenia), do not delay administration of antibiotic therapy (i.e., do not wait for confirmation of the diagnosis).

The GenerEhlist CCFP Exam 105 Topics Podcast

Episode Written By: Sarah Donnelly - IM UofA, and Hermeen Dhillon FM UBC

Episode Reviewed by: Chris Cochrane - FM UofC Medicine Hat

1. Objective One: Assess the risk of decompensation of anemic patients to decide if prompt transfusion or volume replacement is necessary.
2. Objective Two: In a patient with anemia, classify the anemia as microcytic, normocytic, or macrocytic by using the MCV or smear test result, to direct further assessment and treatment.
3. Objective Three In all patients with anemia, determine the iron status before initiating treatment.
4. Objective Four In a patient with iron deficiency, investigate further to find the cause.
5. Objective Five Consider and look for anemia in appropriate patients. Such as those at risk for blood loss or in patients with hemolysis whether they are symptomatic or not, and in those with new or worsening symptoms of angina or CHF.
6. Objective Six Look for other manifestations of the deficiency in order to make the diagnosis of pernicious anemia when it is present.
7. Objective Seven As part of well-baby care, consider anemia in high-risk populations or in high-risk patients
8. Objective Eight When a patient is discovered to have a slightly low hemoglobin level, look carefully for a cause as one cannot assume that this is normal for them.
9. Objective Nine In anemic patients with menorrhagia, determine the need to look for other causes of the anemia.

Script By: Thomsen D'hont Peer-Review By: Hermeen Dhillon Hosts: Caleb Dusdal, Thomsen D'hont, AND Christ Cochrane!

https://thegenerehlist.ca/2020/11/15/episode-four-allergy-anaphylaxis/https://thegenerehlist.ca/ccfp-topics-page/

Objective One: In all patients, always inquire about any allergy and clearly document it in the chart. Re-evaluate this periodically.

Objective Two: Clarify the manifestations of a reaction in order to try to diagnose a true allergic reaction

Objective Three: In a patient reporting allergy, ensure that the patient has the appropriate medication to control symptoms

Objective Four: Prescribe an EpiPen to every patient who has a history of, or is at risk for, anaphylaxis.

Objective Five: Educate appropriate patients with allergy and their families about the symptoms of anaphylaxis and the self-administration of the EpiPen, and advise them to return for immediate reassessment and treatment if those symptoms develop or if the EpiPen has been used.

Objective Six: Advise patients with any known drug allergy or previous major allergic reaction to get a MedicAlert bracelet.

Objective Seven: In a patient presenting with an anaphylactic reaction: a) Recognize the symptoms and signs. b) treat immediately and aggressively c) Prevent a delayed hypersensitivity reaction through observation and adequate treatment

Objective Eight: In patients with anaphylaxis of unclear etiology refer to an allergist for clarification of the cause.

Objective Nine: In the particular case of a child with an anaphylactic reaction to food a) Prescribe an EpiPen for the house, car, school, and daycare. b) Advise the family to educate the child, teachers, and caretakers about signs and symptoms of anaphylaxis, and about when and how to use the EpiPen.

Objective Ten: In a patient with unexplained recurrent respiratory symptoms, include allergy in the differential diagnosis.

Script By: Caleb Dusdal Peer Review By: Thomsen D'hont

https://thegenerehlist.ca/2020/11/08/episode-three-acls-part-ii/

• Objective Four: Suspect and promptly treat some specific reversible causes of arrhythmias even before confirmation of the diagnosis.
• Objective Five: Ensure adequate ventilation and secure the airway in a timely manner. Know how and when to ensure adequate ventilation, and secure the airway in a timely manner
• Objective Six: In patients requiring resuscitation, assess their circumstances to help you decide when to stop
• Objective Seven: In patients with serious medical problems or end-stage disease, discuss code status and end-of-life decisions and readdress these issues periodically.
• Objective Eight: Attend to family members during and after resuscitating a patient.
• Objective Nine: In paediatric resuscitation, use appropriate resources to determine the correct drug doses and tube sizes. In paediatric resuscitation, know what resources you can use to determine the correct drug dosing and tube sizes. As well as how to use these.