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The GenerEhlist - CCFP Exam & Canadian Primary Care Medicine
21 minutes | Oct 10, 2021
CCFP 105 Topics: Eating Disorders
Script by: Eleanor Crawford & Sonja Poole Expert Reviewer: Clare Whitehead Eleanor Crawford, new PGY1 in Yellowknife NWT, and Caleb Dusdal review the fundamentals of Eating Disorders with a Thanksgiving humour and a sprinkling of clinical pearls along the way.
24 minutes | Oct 3, 2021
Low Risk Obstetrics: MFM Lite
Written By : Kyla Freeman, Rural Family Medicine PGY2 Expert Reviewed By : Dr. Megan Cuthbertson Hosts : Kyla Freeman, Patricia Massel, Catilin Blewett Episode Art : Aikansha Chawla In this episode we provide a brief overview of a few topics to consider in pre-conception and first pregnancy appointment counselling to help optimize your patients prenatal care. Topics we will explore include which antihypertensives are safe in pregnancy, who to consider starting on ASA early in pregnancy, how long to delay pregnancy post-C-section in patient's wishing to have a TOLAC, interventions to help reduce the risk of preterm birth, and considerations when managing a pregnant patient with a past history of thyroid
17 minutes | Sep 19, 2021
CCFP 105 Topics: Dysuria
Written By: Caitlin Blewett Peer Review By: Chris Cochrane Episode Art By: Aikansha Chawla We cover the five CCFP objectives for the Key Topic of Dysuria.
33 minutes | Sep 12, 2021
CCFP 105 Topics: Diabetes - Part 2
Written By: Dr Samantha Pomroy Expert Review By: Dr Karin Winston (Paeds Endo) Chris Cochrane and Caleb Dusdal review CCFP CFPC Objectives 3-7 for the Key Topic of Diabetes. Lots and lots of info, with much spaced repition.
20 minutes | Sep 5, 2021
CCFP 105 Topics: Diabetes - Part 1
Written By: Dr. Samantha Pomroy Expert Review By: Dr Karin Winston - Paediatric Endocrinologist Chris Cochrane and Caleb Dusdal review the first two objective of the CCFP Key Topic of Diabetes. Lots of definitions, screening guidelines, numbers, and a review of the lifestyle and pharmacologic options available to you to help your patient.
19 minutes | Aug 29, 2021
Low Risk Obstetrics: Newborn Sleep
Episode written by : Caitlin Blewett (MSI 4), with input from Helen van der Kooy (senior MSI) Episode reviewed by: Dr. Breagh Phipps (Paediatrician) Hosts: Kyla Freeman, Patricia Massel, Caitlin Blewett In this episode we review some of the common questions around newborn sleep, safe sleep, and sleep training. An area mired with opinions, we have tried to present a balanced approach, with some interesting trivia points too! This episode draws on guiding statements from the Canadian Paediatric Society (CPS) and we also discuss some of the common deviations parents and caregivers may take from these guidelines and how to optimize safety in these situations.
25 minutes | Aug 22, 2021
CCFP 105 Topics: Difficult Patient
Written By: Braedon Paul Peer Review By: Sarah Donnelly Join Caleb Dusdal and Braedon Paul to cover the CCFP Key Topic of Difficult patient via two compelling patient cases. https://thegenerehlist.ca/2021/08/22/episode-thirty-two-difficult-patient/
13 minutes | Aug 15, 2021
CCFP 105 Topics: Dementia Part 2
Written By: Chris Cochrane Peer Review By: Caleb Dusdal Join Chris Cochrane and Caleb Dusdal as we review the rest of the CCFP Objectives for Dementia. As usual with loads of resources available on the shownotes at the GenerEhlist website Episode Art and Infographic by MS-2 Aikansha Chawla of McMaster University!
23 minutes | Aug 8, 2021
CCFP 105 Topics: Dementia Part 1
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.
41 minutes | Aug 1, 2021
Low Risk Obstetrics: Post Partum Hemorrhage
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
29 minutes | Jul 25, 2021
CCFP 105 Topics: Diarrhea
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.
8 minutes | Jul 18, 2021
Low Risk Obstetrics: Introduction
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
21 minutes | Jul 11, 2021
CCFP 105 Topics: Deep Vein Thrombosis
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.
26 minutes | Jun 27, 2021
CCFP 105 Topics: Depression
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
22 minutes | Jun 20, 2021
CCFP 105 Topics: Dehydration
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.
15 minutes | Jun 6, 2021
CCFP 105 Topics: Croup
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.
19 minutes | May 30, 2021
CCFP 105 Topics: Crisis
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.
28 minutes | May 23, 2021
CCFP 105 Topics: Chronic Disease
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.
27 minutes | May 16, 2021
CCFP 105 Topics: Chronic Pain
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
17 minutes | Apr 25, 2021
CCFP 105 Topics: Seizure
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).
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