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

Hosts: Eleanor Crawford and Caleb Dusdal Guests: Drs Paul Dhillon and Simon Moore CCFP Exam and Medical Education Gurus and the Duo behind the Nation-Wide 'The Review Course'. Rather than specific key topic review today, we are very pleased to be able to bring you the gurus of the CCFP Exam and medical education in general, as well as the duo behind the nation-wide 'The Review Course'. Drink in the knowledge that these two gents have gathered over many years of teaching, examining and reviewing the CCFP Exam, both SOOs and SAMPs. We discuss: is oxygen considered a medication or a treatment? what should the structure of my SOO approach be? best ways to study? exam accommodation tips? plenty of dad jokes, and more https://www.thereviewcourse.com/

While the title of this key topic makes me uncomfortable, the excellent and succinct script is wonderful. Written By: Dr Nova Zhao - Family Physician - Halifax Nova Scotia Reviewed By: Dr Tania Wong - Paediatrician & Assistant Professor of Community Paediatrics at Dalhousie

Caleb Dusdal and Dr Kristin Dawson discuss the CCFP Objectives for Heart Failure. Lots of crazy sounds, and tons of laughter as ever. Enjoy.

Join us as we update the Dizziness episode with the expertise of vertigo guru, Dr Peter Johns. When he isn't trying to update the medical internet community into more clinically useful vertigo management, he is working as an ER Physician in Ottawa, as well as in the Rapid Access Dizziness(RAD) clinic helping dizzy patients. Here we update the prior episode with clinical pearls like: do not bother with HINTS unless there is persistent nystagmus how to bring out an otherwise hidden nystagmus commonest features of BPPV, and when you might miss a less obvious BPPV please do not focus on the ubiquitous central v peripheral vertigo table we all have been taught and much more

Written By: Dr. Khash Farzam Peer Review By: Dr Kristin Dawson

Episode Written by : Kyla Freema, PGY2 Family Medicine Episode Reviewed by : Elaine Godwin, Family Practice Low Risk Obstetrics Hosts : Kyla Freeman, Patricia Massel, Caitlin Blewett Image Art : Aikansha Chawla

Written By: Josh Piemontesi, FM PGY1 - Black Diamond AB Peer Review By: Caleb Dusdal Join Caleb Dusdal and Josh Piemontesi in reviewing all of the CCFP Exam Objectives for the ubiquitous Headache.

Written By Dr Jessica Dawson Expert Review: Dr Jennifer Ringrose, Internist in Edmonton, AB Hypertension is one of those issues that we encounter every day in family practice, whether in the office or acute settings. Roughly one in four to one in five Canadian has hypertension. It is a top modifiable risk factor for cardiovascular disease and the number one cause of death and disability worldwide. In[JR1] fact, a 2018 systematic review in Canadian Family Physician found that globally, across both developed and developing nations, hypertension was essentially tied with upper respiratory tract infections for being the most common reason for a visit (at least according to the doctors). Which is why it is typically the first disease that comes to my mind when I think about the preventative side of primary care. All that to say, this episode is a big one. We focused primarily on the Hypertension Canada guidelines when researching this episode, since that's what will be most relevant for your CCFP exam. But other guidelines exist and you should be aware that they do not all agree.

Today's episode is a continuation of Episode 9, where we delve into the details of the newborn exam, reviewing both the subtle and the serious findings you may come across. In Part 2, we cover the chest and down. We will review upper-limb birth traumas, approach to murmurs, the differential for increased work of breathing, emergent management of abdominal wall defects, the approach to the infant who has failed to void and/or pass meconium, and so much more. Enjoy!

Written By: Eleanor Crawford Review By: Sonja Poole Join Caleb Dusdal and Eleanor Crawford in review the CCFP objectives for the Key Topic 'Grief', with splashes of interesting stories and clinical pearls.

Written By: Braedon Paul Expert Review By: Dr Jordan Iannuzzi - GI Fellow, Calgary AB

The newborn exam can be completed quickly, but careful attention needs to be paid for any abnormalities. Episode Written By : Kyla Freeman PGY2 Rural Family Medicine Episode Reviewed By : Dr. Ram Venkata, Paediatrician Hosts : Kyla Freeman & Patricia Massel Episode Art : Aikansha Chawla With these episodes we hope to highlight common and critical abnormalities, the differentials for abnormal findings, and at times touch on workup and management. Part 1 is all about the head and face. We will talk about head shape and size, fontanelles, sutures, eyes, ears, and mouth. Part 2 tackles common birth trauma injuries, cardiac, respiratory, abdominal, genitourinary, and dermatologic conditions. Resource wise there will be one hand-out for both episodes.

Written By: Kyla Freeman Peer Review: Caleb Dusdal Kyla has continued to amaze with this episode covering the CCFP Objective for Gender Specific Issues in Primary Care. We discuss domestic violence, medical conditions that present differently depending on the patient's sex, gaps in research, trauma informed care, and caring for your patients from the LGBTQ2 community.

Join Caleb Dusdal and Braedon Paul in discussing the CCFP objectives for the Key Topic of Fractures. In true Braedon Paul fashion, this is done in the form of cases. Written By: Braedon Paul - PGY1 FM - UBC Victoria Expert Review By: Dr Babak Salamati - Sports Medicine Physician - Regina, SK Artwork by: Aikansha Chawla

Written by Karkirat Singh - MS-4 UofA, join Caleb Dusdal and Sarah Donnelly as we go through all you should need to know around fever for the CCFP Board exam, and clinical life.

Join Shaila Gunn in a wonderful discussion on the patient perspective of living with disability and experiences with Primary Care. A massive thank you to this episode's guest Lynda Bennett

Written By: Caleb Dusdal Expert Review By: GP Palliative Care specialists at Foothills Hospital in Calgary Alberta Dr Amir Surmawala @AmirSurmawala and Dr. Katherine Liu Episode Art By: Aikansha Chawla Because of our unique circumstance as Family Doctors, Often we are going to be the ones uncovering and sharing life-threatening and life-limiting diagnoses with our patients. Alongside this, we are their longitudinal link to the services they may need and are best able to have these difficult conversations EARLY, to avoid last minute decisions and emotionally difficult visits to the ER or Intensive care. Today we are going to discuss: what is Palliative Care, the multidisciplinary needs for good Palliative Care, Serious Illness Conversations and identifying patients goals of care, principles of pain management, and longitudinal follow up on patient's wishes at end-of-life.

Written By Sonja Poole - PGY1 FM Yellowknife, NWT Reviewed by: Eleanor Crawford

Episode Written By : Patricia Massel, Rural Family Medicine PGY2 Episode Reviewed By : Charley Boyd, GP in Camrose, AB Hosts : Kyla Freeman (FM-PGY2), Patricia Massel (FM-PGY2), & Caitlin Blewett (MS4) Episode Art : Aikansha Chawla s episode we explore the world of placental abnormalities. We will review placenta previa, acreta spectrum disorders, and cord anomalies including velamentous cords and the single umbilical artery. In this review we hope to share which one's are interesting, which one's need extra workup or monitoring, and which one's are downright dangerous requiring specialist care?

Written & Researched By: Thomsen D'hont Peer Review By: Shaila Gunn (MS4 UBC) Episode Art By: Aikansha Chawla Join Thomsen and Caleb as we cover the seven key CCFP topic objectives for Epistaxis. Learn how to teach your patients to correctly squeeze the nose, an approach to epistaxis even if recurrent, when to refer, and workup and differential.

Written By: Shaila Gunn, MS4 UBC Expert Reviewed By: Dr. Bonita Sawatzky, an orthopaedics biomechanics researcher at iCORD spinal cord injury research center in BC

Written By: Kajsa Heyes Peer Review By: Thomsen D'hont A review of acute otitis externa, otitis media with effusion, acute otitis media and the broad differential to consider. We also review worrying complications and the CPS approach to management.

Episode Written by : Kyla Freeman, Rural Family Medicine PGY2 Episode Reviewed by : Virginia Clark, FP practicing rural and urban obstetrics Hosts : Kyla Freeman (FM-PGY2), Patricia Massel (FM-PGY2), Caitlin Blewett (MS4) Episode Art : Aikansha Chawla In today's episode we explore weight, diet, and exercise. We review the complications of BMIs outside of the normal range, the weight gain recommendations by BMI class, and considerations regarding supplements to reduce the risk of adverse outcomes. When discussing diet we cover everything from "how much should our patient's be eating anyway" to which supplements to be advising and which foods to recommend avoiding. We finish off with a review of the exercise recommendations in pregnancy - what are they and how do we get people to engage safely?

Written By: Jessica Dawson Peer Review By: Caleb Dusdal The GenerEhlist team continues the journey through the 105 CCFP Key Topics, with Fatigue, the first episode written by Dr Jessica Dawson from Edmonton, AB.

Written/Researched By: Caleb Dusdal Peer Review By: Chris Cochrane Join Caleb Dusdal and Chris Cochrane as we review the CCFP Exam Key Topic of Elderly. This includes a discussion of polypharmacy, medications to avoid or stop in the elderly, assessing for frailty, what screening is reasonable in Primary Care, and some conditions that can present atypically in this group of humans.

Episode Written by : Patricia Massel Rural Family Medicine PGY2 Episode Reviewed by : Dr. Maggie Watt (GP) & Dr. Milena Semproni (ID) Hosts : Kyla Freeman, Patricia Massel, & Caitlin Blewett Episode Art : Aikansha Chawla In episode one we covered urine cultures, rubella, varicella, chlamydia, and gonorrhoea. Today we tackle HIV, Hepatitis B, and Syphilis - how to screen, how to proceed with a positive screen, and the implications for newborn care. We wrap up our infectious disease discussions with a review of what to order and how to manage the patient who presents in labour without any infectious disease screening whatsoever.

Written By: Chris Cochrane Peer Review By: Sarah Donnelly Chris and Caleb discuss the ins and outs of Dyspepsia. The broad differential to consider, red flag signs and symptoms, and your overall approach to working these patients up.

Written By: Kajsa Heyes Peer Review: Sarah Donnelly Join Kajsa and Caleb in quickly reviewing the Key Objectives for another CCFP CFPC Key Topic. Also, the GenerEhlist is one year old!

Episode Written By : Patricia Massel, Rural Family Medicine PGY2 Episode Reviewed By : Dr. Maggie Watt (GP) & Dr. Milena Semproni (ID) Hosts : Kyla Freeman, Patricia Massel, Caitlin Blewett Episode Art : Aikansha Chawla In the first of this two-part episode we will review some of the basic infectious disease screening tests in pregnancy. In part one we review the key tests to perform during the first prenatal visit that the family doctor should be able to manage themselves (urine cultures, rubella, varicella, chlamydia and gonorrhoea). We will also discuss GBS screening. Then come on back for part two when we review HIV, syphilis, hepatitis B and the patient who presents in labour without any antenatal care including early ID screening.

Written By: Caleb Dusdal Peer Review By: Hermeen Dhillon Join Chris Cochrane and Caleb to review the massive and sometimes convoluted CCFP Key Topic of Dizziness. We will discuss some definitions, approach to dizziness, differential for orthostatic hypotension, presyncope, vertigo, symptomatic treatments for vertigo, what scary stuff to rule out, HINTS exam and so much more.

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.

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

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.

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.

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.

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.

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/

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!

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.

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