The GenerEhlist - CCFP Exam & Canadian Primary Care Medicine

Written By: Alexzandra Hughes-Visentin - FM PGY2, Toronto Review By: Dr Kyla Freeman, CCFP-OSS Artwork, as ever, by Dr Aikansha Chawla

Written By: Alexzandra Hughes-Visentin, FM-PGY1, Women's College Hospital Expert Review By: Dr Alix Murphy, PGY4 OBGYN, University of Toronto Art and Co-Hosting by Aikansha Chawla - PGY1 OBGYN

  Written and Researched By: Alexzandra Hughes-Visentin, FM PGY1 – Women's College Hospital – Toronto Expert Review By: Dr Alix Murphy, PGY4 OBGYN at University of Toronto

  Episode 4: Assessment of Patients with Memory Concerns Hosts: Care of the Elderly Drs. Christine Miller & Ian Bekker Art: Aikansha Chawla

Today we shall be talking about Pneumonia! What an exciting topic. According to Dr William Osler considered to be the “father of modern medicine” and who trained at McGill, pneumonia is known as “the old man's friend” he wrote, “"Pneumonia may well be called the friend of the aged. Taken off by it in an acute, not often painful illness, the old man escapes those 'cold gradations of decay' so distressing to himself and his friends.” Dr. Olser himself died from complications of pneumonia. Pneumonia has a fascinating history as it has been with humanity for many centuries. Symptoms of pneumonia were first described by Hippocrates around 460 BC, but it wasn't until the 19th century that doctors were aware pneumonia was its own condition and not a symptom of another disease. Interesting tidbits of pneumonia related history, Dr. Edwin Klebs was the first person to observe bacteria causing pneumonia under the microscope in 1875 and the bacterial genus klebsiella was named after him. Strep pneumonia, commonest cause of CAP was the first bacteria to be gram stained to distinguish gram positive from gram negative bacteria by Hans Christian Gram in 1884. Hence the name “Gram” stain. The Spanish Flu in 1918, which was an H1N1 influenza A pandemic, killed more people than the first world war in combat, resulting in approximately 20-50 million deaths, and was the second most deadly pandemic on record. In comparison, Covid19 worldwide deaths stand at around 7 million according to the WHO in November 2023. Alright, we could talk all day about pneumonia history, but its time to focus on CCFP objectives for pneumonia!

  Authors: Veronica Oczkowski (MS4) and Andrea Brabant (rFM PGY-2) Content Expert and Reviewer: Dr. Matt Strickland   The rest of trauma objectives including: secondary survey, child abuse suspicion, and a review of everything before we finish up.

Authors: Veronica Oczkowski (MS4) and Andrea Brabant (rFM PGY-2) Content Expert and Reviewer: Dr. Matt Strickland According to the World Health Organization (WHO) and the Centers for Disease Control (CDC), more than nine people die every minute from injuries or violence. A total of 5.8 million people of all ages and economic groups die every year from unintentional injuries and violence. The burden of injury accounts for 18% of the world's total diseases. Motor vehicle crashes alone cause more than 1 million deaths annually and an estimated 20 million to 50 million significant injuries; they are the leading cause of death due to injury worldwide.  Traumatic presentations are unfortunately quite common, so it's important we get comfortable with a strong approach. Our goal today is in no way to complete an exhaustive review. That being said, we did our best to prepare a brief overview that allows us to cover the CCFP objectives. Get ready. This is a pretty robust topic to cover, so buckle up!!

  https://thegenerehlist.ca/episode-3-bpsd-behavioural-and-psychological-symptoms-of-dementia/   Written By: Christine Miller, COE Resident  Review By: Dr. Christian Weins, Psychiatrist, Palliative Care Hosts: Christine Miller, COE Resident & Hannah Dunnigan, Rural Family Medicine Resident Art: as ever by Aikansha Chawla

Written By: Christine Miller, COE Resident Review By: Dr. Keiran Tuck, Neurologist, Movement Disorder Specialist Hosts: Christine Miller, COE Resident & Hannah Dunnigan, Rural Family Medicine Resident Art: as ever by Aikansha Chawla https://thegenerehlist.ca/episode-2-parkinsons-disease-part-2/ 

First of a two part review of Parkinson's Disease in the elderly. Written By: Christine Miller, COE Resident Review By: Dr. Allison Nakanishi, Geriatrician Hosts: Christine Miller, COE Resident & Hannah Dunnigan, Rural Family Medicine Resident  Art: as ever by Aikansha Chawla

A quick hello to meet the force behind all things Geriatrics in Family medicine in the GenerEHlist family.

Obesity Canada published a guideline in 2020 that we will be referring to a lot in this episode. It defines obesity as a chronic, progressive and relapsing disease characterized by the presence of adiposity that impairs health and social well-being.    So today you'll learn what you need to know for the exam, but also some practical considerations for real life visits that take into account the pressures of diet culture, and how we as physicians can provide evidence based advice that doesn't isolate and judge our patients. And because we know language matters, you'll hear us use terms like “large bodies”, instead of saying someone is fat. There are advocates who have reclaimed the term fat, but today we'll stick with medical jargon and terms aimed to avoid stigma.  

Syncope = a brief loss of consciousness and postural tone that resolves spontaneously with a return to baseline neurological function within seconds or a few minutes. Presyncope = near LOC. Should be worked up the same as we know it portends a similar risk of downstream badness as syncope. presyncope is “I almost lost consciousness and then recovered” → more of acute thing. The final common pathway of syncope is the same regardless of the underlying cause. In general, 10 seconds of interrupted blood flow to the brain.

An update episode for 2023 on some tips and tricks for both the SAMP and SOOs from the founders of The Review Course: Dr Paul Dhillon and Dr Simon Moore. New bundled labs that are okay What guidelines are too new? Review the SNO PQRST method AND, get $100 off The Review Course in 2024 by using the code 'GenerEhlist' when you register.

Written By: Savannah Leigh Bennet and Samantha Kent, FM PGY-2s, Memorial University Expert Review By: Dr Gillian Morrison, Geriatrician, St John's Newfoundland

 Hello and welcome to another episode of The GenerEhlist's CFPC 105 topics podcast.  ●        Today's topic is renal failure ●        This episode was written by Vaishvi Patel, a third-year medical student from the University of Alberta, and Ronan Noble an MD/PhD student from the UofA as well, and it was reviewed by Dr. Whitney Hung, an internal medicine senior resident in Edmonton, AB.

Episode Written By : Kyla Freeman PGY3 Content Reviewer : Dr. Charley Boyd, FP working Obstetrics Hosts : Kyla Freeman, Patricia Massel Artwork : Aikansha Chawla In today's episode we review the basics of gestational diabetes screening and management. We also briefly discuss the newborn hypoglycemia screening protocol for infants born to gestational parents with diabetes and first steps of management.

Written By: Cezara-Maria Latcu Peer Review By: Bianca-Mariana Baila FM PGY1 Check also the CCFP 105 Topics: Periodic Health Assessment Part One and Two episodes.  So, first things first: Who should be assessed for osteoporosis and fracture risk?  There are three categories: 1.   All women and men aged 65 or more; 2.   Adults aged 50-64 who are at high risk of fracture or have already experienced a fragility fracture; 3.   Younger adults under the age of 50 who are at high risk of fractures. We know who, let's see „How?”

Written By: Vaishvi Patel, a third-year medical student from the University of Alberta, and Ronan Noble an MD/PhD student from the UofA Expert Review By: Dr. Whitney Hung, an internal medicine senior resident in Edmonton, AB.

  We have a bread-and-butter family medicine topic ready for you today – immunizations! This episode was: written by Sean Wang, a third-year Dalhousie medical student out of Halifax, Nova Scotia and  peer-reviewed by another East-Coaster, Dr. Melissa Power, Dalhousie Family Medicine Staff and the Faculty Undergraduate Coordinator of South-West Nova. This is a large topic and don't worry, we won't just repeat routine vaccine schedules to you the whole time; rather the CCFP objectives focus on the more nuanced details of vaccines – which we all need to have a solid grasp on.

Written By: Andrea Brabant – FM PGY1 - NWT Expert Review By: Dr Katherine Breen, ER Physician NWT Meningitis is defined as inflammation of the meninges, the membranes covering the brain and spinal cord. It is most commonly due to infection, either bacterial or viral. This can happen through hematogenous spread, when bacteria invade the bloodstream (often from the upper airway), and gradually make their way to the subarachnoid space.  However, it can also happen through direct contiguous spread. This is when organisms gain entry into the cerebrospinal fluid from adjacent infections (think sinusitis, brain abscess, otitis media) or directly through penetrating traumatic injury, congenital defects, or during neurosurgical procedures.

Episode Written By : Patricia Massel MD, CCFP Content Reviewer : Natasha White, L&D RN and Breastfeeding Coach Hosts : Kyla Freeman, Caitlin Blewett, Patricia Massel Artwork : Aikansha Chawla In today's episode we will review some tips around breastfeeding including how to give the breastfeeding pitch to expectant parents. We will review some common challenges parents face that can contribute to cessation of breastfeeding, such as concerns about breastfeeding logistics and supply. We will cover some breastfeeding norms and norms around infant weight gain. Finally we discuss bottle feeding and breast pumps.    Shownotes 

Written By: Shaila Gunn, FM PGY2, Calgary AB Expert Review: Dr Darby Ewashina, ER Psychiatrist, Calgary AB @doc.darbs on Instagram   Why should a family physician learn about personality disorders? Well, to start, we are the first point of contact with the patients who have them, and often the first to recognize they have a personality disorder. While psychiatrists may have a role in their treatment, most patients do not require a referral, making family doctors the primary provider of care. Even if you do not plan on managing the personality disorder, you WILL have patients with personality disorders and this podcast will help you effectively manage challenging situations.   Personality disorders make up over 10% of the general population, and 24% of the population in primary care. They may or may not seek treatment for aspects pertaining to their personality disorder, but they sure as well will have other health concerns.

A new topic added by the CCFP with the recent increase to 105 Key Topics. Written By: Vaishvi Patel, MS3 - University of Alberta Expert Review By: Dr Stephen Yam - Family Physician with expertise in Oncology and Palliative care - Fort McMurray AB  

Episode Written By : Kyla Freeman, FM PGY3 Episode Reviewed By : Dr. Vanessa Poliquin, OBGYN Hosts : Kyla Freeman (FMR3) & Patricia Massel (MD-CCFP) Artwork : Aikansha Chawla MS4 In this episode we dive into the hypertensive diseases of pregnancy. We will review the various hypertensive disorders, but our main focus will be on preeclampsia. We will go over screening, ASA starts, and calcium supplementation. We review the clinical presentation and diagnosis of preeclampsia with a nod to HELLP syndrome (see our Liver Disease episode for more on that one!). Finally we will discuss the first steps in management and some post-partum considerations. We hope you enjoy! 

Written By: Christopher Clarke, FM PGY2, Victoria BC Expert Review: Dr Jaques De Jager, GP, CFB Edmonton AB We are talking Low Back Pain. Amanda is a 32 year old Search and Rescue Technician with the Royal Canadian Airforce based out of Canadian Forces Base - Comox here on the island. Two days ago, she was on a mission med-evacing a patient from a fishing vessel of the coast.    She and her fellow SAR - Tech were able to stabilize the patient for transport. However, upon bending over to lift the stretcher, Amanda felt an immediate sharp pain her in lumbar spine. Upon returning home for her days off, despite taking Tylenol, which offered little relief, she stayed mainly in bed because the pain was so intense.   She presents to sick parade on Monday at the base clinic, because the pain has not resolved and now she is having some pain radiate down her right leg.   When it comes to back pain, I find it useful to consider timelines as this can help to guide our differential and management.   Definitions ●        Acute back pain: 4 weeks ●        Subacute back pain: 4-12 weeks ●        Chronic back pain: >12 weeks

Written By: Jessica Dawson , FM PGY2 in Edmonton       Expert Review By: Dr. Brent Crawford, an Emergency Medicine physician at Westview Health Center in Stony Plain Alberta.   Lacerations come in many shapes and flavours - big ones, little ones, simple ones, dirty ones, bloody ones, complicated ones - . . .you get it. As family physicians we tend to encounter accidental lacerations (as opposed to incisions of our own making) most often in emergency medicine or urgent care, but we will also see a lot of lacerations in follow up. Lacerations are one of those topics where art, science and personal preference tend to collide. There is enormous practice variation between physicians - probably in part because there is an absence of evidence for and lot of dogma behind many common practices.  We will focus on the fundamentals for the CCFP exam – the things you need to know to put back together the most common lacerations you'll encounter, and to identify those situations where referral might be necessary or when it's best not to close things up at all!  There are some great links in the show notes you can reference with tips and tricks for repairing different types of lacerations and deep dives into the evidence.

In this episode we review some of the liver diseases of pregnancy including cholestasis, HELLP syndrome, Acute Fatty Liver Disease of Pregnancy, Cholecystitis, and Hepatitis B and C. We hope this episode helps you broaden your differential when it comes to these patients as well as think about and recognize some rare, but serious liver disorders in pregnancy.

Written By: Timothy Collier, PGY1 FM, Memorial University - Newfoundland Peer Review By: Dr Sarah Donnelly, PGY3 IM, University of Alberta - Edmonton All the CCFP Objectives recommended for Hepatitis!

Written By: Braedon Paul, FM PGY2, Victoria Peer Review: Alysha Thomson, FM PGY2, Victoria BC Audio Production: Braedon Paul Abdominal Aortic Aneurysm, Green Eggs and Ham, Osteoporosis, Diabetes and Hyperlipidaemia screening, updated STI screening, Immunizations recommendations, and we tidy it up.

CCFP 105 Topics: Periodic Health Assessment Author: Braedon Paul (FM R2, Victoria) Peer Review: Alysha Thomson (FM R2, Victoria) Audio Production: Braedon Paul BACKGROUND AND RATIONALE FOR PERIODIC EXAM Let's read off those objectives, right up front, so you know what you're getting yourself into: 1.     Do a periodic health assessment in a proactive or opportunistic manner (i.e., address health maintenance even when patients present with unrelated concerns). 2.     In any given patient, selectively adapt the periodic health examination to that patient's specific circumstances (i.e., adhere to inclusion and exclusion criteria of each manoeuvre/intervention, such as the criteria for mammography and prostate-specific antigen [PSA] testing). 3.     In a patient requesting a test (e.g., PSA testing, mammography) that may or may not be recommended: 1.     Inform the patient about limitations of the screening test (i.e., sensitivity and specificity). 2.     Counsel the patient about the implications of proceeding with the test. 4.     Keep up to date with new recommendations for the periodic health examination, and critically evaluate their usefulness and application to your practice.

This episode was written by Two incredible Family medicine residents out of Memorial University in Newfoundland, Sarah Vincent and Kelly Mitchelmore. It was expert review by Dr Sean Hamilton, Divisional Chief of Rheumatology for Eastern Health, in Newfoundland. As well as Ian Parsons, FM and Sports Medicine physician, Newfoundland. In Part Two of Joint Disorders we continued with the remaining objectives and finish it off with ten Rheumatology clinical pearls from Dr Sean Hamilton

Written By: Sarah Vincent (PGY1 FM, Memorial University) and Kelly Mitchelmore (also PGY1 FM, Memorial University) Expert Review By: Dr Sean Hamilton, Head of Rheumatology for Eastern Health in St Johns Newfoundland.

Episode Written by : Cadence MacPherson, Family Medicine PGY2 Episode Reviewed by : Dr. Farrukh, Family Doctor Hosts : Kyla Freeman FMR3 in obstetrics & Cadence MacPherson FMR2 Episode Art : Aikansha Chawla MS4 Today we are making a splash! We will review premature rupture of membranes, both at term (Term PROM) and premature rupture (PPROM) as well as pre-term labour. We are going to talk about when to give steroids, who you should induce, and who you should try to slow things down in. We hope you find it useful!

  Written By: Shaila Gunn - PGY , Calgary AB Expert Review: Dr Darby Ewashina, ER Psychiatrist, Calgary AB @doc.darbs It is important that as family physicians, we learn to not only diagnose insomnia but learn to counsel patients in the management, both behavioral and pharmacological. Insomnia is a common problem, impacting 35-50% of adults. However, only 12-20% of patient with symptoms of insomnia meet the criteria for insomnia disorder. Many other factors including other sleep related conditions, mental health concerns, and organic health problems may present with symptoms of insomnia. Knowing what is causing the insomnia is an important step, as this will guide the most effective treatment strategies. Common, non-modifiable risk factors for insomnia include female gender and middle aged to older adults. However, most patients with insomnia will have another treatable condition. It is important to note that the MOST COMMON CAUSE OF SLEEPINESS IS INADEQUATE SLEEP WITH LACK OF TIME SPENT IN BED AND POOR SLEEP QUALITY Regardless of the cause of insomnia, there are some important, non-pharmacologic treatments that we will talk about that can be beneficial for all patients struggling (or not!) with sleep. The two main treatments are sleep hygiene techniques and Cognitive Behavioral therapy for insomnia (or CBT-I for short). We will get into this later in the episode.

  Written by:  third-year medical student, Kim Papp, and Expert Review By: Dr. Meghan Smith, PGY-5 in Ophthalmology, University of Alberta

Episode Written By : Kyla Freeman, FM-PGY3 Episode Reviewed By : Jillian Gilroy, OBGYN-PGY3 Hosts : Kyla Freeman PGY3, Patricia Massel MD-CCFP, Caitlen Blewett PGY1 Art : Aikansha Chawla   In today's episode we sloooow it right down and go back to basics to review "what is labour" and when is labour prolonged or arrested? We will review the stages of labour as well as how to recognize and manage prolonged or obstructed labour in the first or second stage. We will also very briefly talk about cesarean sections and assisted vaginal deliveries. We hope you enjoy!

  Written By: Sonja Poole, PGY2 FM - Yellowknife NWT Reviewed By: Dr Andrew Kotaska OBGYN, - Yellowknife NWT Some definitions: Infertility = inability to conceive or carry to term after 1 year of regular, unprotected intercourse Primary infertility = infertility in the context of no prior pregnancies Secondary infertility = infertility in the context of a prior conception As a disclaimer, we are going to be heteronormative with our language to simplify referring to the person providing the sperm as the male partner and the person providing the ovum as the female partner, and using cis-gendered pronouns. This is because those are the two essential ingredients for producing an embryo and they both have specific health considerations.  People who are non-binary, trans, or in queer relationships may also struggle with infertility. Referring to people by their preferred pronouns is extremely important and separating our ideas of sex and gender identity is crucial to providing excellent care. Keep this in mind as you listen to this episode. 

  Today's episode is a little unique - Dr. Patricia Massel interviews Nicole Schmitt, a pelvic floor physio to get a whole bunch of tips and pearls about how to support your patient in pregnancy and post-partum with their pelvic floor concerns. They said they'd be 30 minutes, but you know of course it's longer to hopefully enhance your knowledge in this important, yet under-discussed area of pregnancy care! We hope you enjoy.

  Written By: Karkirat Singh, FM PGY1 - Vancouver BC Review By: Dr Hermeen Dhillon Hosted By: Braedon Paul and Caleb Dusdal  

    Written By: Christopher Clarke - FM Resident, Victoria BC Review By: Dr Ajay Bains - IM PGY4 - UBC Sound Editing By: Braedon Paul Hosted By: Christopher Clarke & Caleb Dusdal As a brief review, ischemic heart disease or coronary artery disease can be thought of as a spectrum that ranges from stable angina to unstable angina which may progress to myocardial infarction and sudden cardiac death. As we know, stable angina is caused by luminal narrowing of coronary arteries whereas unstable angina is caused by plaque rupture and thrombus formation leading to stenosis. Myocardial infarction results when you have occlusion of the coronary artery leading to ischemia and then infarction of the myocardium. And within that, a STEMI is generallycaused by complete occlusion and a NSTEMI is typically caused by a partial occlusion.  

  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!