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SpC Family Medicine > FM CCT Notes > Flashcards

FM CCT Notes Flashcards

1
Q

FM Management Interview / Consultation

A
  1. HPI
    - Sx
    - DDx
    - Red flags: Trauma, Infection, Inflammation, Malignancy
    - Causes
    - Control, Compliance, Complications, Comorbidity, Lifestyle
  2. PMH
    - Medications
    - Drug allergy
  3. FH
  4. SH
    - Smoking, Drinking
    - Diet
    - Exercise
    - Occupation
    - Weight, BMI
    - Live with whom
  5. Impact on ADL (Bio-Psycho-Social)
    - 對你日常生活有咩影響
    - 對你心理有咩影響
    - 對你社交有咩影響
  6. RICE
  7. BATHE (for mental health problem)
  8. 4P + Barrier (for Management interview)
    - Precipitating: 最近有無野發生?
    - Perpetuating / Barrier: 有咩令你做唔到?
    - Protective: 有咩可以促使你做得到, 有咩對你黎講最重要?
  9. Management
    - Reassure ICE
    - Explain: Pathophysiology, nature, course
    - Advice Non-drug intervention
    - Prescription + SE of drug
    - Referral: Sick leave
    - Investigation: H. stix, Urine dipstick, CBC, LRFT, TFT, FG, HbA1c, Lipid profile, ECG
    - Observe: Red flag advice
    - Prevention: Further episode of same problem, Secondary problems e.g. stroke, Anticipatory care e.g. flu vaccine, pap smear
    - Red-flag symptom advice
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2
Q

SOAP form

A

Subjective:
1. HPI
- Sx
- DDx
- Red flags: Trauma, Infection, Inflammation, Malignancy
- Causes
- Control, Compliance, Complications, Comorbidity, Lifestyle
2. PMH
- Medications
- Drug allergy
3. FH
4. SH
- Smoking, Drinking
- Diet
- Exercise
- Occupation
- Weight, BMI
- Live with whom
5. Impact on ADL (Bio-Psycho-Social)
- 對你日常生活有咩影響
- 對你心理有咩影響
- 對你社交有咩影響
6. RICE

Objective:
1. P/E
- Temp, BP, Pulse, RR, SaO2
- Cervical LN
- Look, Feel (Temp, Tenderness, ROM, Swelling), Move (ROM, Power)
- GI need PR exam
- Important negatives

  1. Investigations

Assessment:
1. Dx + DDx
2. Bio-Psycho-Social

Plan:
1. RAPRIOP

Prescription:
1. Drug name
2. Preparation
3. Dosage
4. Route
5. Frequency
6. Duration
7. Amount

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3
Q

Common investigations in FM (self notes)

A
  1. H’stix
  2. Urine dipstick
  3. CBC
  4. LRFT
  5. TFT
  6. FG, HbA1c
  7. Lipid profile
  8. ECG
  9. Proctoscopy
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4
Q

Smoking / Alcohol cessation

A
  1. Background
    - When started
    - Why
    - How much
  2. Dependence Sx
    - Craving, Compulsion
    - Withdrawal, Tolerance
    - Neglect, Persist
  3. CAGE
  4. Impact
    - Bio
    - Psycho
    - Social
  5. Quit
    - Prior attempt
    - Current attitude
    - Barrier / Facilitator
  6. Drug allergy
  7. RAPRIOP
    - R: Harmful effects
    - A: Avoid trigger, Other hobbies, Set a date
    - P: NRT (smoking), Naltrexone, BDZ (alcohol)
    - R: Quitting services, Support group
    - I: CBC, LRFT, FG, Lipid
    - O: 3/12
    - P: Health screening, Vaccination
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5
Q

Non-drug intervention (常用)

A
  1. Psychoeducation
  2. Relaxation techniques
    - Slow breathing exercises
    - Progressive muscle relaxation
  3. Behavioural activation / Exercise
  4. Sleep hygiene
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6
Q

MSK management

A

Non-pharmacological:
1. Rest
2. Physical modalities
3. Support / Bracing
4. Injection
5. Exercise / Manipulation
6. Activity modification
7. Rehabilitation

Pharmacological:
1. Drugs

Operative:
1. Surgery

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7
Q

Fall management

A
  1. Correct underlying cause
    - Neurological: PD, Stroke, NPH, Dementia
    - Vision: Cataract
    - CVS: Arrhythmia, Postural hypotension
    - Endocrine: Hypoglycaemia
    - Drugs: SE
    - MSS: Muscle weakness, Gait problem, Frailty
    - Extrinsic: Wrong footwear, Home environment
  2. Exercise
  3. Diet
    - Protein
    - Ca, Vit D
  4. Non-pharmacological
    - Review polypharmacy
    - Carer advice: 平安鐘
  5. Refer
    - PT: Strength, Balance, Coordination, Gait training
    - OT: Walking aid, Home modification, Footwear
    - Dietitian: Vit D3, Ca supplement
    - OAH
    - MSW
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8
Q

Malnutrition management

A
  1. Correct underlying cause
    - Dental problem
    - Dysgeusia (change in taste)
    - Dysphagia (Bedside swallowing screen, VFSS, FEES)
    - Diseases
    - Drugs
    - Dementia
    - Depression
    - Destitution
  2. Exercise
  3. Diet
    - Protein
    - Fibre
    - Ca, Vit D
  4. Non-pharmacological
    - Thickener
    - Feeding position
    - Herbs / Spices
    - Large bowl
    - NG / PEG
  5. Pharmacological
    - Megestrol (Megace)
  6. Refer
    - ST
    - Dietitian
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9
Q

Dementia management

A
  1. Correct underlying cause
    - TFT
    - B12
    - VDRL
    - Alcohol (AUDIT)
    - Depression (GDS)
    - Sensory deficit
    - CT / MRI brain
    - Traumatic brain injury
    - Brain tumour
  2. Exercise
  3. Diet
    - Vit B12
  4. Non-pharmacological
    - Home modification
    - Good mood
    - Social support
    - Advanced directive
  5. Pharmacological
    - AChE inhibitor: Donepezil, Rivastigmine
    - NMDA antagonist: Memantine
    - BPSD treatment
  6. Referral
    - Geriatrician
    - OT
    - CP
    - OAH
    - Geriatric day hospital, Geriatric day care centre, Dementia day care centre
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10
Q

DDx of Tiredness

A
  1. Physiological: Lack of sleep
  2. Anaemia
  3. Hypothyroidism
  4. Malignancy
  5. Infection
  6. OSA
  7. Depression
  8. Heart failure
  9. Other diseases e.g. Myasthenia gravis
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11
Q

DDx of Palpitations

A
  1. Arrhythmia
  2. Anaemia
  3. Hypoglycaemia
  4. Hyperthyroidism
  5. Phaeochromocytoma
  6. GAD, Panic disorder
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12
Q

Multidisciplinary team

A
  1. Geriatrician
    - Polypharmacy review
    - Drug optimisation
    - Interdisciplinary team care
    - Drug prescription
    - Compensation
  2. Physiotherapy (PT)
    - Balance, Coordination, Gait training
    - ROM exercise
    - Strength exercise
    - Physical modalities
  3. Occupational therapy (OT)
    - Splint / Prosthesis / Orthosis / Walking aids
    - Home environment modification
    —> Urinal
    —> Shower chair / bed
    —> Handrail
    —> Ramp
    —> O2 therapy
    - Vocational training
    - ADL assessment + training
    - Cognitive assessment + training
  4. Speech therapy (ST)
    - Language assessment + Speech training
    - Swallowing assessment + Swallowing training
    - Tube / PEG feeding
    - Consistency of food
  5. Dietitian
    - Nutritional assessment
  6. CP
    - Counselling
    - Psychotherapy
  7. MSW
    - Rehab
    - Supported employment
    - Financial support
    - Self-help groups
  8. Community services
    - Geriatric day hospital (老人科日間醫院) (assessment, management, rehabilitation)
    - Geriatric day care centre (長者日間護理中心) (maintenance of physical condition, social support)
    - Dementia day care centre (健智支援服務中心) (cognitive training, care-giver training, social support)
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13
Q

Important numbers

A

Geriatric:
- MUST (Malnutrition Universal Screening Tool): >=2 —> High risk
- Frailty: >=3 (Weight loss, Weakness, Slowness, Low energy, Low activity)
- Sarcopenia: Low muscle mass, Low muscle strength, Low physical performance
- GDS (Geriatric Depression Scale): >=5 —> Mild depression
- TUGT >=15 —> Risk of fall
- AMT <5/6 —> Proceed to MoCA
- MoCA >=26 Normal
—> >16th centile: Normal
—> 16th - 2nd centile: Mild NCD (Neurocognitive disorder)
—> <=7th centile: MCI (Mild cognitive impairment)
—> <=2nd centile: Major NCD

Adult:
- GAD-7: >=10
- PHQ-9:
—> >=5 Mild depression (Watchful waiting)
—> >=10 Moderate depression (Counselling +/- Pharmacotherapy)
- BMI: >23 Overweight, >25 Obese
- WHR: >0.9 Men, >0.85 Women
- Waist circumference: >90cm Men, >80cm Women
- Pre-DM: IFG >5.6, IGT >7.8, HbA1c >5.7
- Alcohol:
—> AUDIT (Alcohol Use Disorders Identification Test) >=8 Increased risk, >=16 Harmful, >=20 Dependence
—> CAGE >=2
- 10-year CVS risk: 1-4 Moderate, 5-9 High, >=10 Very high

Target:
- DM: FG <=7.2, OGTT <=10, HbA1c <=7
- LDL: 1.8
- BP: 130/80

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14
Q

Exercise for neck, shoulder, elbow, low back, knee, ankle pain

A

Neck pain:
1. Back and forward bend
2. Head tilt
3. Neck retraction

Shoulder pain:
1. Shoulder shrug
2. Wall angel

Elbow pain:
1. Forearm flexor stretch
2. Forearm extensor stretch

Low back pain:
1. Bridging
2. Extension exercise
3. Quadruped arm / leg raise

Knee pain:
1. Seated knee extension
2. Step up
3. Straight leg raise

Ankle pain:
1. Toe circle
2. Alphabet exercise
3. Towel stretch

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SpC Family Medicine (4 decks)

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