Family Medicine Clerkship. Learning Prompts

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Transcription:

Family Medicine Clerkship Learning Prompts

9 SYSTEMS & CONDITIONS Respiratory conditions................................. 1 COPD Asthma Infectious diseases.................................... 2 Sore throat Pneumonia Psychiatry........................................... 2 Depression Renal/Urology....................................... 3 UTI Chronic kidney disease Musculoskeletal...................................... 4 Arthropathy Low back pain Neurological......................................... 5 Neuropathy Headache Gastroenterology..................................... 6 GERD/Dyspepsia Diverticular disease Endocrine.......................................... 6-7 Diabetes Hyperlipidemia Thyroid disorders Cardiovascular conditions............................. 8-9 Hypertension Heart Failure Coronary artery disease Atrial fibrillation Cardiovascular conditions HYPERTENSION Learning prompts: What is the initial evaluation for a patient with a new diagnosis of HTN? What level of blood pressure is considered pre hypertension? What are the blood pressure treatment goals in different age groups? What is a hypertensive urgency? What criteria do you use to diagnose a hypertensive emergency? What is your first line treatment for HTN? Why? What is the maximum tolerated increase in creatinine after starting an ACE inhibitor? What is resistant hypertension? What are the causes of secondary hypertension? What patients do you evaluate for secondary hypertension? What medications have different responses in African Americans? HEART FAILURE Learning prompts: What are the 2 types of heart failure and the criteria for their diagnoses? What are the 2 classes of medications that all patients with systolic heart failure should take and how do you determine the doses of these medications to use? If a patient is allergic to an ACE inhibitor what benefit would be derived from an ARB? How do you stage heart failure? Which heart failure patients benefit from an aldosterone antagonist? What are the contraindications to aldosterone antagonists? What medications improve symptoms but not mortality in people with heart failure?

8 1 Cardiovascular conditions CORONARY ARTERY DISEASE Learning prompts: What 3 class of medications should someone with a history of an MI take? How do you determine the doses of the above medications? What is the definition of unstable angina? What is the difference between atypical angina and nonanginal chest pain? What types of stress tests are available? What factors determine which stress test is appropriate in which situation? What is the relationship between NSAIDS and risk of death from MI? Which medications can be used for symptom relief of chronic angina? What are the anticoagulation strategies for post angioplasty and the different types of coronary stents? ATRIAL FIBRILLATION Learning prompts: What is the initial work up for a patients presenting with new onset atrial fibrillation? What are the complications of atrial fibrillation? What are the heart rate goals for atrial fibrillation? From which study were these goals derived? What is the CHADS 2 or CHADS-VASc score? What medications can be used for rate control of atrial fibrillation? What are your anticoagulation options for a patient with a CHADS score of over 2? Respiratory conditions COPD Learning prompts: What are the diagnostic criteria for COPD? How is COPD staged? What is the next line of treatment after short acting bronchodilators? What are the 2 classes of long acting bronchodilators? What are brand and generic drug names from each of these 2 classes? Which COPD patients do you treat with prophylactic inhaled corticosteroids? How do you define a COPD exacerbation? What is the standard treatment for a COPD exacerbation? ASTHMA Learning prompts: What criteria do you use to diagnose asthma? What are the 4 stages of asthma? What is the next treatment step after short acting beta agonists? What are low, medium and high doses of inhaled fluticasone (flovent) and beclomethasone (Qvar)? Can you find the gold standard guidelines for asthma care? Can you find and complete an asthma action plan for an adult?

2 7 Infectious diseases SORE THROAT Learning prompts: What are the commonest causes of a sore throat? What are the Centor criteria? What is the treatment threshold? What are the antibiotic regimes for treating GAS pharyngitis? What are the benefits of treating GAS pharyngitis? PNEUMONIA Learning prompts: What are the causes of community acquired pneumonia? What factors or decisions rules can help determine whether the patient should be treated as an inpatient or outpatient? How does legionella pneumonia present? Psychiatry DEPRESSION Learning prompts: What are the criteria to diagnose major depression? Which antidepressant would you choose for initial treatment and why? What are the main side effects of your chosen antidepressant? What are the treatment options for drug resistant depression? How long would you treat a patient for a 1st, 2nd or 3rd bout of major depression? Endocrine DIABETES Learning prompts: What are the diagnostic criteria for pre diabetes/glucose intolerance? What are the diagnostic criteria for diabetes? What are the targets for HBA1C? What are your 2 first line oral medications for diabetes? What are contra-indications to metformin? What would be your 3rd oral agent? What are the thiazolidinediones? How do they work, and what are the side effects? Should normotensive diabetics without proteinuria take an ACE inhibitor? HYPERLIPIDEMIA Learning prompts: When do you screen for hyperlipidemia? What are the coronary heart disease risk equivalents? What are the ATP III soon to be 4 cholesterol goals for different risk groups? What are ATP III/4 cut offs for treatment with medication? When is it appropriate to use niacin? When do you treat hypertriglyceridemia? What are the cardiovascular benefits of treating hypertriglyceridemia?

6 3 Gastroenterology GERD/DYSPEPSIA Learning prompts: In which patients should you do an H pylori test? What are your options for testing for H pylori? What do the American Society of gastroenterologists recommend for the initial treatment of GERD? Which patients should receive a PPI with an NSAID? Which patients with GERD warrant upper endoscopy? What is the effect of a PPI on the efficacy of Plavix? DIVERTICULAR DISEASE Learning prompts: How do you treat diverticulitis? What is the differential diagnosis of a patient over 60 presenting with left lower quadrant abdominal pain? Endocrine THYROID DISORDERS Learning prompts: When a patient is found to have a low TSH what other lab work should be done? What is the value of thyroid autoantibody measurement? What patient factors do you consider when determining the starting dose of thyroxine replacement? How often do you check TSH when establishing the correct dose? What is the most common cause of hyperthyroidism? What are the causes of high/low uptake on a thyroid scan? What other lab work or investigations should be done in a patient who is found to be hyperthyroid with a high T3 and T4 and low TSH? How do you manage a patient with a high TSH and normal T4? Renal/Urology UTI Learning prompts: What are the red flags in the history and physical exam for a complicated UTI / pyelonephritis? When a healthy female complains of frequency and dysuria with no abnormal vaginal discharge, what is the probability she has a UTI? What are the most common urinary pathogens? Which of the most common urinary pathogens cause a positive urinary nitrite test? What factors cause a false positive leukocyte esterase test? When do you send the urine for culture? How long a course of antibiotics do you give for an uncomplicated UTI? What antibiotics are appropriate for treatment of a UTI? How long a course of antibiotics do you give for pyelonephritis? What is the differential diagnosis of UTI in a male? After how many UTIS in a male would you recommend imaging? How sensitive is urinalysis in a child? Which children with a UTI should have follow up renal tract imaging? What sort of imaging? CHRONIC KIDNEY DISEASE Learning prompts: What is the definition of chronic kidney disease? What diagnoses do you consider when you find a raised creatinine in clinic? What strategies do you use to slow the progression of chronic kidney disease?

4 5 Musculoskeletal ARTHROPATHY Learning prompts: What are the diagnostic criteria for gout? What are treatment options for an acute gout flare? What medications and foods increase the risk of gout? What medications are used to prevent gout? When do you start prophylactic gout medications? What medications can you co-administer when starting gout prophylaxis medications? What evidence based therapies are there for DJD? What are the diagnostic criteria for rheumatoid arthritis? What joints does RA typically affect? What type of patients and which symptoms are red flags for SLE? How specific and sensitive is ANA? What follow up serology can be done to further evaluate a positive ANA? Neurological NEUROPATHY Learning prompts: What are the most common causes of neuropathy? What basic work up do you do for neuropathy? What evidence based treatments are there for diabetic neuropathy? HEADACHE Learning prompts: What are the distinguishing historical features of tension and migraine headaches? What medications cause rebound headaches? What prophylactic medications can be used for migraine? What are the contra-indications to triptans? When would you image a patient with a headache? What are the most common primary headaches? What are the causes of secondary headaches? LOW BACK PAIN Learning prompts: What are the 3 categories of low back pain? When is imaging indicated for nonspecific LBP? When do you do an MRI in patients with radiculopathy? When do you refer these patients for surgery? In a patient with sciatica what abnormalities may you find on examination?

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