Last Minute study points

Read the SAMP instructions & do the practice exam (get to know the interface)

Four Principles of Family Medicine
  1. The family physician is a skilled clinician.
  2. Family medicine is a community-based discipline.
  3. The family physician is a resource to a defined practice population.
  4. The patient-physician relationship is central to the role of the family physician.

Canadian CT head Rule – Minor Head injury pt
  • Not for <16yo, GCS <13, non-trauma, coumadin / bleeding disorder, or obvious open skull #
  • High risk – neurological intervention
    • GCS <15 2hours after injury
    • Suspected open or depressed skull #
    • Sign of basal skull fracture
      • Hemotympanum, racoon eyes, Battle’s sign
      • CSF otorrhea/rhinorrhea
    • Vomiting >=2
    • Age >=65
  • Medium risk – CT
    • Retrograde Amnesia >=30min
    • Dangerous Mechanism
      • Pedestrian struck by vehicle
      • Occupant ejected from vehicle
      • Fall >=3 ft or 5 stairs

The Ottawa SAH (Subarachnoid hemorrhage) Rule
  • For alert patients older than 15 y with new severe nontraumatic headache reaching maximum intensity within 1 h
  • Not for patients with new neurologic deficits, previous aneurysms, SAH, brain tumors, or history of recurrent headaches (≥3 episodes over the course of ≥6 mo)
  • Investigate if ≥1 high-risk variables present:
    1. Age ≥40 y
    2. Neck pain or stiffness
    3. Witnessed loss of consciousness
    4. Onset during exertion
    5. Thunderclap headache (instantly peaking pain)
    6. Limited neck flexion on examination

Canadian C-Spine rules (see neck pain post)
  • Stable, Age >16, non-pregnant, GCS15, non-penetrating injury <48hr, no vertebral dz
  • X-ray if
    • Age >65
    • Dangerous mechanism: Fall >3ft / 5 stairs, axial load, MCV >100km/h, motorized recreation vehicle / bicycle struck
    • Paresthesia in extremities
  • Low risk factors for assessment of ROM
    • sitting position in ER
    • ambulatory at any time
    • Simple rearend MVA: except pushed into traffic, hit by bus, rollover, hit by high speed vehicle
    • Delayed onset of pain
    • No Midline C-spine tenderness
    • Rotate Neck 45 degree L and R 
      • X-ray if Can’t rotate neck 45 degree

Ottawa Knee rules – X-ray if
  • Age >55
  • Isolated patellar tenderness
  • Tenderness of head of fibula
  • Inability to flex 90 degree
  • Inability to wt bear (4 steps) immediately AND in ER

Ottawa Ankle Rules – Not for pt <18yo
  • Ankle X-ray if Pain in malleolar zone &
    • Bone tenderness on posterior 6cm of lateral or medial malleolus
    • Inability to wt bear (4 steps) both immediately and in ER
  • Foot X-ray if Pain in midfoot zone &
    • Bone tenderness at base of 5th metatarsal
    • Bone tenderness at navicular bone
    • Inability to wt bear both immediately and in ER

Statistics:
  • Sensitivity = True positive / condition positive
  • Specificity = True negative / condition negative
  • Positive Predictive value = True positive / (true positive + False positive)
  • Negative Predictive value = True Negative / (true negative + False negative)
  • Positive likelihood ratio = sensitivity / (1-specificity)
  • Negative likelihood ratio = (1-sensitivity) / specificity
Events Non-events
Experimental group (exposed) A B
Control Group (not exposed) C D
  • Control event rate (CER) = C / (C+D)
  • Experimental event rate (EER) = A / (A+B)
  • Relative Risk = EER / CER
  • Absolute risk Reduction (ARR) = CER – EER
  • Relative Risk Reduction (RRR) = (CER – EER) / CER
  • Number need to treat (NNT) 1 / ARR

References:
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CCFP ExamApril 30th, 2015
The big day is here.
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