Family Medicine Notes PDF

☑ Introduction to family medicine ✔ General practice/Family medicine : is an academic and scientific discipline, with its own educational content, research, evidence based and clinical activity. ✔ Family doctor : is needed to translate this ⬆ academic definition into the reality of the specialist....

☑ Introduction to family medicine ✔ General practice/Family medicine : is an academic and scientific discipline, with its own educational content, research, evidence based and clinical activity. ✔ Family doctor : is needed to translate this ⬆ academic definition into the reality of the specialist. ✔ Primary health care : It is the first contact care ✔ Secondary health care : - Patient referred to it for specific expert care - Support provided by doctors & other health professionals - Provided in hospitals or clinics ✔ Tertiary health care : - Highly specialised medical care - Involves advanced and complex diagnostics, procedures and treatment - Performed by specialists in state-of-the-art facilities. ☑ Child health maintenance (‫ خي ًرا ()نوتس الشابتر ده‬1‫ول جزاهم ا‬8‫)من زمايلنا الراوند ا‬ ▪ Counseling : ✔ Sun exposure & vit D3 5-30 min (10pm-3pm) at least twice a week [without sun screen] ✔ Being active for at least 60 minutes per day, consistent screen media limits and obtaining adequate sleep Stages of growth and development. ▪ prenatal 1. Embryonic period (first 2 week) 2. Fetal period (9-40 weeks) ▪ Postnatal 1. Neonatal period (first 28 days) 2. Infant (till 2 years) 3. Early childhood (2-6 years) 4. Late childhood (6-10 years) 5. Adolescence (10-19 years) ▪ Routine Visit schedules are set according to age groups: 1. Neonate: within 1-2 Weeks of birth 2. Infant: at 2, 4, 6, 9, and 12 months 3. Toddler: at 15, and 18 months; 2 and 3 years old 4. Preschool: annual visits beginning at 3 years old 5. Primary school age: annual visits 5 through 10 years old Middle school age: annual visits 10 through 13 years old 6. Middle and late adolescent period: annual visits 13 through 19 years old ▪ Growth monitoring ✔ Posterior Fontanelle: Usually, cannot be palpated after two months of age ✔ Anterior Fontanelle: Generally, closes between 10 - 24 months of age, the fontanelles of premature infants tend to close later. ▪ Minimal weight gain : - (30 g/day) through 3 months - (20 g/day) through 3-6 months - (10 g/day) through 6-12 months ✔ Infants focus on a face by age 1 month ✔ Move their eyes consistently and symmetrically by age 6 months. ✔ Occasional strabismus until 3 months of age. (After this should be managed ) ✔ 3 years of age (visual acuity & cover/uncover test ) & Refer child at 3 years of age for standardized audiometric testing. ✔ CBC at age 9 month & repeated at 2-3 year ✔ AAP ( start elemental iron supplement 4 month until appropriate iron containing food ✔ Oral fluoride start at 6 month ✔ Infants who are exclusively breastfeed or receive less than 1 liter of formula daily should be supplemented with 400 IU of vitamin D daily, starting in the first few days of life and continuing until they are 12 months of age. 1. 12 months 400 IU (10 mcg)/day 2. 13 years 600 TU (15 mcg)/day ✔ Water heaters should be set to a maximum of 49°C to prevent scald burns. ✔ Infants should never have a bottle in bed, and babies should be weaned to a cup by 12 months of age. And Juices should be avoided in infants younger than 12 months. ✔ Digital media should be avoided in children younger than 18 months ✔ Parents and caregivers may use educational programs and applications with children 18 to 24 months. ✔ Children 2-5 of age, max. 1 hour per day of screen time. ✔ Infant sleep on their backs on a firm mattress ✔ Exclusive breastfeeding until six month ✔ Trans to solid food before 6 months (with high fatty & sugary food & increase risk atopic disease ✔ Cessation of breastfeeding before six months and introducing solid foods before six months is associated with childhood obesity and is not recommended. ✔ Avoided before 1 year of age ,if given to older children (100% only fruit) ✔ Intake of other sugar-sweetened beverages should be discouraged. ✔ Children should participate in at least 60 minutes of active free play per day. ☑ Adolescents health maintenance ▪ The adolescent interview : ✔ The physician should limit the yes/no and other types of closed ended questions ✔ Adolescents should take an increasingly active role in their own health care. ✔ Important information to obtain from teenager centres around the teenager’s interaction with his/her environment and social world. ▪ Screening in adolescents : ✔ Screening for primary hypertension ✔ Screening for iron deficiency anemia ✔ Screening for hepatitis B virus infection ✔ Screening for obesity : - Overweight : age & gender-specific BMI at >= 85-94th percentile - Obesity : age & gender specific BMI at > 95th percentile ✔ Screening for depression by PHQ2 and confirm by PHQ9 ▪ Counselling : ✔ To reduce risk of Motor vehicle crashes ✔ To reduce risk of Tobacco use ▪ Immunization : ▪ General health guidance : ✔ All married adolescents planning for pregnancy should take a daily (0.4 to 0.8 mg folic acid at least month before conception & continue daily supplement through the first 2 to 3 month of pregnancy. ✔ Physical activities : ‣ At least 60 minutes per day of moderate to vigorous physical activity ☑ Adult health maintenance ✔ Ca+2 to adult women to reduce the risk of osteoporosis and bone fracture. Daily 1,000 ot 1,200 mg. The adverse effect of carbonated drinks with phosphorus on calcium and bone growth should also be discussed. ▪ Physical activities : A. Low to moderate level aerobic activity Frequency: Daily Duration: 30 minutes or more of cumulative activity, may split into three ten-minute activities daily Example: walking, using stairs instead of elevator B. Moderate to vigorous aerobic activity Frequency: 3-5 times per week Duration: >20-30 minutes moderate intensity Example: footbal, biking, swimming, and running ▪ Screening in adults : ✔ Screening for depression by PHQ2 and confirm by PHQ9 ✔ All women of childbearing age should be screened for domestic violence ✔ Calculating global CHD risk every 5 years for all adults over age 40 years or those with 2 or more risk factors, in order to consider risk modification. ✔ USPSTF recommends low-dose aspirin use for the primary prevention (CVD) in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing ot take low-dose aspirin daily for at least 10 years ✔ Screening for tobacco use (All adults) ✔ Screening for obesity (at each visit) : Calculating BMI ➡ * BMI between 25-30 ➡ Overweight * BMI of 30 or greater ➡ Obese ✔ Screening for hypertension at every visit and at least once every 2 years ✔ Screening for lipid disorders * Men starting from age 35y * Women starting from age 45y ✔ Screening for diabetes : all asymptomatic adults at age 35 years ✔ & Screening for cancer : & ☑ Geriatric health assessment & maintenance ▪ Functional Domain : ✔ Basic activities of daily living (BADLs) * Feeding * Bathing Dressing * Toileting * Continence * Transfer ✔ Instrumental activities of daily living (IADLs) * Preparing food * Taking medications * Managing money * Shopping * Using telephone * Transportation ▪ Medical Domain : ✔ Weight loss ➡ Weight loss in past 3 months >2 kg ✔ Screening for Fall ➡ Timed get up and go test * < 20 seconds = Independent * > 30 seconds = High risk ✔ Screening of hearing impairment * Questions about hearing difficulties * Inspect ear for impacted cerumen * Whisper Voice, finger test * Audioscopy ✔ Screening for visual impairment * Questions about visual difficulties * Snellen Chart to screen visual deficits ✔ Screening for Incontinence : 2 Qs * In the past year, have you ever lost urine and getten wet ? * Have you lost your urine on at least 6 separate days ? ✔ Screening of poly-pharmacy at least annually ▪ Cognitive Domain ✔ Depression screening by PHQ2 +—> Geriatric depression scale (reliablr for diagnosis of depression in elderly) ✔ Dementia screening : * Mini cog test (clock drow + theee-item recall) * When patients fail either of these screening tests , further testing with flostein mini- mental state questionnaires should be performed. ▪ Social Domain : ✔ Availability of help in case of emergency ✔ Availability of a personal support system ✔ Living arrangement ✔ Relationship with (Friends, family & neighbours) ✔ Social activities, hobbies ✔ Need for a caregiver ✔ Economic status ✔ Elder mistreatment * Vaccinations (influenza-tetanus-diphtheria every 10 years) * Osteoporosis : DEXA for women of 65 years and older and those younger than 65 years with risk for fractures as * Ca carbonate & vit D reduce risk osteoporosis  ☑ Immunization & Travelling ✔ Pre traveling evaluation : - Fruits are safe only when peeled - Vegetables need to be fully cooked - Avoid ice cubes - Water is save only after it has been boiled - Use at least 20% DEET on clothing and exposed skin - Treat clothing and bed netting with permethrin - Take with you adequate supplies of regularly used medications - Medications should be stored in carry-on luggage - Avoid swimming in fresh water in areas where schistomiasis is prevalent - Avoid walking barefoot or in loose-fitting footwear on beaches, soil or water - Avoid outdoor exposure during mosquito feeding time ▶ Traveling during pregnancy : ✔ Most airlines allow women to fly up to 37 weeks of pregnancy ▶ Traveler diaarhea : ✔ 85% are caused by bacterial pathogens most common of which is $ Enterotoxigenic E.Coli ( ETEC ) ☑ Fatigue ▶ Classification : ✔ Acute Fatigue ➡ Within 1 month ✔ Prolonged Fatigue ➡ Lasting 1-6 months ✔ Chronic Fatigue ➡ Lasting > 6 months ✔ Chronic Fatigue Syndrome ⬇ ☑ Acute Abdomen ▶ Sever abdominal pain lasting