CFPC Exam (CCFP) cheat sheet

Patient-centred clinical method: explore illness experience (FIFE: feelings, ideas, function, expectations), understand the whole person, find common ground, incorporate prevention/health promotion, enhance the patient-physician relationship, and be realistic about time and resources.

Screening in average-risk adults: colorectal cancer 50-74 (FIT every 2 years or colonoscopy every 10 years); cervical cancer from age 21-25 to 69 with cytology every 3 years or HPV testing every 5 years; breast screening mammography every 2 years from age 50-74 (individualize 40-49).

Periodic health visit priorities by age: 18-34 (BP, weight, STI/immunization, mental health, substance use); 35-49 (lipids every 5 years, diabetes risk with BMI ≥25 plus one risk factor); 50-64 (colorectal, breast, cervical, osteoporosis risk); ≥65 (falls, cognition, incontinence, polypharmacy, advance care planning).

Immunization schedule anchors: Tdap booster every 10 years; influenza annually; shingles (recombinant zoster) at 50; pneumococcal conjugate at 65 (or earlier with risk); RSV vaccine for adults ≥60 (shared decision) and pregnancy 32-36 weeks in season; HPV for ages 9-26.

Cardiovascular risk: use a validated risk calculator (e.g., Framingham/SCORE2-type) before starting statin; statin benefit when 10-year ASCVD risk ≥10% (moderate-intensity) or ≥20% (high-intensity); lifestyle change is first-line for all.

Diabetes screening: HbA1c, fasting glucose, or 2-h OGTT every 3 years for adults ≥40, or earlier with risk factors (BMI ≥25, family history, prior GDM, hypertension, dyslipidemia); HbA1c ≥6.5%, FPG ≥7.0 mmol/L, or 2-h ≥11.1 mmol/L diagnoses diabetes.

Hypertension: office BP ≥140/90 mmHg (or ≥135/85 on home/ambulatory) confirms diagnosis; first-line in non-Black patients without comorbidity is thiazide, ACEi/ARB, or CCB; in Black patients without CKD/diabetes, thiazide or CCB.

Osteoporosis: screen women ≥65 and men ≥70 by DXA; also postmenopausal women 50-64 with risk factors; FRAX-guided; treat with bisphosphonate when T-score ≤-2.5 or fragility fracture.

Sick-day and chronic disease management: apply the 'sick day rules' for ACEi/ARB, diuretics, metformin, and NSAIDs during acute illness with dehydration; structured chronic disease reviews use a planned visit with a problem list, targets, and self-management goals.

ACLS cardiac arrest: high-quality CPR (100-120/min, depth 5-6 cm, full recoil, minimize interruptions); shockable rhythms (VF/pVT) get defibrillation plus epinephrine 1 mg q3-5 min and amiodarone 300 mg after the 3rd shock; non-shockable (PEA/asystole) get epinephrine early.

Anaphylaxis: IM epinephrine 0.3-0.5 mg (1:1000) into the anterolateral thigh, repeat q5-15 min; adjuncts (antihistamine, corticosteroid, fluids) do not replace epinephrine; observe 4-6 h for biphasic reactions.

Acute stroke: activate stroke pathway; non-contrast CT within 20 min of arrival; IV thrombolysis (alteplase/tenecteplase) within 4.5 h if no contraindication; endovascular thrombectomy up to 24 h in selected large-vessel occlusion. Use the NIHSS and door-to-needle <60 min target.

Sepsis: suspect with infection plus ≥2 SIRS criteria; start broad-spectrum antibiotics within 1 h of recognition for septic shock, and within 3 h for sepsis without shock; 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L; measure lactate.

Acute coronary syndrome: 12-lead ECG within 10 min of arrival; aspirin 160-325 mg chewed plus P2Y12 inhibitor; STEMI requires reperfusion (PCI within 90 min of first medical contact or fibrinolysis within 30 min if PCI unavailable).

Trauma primary survey: ABCDE with cervical spine precautions; permissive hypotension in penetrating trauma until hemorrhage control; tranexamic acid within 3 h of injury in major bleeding; massive transfusion protocol 1:1:1 ratio.

Airway: predict difficult airway (LEMON: Look, Evaluate 3-3-2, Mallampati, Obstruction, Neck mobility); rapid sequence intubation with preoxygenation, induction agent, and paralytic; confirm with waveform capnography.

Toxicology: activated charcoal only within 1-2 h and if airway protected; naloxone for opioid overdose (titrate to respiratory effort); N-acetylcysteine for acetaminophen within 8 h of ingestion; sodium bicarbonate for TCA with QRS >100 ms; fomepizole for methanol/ethylene glycol.

Common emergency procedures: needle decompression at 2nd intercostal space midclavicular line (or 4th-5th anterior axillary) for tension pneumothorax; cardioversion for unstable tachyarrhythmia; reduce dislocations with procedural sedation and post-reduction neurovascular check.

Heart failure: diagnose with symptoms plus elevated BNP/NT-proBNP or echocardiographic structural/functional abnormality; HFrEF (EF ≤40%) gets guideline-directed quadruple therapy (ARNI/ACEi/ARB, beta-blocker, MRA, SGLT2 inhibitor), diuretics for congestion.

COPD: post-bronchodilator FEV1/FVC <0.70 confirms airflow obstruction; GOLD groups A/B/E guide therapy; LAMA/LABA for most symptomatic patients; add ICS for frequent exacerbations and eosinophils ≥300; smoking cessation and vaccination are core.

Asthma: variable expiratory airflow limitation; diagnosis supported by ≥12% and ≥200 mL improvement in FEV1 post-bronchodilator; SMART (ICS-formoterol) preferred reliever; do not use LABA monotherapy.

Acute kidney injury: KDIGO criteria (creatinine rise ≥26.5 µmol/L in 48 h, or ≥1.5× baseline in 7 days, or urine output <0.5 mL/kg/h for 6 h); classify prerenal/intrinsic/postrenal; stop nephrotoxins, assess volume, and look for obstruction.

Chronic kidney disease: eGFR <60 or albuminuria ≥3 mg/mmol for ≥3 months; stage by GFR (G1-G5) and albuminuria (A1-A3); ACEi/ARB for albuminuria; SGLT2 inhibitor for CKD with albuminuria or diabetic kidney disease.

Cirrhosis: Child-Pugh and MELD for prognosis; screen with ultrasound ± AFP every 6 months for HCC; variceal screening with endoscopy; lactulose and rifaximin for hepatic encephalopathy; avoid NSAIDs and aminoglycosides.

Thyroid disease: hypothyroidism treated with levothyroxine titrated to TSH; Graves disease managed with antithyroid drugs, radioiodine, or surgery; thyroid storm treated with beta-blocker, thionamide, iodine (after thionamide), and steroids.

Anticoagulation: CHA2DS2-VASc guides stroke prophylaxis in atrial fibrillation (anticoagulate if ≥2 in men, ≥3 in women); HAS-BLED estimates bleeding risk; DOACs preferred over warfarin in non-valvular AF.

Community-acquired pneumonia: use CURB-65 (confusion, urea >7 mmol/L, RR ≥30, BP low, age ≥65) to decide site of care; amoxicillin or doxycycline for outpatients; beta-lactam plus macrolide or respiratory fluoroquinolone for admitted patients.

Growth monitoring: plot weight, length/height, and head circumference on WHO/CDC charts; crossing two major percentile lines or weight <3rd percentile warrants evaluation; double birth weight by 4-5 months and triple by 12 months.

Developmental milestones: social smile 6 weeks; head control 3-4 months; sits unsupported 6-8 months; pincer grasp 9-12 months; walks 12-18 months; two-word phrases 18-24 months; stranger anxiety 6-9 months.

Fever in infants: <28 days with fever ≥38.0°C needs full sepsis workup and admission; 28-90 days uses risk stratification (urinalysis, blood, CSF) and may be observed or treated; antipyretics for comfort, not to prevent febrile seizures.

Immunization: 2, 4, 6, 12, 18 months and 4-6 years per provincial schedule; MMR at 12 months and 18 months or 4-6 years; varicella at 12-15 months; HPV at 9-13; meningococcal and pneumococcal conjugate in infancy.

Dehydration and gastroenteritis: use the Clinical Dehydration Scale; oral rehydration solution 50-100 mL/kg over 3-4 h for mild-moderate dehydration; continue breastfeeding; ondansetron can reduce vomiting; avoid routine antibiotics.

Bronchiolitis: most common in infants <2 years; RSV is the leading cause; supportive care (oxygen if SpO2 <90-92%, hydration, suction); no routine bronchodilators, steroids, or antibiotics.

Kawasaki disease: fever ≥5 days plus ≥4 of conjunctivitis, oral changes, rash, extremity changes, cervical lymphadenopathy; IVIG plus aspirin to prevent coronary aneurysms; echocardiography at diagnosis and follow-up.

Asthma in children: diagnosis supported by spirometry and bronchodilator response; controller ICS for persistent symptoms; spacer with mask for young children; written action plan and trigger avoidance.

Common infections: acute otitis media - watchful waiting for ≥6 months with mild symptoms; antibiotics (amoxicillin) for <6 months, severe symptoms, or bilateral infection; group A strep pharyngitis treated with penicillin/amoxicillin to prevent rheumatic fever.

Prenatal care schedule: first visit by 10 weeks; visits every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, then weekly; routine labs include CBC, blood group and antibody screen, rubella immunity, hepatitis B, HIV, syphilis, and urinalysis.

Gestational diabetes screening: 50 g glucose challenge at 24-28 weeks (threshold ~7.8 mmol/L) followed by 75 g OGTT; screen earlier with risk factors (obesity, prior GDM, PCOS, family history).

Hypertensive disorders of pregnancy: preeclampsia is new hypertension after 20 weeks plus proteinuria or end-organ dysfunction; severe features (BP ≥160/110, platelets <100, elevated liver enzymes, renal insufficiency, pulmonary edema, visual/cerebral symptoms) require magnesium sulfate and delivery.

Postpartum hemorrhage: most common cause is uterine atony; manage with uterine massage, oxytocin, then second-line uterotonics (carboprost, misoprostol, tranexamic acid); quantify blood loss and activate massive transfusion if needed.

Contraception: combined hormonal contraceptives contraindicated with migraine with aura, smoking ≥35 years, hypertension, VTE history, and breastfeeding <6 weeks; LARC (IUD, implant) is first-line for most patients.

Cervical cancer screening and HPV: screening from age 21-25 to 69; HPV testing every 5 years or cytology every 3 years; colposcopy for abnormal results; HPV vaccination for ages 9-26 (up to 45 by shared decision).

Menopause: diagnosis is clinical (12 months of amenorrhea); hormone therapy is the most effective treatment for vasomotor symptoms; use lowest effective dose for shortest duration; contraindicated with breast cancer, VTE, or active liver disease.

Ectopic pregnancy: suspect with abdominal pain, amenorrhea, and positive hCG; transvaginal ultrasound and serial hCG; methotrexate for stable, unruptured cases meeting criteria; surgery for rupture or hemodynamic instability.

Labour and delivery: assess with partograph; active phase starts at 6 cm dilation; fetal heart monitoring and maternal vital signs; oxytocin for augmentation with caution; postpartum check within 6 weeks.

Major depressive disorder: ≥5 symptoms for ≥2 weeks including depressed mood or anhedonia; screen with PHQ-9; first-line treatment is psychotherapy (CBT/IPT) or SSRI; assess suicide risk at every visit.

Bipolar disorder: mania requires elevated/irritable mood plus increased energy for ≥1 week with ≥3 symptoms (grandiosity, decreased sleep, pressured speech, flight of ideas, distractibility, increased goal-directed activity, risky behaviour); treat acute mania with mood stabilizer (lithium, valproate) ± antipsychotic; avoid antidepressants alone.

Schizophrenia: ≥2 core symptoms (delusions, hallucinations, disorganized speech, grossly disorganized behaviour, negative symptoms) for ≥6 months with functional decline; antipsychotics are first-line; monitor metabolic side effects (weight, glucose, lipids).

Anxiety disorders: generalized anxiety disorder requires excessive worry ≥6 months with ≥3 symptoms; first-line CBT and SSRIs/SNRIs; benzodiazepines only short-term. Panic disorder: recurrent unexpected attacks plus ≥1 month of worry or behaviour change.

Substance use: screen with AUDIT-C or CAGE; brief intervention (FRAMES) and motivational interviewing; alcohol withdrawal treated with benzodiazepines and thiamine; opioid use disorder treated with buprenorphine or methadone.

Suicide risk assessment: ask directly about ideation, plan, intent, means, and protective factors; high risk (plan, intent, means, prior attempt) warrants urgent psychiatric referral or emergency assessment; safety planning and means restriction.

Delirium versus dementia: delirium is acute, fluctuating, with inattention and altered consciousness; dementia is chronic progressive cognitive decline; use the Confusion Assessment Method (CAM) for delirium; investigate reversible causes.

Perinatal psychiatry: Edinburgh Postnatal Depression Scale for screening; postpartum psychosis is a psychiatric emergency (risk of infanticide) requiring admission; SSRIs are generally compatible with breastfeeding (sertraline preferred).

Psychotropic monitoring: lithium requires levels, renal and thyroid function, and ECG; clozapine requires regular WBC/ANC monitoring for agranulocytosis; SSRIs carry serotonin syndrome and discontinuation syndrome risks; antipsychotics require metabolic monitoring.

Patient-centred clinical method: explore illness experience (FIFE: feelings, ideas, function, expectations), understand the whole person, find common ground, incorporate prevention/health promotion, enhance the patient-physician relationship, and be realistic about time and resources.

Screening in average-risk adults: colorectal cancer 50-74 (FIT every 2 years or colonoscopy every 10 years); cervical cancer from age 21-25 to 69 with cytology every 3 years or HPV testing every 5 years; breast screening mammography every 2 years from age 50-74 (individualize 40-49).

Periodic health visit priorities by age: 18-34 (BP, weight, STI/immunization, mental health, substance use); 35-49 (lipids every 5 years, diabetes risk with BMI ≥25 plus one risk factor); 50-64 (colorectal, breast, cervical, osteoporosis risk); ≥65 (falls, cognition, incontinence, polypharmacy, advance care planning).

Immunization schedule anchors: Tdap booster every 10 years; influenza annually; shingles (recombinant zoster) at 50; pneumococcal conjugate at 65 (or earlier with risk); RSV vaccine for adults ≥60 (shared decision) and pregnancy 32-36 weeks in season; HPV for ages 9-26.

Cardiovascular risk: use a validated risk calculator (e.g., Framingham/SCORE2-type) before starting statin; statin benefit when 10-year ASCVD risk ≥10% (moderate-intensity) or ≥20% (high-intensity); lifestyle change is first-line for all.

Diabetes screening: HbA1c, fasting glucose, or 2-h OGTT every 3 years for adults ≥40, or earlier with risk factors (BMI ≥25, family history, prior GDM, hypertension, dyslipidemia); HbA1c ≥6.5%, FPG ≥7.0 mmol/L, or 2-h ≥11.1 mmol/L diagnoses diabetes.

Hypertension: office BP ≥140/90 mmHg (or ≥135/85 on home/ambulatory) confirms diagnosis; first-line in non-Black patients without comorbidity is thiazide, ACEi/ARB, or CCB; in Black patients without CKD/diabetes, thiazide or CCB.

Osteoporosis: screen women ≥65 and men ≥70 by DXA; also postmenopausal women 50-64 with risk factors; FRAX-guided; treat with bisphosphonate when T-score ≤-2.5 or fragility fracture.

Sick-day and chronic disease management: apply the 'sick day rules' for ACEi/ARB, diuretics, metformin, and NSAIDs during acute illness with dehydration; structured chronic disease reviews use a planned visit with a problem list, targets, and self-management goals.

ACLS cardiac arrest: high-quality CPR (100-120/min, depth 5-6 cm, full recoil, minimize interruptions); shockable rhythms (VF/pVT) get defibrillation plus epinephrine 1 mg q3-5 min and amiodarone 300 mg after the 3rd shock; non-shockable (PEA/asystole) get epinephrine early.

Anaphylaxis: IM epinephrine 0.3-0.5 mg (1:1000) into the anterolateral thigh, repeat q5-15 min; adjuncts (antihistamine, corticosteroid, fluids) do not replace epinephrine; observe 4-6 h for biphasic reactions.

Acute stroke: activate stroke pathway; non-contrast CT within 20 min of arrival; IV thrombolysis (alteplase/tenecteplase) within 4.5 h if no contraindication; endovascular thrombectomy up to 24 h in selected large-vessel occlusion. Use the NIHSS and door-to-needle <60 min target.

Sepsis: suspect with infection plus ≥2 SIRS criteria; start broad-spectrum antibiotics within 1 h of recognition for septic shock, and within 3 h for sepsis without shock; 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L; measure lactate.

Acute coronary syndrome: 12-lead ECG within 10 min of arrival; aspirin 160-325 mg chewed plus P2Y12 inhibitor; STEMI requires reperfusion (PCI within 90 min of first medical contact or fibrinolysis within 30 min if PCI unavailable).

Trauma primary survey: ABCDE with cervical spine precautions; permissive hypotension in penetrating trauma until hemorrhage control; tranexamic acid within 3 h of injury in major bleeding; massive transfusion protocol 1:1:1 ratio.

Airway: predict difficult airway (LEMON: Look, Evaluate 3-3-2, Mallampati, Obstruction, Neck mobility); rapid sequence intubation with preoxygenation, induction agent, and paralytic; confirm with waveform capnography.

Toxicology: activated charcoal only within 1-2 h and if airway protected; naloxone for opioid overdose (titrate to respiratory effort); N-acetylcysteine for acetaminophen within 8 h of ingestion; sodium bicarbonate for TCA with QRS >100 ms; fomepizole for methanol/ethylene glycol.

Common emergency procedures: needle decompression at 2nd intercostal space midclavicular line (or 4th-5th anterior axillary) for tension pneumothorax; cardioversion for unstable tachyarrhythmia; reduce dislocations with procedural sedation and post-reduction neurovascular check.

Heart failure: diagnose with symptoms plus elevated BNP/NT-proBNP or echocardiographic structural/functional abnormality; HFrEF (EF ≤40%) gets guideline-directed quadruple therapy (ARNI/ACEi/ARB, beta-blocker, MRA, SGLT2 inhibitor), diuretics for congestion.

COPD: post-bronchodilator FEV1/FVC <0.70 confirms airflow obstruction; GOLD groups A/B/E guide therapy; LAMA/LABA for most symptomatic patients; add ICS for frequent exacerbations and eosinophils ≥300; smoking cessation and vaccination are core.

Asthma: variable expiratory airflow limitation; diagnosis supported by ≥12% and ≥200 mL improvement in FEV1 post-bronchodilator; SMART (ICS-formoterol) preferred reliever; do not use LABA monotherapy.

Acute kidney injury: KDIGO criteria (creatinine rise ≥26.5 µmol/L in 48 h, or ≥1.5× baseline in 7 days, or urine output <0.5 mL/kg/h for 6 h); classify prerenal/intrinsic/postrenal; stop nephrotoxins, assess volume, and look for obstruction.

Chronic kidney disease: eGFR <60 or albuminuria ≥3 mg/mmol for ≥3 months; stage by GFR (G1-G5) and albuminuria (A1-A3); ACEi/ARB for albuminuria; SGLT2 inhibitor for CKD with albuminuria or diabetic kidney disease.

Cirrhosis: Child-Pugh and MELD for prognosis; screen with ultrasound ± AFP every 6 months for HCC; variceal screening with endoscopy; lactulose and rifaximin for hepatic encephalopathy; avoid NSAIDs and aminoglycosides.

Thyroid disease: hypothyroidism treated with levothyroxine titrated to TSH; Graves disease managed with antithyroid drugs, radioiodine, or surgery; thyroid storm treated with beta-blocker, thionamide, iodine (after thionamide), and steroids.

Anticoagulation: CHA2DS2-VASc guides stroke prophylaxis in atrial fibrillation (anticoagulate if ≥2 in men, ≥3 in women); HAS-BLED estimates bleeding risk; DOACs preferred over warfarin in non-valvular AF.

Community-acquired pneumonia: use CURB-65 (confusion, urea >7 mmol/L, RR ≥30, BP low, age ≥65) to decide site of care; amoxicillin or doxycycline for outpatients; beta-lactam plus macrolide or respiratory fluoroquinolone for admitted patients.

Growth monitoring: plot weight, length/height, and head circumference on WHO/CDC charts; crossing two major percentile lines or weight <3rd percentile warrants evaluation; double birth weight by 4-5 months and triple by 12 months.

Developmental milestones: social smile 6 weeks; head control 3-4 months; sits unsupported 6-8 months; pincer grasp 9-12 months; walks 12-18 months; two-word phrases 18-24 months; stranger anxiety 6-9 months.

Fever in infants: <28 days with fever ≥38.0°C needs full sepsis workup and admission; 28-90 days uses risk stratification (urinalysis, blood, CSF) and may be observed or treated; antipyretics for comfort, not to prevent febrile seizures.

Immunization: 2, 4, 6, 12, 18 months and 4-6 years per provincial schedule; MMR at 12 months and 18 months or 4-6 years; varicella at 12-15 months; HPV at 9-13; meningococcal and pneumococcal conjugate in infancy.

Dehydration and gastroenteritis: use the Clinical Dehydration Scale; oral rehydration solution 50-100 mL/kg over 3-4 h for mild-moderate dehydration; continue breastfeeding; ondansetron can reduce vomiting; avoid routine antibiotics.

Bronchiolitis: most common in infants <2 years; RSV is the leading cause; supportive care (oxygen if SpO2 <90-92%, hydration, suction); no routine bronchodilators, steroids, or antibiotics.

Kawasaki disease: fever ≥5 days plus ≥4 of conjunctivitis, oral changes, rash, extremity changes, cervical lymphadenopathy; IVIG plus aspirin to prevent coronary aneurysms; echocardiography at diagnosis and follow-up.

Asthma in children: diagnosis supported by spirometry and bronchodilator response; controller ICS for persistent symptoms; spacer with mask for young children; written action plan and trigger avoidance.

Common infections: acute otitis media - watchful waiting for ≥6 months with mild symptoms; antibiotics (amoxicillin) for <6 months, severe symptoms, or bilateral infection; group A strep pharyngitis treated with penicillin/amoxicillin to prevent rheumatic fever.

Prenatal care schedule: first visit by 10 weeks; visits every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, then weekly; routine labs include CBC, blood group and antibody screen, rubella immunity, hepatitis B, HIV, syphilis, and urinalysis.

Gestational diabetes screening: 50 g glucose challenge at 24-28 weeks (threshold ~7.8 mmol/L) followed by 75 g OGTT; screen earlier with risk factors (obesity, prior GDM, PCOS, family history).

Hypertensive disorders of pregnancy: preeclampsia is new hypertension after 20 weeks plus proteinuria or end-organ dysfunction; severe features (BP ≥160/110, platelets <100, elevated liver enzymes, renal insufficiency, pulmonary edema, visual/cerebral symptoms) require magnesium sulfate and delivery.

Postpartum hemorrhage: most common cause is uterine atony; manage with uterine massage, oxytocin, then second-line uterotonics (carboprost, misoprostol, tranexamic acid); quantify blood loss and activate massive transfusion if needed.

Contraception: combined hormonal contraceptives contraindicated with migraine with aura, smoking ≥35 years, hypertension, VTE history, and breastfeeding <6 weeks; LARC (IUD, implant) is first-line for most patients.

Cervical cancer screening and HPV: screening from age 21-25 to 69; HPV testing every 5 years or cytology every 3 years; colposcopy for abnormal results; HPV vaccination for ages 9-26 (up to 45 by shared decision).

Menopause: diagnosis is clinical (12 months of amenorrhea); hormone therapy is the most effective treatment for vasomotor symptoms; use lowest effective dose for shortest duration; contraindicated with breast cancer, VTE, or active liver disease.

Ectopic pregnancy: suspect with abdominal pain, amenorrhea, and positive hCG; transvaginal ultrasound and serial hCG; methotrexate for stable, unruptured cases meeting criteria; surgery for rupture or hemodynamic instability.

Labour and delivery: assess with partograph; active phase starts at 6 cm dilation; fetal heart monitoring and maternal vital signs; oxytocin for augmentation with caution; postpartum check within 6 weeks.

Major depressive disorder: ≥5 symptoms for ≥2 weeks including depressed mood or anhedonia; screen with PHQ-9; first-line treatment is psychotherapy (CBT/IPT) or SSRI; assess suicide risk at every visit.

Bipolar disorder: mania requires elevated/irritable mood plus increased energy for ≥1 week with ≥3 symptoms (grandiosity, decreased sleep, pressured speech, flight of ideas, distractibility, increased goal-directed activity, risky behaviour); treat acute mania with mood stabilizer (lithium, valproate) ± antipsychotic; avoid antidepressants alone.

Schizophrenia: ≥2 core symptoms (delusions, hallucinations, disorganized speech, grossly disorganized behaviour, negative symptoms) for ≥6 months with functional decline; antipsychotics are first-line; monitor metabolic side effects (weight, glucose, lipids).

Anxiety disorders: generalized anxiety disorder requires excessive worry ≥6 months with ≥3 symptoms; first-line CBT and SSRIs/SNRIs; benzodiazepines only short-term. Panic disorder: recurrent unexpected attacks plus ≥1 month of worry or behaviour change.

Substance use: screen with AUDIT-C or CAGE; brief intervention (FRAMES) and motivational interviewing; alcohol withdrawal treated with benzodiazepines and thiamine; opioid use disorder treated with buprenorphine or methadone.

Suicide risk assessment: ask directly about ideation, plan, intent, means, and protective factors; high risk (plan, intent, means, prior attempt) warrants urgent psychiatric referral or emergency assessment; safety planning and means restriction.

Delirium versus dementia: delirium is acute, fluctuating, with inattention and altered consciousness; dementia is chronic progressive cognitive decline; use the Confusion Assessment Method (CAM) for delirium; investigate reversible causes.

Perinatal psychiatry: Edinburgh Postnatal Depression Scale for screening; postpartum psychosis is a psychiatric emergency (risk of infanticide) requiring admission; SSRIs are generally compatible with breastfeeding (sertraline preferred).

Psychotropic monitoring: lithium requires levels, renal and thyroid function, and ECG; clozapine requires regular WBC/ANC monitoring for agranulocytosis; SSRIs carry serotonin syndrome and discontinuation syndrome risks; antipsychotics require metabolic monitoring.