MAFP/icFRACGP Part 1 flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Calgary-Cambridge model

A structured consultation framework with initiating the session, gathering information, physical examination, explanation and planning, and closing the session, plus building rapport and structuring throughout.

SPIKES protocol

Six steps for breaking bad news: Setting, Perception, Invitation, Knowledge, Empathy, and Strategy or summary. The Invitation step establishes how much the patient wants to know.

Motivational interviewing OARS

Core skills of open questions, affirmations, reflections and summaries. The clinician elicits change talk rather than arguing for change, and suppresses the righting reflex.

Number needed to treat

The reciprocal of the absolute risk reduction: NNT = 1/(control event rate minus intervention event rate). It estimates how many patients need treatment for one additional benefit.

Positive likelihood ratio

Sensitivity divided by (1 minus specificity). A value above 10 strongly supports the diagnosis, while a value below 0.1 strongly argues against it.

Positive predictive value

The proportion of people with a positive test who truly have the disease. Unlike sensitivity and specificity, it changes with disease prevalence in the population tested.

Anion gap formula

Sodium minus (chloride plus bicarbonate), normally about 8 to 12 mmol/L. A raised gap suggests ketoacidosis, lactic acidosis, renal failure or toxin ingestion.

Corrected calcium formula

Corrected calcium in mg/dL equals measured calcium plus 0.8 times (4.0 minus albumin in g/dL). Ionised calcium is unaffected by albumin and is measured directly when available.

Wilson-Jungner criteria

Criteria for justified screening: an important condition, accepted treatment, adequate test, detectable latent stage, agreed policy, cost-effectiveness, and continuous case-finding rather than one-off testing.

Lead-time bias

Screening advances diagnosis without changing the time of death, so measured survival appears longer even when the disease course is unaltered. This can falsely suggest screening benefit.

Herd immunity threshold

The proportion immune needed to interrupt transmission, equal to 1 minus 1/R0. Measles has a very high R0, so coverage above about 90 to 95 percent is needed.

Incidence versus prevalence

Incidence counts new cases per population at risk per unit time. Prevalence counts all existing cases at a point or period, and rises when survival lengthens.

Four ethical principles

Autonomy, beneficence, non-maleficence and justice. When a competent adult refuses treatment, autonomy generally takes precedence over the clinician's view of benefit.

Gillick competence

A legal and ethical test of whether a minor has sufficient understanding and intelligence to consent to a specific treatment. It is decision-specific, not a blanket age threshold.

Duty of candour

An obligation to tell a patient honestly when a harmful incident has occurred, explain what happened, and apologise. An apology is generally not an admission of legal liability.

Capacity assessment four elements

The patient must be able to understand the decision, retain the information, weigh it in the balance, and communicate a choice. Capacity is specific to the decision and time.

Conditional driving licence

A licence granted with restrictions, such as automatic transmission only, daytime driving only, or periodic medical review. It differs from an unconditional licence and from revocation.

Record retention after death

Records are generally kept for a defined period after the patient's last contact or death, set by local law. Retention periods for minors run from when they reach adulthood.

Migraine with aura and COC

Combined hormonal contraception is contraindicated in migraine with aura because of increased ischaemic stroke risk. Progestogen-only methods are generally preferred in this situation.

Emergency contraception options

Levonorgestrel works up to 72 hours but less well near ovulation; ulipristal acetate up to 120 hours; a copper intrauterine device is the most effective and can be inserted up to 5 days.

Menopause diagnosis

Menopause is diagnosed clinically after 12 months of amenorrhoea in a woman over 45. Follicle-stimulating hormone testing is not required in that age group.

Primary postpartum haemorrhage

Blood loss of 500 mL or more within 24 hours of birth. Uterine atony is the commonest cause; treatment is uterine massage, uterotonics and resuscitation.

Paediatric emergency weight formula

For children aged 1 to 10 years, estimated weight in kilograms equals (age in years plus 4) multiplied by 2. This is used for emergency drug and fluid dosing.

Croup management

Give a single dose of oral dexamethasone. Add nebulised adrenaline for moderate to severe stridor, then observe for at least a few hours because stridor can rebound.

Kawasaki disease criteria

Fever for at least 5 days plus 4 of 5 features: rash, conjunctivitis, oral mucosal changes, extremity changes and cervical lymphadenopathy. IVIG and aspirin reduce coronary risk.

Febrile convulsion features

Typically occurs between 6 months and 5 years, is generalised, lasts under 15 minutes and does not recur within 24 hours. Most children need no investigation.

Serotonin syndrome features

Agitation, clonus, hyperreflexia and hyperthermia caused by serotonergic drug combinations. It is a clinical diagnosis and requires stopping the offending agents and supportive care.

SSRI onset of action

Antidepressant benefit usually takes 2 to 4 weeks to appear. Early review at 1 to 2 weeks checks for adverse effects and suicidality, particularly in young people.

Delirium versus dementia

Delirium has acute onset, a fluctuating course and impaired attention. Dementia is chronic and progressive. Delirium superimposed on dementia is common and often missed.

WHO analgesic ladder

A three-step approach for cancer pain: non-opioid, then weak opioid, then strong opioid, with adjuvants at any step. Regular opioid use requires prophylactic laxatives.

Advance directive validity

It must be made voluntarily by a competent adult who is informed, and it must apply to the current clinical situation. An outdated directive may not apply and should be reviewed.

Clinical Frailty Scale

A judgement-based scale from very fit to terminally ill that predicts outcomes such as hospitalisation and mortality. Frailty is distinct from chronological age.