- Dr. Emma Galloway MD CCFP
EXAM STUDY TIP
Approaches will save your bacon. Mnemonics can be great, but they’re not always easy to remember. Is pancreatitis PANCREATITIS? Or MUDPILES? Or Some Lovers Try Positions That They Can’t Handle?
Have you come up with a rational, logical approach to each topic? If so, you might find it very straightforward to outline your history, physical, investigations and management. If not - fear not, we have developed some which you'll learn at The Review Course!
I’m a simple person and so when I think infertility I think simple anatomy. Let’s follow the egg from start to (hopefully) finish to take a thorough yet concise history for infertility.
The egg is released from the ovary. Or is it? Consider ovulatory dysfunction from top to bottom. Is there hypothalamic dysfunction? Hyperprolactinemia? Thyroid disturbance? PCOS?
Next the egg has to travel down the tube. Is the tube patent? Consider infections (PID, chlamydia, ruptured appendicitis) or scarring (endometriosis, ruptured ectopic pregnancy, pelvic surgery).
The egg now has to find the sperm. Is it there and is it normal? Is there any history of testicular trauma, surgery or congenital anomaly? Are medications, smoking or drugs affecting sperm motility or morphology?
Finally, the embryo has to implant. Is there anything in the uterus that doesn't belong? A septum? Adhesions from prior uterine instrumentation? A big old fibroid?
If you're faced with a patient with infertility on the Family Medicine exam, keeping this in mind will help you remember to hit all the important parts you need to include in your history. As well this will help you navigate any question that covers an approach to infertility causes and management.
One more key exam tip - when you are asked about management of infertility, don't forget that Management = More than Medication. Definitely cover all the points of management, but to be comprehensive don't forget that when all else fails, and when the time is right, be sure to offer adoption as an option.
See you at The Review Course for more study tips about the Family Medicine exam! Residents are already signing up for the course quickly - and our early signup bonus for $100 off of the early bird price is NEARLY SOLD OUT! So, be sure to register for The Review Course before we run out of space.
PEARLS FOR PRACTICE
A simple, straightforward and logical approach like the one above will help you think of a broader differential, which is crucial for your Family Medicine exam, but even more important when you're in practice. Keeping your differential diagnosis broad when will make sure you consider all of the options and think about serious conditions that need to be ruled out.
Try to get in the habit of documenting your differential diagnoses, which will keep the CMPA happy. According to their Good Practices Guide, a note with a thorough differential shows that you've been thorough and thoughtful. But most importantly, it will help you take the best possible care of your patients.