MCC Objectives

Abdominal distension may indicate the presence of serious intra-abdominal or systemic disease, but it is also a common symptom of benign disease, such as irritable bowel syndrome.

Abdominal injuries are common and may be life-threatening. Assessment of patients with an abdominal injury may be difficult because it may produce few clinical signs. Interpretation of abdominal physical examination findings may also be difficult in unconscious patients with multiple injuries.

Abdominal masses and pelvic masses may be noted on physical examination or discovered incidentally on imaging. It is imperative for a physician to determine which masses require immediate investigation and treatment, and which can be safely monitored.

Abdominal pain is a common presentation in children. While the symptoms may result from serious abdominal pathology, in a large proportion of cases, an identifiable organic cause is not found. When a cause is identified, the cause is often age dependent.

Murmurs and abnormal heart sounds may be detected on physical examination. Although systolic murmurs are often “innocent” or physiologic, diastolic murmurs are virtually always pathologic. A thorough history and physical examination almost always identify which patient cases require further investigation and management.

Hypercholesterolemia is a common and important modifiable risk factor for ischemic heart disease, cerebrovascular disease, and peripheral vascular disease. Determination of levels is usually based on concomitant risk factors.

Abnormal liver function tests are common in clinical practice. Appropriate investigation can distinguish benign reversible liver disease from potentially life-threatening conditions.

Puberty is the physiologic and psychosocial transition from childhood to adolescence. Questions about typical and atypical pubertal development are a common reason for presentation to primary care clinics. Abnormalities in pubertal development can be indicators of severe underlying disorders and can be a cause of significant anxiety for patients and families. They require careful investigation and follow-up.

Abuse of older adults is action or neglect causing harm or distress to an older person where there is an expectation of trust.

Abnormally high or low hydrogen ion concentration—acidemia and alkalemia, respectively—is encountered relatively frequently, particularly in hospital-based practice. Acidemia may be caused by an underlying life-threatening condition. Several acid-base abnormalities can coexist in a single patient.

Acute abdominal pain is common in adults, leading to frequent physician visits in both Emergency Department and office settings. Acute abdominal pain may result from serious intra-abdominal, intrathoracic, or retroperitoneal processes.

Acute diarrhea (lasting less than 1 week) is defined as a disturbance of stool frequency and/or consistency. Diarrheal diseases are extremely common worldwide, including in North America, where morbidity and mortality are significant.

Acute kidney injury is an abrupt reduction in kidney function and is defined as an increasing serum creatinine level from baseline over a short period. It is associated with morbidity and mortality.

Sudden decreases in visual acuity or visual field are symptoms that require urgent evaluation. The outcome may depend on early, accurate diagnosis and timely treatment. Many patients require an urgent ophthalmologic opinion.

Knowing the organization of the health care and public health systems in Canada as well as how to determine the most cost-effective interventions are becoming key elements of clinical practice. Physicians also must work well in multidisciplinary teams within the current system in order to achieve the maximum health benefit for all patients and residents.

Adult abuse or intimate partner violence is very common and can occur in many different circumstances or interactions. Human trafficking is a complex and largely hidden crime. Abuse and trafficking are often kept hidden by the victim and may be difficult to diagnose, yet they cause significant physical and emotional morbidity. They can also lead to the death of the abused or trafficked person.

Constipation is common in adult patients and can be attributed to several possible functional and organic causes. It may have a significant effect on quality of life and may be the presenting feature of significant pathology.

The need for health care for adults with developmental disabilities is growing because of greater social integration and accessibility and longer life expectancy than in the past. These patients may have complex health issues and poor health status.

Allergic conditions are common and may be life-threatening. Many patients may have multiple manifestations of an atopic disorder.

Amenorrhea and oligomenorrhea are common patient concerns and can be associated with potentially serious underlying pathology. Primary amenorrhea is the absence of menarche by age 15 years in the presence of normal growth and secondary sexual characteristics. Secondary amenorrhea is the absence of menstruation for more than three cycles or six months in patients who were previously menstruating. Oligomenorrhea refers to infrequent menstruation, a cycle of menstrual periods with an interval of more than 35 days. Infrequent or absent menstruation in these circumstances is a reason for investigation and management.

Anemia is a common problem; however, making the diagnosis may be complex. Anemia may be the sole manifestation of serious medical disease.

Anorectal pain can be associated with potentially serious underlying pathology. However, most causes of anorectal pain are treatable. Early identification and treatment are important to reduce morbidity.

Anxiety is a common presentation in both primary care and hospital settings. It is often comorbid with other medical conditions and can be the presenting feature of an underlying medical condition (e.g., hyperthyroidism). When severe, it can be associated with life-threatening complications (e.g., suicidal ideation).

Knowing the health status of a population allows for better planning and evaluation of health programs and tailoring of interventions to meet patient and community needs. Physicians are also active participants in disease surveillance programs, encouraging them to address health needs in the population and not merely health demands.

Neurologic abnormalities of gait can result from disorders affecting several levels of the nervous system. The type of abnormality observed clinically often indicates the site affected.

School and learning problems are among the most common reasons for children to present to primary care clinicians. Difficulties at school can be caused by treatable medical and developmental conditions which, if unaddressed, can lead to long-term psychosocial dysfunction and chronic health problems.