ABFM HALM cheat sheet

USPSTF grades: A and B are recommended (offer or provide); C is individualized; D is discouraged; I is insufficient evidence.

Colorectal cancer screening: start at age 45 for average risk (USPSTF B); options include colonoscopy every 10 years, annual FIT, FIT-DNA every 1-3 years, CT colonography every 5 years.

Lung cancer screening with low-dose CT: adults 50-80 with 20 pack-year history who currently smoke or quit within 15 years (USPSTF B).

Cervical cancer screening: start at 21; ages 21-29 cytology every 3 years; ages 30-65 cytology every 3 years, HPV every 5 years, or co-testing every 5 years.

Hepatitis C: one-time antibody screening for all adults 18-79; hepatitis B screening for all adults at least once.

HIV screening: ages 15-65 at least once; all pregnant persons at each pregnancy; repeat screening for high-risk persons.

Latent TB screening in populations at increased risk; one-step IGRA or TST, with IGRA preferred in BCG-vaccinated persons.

Tetanus-diphtheria booster every 10 years; Tdap once in adulthood; zoster recombinant vaccine at age 50; pneumococcal vaccine at 50 (or earlier with risk).

AAA ultrasound screening: men 65-75 who ever smoked (one-time).

ACC/AHA BP categories: normal <120/<80; elevated 120-129/<80; stage 1 130-139 or 80-89; stage 2 ≥140 or ≥90; hypertensive crisis >180 and/or >120.

ASCVD 10-year risk via pooled cohort equations: <5% low, 5-7.4% borderline, 7.5-19.9% intermediate, ≥20% high.

Statin therapy: moderate-intensity for 10-year risk 7.5-19.9% with risk enhancers; high-intensity for ≥20% or diabetes age 40-75.

First-line hypertension agents: thiazide diuretics, ACE inhibitors/ARBs, and dihydropyridine CCBs; ACEi and ARB are not combined.

Stage 1 hypertension with 10-year ASCVD risk <10%: lifestyle first; ≥10% or clinical CVD: start medication plus lifestyle.

Heart failure with reduced EF: four pillars - ARNI/ACEi/ARB, beta-blocker (bisoprolol, carvedilol, metoprolol succinate), MRA, SGLT2 inhibitor.

Atrial fibrillation anticoagulation: CHA2DS2-VASc ≥2 in men or ≥3 in women favors anticoagulation; score of 1 (men) or 2 (women) is a shared decision.

Acute chest pain: obtain ECG within 10 minutes; troponin at 0 and 1-3 hours with high-sensitivity assay; HEART score stratifies risk.

ADA diagnostic criteria: A1c ≥6.5%, fasting glucose ≥126, 2-hour OGTT ≥200, or random glucose ≥200 with symptoms; repeat to confirm absent classic symptoms.

Prediabetes: A1c 5.7-6.4%, fasting glucose 100-125, or 2-hour OGTT 140-199.

A1c goal: <7% for most nonpregnant adults; <8% for limited life expectancy or high hypoglycemia risk; <6.5% if achievable safely.

Metformin is first-line unless contraindicated (eGFR <30, metabolic acidosis); consider SGLT2 inhibitor or GLP-1 RA with ASCVD, heart failure, or CKD regardless of A1c.

Screen for type 2 diabetes at age 35 (or earlier with risk factors); repeat every 3 years if normal.

Diabetic kidney disease: annual urine albumin-to-creatinine ratio and eGFR; ACEi/ARB for albuminuria; SGLT2 inhibitor for CKD with albuminuria.

Diabetic retinopathy screening: dilated eye exam at diagnosis for type 2, then every 1-2 years.

Hypothyroidism: elevated TSH with low free T4 confirms primary hypothyroidism; subclinical is elevated TSH with normal free T4.

Metabolic syndrome: ≥3 of - waist >40 in (men)/>35 in (women), TG ≥150, HDL <40/<50, BP ≥130/85, fasting glucose ≥100.

Asthma: symptoms variable and reversible; spirometry shows ≥12% and ≥200 mL improvement in FEV1 after bronchodilator.

Asthma step therapy: as-needed SABA alone only for mild intermittent; otherwise low-dose ICS-formoterol or ICS-containing regimens; never LABA alone.

COPD diagnosis requires post-bronchodilator FEV1/FVC <0.70 in a patient with symptoms and exposure history.

COPD maintenance: LAMA or LABA first; add ICS if exacerbations and eosinophils ≥300, or history of asthma.

GOLD ABE grouping uses exacerbation history and symptom scores (mMRC, CAT); group E = ≥2 moderate or ≥1 hospitalization.

CAP outpatient: no comorbidities - amoxicillin or doxycycline; with comorbidities - amoxicillin-clavulanate plus macrolide, or respiratory fluoroquinolone.

CURB-65 (confusion, urea >7 mmol/L, RR ≥30, BP low, age ≥65) ≥2 suggests inpatient admission.

Pulmonary embolism: Wells score plus age-adjusted D-dimer; PERC rule to rule out in low pretest probability.

OSA screening: STOP-BANG ≥3 indicates intermediate risk; diagnosis confirmed by polysomnography or home sleep apnea test.

PHQ-9: 5-9 mild, 10-14 moderate, 15-19 moderately severe, ≥20 severe; item 9 positive requires suicide risk assessment.

GAD-7: 5-9 mild, 10-14 moderate, ≥15 severe anxiety.

First-line for major depression: SSRI, SNRI, bupropion, or mirtazapine plus psychotherapy; full effect at 4-6 weeks; continue 6-12 months after remission.

Bipolar disorder: antidepressant monotherapy can precipitate mania; mood stabilizer (lithium, valproate, lamotrigine) is required.

AUDIT-C positive screen (≥4 men, ≥3 women) prompts brief intervention; DSM-5 AUD requires ≥2 of 11 criteria in 12 months.

Opioid use disorder: buprenorphine or methadone reduces mortality; naloxone co-prescribing for overdose risk.

Suicide risk: ask directly about ideation, plan, intent, and means; lethal-means counseling reduces risk.

Delirium vs dementia: delirium is acute, fluctuating, inattentive; dementia is chronic and progressive; 4AT or CAM for screening.

Serotonin syndrome triad: mental status change, autonomic instability, neuromuscular hyperactivity (clonus, hyperreflexia).

Acute low back pain without red flags: no imaging in first 6 weeks; red flags include age >50 new pain, cancer history, fever, IV drug use, neuro deficits, bowel/bladder changes.

Osteoporosis: DXA T-score ≤-2.5 defines osteoporosis; -1.0 to -2.5 is osteopenia; FRAX guides treatment in osteopenia.

Osteoporosis treatment: bisphosphonates first-line; denosumab requires sequential therapy to prevent rebound fracture.

Calcium intake 1000-1200 mg/day and vitamin D 800-1000 IU/day for osteoporosis prevention.

Cauda equina syndrome: saddle anesthesia, urinary retention, bilateral sciatica - emergent MRI and surgical referral.

Gout: acute flare treated with NSAIDs, colchicine, or steroids; urate-lowering (allopurinol) is not started or stopped during a flare in most cases.

Septic arthritis: joint aspiration with synovial WBC >50,000 (often >100,000) and positive Gram stain; emergent drainage and IV antibiotics.

Carpal tunnel syndrome: nocturnal paresthesias in median nerve distribution; Phalen and Tinel tests; EMG/NCS for confirmation.

Osteoarthritis: weight loss and exercise are first-line; intra-articular steroids provide short-term relief.

Cervical cancer screening: 21-29 cytology every 3 years; 30-65 cytology every 3, HPV every 5, or co-test every 5; stop at 65 with adequate prior negative screening.

Mammography: biennial ages 40-74 (USPSTF B); start at 40 or 50 per shared decision with individual risk.

Pregnancy: folic acid 400 mcg daily (4 mg if prior neural tube defect) started at least 1 month before conception.

Preeclampsia: BP ≥140/90 after 20 weeks plus proteinuria or end-organ dysfunction; low-dose aspirin for high-risk patients.

Gestational diabetes screening: 24-28 weeks with 1-hour 50 g glucose challenge; diagnosis with 3-hour 100 g OGTT (two abnormal values).

Menopause vasomotor symptoms: hormone therapy is most effective; use lowest effective dose, reassess annually; contraindicated with breast cancer history.

Emergency contraception: levonorgestrel up to 72 hours (less effective with higher BMI); ulipristal up to 120 hours; copper IUD most effective.

Abnormal uterine bleeding: endometrial biopsy for age ≥45 or risk factors; PALM-COEIN classification.

Osteoporosis screening in women begins at age 65 (or earlier with risk factors).

Prostate cancer screening: shared decision for ages 55-69 (USPSTF C); PSA with or without DRE; do not screen ≥70.

Elevated PSA: repeat PSA before biopsy; consider free/total PSA ratio and risk calculators; prostatitis and BPH raise PSA.

BPH: IPSS symptom score; first-line alpha blocker (tamsulosin, doxazosin) or 5-alpha reductase inhibitor for larger prostates.

5-alpha reductase inhibitors lower PSA by ~50% at 6 months; double the measured PSA when interpreting.

Testosterone deficiency: symptoms plus two morning total testosterone values <300 ng/dL; check hematocrit and PSA on therapy.

Erectile dysfunction: PDE5 inhibitors first-line; contraindicated with nitrates; evaluate for cardiovascular risk and diabetes.

Testicular cancer: painless firm mass; scrotal ultrasound first; tumor markers AFP, beta-hCG, LDH.

Male hypogonadism workup: LH and FSH to distinguish primary (high) from secondary (low/normal) testicular failure.

Torsion: acute scrotal pain with high-riding testis and absent cremasteric reflex - emergent urology referral within 6 hours.

Beers criteria identify potentially inappropriate medications in older adults: benzodiazepines, anticholinergics, long-acting sulfonylureas, and NSAIDs.

Start low, go slow: begin at 25-50% of adult dose in frail elders; deprescribe when benefit is unclear.

Comprehensive geriatric assessment: function (ADLs/IADLs), cognition, mood, gait, nutrition, polypharmacy, and social support.

Fall risk: annual screening; STEADI algorithm; gait/balance assessment and vision check; vitamin D and exercise reduce falls.

Delirium prevention: multicomponent nonpharmacologic bundle (orientation, sleep, mobility, hydration, pain control).

Dementia workup: cognitive testing, B12, TSH, CBC, CMP, and neuroimaging if focal findings or rapid decline.

Advance care planning: discuss goals of care and document health care proxy and POLST/MOLST where applicable.

Urinary incontinence: behavioral therapy and pelvic floor training first-line; avoid anticholinergics in cognitively impaired.

Polypharmacy: ≥5 medications; use STOPP/START criteria and review at every transition of care.

Well-child visits: newborn, 1, 2, 4, 6, 9, 12, 15, 18, 24 months, then annually; developmental surveillance at each visit.

Vaccine schedule: DTaP, IPV, Hib, PCV, MMR, varicella, hepatitis A/B, HPV at 11-12, Tdap and MenACWY at 11-12, MenB at 16-18.

Growth: use WHO charts for <2 years, CDC for ≥2; failure to thrive = weight <5th percentile or crossing two major percentile lines.

Fever in infant <28 days: full sepsis workup and hospitalization; 29-90 days: risk-stratified workup.

Otitis media: observation for 6-23 months with nonsevere unilateral disease; amoxicillin first-line when antibiotics indicated.

ADHD: symptoms before age 12 in ≥2 settings; behavioral therapy first for preschool; stimulants first-line for school-age.

Adolescent depression screening annually ages 12-18; PHQ-A; assess suicide risk.

Autism screening at 18 and 24 months with M-CHAT; refer for diagnostic evaluation if positive.

Lead screening at 12 and 24 months in at-risk children; hemoglobin at 12 months for anemia.

Physical activity: 150-300 minutes/week moderate or 75-150 minutes/week vigorous aerobic plus 2 days muscle strengthening.

Dietary pattern: emphasize vegetables, fruits, whole grains, legumes, nuts, fish; limit added sugars, sodium <2300 mg/day, saturated fat <10% of calories.

Weight loss: 5-10% body weight loss improves metabolic markers; 500-750 kcal/day deficit yields ~0.5-0.75 kg/week.

Tobacco cessation: combination NRT or varenicline most effective; brief 5A's (Ask, Advise, Assess, Assist, Arrange).

Alcohol: moderate limits - ≤2 drinks/day for men, ≤1 for women; no level is entirely risk-free.

Sleep: 7-9 hours for adults; CBT-I is first-line for chronic insomnia.

Nutrition screening: BMI, waist circumference, and diet quality; refer to registered dietitian for medical nutrition therapy.

Mediterranean and DASH diets reduce cardiovascular risk; DASH lowers BP by 8-14 mmHg.

Motivational interviewing: use open questions, affirmations, reflections, and summaries (OARS) to build change talk.

Screening intervals: annual depression screening, biennial mammography 40-74, colorectal 45-75, cervical 21-65, lung CT 50-80 high risk.

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); PPV depends on prevalence.

Lead-time bias inflates survival in screened populations; length bias favors detection of slow-growing disease.

Herd immunity threshold = 1 - 1/R0; higher R0 requires higher coverage.

Number needed to treat = 1/absolute risk reduction; NNH = 1/absolute risk increase.

Immunization registries and reminder/recall improve vaccination rates; standing orders increase adult coverage.

Social determinants of health: screen for food insecurity, housing, transportation; refer to community resources.

Quality measures: HEDIS and UDS track preventive care; pay-for-performance ties reimbursement to metrics.

Outbreak investigation: case definition, line listing, attack rate, epidemic curve, and analytic study (cohort or case-control).