ABFM Family Medicine cheat sheet

Hypertension stage 1 = 130–139/80–89 mm Hg and stage 2 = ≥140/90; first-line agents in non-Black adults without CKD or diabetes are a thiazide diuretic, ACE inhibitor/ARB, or dihydropyridine calcium channel blocker.

Type 2 diabetes: A1c goal <7% for most adults; metformin is first-line, and an SGLT2 inhibitor or GLP-1 receptor agonist is added for ASCVD, heart failure, or CKD independent of A1c.

Statin intensity by 10-year ASCVD risk: ≥20% high-intensity (atorvastatin 40–80 mg or rosuvastatin 20–40 mg); 7.5–19.9% moderate-intensity; <5% generally no statin.

COPD is confirmed by post-bronchodilator FEV1/FVC <0.70; GOLD grades by FEV1 percent predicted: GOLD 1 ≥80%, GOLD 2 50–79%, GOLD 3 30–49%, GOLD 4 <30%.

Atrial fibrillation: CHA2DS2-VASc ≥2 in men or ≥3 in women warrants anticoagulation; a score of 1 in men or 2 in women is individualized.

Heart failure with EF ≤40%: four mortality-reducing pillars - ARNI/ACE inhibitor/ARB, evidence-based beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor.

CKD = eGFR <60 mL/min/1.73 m² or urine albumin-to-creatinine ratio ≥30 mg/g persisting >3 months; ACE inhibitor or ARB is indicated when albuminuria is present.

CAP severity: CURB-65 (confusion, BUN >19 mg/dL, respiratory rate ≥30, SBP <90 or DBP ≤60, age ≥65); score ≥2 suggests admission and ≥3 suggests severe disease.

All adults aged 18–79 should be screened at least once for hepatitis C antibody.

Fever ≥38.0 °C in an infant ≤28 days old requires full sepsis evaluation (blood, urine, CSF) with empiric antibiotics and admission; ages 29–90 days use validated risk stratification.

Acute otitis media: high-dose amoxicillin 80–90 mg/kg/day first-line; observation for 48–72 hours is acceptable at age ≥6 months with nonsevere unilateral disease.

Bronchiolitis management is supportive (oxygen, hydration); routine bronchodilators, corticosteroids, and antibiotics are not recommended.

Croup: single dose dexamethasone 0.15–0.6 mg/kg; add nebulized epinephrine for stridor at rest or severe retractions.

Group A streptococcal pharyngitis: penicillin or amoxicillin for 10 days; testing and treatment are not indicated in children younger than 3 years.

ADHD requires ≥6 symptoms (≥5 in older adolescents/adults) for ≥6 months, onset before age 12, in ≥2 settings, with functional impairment.

Autism-specific screening at 18 and 24 months; blood lead testing at 9–12 months and 24 months for at-risk children.

Febrile UTI in infants and young children: obtain urine by catheterization or suprapubic aspiration; bag specimens have unacceptable contamination rates.

Routine immunization: DTaP at 2, 4, 6, 15–18 months and 4–6 years; MMR at 12–15 months and 4–6 years.

Folic acid 400 mcg daily starting at least 1 month before conception; 4 mg daily when a prior pregnancy was affected by a neural tube defect.

Gestational diabetes screening at 24–28 weeks with a 50-g 1-hour glucose challenge; diagnosis by 3-hour 100-g OGTT (Carpenter–Coustan) or a 75-g 2-hour test.

Preeclampsia = new hypertension after 20 weeks plus proteinuria (≥300 mg/24 h or protein-to-creatinine ≥0.3) or end-organ dysfunction; delivery is the only definitive treatment.

RhD immune globulin at 28 weeks and within 72 hours postpartum for Rh-negative unsensitized patients when the newborn is Rh positive.

Postpartum hemorrhage: uterine atony is most common; oxytocin first-line, then methylergonovine (avoid in hypertension) or carboprost (avoid in asthma).

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

Emergency contraception: levonorgestrel 1.5 mg within 72 hours, ulipristal 30 mg within 120 hours, or copper IUD within 5 days (most effective).

Ectopic pregnancy: methotrexate 50 mg/m² if hemodynamically stable, unruptured, hCG <5000, no fetal cardiac activity, and reliable follow-up.

Beers criteria: avoid benzodiazepines, anticholinergics, long-term NSAIDs, and first-generation antihistamines in adults ≥65 because of falls, delirium, and bleeding risk.

Screen annually for falls in adults ≥65; a positive screen prompts orthostatic vital signs, vision assessment, gait/balance testing, and medication review.

Osteoporosis: DEXA for women ≥65 and men ≥70; T-score ≤−2.5 at hip or spine defines osteoporosis, and FRAX estimates 10-year fracture risk.

Delirium is acute and fluctuating with inattention (CAM criteria); identify and treat the underlying cause - antipsychotics are not first-line therapy.

Urinary incontinence: behavioral therapy and pelvic floor training first; anticholinergics carry cognitive and urinary retention risk in older adults.

Polypharmacy (≥5 medications) warrants periodic deprescribing review using STOPP/START and the Beers criteria.

Vaccines for older adults: influenza annually, recombinant zoster ≥50, pneumococcal conjugate ≥65, RSV for ≥75 and for 60–74 with risk factors.

Low-dose aspirin for primary prevention is generally not recommended at age ≥70 because bleeding risk outweighs cardiovascular benefit.

Major depressive disorder: ≥5 symptoms for ≥2 weeks that include depressed mood or anhedonia, with functional impairment.

PHQ-9 severity bands: 5–9 mild, 10–14 moderate, 15–19 moderately severe, ≥20 severe; GAD-7 ≥10 supports further anxiety evaluation.

SSRIs are first-line for depression and anxiety; full effect takes 4–6 weeks and treatment continues 6–12 months after remission, longer if recurrent.

Bipolar disorder: antidepressant monotherapy can precipitate mania or rapid cycling, so a mood stabilizer is required.

Opioid use disorder: buprenorphine, methadone, or extended-release naltrexone reduce mortality; buprenorphine can be initiated in primary care.

Alcohol use disorder: naltrexone or acamprosate reduce relapse; screen with AUDIT-C and combine medication with behavioral intervention.

Suicide risk assessment asks directly about ideation, plan, and intent; high risk warrants lethal-means counseling and same-day behavioral health referral.

Serotonin syndrome presents with clonus, hyperreflexia, agitation, and hyperthermia; stop serotonergic agents and provide supportive care with benzodiazepines.

Ottawa ankle rules: radiograph only with malleolar pain plus tenderness at the posterior edge or tip of either malleolus or the navicular/base of the fifth metatarsal, or inability to bear weight 4 steps.

Ottawa knee rules: radiograph if age ≥55, isolated patellar tenderness, fibular head tenderness, inability to flex to 90°, or inability to bear weight.

Acute nonspecific low back pain: no imaging within 6 weeks absent red flags such as saddle anesthesia, bowel/bladder dysfunction, fever, cancer history, trauma, or progressive deficit.

Lachman test is the most sensitive examination for ACL tear; McMurray tests the meniscus and the anterior drawer also assesses the ACL.

Knee osteoarthritis: exercise/physical therapy, weight loss, and topical NSAIDs are core; intra-articular glucocorticoid gives short-term relief and opioids are not first-line.

Shoulder: drop-arm sign and external rotation lag suggest rotator cuff tear; a painful arc suggests subacromial impingement.

Lateral epicondylitis produces pain with resisted wrist extension; a counterforce brace plus eccentric strengthening are mainstays.

Acute gout: arthrocentesis showing needle-shaped negatively birefringent crystals is diagnostic; treat with NSAID, colchicine, or glucocorticoid.

Carpal tunnel syndrome: nocturnal median-distribution paresthesias with positive Phalen or Tinel sign; night splint and corticosteroid injection are first-line.

Anaphylaxis: IM epinephrine 0.3–0.5 mg of the 1 mg/mL concentration in the anterolateral thigh, repeated every 5–15 minutes; antihistamines and steroids are adjuncts only.

Septic shock: measure lactate, obtain cultures, and give broad-spectrum antibiotics within 1 hour; 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

Acute coronary syndrome: obtain a 12-lead ECG within 10 minutes of arrival and give chewed aspirin 162–325 mg unless contraindicated.

Ischemic stroke: IV thrombolysis within 4.5 hours of last known well; endovascular thrombectomy up to 24 hours in selected large-vessel occlusion.

Status epilepticus: benzodiazepine first (lorazepam 0.1 mg/kg IV or midazolam IM), then levetiracetam, fosphenytoin, or valproate.

Hypoglycemia <70 mg/dL: 15–20 g oral glucose if conscious and able to swallow, recheck in 15 minutes; IV dextrose or IM glucagon if not.

Hyperkalemia with ECG changes: IV calcium gluconate or calcium chloride first for membrane stabilization, then insulin/glucose, albuterol, and potassium removal.

Burn resuscitation (Parkland): 4 mL/kg × %TBSA lactated Ringer over 24 hours, with half given in the first 8 hours from the time of injury.

Opioid overdose: naloxone 0.4–2 mg IV/IM or 4 mg intranasal, repeated every 2–3 minutes, with observation for recurrent respiratory depression.

USPSTF grade A means high certainty of substantial net benefit and grade B moderate certainty of substantial benefit; both are recommended for offer or provision.

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

Sensitivity = TP/(TP+FN) and specificity = TN/(TN+FP); positive predictive value rises with prevalence and negative predictive value falls.

Herd immunity thresholds approximate measles 95%, diphtheria 85%, and polio 80–85%; falling coverage permits outbreaks.

Colorectal cancer screening is recommended for adults aged 45–75 (grade B at 45–49, grade A at 50–75).

Lung cancer screening: annual low-dose CT for ages 50–80 with ≥20 pack-years who currently smoke or quit within 15 years.

Screening biases: lead-time bias inflates survival, length bias favors detection of slow-growing disease, and healthy adherer bias overstates benefit.

Notifiable conditions such as tuberculosis, measles, syphilis, and salmonellosis must be reported to local public health authorities.