ABPS Family Medicine (BCFM) cheat sheet

ASCVD 10-year risk ≥7.5% with risk enhancers or ≥10%: start moderate-intensity statin; ≥20%: high-intensity statin.

Hypertension diagnosis requires ≥2 elevated readings on ≥2 occasions; stage 1 is 130-139/80-89, stage 2 is ≥140/90.

Type 2 diabetes: A1c ≥6.5%, fasting glucose ≥126 mg/dL, or 2-h OGTT ≥200 mg/dL; repeat unless unequivocal hyperglycemia.

Metformin remains first-line for type 2 diabetes unless eGFR <30 mL/min/1.73 m²; reduce dose at eGFR 30-45.

Community-acquired pneumonia: CURB-65 ≥2 points generally warrants inpatient admission.

Heart failure with reduced EF (≤40%): use ACEi/ARB/ARNI + beta-blocker + MRA + SGLT2 inhibitor.

DVT/PE anticoagulation: DOACs preferred for most provoked/unprovoked VTE without cancer; LMWH for active malignancy.

Thyroid nodule with TSH suppressed: obtain radionuclide scan before FNA to identify autonomous (hot) nodules.

Infant fever ≥38.0°C (100.4°F) under 8 weeks requires full sepsis workup including lumbar puncture and empiric antibiotics.

Normal pediatric heart rate declines with age: newborn 100-160, infant 90-140, preschool 80-110, school-age 70-100 bpm.

Kawasaki disease: fever ≥5 days plus 4 of 5 criteria (rash, conjunctivitis, mucosal changes, extremity changes, cervical adenopathy); treat with IVIG + aspirin.

Otitis media in children <2 years or severe symptoms: antibiotics first-line (high-dose amoxicillin); observation option for ≥2 years with mild disease.

Pediatric dehydration: 50-100 mL/kg isotonic fluid over 3-4 h for mild-moderate; use ORT when tolerated.

Adolescent depression screening: USPSTF recommends screening ages 12-18; PHQ-9 or PHQ-A are validated tools.

Febrile seizure simple: age 6 months-5 years, generalized, <15 min, once in 24 h; no routine EEG or imaging needed.

Immunization schedule: DTaP at 2, 4, 6, 15-18 months and 4-6 years; MMR and varicella at 12-15 months and 4-6 years.

Preeclampsia: BP ≥140/90 after 20 weeks plus proteinuria ≥300 mg/24 h or end-organ dysfunction; delivery is definitive treatment.

Gestational diabetes screening: 1-h 50 g glucose challenge at 24-28 weeks; diagnostic 3-h 100 g OGTT using Carpenter-Coustan or NDDG criteria.

Ectopic pregnancy: discriminatory hCG zone ~3,500 mIU/mL; empty uterus on transvaginal US above this threshold warrants concern.

RhD-negative unsensitized women receive anti-D immune globulin at 28 weeks and within 72 h of delivery of an RhD-positive infant.

Emergency contraception: levonorgestrel effective up to 72 h (best <24 h); ulipristal up to 120 h; copper IUD most effective up to 5 days.

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

Postpartum hemorrhage: uterine atony most common cause; first-line uterotonic is oxytocin; bimanual massage and uterotonics per stepwise protocol.

PROM at term: induction generally recommended to reduce chorioamnionitis risk; group B strep prophylaxis if indicated.

Beers Criteria identify potentially inappropriate medications in older adults (e.g., benzodiazepines, anticholinergics, sulfonylureas with long half-life).

STOPP/START criteria flag inappropriate prescribing and omitted indicated medications in elderly patients.

Falls: annual screening; multifactorial assessment for those with fall history or gait/balance problems; vitamin D supplementation if deficient.

Delirium: acute onset, fluctuating course, inattention; use CAM (Confusion Assessment Method) for detection; treat underlying cause.

Dementia screening: cognitive assessment when symptoms or informant concern; MoCA or MMSE are common tools.

Polypharmacy: reconcile medications at every transition; deprescribe when harms outweigh benefits.

Advance care planning: discuss goals of care and document advance directives; POLST/MOLST for seriously ill patients.

Urinary incontinence: behavioral therapy (bladder training, pelvic floor exercises) first-line; avoid anticholinergics in cognitively impaired.

PHQ-9 scores: 5-9 mild, 10-14 moderate, 15-19 moderately severe, ≥20 severe; ≥10 suggests clinically significant depression.

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

First-line for major depression: SSRI or psychotherapy; combine for moderate-severe; assess suicide risk at every visit.

Serotonin syndrome: triad of mental status change, autonomic instability, neuromuscular hyperactivity; stop serotonergic agents and supportive care.

Alcohol use disorder: AUDIT-C screening; brief intervention; medications include naltrexone, acamprosate, disulfiram.

Opioid use disorder: buprenorphine or methadone are first-line medication-assisted treatment; naloxone for overdose reversal.

Bipolar disorder: mood stabilizer (lithium, valproate) first-line; avoid antidepressant monotherapy due to mania risk.

Screening: USPSTF recommends depression screening in adults and adolescents; anxiety screening in adults ≤64.

Incidence = new cases / population at risk per time; prevalence = all existing cases / total population at a point or period.

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

Relative risk used in cohort studies; odds ratio used in case-control studies; attributable risk = incidence in exposed − incidence in unexposed.

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

Screening test criteria: important disease, accepted treatment, detectable preclinical phase, acceptable test, cost-effective.

Lead-time bias: earlier detection without prolonged survival; length-time bias: slower-progressing cases overrepresented in screening.

Outbreak investigation steps: verify diagnosis, define cases, characterize by time/place/person, generate hypothesis, control measures.

Social determinants of health: income, education, housing, food security, and environment influence health outcomes and should be screened.

USPSTF: colorectal cancer screening ages 45-75 (colonoscopy every 10 years, FIT annually, or other endorsed strategies).

Breast cancer screening: biennial mammography ages 40-74 per current USPSTF recommendation.

Lung cancer screening: annual low-dose CT ages 50-80 with ≥20 pack-year history and currently smoking or quit within 15 years.

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

Osteoporosis screening: DXA for women ≥65 and younger postmenopausal women at increased risk.

Hepatitis C screening: all adults 18-79 once; hepatitis B screening for at-risk groups.

Tobacco cessation: 5 A's (Ask, Advise, Assess, Assist, Arrange); varenicline, bupropion, or NRT are first-line pharmacotherapy.

Immunizations: annual influenza for all ≥6 months; Tdap booster every 10 years; shingles vaccine ≥50; pneumococcal per age/risk.

Anaphylaxis: IM epinephrine 0.3-0.5 mg (1:1000) in mid-outer thigh, repeat every 5-15 min as needed; adjuncts are antihistamines and steroids.

Acute coronary syndrome: aspirin 162-325 mg chewed, nitroglycerin if no contraindication, ECG within 10 min of arrival.

Stroke: activate stroke pathway; IV thrombolysis window generally up to 4.5 h; thrombectomy up to 24 h in selected patients.

Sepsis: obtain cultures, start broad-spectrum antibiotics within 1 h, and begin 30 mL/kg crystalloid for hypotension or lactate ≥4.

Status epilepticus: benzodiazepine first-line (lorazepam or midazolam), then second-line antiepileptic (fosphenytoin, levetiracetam, valproate).

Hyperkalemia with ECG changes: IV calcium first, then insulin/glucose, albuterol, and potassium removal.

Opioid overdose: naloxone 0.4-2 mg IV/IM or 4 mg intranasal; repeat as needed; support airway.

Acute asthma exacerbation: SABA, ipratropium, systemic corticosteroids; magnesium sulfate for severe refractory cases.

Preoperative risk: ASA classification and Revised Cardiac Risk Index (RCRI) guide perioperative cardiac evaluation.

Prophylactic antibiotics: administer within 60 min before incision (within 120 min for vancomycin/fluoroquinolones); redose for long procedures.

VTE prophylaxis: assess Caprini score; use pharmacologic and/or mechanical prophylaxis per risk.

Wound classification: clean, clean-contaminated, contaminated, dirty; infection risk increases with class.

Surgical site infection prevention: normothermia, glucose control, avoid shaving (use clippers if needed), chlorhexidine skin prep.

Local anesthesia maximums: lidocaine 4.5 mg/kg without epinephrine, 7 mg/kg with epinephrine; bupivacaine 2.5 mg/kg (with or without epi).

Suturing: simple interrupted for tension; absorbable for mucosal/subcuticular; nonabsorbable for skin; remove facial sutures in 5-7 days, trunk/extremity 7-14 days.

Informed consent elements: diagnosis, nature of procedure, risks, benefits, alternatives, and consequences of refusal.

Ottawa ankle rules: obtain X-ray if pain in malleolar zone plus bone tenderness at posterior edge of lateral/medial malleolus or inability to bear weight 4 steps.

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

Anterior cruciate ligament injury: positive Lachman and pivot-shift tests most sensitive; MRI confirms.

Carpal tunnel syndrome: Phalen and Tinel tests; EMG/NCS confirm; night splinting and activity modification first-line.

Rotator cuff tear: painful arc, drop-arm test, weak abduction; MRI or ultrasound for confirmation.

Plantar fasciitis: morning first-step pain; first-line stretching, orthotics, night splint; corticosteroid injection for refractory cases.

Concussion: graded return-to-learn then return-to-play protocol; no same-day return to play.

Osteoarthritis: exercise, weight loss, PT first-line; intra-articular corticosteroid for flares; joint replacement for severe refractory disease.

EMR meaningful use: structured data capture, clinical decision support, e-prescribing, and health information exchange.

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

HIPAA Privacy Rule: minimum necessary standard; permitted disclosures for treatment, payment, and operations; breach notification within 60 days.

Informed consent and shared decision-making are core ethical obligations; document discussion of risks, benefits, alternatives.

Malpractice: four elements-duty, breach, causation, damages; documentation is the strongest defense.

Billing: E/M coding by medical decision-making or time; preventive visits may be billed with problem-oriented visits using modifier 25.

Patient safety: root cause analysis for sentinel events; encourage incident reporting and closed-loop communication.

Physician impairment and burnout: recognize signs; use peer support and employee assistance programs; state physician health programs for substance use.

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