AOBFP Family Medicine cheat sheet

USPSTF/ACS average-risk colorectal cancer screening begins at age 45 and continues to age 75; ages 76-85 is individualized.

Hypertension diagnosis requires confirmed readings of at least 130/80 mmHg; stage 2 (at least 140/90) may be treated on repeat or single encounter when clearly elevated.

ASCVD 10-year risk is estimated with the Pooled Cohort Equations; statin therapy is offered at risk of 7.5% or greater after clinician-patient discussion.

Prediabetes: A1c 5.7-6.4%, fasting glucose 100-125 mg/dL, or 2-hour OGTT 140-199 mg/dL; annual monitoring is recommended.

Type 2 diabetes A1c goal is generally less than 7% for most nonpregnant adults; relax to less than 8% with limited life expectancy or hypoglycemia risk.

Adult depression screening uses PHQ-2 followed by PHQ-9; a PHQ-9 score of 10 or more suggests at least moderate depression.

Lung cancer screening with annual low-dose CT applies to ages 50-80 with 20 pack-years and current smoking or quit within 15 years.

Acute otitis media in children: observation is acceptable for ages 6 months to 2 years with nonsevere unilateral disease; amoxicillin is first-line when antibiotics are used.

Somatic dysfunction is defined by TART: Tissue texture abnormality, Asymmetry, Restriction of motion, and Tenderness.

Counterstrain (positional release) places the tender point in a position of comfort and holds about 90 seconds to reduce reflex muscle hypertonicity.

Muscle energy technique uses patient-initiated isometric contractions against operator resistance, typically 3-5 seconds, repeated 3-5 times.

High-velocity low-amplitude (HVLA) thrust is generally avoided in severe osteoporosis, bony metastasis, fracture, and unstable spinal disease.

Lymphatic techniques include thoracic and abdominal diaphragm release and pedal pump; indications include edema and respiratory congestion.

Myofascial release applies sustained traction or torsion to fascial planes until a release is felt, then follows the tissue to a new barrier.

Cranial (craniosacral) treatment assesses the primary respiratory mechanism via cranial rhythmic impulse, commonly described near 10-14 cycles per minute.

Visceral techniques address restricted mobility of an organ relative to its fascial attachments; they are not substitutes for surgical evaluation of acute abdomen.

Well-child visits follow Bright Futures periodicity: more frequent in infancy, then annual from age 3 through adolescence.

Childhood immunization schedule: DTaP, IPV, and MMR are each given as multi-dose series; HPV series begins at ages 11-12 (may start at 9).

Group A streptococcal pharyngitis is confirmed by rapid antigen or culture; penicillin or amoxicillin remains first-line therapy.

Community-acquired pneumonia in adults is treated with amoxicillin or doxycycline as outpatient first-line, guided by local resistance.

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

Osteoporosis screening with DXA is recommended for women aged 65 and older and for younger women with elevated fracture risk.

Contraceptive counseling: combined hormonal contraceptives are contraindicated with migraine with aura, current VTE, and uncontrolled hypertension.

Barrier terminology: a restrictive barrier limits motion; the physiologic barrier is the anatomic limit; the operator moves toward the restrictive barrier.

Direct techniques engage the restrictive barrier (HVLA, muscle energy, myofascial release); indirect techniques move away from it (counterstrain, functional).

Soft tissue technique uses kneading, inhibition, and stretch to treat superficial and deep fascia and muscle.

Spencer technique (a lymphatic pump variant) uses alternating shoulder and arm motion to improve lymphatic return.

Sacral diagnosis: forward torsion is named for the side of the anterior sacral base; backward torsion is named for the side of the posterior base.

Cranial bone motion: the sphenoid and occiput are described as moving in opposite directions during flexion and extension of the cranial mechanism.

OMT in pregnancy is often used for low back and pelvic pain, with attention to positioning and avoiding prone treatment in late pregnancy.

Fever in infants under 2 months is a full evaluation with blood, urine, and CSF testing and hospitalization; febrile infants 2-3 months are risk-stratified.

Acute sinusitis: bacterial diagnosis requires symptoms at least 10 days, severe onset with fever, or worsening after initial improvement.

Bronchiolitis management is supportive; routine bronchodilators, corticosteroids, and antibiotics are not recommended.

Asthma severity is classified by impairment and risk; stepwise therapy uses inhaled corticosteroids as the preferred controller in all age groups.

Screening for intimate partner violence is recommended for women of reproductive age; direct questioning increases identification.

Anemia workup: microcytic suggests iron deficiency or thalassemia; ferritin is the most specific test for iron deficiency in adults.

Anticoagulation for atrial fibrillation uses CHA2DS2-VASc to estimate stroke risk; score of 2 or more in men (3 or more in women) generally warrants anticoagulation.

Facilitated segment: a region of the spinal cord rendered hyperexcitable by afferent input from somatic dysfunction, producing autonomic or motor effects.

Chapman points are anterior and posterior myofascial tender points associated with organ dysfunction; they are used as diagnostic markers.

Trigger points are hyperirritable spots within a taut band of skeletal muscle; treatment includes spray-and-stretch, injection, and ischemic compression.

Inhalation dysfunction of ribs relates to restricted rib motion at the pump handle (upper ribs) or bucket handle (lower ribs) mechanics.

Strain-counterstrain uses a position of greatest comfort to reduce muscle spindle and Golgi tendon organ reflex activity.

Osteopathic pelvic diagnosis considers sacral base motion, innominate rotation, and pubic symphysis alignment; the sacrum and innominates move as a unit.

Contraindications to OMT include acute fracture, severe osteoporosis, malignant bone lesions, and unstable spinal or vascular disease.

Acute low back pain without red flags is managed with activity as tolerated and short-course NSAIDs; imaging is not routine in the first 6 weeks.

Red flags for low back pain include bowel or bladder dysfunction, saddle anesthesia, fever, cancer history, and progressive neurologic deficit.

Otitis media with effusion is managed with watchful waiting; antibiotics are not recommended for asymptomatic effusion.

Constipation in children is managed with disimpaction followed by maintenance osmotic laxative; behavior modification supports treatment.

Screening for latent tuberculosis is recommended for populations at increased risk; a positive test requires chest imaging and treatment of latent infection.

Adult immunization: Tdap every 10 years, annual influenza, and pneumococcal vaccine for adults aged 65 and older or with risk conditions.

Acute gout is treated with NSAIDs, colchicine, or glucocorticoids; urate-lowering therapy is not started during an acute flare in most cases.

Functional technique uses a position of ease and gentle compression or traction to allow spontaneous tissue release.

Still technique combines a passive arc of motion with a thrust at the end range to restore motion.

Cervical HVLA is avoided with vertebral artery insufficiency symptoms, recent trauma, or severe osteoporosis; a thorough history precedes treatment.

Lymphatic pump techniques increase lymph flow and are used in edema and respiratory infection as an adjunct to standard care.

Somatic dysfunction of the thoracic spine commonly refers pain to the chest wall; it must be distinguished from cardiac and pulmonary causes.

Screening for alcohol misuse uses AUDIT-C or single-question screening; brief intervention is recommended for positive screens.

Obesity is defined by BMI of 30 or greater; intensive multicomponent behavioral intervention is recommended for adults with BMI of 30 or greater.

Tobacco cessation: varenicline, bupropion, and nicotine replacement are first-line; combination NRT improves quit rates.

Screening for hepatitis C is recommended once for adults aged 18-79; treatment with direct-acting antivirals achieves high cure rates.

Depression treatment: SSRIs are first-line; monitor for suicidality early in treatment, especially in adolescents and young adults.

Acute pharyngitis in adults: group A strep testing is indicated when clinical features suggest bacterial cause; treat with penicillin or amoxicillin.

Cranial rhythmic impulse is assessed by light touch at the cranial vault; a normal rate is about 10-14 cycles per minute.

The primary respiratory mechanism includes cranial bone motion, dural tension, CSF fluctuation, and sacral motion.

Myofascial release may be direct (toward the barrier) or indirect (away from the barrier), depending on tissue response.

Soft tissue and myofascial techniques are often used in the acute setting because they are gentle and well tolerated.

Muscle energy technique is useful for somatic dysfunction where the patient can actively contract muscles; it is contraindicated with acute fracture or severe pain.

Screening for osteoporosis: DXA for women 65 and older; for younger postmenopausal women with risk factors, use FRAX to guide testing.

Type 2 diabetes screening: adults aged 35-70 with overweight or obesity should be screened; repeat every 3 years if normal.

Hypertension in pregnancy: severe hypertension (at least 160/110) requires urgent treatment; labetalol and nifedipine are options.

Acute otitis media treatment in children: high-dose amoxicillin 80-90 mg/kg/day; add amoxicillin-clavulanate for treatment failure or recent antibiotics.

Screening for colorectal cancer in adults 45-75 is recommended; options include colonoscopy every 10 years, FIT annually, or stool DNA testing.

Asthma exacerbation: short-acting beta agonist is first-line; systemic corticosteroids are added for moderate to severe exacerbations.

Osteopathic structural exam includes inspection, palpation, range of motion, and regional motion testing.

Somatic dysfunction is coded in ICD-10 as M99.0x by region; documentation should include TART findings.

Counterstrain tender points are treated by shortening the muscle to reduce spindle cell firing and holding for about 90 seconds.

HVLA thrust is applied at the restrictive barrier after positioning and setup; a pop is not required for clinical benefit.

Lymphatic techniques are contraindicated in acute infection with fever, untreated congestive heart failure, or acute fracture.

Screening for depression in adults is recommended when systems are in place for follow-up; PHQ-9 is commonly used.

Acute bronchitis is usually viral; antibiotics are not recommended in the absence of pneumonia or comorbid disease.

Otitis externa is treated with topical antibiotic drops; avoid systemic antibiotics unless severe or spreading cellulitis.

Screening for intimate partner violence is recommended for women of reproductive age; direct questioning improves identification.

Adult vaccination: annual influenza, Tdap every 10 years, and zoster vaccine for adults aged 50 and older.

Cervical somatic dysfunction may cause headache; OMT can be an adjunct to standard headache management.

Rib somatic dysfunction can mimic cardiac chest pain; cardiac causes must be excluded before attributing symptoms to musculoskeletal dysfunction.

OMT in the elderly requires gentler techniques because of reduced bone density and tissue elasticity.

The osteopathic philosophy emphasizes the body's self-healing capacity and the interrelationship of structure and function.

Screening for cervical cancer: ages 21-65 with cytology every 3 years, or HPV testing every 5 years for ages 30-65.

Acute pharyngitis in children: group A strep testing is indicated for suspected bacterial pharyngitis; treat with penicillin or amoxicillin.

Screening for colorectal cancer: ages 45-75; colonoscopy every 10 years or annual FIT are options.

Adult hypertension: lifestyle modification and pharmacotherapy are both first-line; thiazide, ACE inhibitor, ARB, or calcium channel blocker are preferred.

Osteopathic manipulative treatment should be documented with the technique used, region treated, and response.

Somatic dysfunction in the thoracic region can contribute to respiratory symptoms; OMT may be used as an adjunct.

Cranial technique is controversial; evidence is limited, and it should not replace standard medical care.

OMT is generally safe when contraindications are respected; adverse events are usually mild and transient.