Arab Board Family Medicine Clinical cheat sheet

Hypertension diagnosis requires ≥2 readings on ≥2 occasions with office BP ≥140/90 mmHg; home/ambulatory thresholds are ≥135/85 mmHg.

Type 2 diabetes: metformin remains first-line unless eGFR <30 mL/min/1.73 m²; add SGLT2 inhibitor or GLP-1 agonist when ASCVD, heart failure, or CKD coexist.

CHA₂DS₂-VASc ≥2 in men or ≥3 in women supports anticoagulation in nonvalvular atrial fibrillation; score of 1 in men is a shared-decision scenario.

Statin intensity: high-intensity (atorvastatin 40–80 mg or rosuvastatin 20–40 mg) lowers LDL-C by ≥50%; moderate intensity by 30–49%.

Acute asthma severity: inability to speak in full sentences, RR >30, HR >120, and SpO₂ <90% indicate severe exacerbation requiring urgent transfer.

CURB-65 (confusion, urea >7 mmol/L, RR ≥30, low BP, age ≥65) of 0–1 supports outpatient CAP management; ≥2 suggests admission.

Anemia workup starts with MCV: microcytic → iron studies; normocytic → reticulocyte count; macrocytic → B12, folate, TSH, and medication review.

Hypothyroidism is confirmed by elevated TSH with low free T4; subclinical disease shows elevated TSH with normal free T4.

Weight-based pediatric dosing uses mg/kg; verify maximum adult dose before prescribing to avoid overdose in heavier children.

Normal infant growth: weight doubles by 5 months, triples by 12 months; birth length increases ~50% by 12 months.

Developmental red flags: no social smile by 2 months, no sitting without support by 9 months, no single words by 16 months, no two-word phrases by 24 months.

Acute otitis media in children ≥6 months with nonsevere illness may be observed 48–72 h; amoxicillin 80–90 mg/kg/day is first-line when antibiotics are indicated.

Kawasaki disease: fever ≥5 days plus ≥4 of conjunctivitis, oral changes, rash, extremity changes, cervical lymphadenopathy; treat with IVIG plus aspirin.

Adolescent confidentiality: many jurisdictions permit confidential care for STI testing, contraception, and mental health; always state limits around imminent harm.

Universal pediatric screening: newborn hearing, developmental surveillance at 9/18/30 months, and adolescent depression screening (e.g., PHQ-A) from age 12.

Dehydration in gastroenteritis: use ORS 50 mL/kg for mild and 100 mL/kg for moderate dehydration over 3–4 hours, replacing ongoing losses.

Prenatal folic acid 400 µg daily (5 mg if prior neural tube defect) started ≥1 month before conception reduces neural tube defects.

Dating by last menstrual period is replaced by first-trimester ultrasound when it differs by >7 days before 9 weeks or >7 days at 9–14 weeks.

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

Rh-negative unsensitized women receive anti-D immunoglobulin at 28 weeks and within 72 hours of delivery of an Rh-positive infant.

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

Cervical cancer screening: start at 21 (or 25 per local guidance); cytology every 3 years or co-testing/HPV testing every 5 years to age 65.

Combined oral contraceptives are contraindicated with migraine with aura, prior VTE, and BP ≥160/100 due to thrombotic risk.

Postpartum hemorrhage: uterine atony accounts for ~70%; first-line is uterine massage plus oxytocin, then tranexamic acid within 3 hours.

Acute appendicitis: migration of pain to right lower quadrant with McBurney point tenderness; Alvarado score ≥7 supports operative management.

Postoperative fever timing: day 1–2 atelectasis, day 3–5 urinary or pneumonia, day 5–7 wound infection, day 7+ deep abscess or DVT.

Small bowel obstruction: air-fluid levels and absent distal gas on plain film; IV fluids plus nasogastric decompression, surgery if strangulation signs.

Hernia: irreducible and tender suggests incarceration/strangulation and requires urgent surgical referral.

Breast lump: triple assessment (clinical exam, imaging, tissue sampling) achieves >99% diagnostic accuracy; age <30 usually starts with ultrasound.

Cholecystitis: RUQ pain, Murphy sign, fever, leukocytosis; ultrasound showing wall thickening >3 mm and pericholecystic fluid supports diagnosis.

Wound closure timing: clean wounds may be closed primarily; contaminated wounds with >6–12 hours delay often need delayed primary closure.

Perioperative VTE prophylaxis: assess Caprini score; use LMWH plus mechanical prophylaxis in high-risk abdominal or pelvic surgery.

Anaphylaxis: IM epinephrine 0.01 mg/kg (max 0.5 mg) into the anterolateral thigh, repeated every 5–15 minutes; antihistamines and steroids are adjuncts only.

Adult cardiac arrest: high-quality CPR at 100–120 compressions/min, depth 5–6 cm, minimize interruptions, and defibrillate shockable rhythms immediately.

Acute coronary syndrome: obtain 12-lead ECG within 10 minutes of arrival; door-to-balloon target ≤90 minutes for STEMI.

Stroke: activate stroke pathway; noncontrast CT within 20 minutes of arrival; thrombolysis window generally ≤4.5 hours from symptom onset.

Sepsis bundle: measure lactate, draw cultures, give broad-spectrum antibiotics and 30 mL/kg crystalloid within 1 hour for septic shock.

Status epilepticus: benzodiazepine first-line (IV lorazepam 0.1 mg/kg), then second-line antiepileptic if seizures persist beyond 20 minutes.

Diabetic ketoacidosis: IV fluids, insulin infusion 0.1 units/kg/h, and potassium replacement once K⁺ <5.5 mmol/L; avoid insulin if K⁺ <3.3.

Opioid overdose: naloxone 0.4–2 mg IV/IM or 4 mg intranasal, titrated to respiratory rate; observe for re-sedation due to short half-life.

Depression screening uses PHQ-2 then PHQ-9; score ≥10 indicates moderate depression warranting treatment or referral.

Suicide risk assessment documents ideation, intent, plan, means, prior attempts, and protective factors; means restriction reduces completed suicide.

SSRIs take 2–6 weeks for full effect; monitor for activation and increased suicidality in patients under 25 during the first weeks.

Serotonin syndrome: clonus, hyperreflexia, agitation, hyperthermia after serotonergic agents; stop offending drugs and give supportive care.

First-line generalized anxiety treatment is CBT plus SSRI/SNRI; benzodiazepines are reserved for short-term crisis use due to dependence risk.

Bipolar disorder: antidepressant monotherapy can precipitate mania; mood stabilizers (lithium, valproate) are required for maintenance.

Alcohol withdrawal: use CIWA-Ar to guide therapy; benzodiazepines are first-line, with thiamine before glucose to prevent Wernicke encephalopathy.

Dementia screening: cognitive testing plus functional assessment; reversible causes include B12 deficiency, hypothyroidism, depression, and medication effects.

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

Attack rate = new cases during an outbreak ÷ population at risk during the outbreak × 100.

Herd immunity threshold = 1 − 1/R₀; for measles (R₀ ≈ 12–18) this requires ~92–95% coverage.

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

Screening test validity: sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); predictive values depend on prevalence.

Lead-time bias inflates apparent survival in screened populations without changing true mortality; length bias favors detection of slow-growing disease.

Case-control studies estimate odds ratios; cohort studies estimate relative risk and incidence directly.

Screening criteria (WHO): important health problem, accepted treatment, detectable latent stage, acceptable test, and cost-effective program.

Counseling for smoking cessation: brief 5A approach (Ask, Advise, Assess, Assist, Arrange) increases quit rates; combine with pharmacotherapy.

Colorectal cancer screening from age 45–50 to 75: colonoscopy every 10 years, FIT annually, or stool DNA every 3 years.

Adult immunization: influenza annually; tetanus-diphtheria booster every 10 years; zoster vaccine from age 50; pneumococcal according to risk.

Physical activity target: 150 minutes of moderate or 75 minutes of vigorous activity weekly plus muscle-strengthening twice weekly.

Osteoporosis screening with DXA for women ≥65 and younger women with risk factors; FRAX guides treatment threshold.

Tobacco, alcohol, diet, and physical inactivity account for a large share of preventable chronic disease; brief intervention is effective.

Screening for intimate partner violence and depression is recommended in primary care when systems for follow-up exist.

Cardiovascular risk estimation (e.g., ASCVD pooled equations) guides statin initiation and shared decision-making.

The Calgary-Cambridge model structures the consultation: initiating, gathering information, physical examination, explanation/planning, closing.

Open-to-closed questioning: begin with open questions, narrow with closed questions; avoid leading questions that bias the history.

SPIKES protocol for breaking bad news: Setting, Perception, Invitation, Knowledge, Empathy, Strategy/Summary.

Teach-back confirms understanding by asking the patient to explain the plan in their own words, not by asking 'do you understand?'.

Motivational interviewing uses OARS (Open questions, Affirmation, Reflection, Summary) and explores ambivalence rather than advising directly.

Interpreters should be professional and trained; using family members, especially children, risks errors and confidentiality breaches.

Shared decision-making requires discussing options, benefits, harms, and patient values, then agreeing on a plan.

Health literacy: use plain language, chunk information, avoid jargon, and confirm comprehension with the patient.

Informed consent requires capacity, adequate disclosure of risks/benefits/alternatives, comprehension, and voluntariness.

Four ethical principles: autonomy, beneficence, non-maleficence, and justice; confidentiality is a professional duty with limited exceptions.

Mandatory reporting exceptions to confidentiality include suspected child abuse, certain communicable diseases, and imminent serious harm.

Minors: consent for treatment generally requires parental permission except for emancipated minors, emergencies, and specific statutory services.

Medical error disclosure: apologize, explain what happened, outline remediation, and document; disclosure reduces litigation risk.

Root cause analysis identifies systems failures in adverse events; it focuses on process, not individual blame.

Conflict of interest: declare financial or personal interests and withdraw from decisions where objectivity is compromised.

Patient safety: use two identifiers before procedures; hand hygiene and surgical safety checklists reduce preventable harm.

Levels of evidence: systematic reviews/meta-analyses of RCTs > RCTs > cohort > case-control > case series > expert opinion.

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

p-value is the probability of the observed result (or more extreme) if the null hypothesis is true; it is not the probability the null is true.

Confidence interval width decreases with larger sample size and reflects precision; if the 95% CI for a risk ratio crosses 1, the result is not statistically significant.

Bias types: selection, information, recall, publication, and confounding; randomization and blinding reduce them.

Sensitivity analysis tests robustness of results by varying assumptions; intention-to-treat analysis preserves randomization.

Quality improvement uses PDSA cycles (Plan-Do-Study-Act) and measures structure, process, and outcome.

Critical appraisal asks: validity, results, applicability to the patient, and magnitude of benefit/harm.

Venipuncture: choose appropriate gauge (21–23G for adults), apply tourniquet <1 minute, cleanse skin, and confirm identity before sampling.

Informed consent and aseptic technique are required before any invasive procedure; document procedure, consent, and complications.

Local anesthetic maximum doses: lidocaine 4.5 mg/kg without epinephrine and 7 mg/kg with epinephrine to avoid toxicity.

Incision and drainage of abscess: incise along skin lines, drain purulent material, pack if large, and consider antibiotics for systemic signs.

Urinary catheterization: use sterile technique, adequate lubrication, and confirm urine flow; remove as soon as clinically appropriate to reduce CAUTI.

Suturing: approximate wound edges, avoid tension, and remove facial sutures in 4–5 days, trunk 7–10 days, and extremities 10–14 days.

Lumbar puncture: position, identify L3–L4 or L4–L5 space, use aseptic technique; contraindicated with signs of raised intracranial pressure or coagulopathy.

Intravenous access: select site, use aseptic technique, secure line, and document insertion and removal dates to reduce infection.