Egyptian Board Family Medicine cheat sheet

Definition: family medicine is a specialty providing continuous, comprehensive, coordinated, accessible and accountable care to individuals and families across all ages, sexes and organs; its defining instruments are first contact, longitudinality, comprehensiveness and coordination.

The four core attributes (Starfield) are first-contact access, longitudinality (person-focused continuity over time), comprehensiveness (breadth of services) and coordination (linkage to other levels); each can be measured and audited.

Patient-centred clinical method has six components: exploring both disease and illness experience, understanding the whole person, finding common ground, incorporating prevention and health promotion, enhancing the doctor-patient relationship, and being realistic with time and resources.

Consultation models: Pendleton's seven tasks (define reason for attendance, consider other problems, choose action with the patient, share understanding, involve in management, use time/resources, establish/maintain relationship); Neighbour's five checkpoints (connecting, summarising, handing over, safety netting, housekeeping).

Continuity types: relational (same clinician), informational (shared records), management (consistent plan); higher relational continuity is associated with better preventive care uptake and lower hospitalisation in chronic disease.

Gatekeeping/primary care ratio: WHO estimates a higher density of primary care physicians relative to specialists is associated with better population health outcomes and lower costs; the ratio, not absolute numbers alone, is the comparative metric.

Principles of family-oriented care: genogram to three generations, family life-cycle stages (leaving home, joining families, young children, adolescents, launching children, later life), and family systems concepts of homeostasis, boundaries and triangulation.

Home visit indications: housebound patients, palliative/terminal care, assessment of the home environment and caregiver capacity, suspected child or elder maltreatment, and post-discharge review of frail patients.

Hypertension diagnosis: office BP ≥140/90 mmHg on two or more occasions; ambulatory or home monitoring thresholds are ≥135/85 mmHg daytime and ≥130/80 mmHg over 24 hours; confirm before labelling.

Type 2 diabetes diagnostic criteria: fasting plasma glucose ≥7.0 mmol/L (126 mg/dL), 2-hour OGTT ≥11.1 mmol/L (200 mg/dL), HbA1c ≥6.5% (48 mmol/mol), or random ≥11.1 mmol/L with classic symptoms; asymptomatic results require a repeat confirmatory test.

Acute coronary syndrome: ST-elevation requires immediate reperfusion; non-ST-elevation uses risk scores (GRACE, TIMI) with serial high-sensitivity troponin; dual antiplatelet therapy plus statin is standard after acute coronary syndrome.

Heart failure with reduced ejection fraction (≤40%) improves with four pillars: renin-angiotensin system inhibitor/ARNI, beta-blocker, mineralocorticoid receptor antagonist and SGLT2 inhibitor; diuretics are for congestion only.

Asthma versus COPD: asthma shows variable, reversible airflow limitation with atopy and diurnal symptoms; COPD shows persistent post-bronchodilator FEV1/FVC <0.70 with smoking exposure; spirometry is required to confirm either.

Thyroid: primary hypothyroidism shows high TSH with low free T4; subclinical hypothyroidism shows high TSH with normal free T4; treat overt disease, and in pregnancy use trimester-specific TSH ranges and increase levodopa-equivalent dosing early.

Chronic kidney disease staging uses eGFR (G1 ≥90, G2 60-89, G3a 45-59, G3b 30-44, G4 15-29, G5 <15 mL/min/1.73 m2) plus albuminuria category (A1 <30, A2 30-300, A3 >300 mg/g); both determine risk and referral.

Anemia approach: microcytic (iron deficiency, thalassemia, chronic disease), normocytic (renal, hemolytic, acute blood loss), macrocytic (B12/folate, alcohol, hypothyroidism, myelodysplasia); ferritin <30 ng/mL is diagnostic of iron deficiency, and <100 ng/mL with inflammation is supportive.

Growth: plot weight, length/height, head circumference and body mass index on appropriate charts; crossing two major centile lines downward suggests failure to thrive and warrants investigation.

Development milestones: social smile 6 weeks, head control 3 months, sits unsupported 6-8 months, pincer grasp 9-10 months, walks 12-18 months, two-word phrases 18-24 months, three-word sentences by 3 years.

Red flags for developmental delay: no social smile by 8 weeks, no head control by 4 months, no sitting by 9 months, no walking by 18 months, no words by 18 months, no two-word phrases by 24 months, or loss of any skill at any age.

Exclusive breastfeeding is recommended to 6 months with continued breastfeeding to 2 years; complementary feeding starts at 6 months with iron-rich foods; vitamin D 400 IU/day is given to exclusively breastfed infants.

Immunisation is schedule-driven; live vaccines (BCG, MMR, oral polio, rotavirus, varicella, yellow fever) are contraindicated in significant immunosuppression and pregnancy; mild illness with or without low-grade fever is not a contraindication.

Acute otitis media: bulging tympanic membrane or new-onset otorrhea with acute symptoms; observation is acceptable in children ≥6 months with non-severe illness; amoxicillin is first-line when antibiotics are indicated.

Bronchiolitis management is supportive: oxygen for saturations below 90-92%, hydration, and nasal suction; bronchodilators, corticosteroids and antibiotics are not routinely indicated.

Febrile child: age under 3 months with fever ≥38°C is a high-risk group requiring full sepsis evaluation and empirical antibiotics; use age-specific heart and respiratory rate limits when applying paediatric early warning scores.

Antenatal schedule: booking visit before 10 weeks, then visits every 4 weeks to 28 weeks, every 2 weeks to 36 weeks, and weekly thereafter; routine screening includes blood group and antibodies, hemoglobin, HIV, syphilis and hepatitis B, plus rubella immunity.

Gestational diabetes screening: 75 g oral glucose tolerance test at 24-28 weeks; thresholds commonly used are fasting ≥5.1 mmol/L, 1-hour ≥10.0 mmol/L or 2-hour ≥8.5 mmol/L (IADPSG/WHO criteria).

Preeclampsia: new hypertension after 20 weeks with proteinuria or maternal organ dysfunction; low-dose aspirin (75-150 mg) started before 16 weeks reduces risk in high-risk women; delivery is the definitive treatment.

Postpartum hemorrhage definition: blood loss ≥500 mL after vaginal birth or ≥1000 mL after caesarean; uterine atony is the commonest cause, and management follows the four T's: tone, trauma, tissue, thrombin.

Contraception effectiveness: typical-use failure rates are lowest for implants and intrauterine devices (<1%), intermediate for injectables and pills (about 7-9%), and highest for barrier and fertility-awareness methods; only condoms protect against sexually transmitted infection.

Cervical screening: start at age 21-25 depending on national guidance, with cytology every 3 years or HPV testing every 5 years; stop at 65 if adequate prior negative screening; abnormal results are triaged by colposcopy.

Menopause: diagnosis is clinical in women over 45 with amenorrhoea ≥12 months and vasomotor symptoms; hormone therapy is the most effective treatment for vasomotor symptoms and is safest when started before age 60 or within 10 years of menopause.

Ectopic pregnancy: any woman of reproductive age with abdominal pain and amenorrhoea needs a pregnancy test; transvaginal ultrasound plus serial beta-hCG (discriminatory zone about 1500-3500 IU/L) guides diagnosis and management.

Acute abdominal pain: assess with the surgical sieve (inflammatory, obstructive, vascular, traumatic, neoplastic, congenital, autoimmune, metabolic); peritonism (rigidity, rebound, guarding) mandates urgent surgical review.

Appendicitis: migration of pain to the right iliac fossa, anorexia, low-grade fever and raised inflammatory markers; Alvarado and AIR scores stratify; ultrasound or CT confirms in equivocal cases.

Bowel obstruction: colicky pain, vomiting, distension and absolute constipation with high-pitched tinkling bowel sounds; erect chest and supine abdominal radiographs show dilated loops and air-fluid levels; CT identifies the transition point.

Hernia: reducible, incarcerated or strangulated; strangulation signs are severe pain, tenderness, erythema, absent cough impulse and systemic upset, requiring emergency surgery; inguinal hernia is the commonest type.

Wound assessment and closure: clean wounds can be closed primarily within 6-8 hours (up to 24 hours on the face); contaminated or bite wounds are left open, irrigated and reviewed; tetanus prophylaxis depends on wound type and immunisation history.

Surgical site infection prevention: chlorhexidine-alcohol skin preparation, appropriate prophylactic antibiotic within 60 minutes of incision, normothermia, glycaemic control and hair removal by clipping rather than shaving.

Postoperative complications by timing: immediate (hemorrhage, anesthetic reaction), early (infection, atelectasis, deep vein thrombosis, anastomotic leak, acute urinary retention), late (adhesions, incisional hernia, stricture).

Breast lump: triple assessment combines clinical examination, imaging (ultrasound under 35-40 years, mammography above) and tissue sampling; any suspicious or persistent lump requires referral regardless of age.

Primary survey sequence is catastrophic hemorrhage control, airway with cervical spine protection, breathing, circulation, disability and exposure (ABCDE); reassess after every intervention.

Glasgow Coma Scale: eye 1-4, verbal 1-5, motor 1-6; total 3-15; score ≤8 indicates need for airway protection; use paediatric adaptations for children under 5 years.

Anaphylaxis: intramuscular adrenaline 0.5 mg (0.5 mL of 1:1000) into the anterolateral thigh for adults, repeated after 5 minutes; children receive 0.01 mg/kg (maximum 0.5 mg); remove the trigger, give oxygen and fluids, then antihistamine and steroid as adjuncts.

Fracture description: site, pattern (transverse, oblique, spiral, comminuted, greenstick), displacement, angulation, rotation, shortening and joint involvement; open fractures are graded (Gustilo-Anderson) and need antibiotics and debridement.

Ottawa ankle rules: radiography is indicated if there is malleolar pain plus bone tenderness at the posterior edge or tip of either malleolus, or inability to bear weight for four steps; similar rules exist for the knee and foot.

Compartment syndrome: pain out of proportion, worse on passive stretch, tense compartment, paraesthesia, then pallor and pulselessness late; pressure above 30 mmHg or within 30 mmHg of diastolic is an emergency requiring fasciotomy.

Hip fracture: shortened, externally rotated leg after a fall; urgent analgesia, nerve block, and surgery within 48 hours reduce mortality; assess for osteoporosis and start bone protection.

Burns: estimate surface area with Wallace rule of nines (head 9%, each arm 9%, each leg 18%, front trunk 18%, back trunk 18%, perineum 1%); fluids use the Parkland formula 4 mL/kg/% burn over 24 hours, half in the first 8 hours from injury time.

Depression: core symptoms are low mood and/or anhedonia for at least 2 weeks with functional impairment; severity is graded by symptom count and impact; screen with PHQ-9 or similar validated tool.

Suicide risk assessment covers ideation, intent, plan, means, previous attempts, substance misuse, hopelessness and protective factors; direct questioning does not increase risk; urgent referral for intent or plan with means.

Bipolar disorder: mania requires ≥1 week of elevated or irritable mood with increased energy plus ≥3 symptoms (grandiosity, reduced sleep need, pressured speech, flight of ideas, distractibility, increased activity, risky behaviour); hypomania is shorter and without marked impairment.

Psychosis: delusions, hallucinations, disorganized speech or behaviour, and negative symptoms for ≥1 month (ICD-10) with functional decline; first-episode psychosis needs urgent specialist referral and physical causes excluded.

Anxiety: generalised anxiety disorder is excessive worry for ≥6 months that is difficult to control with ≥3 of restlessness, fatigue, poor concentration, irritability, muscle tension and sleep disturbance.

Alcohol withdrawal: symptoms start 6-24 hours after the last drink, peak at 24-72 hours; seizures occur at 6-48 hours and delirium tremens at 48-96 hours; treat with benzodiazepines and thiamine (before glucose) to prevent Wernicke encephalopathy.

Dementia: progressive cognitive decline affecting daily function; Alzheimer disease is commonest, followed by vascular dementia; screen with validated tools (MMSE, MoCA) and exclude reversible causes (thyroid, B12, depression, medication).

Mental health law: detention requires mental disorder of a nature or degree warranting detention plus risk to self or others; document capacity assessment using understanding, retention, weighing and communication of decision.

Levels of prevention: primordial (avoid risk-factor emergence), primary (prevent disease before onset), secondary (early detection and treatment), tertiary (limit disability and rehabilitation), quaternary (avoid overmedicalisation).

Herd immunity threshold = 1 - 1/R0; for measles (R0 about 12-18) the threshold exceeds 90-95%, which is why two-dose coverage above 95% is required for elimination.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives); both are properties of the test, unaffected by prevalence.

Positive predictive value = true positives / all positives; negative predictive value = true negatives / all negatives; both change with prevalence, so a test performs differently in primary versus secondary care.

Screening criteria (Wilson-Jungner): important health problem, accepted treatment, facilities for diagnosis and treatment, recognizable latent stage, suitable test, agreed policy on whom to treat, cost-effective, continuous case finding.

Epidemiological study designs: cross-sectional (prevalence), case-control (odds ratio), cohort (incidence and relative risk), randomised controlled trial (causality); attributable risk is the difference in incidence between exposed and unexposed.

Outbreak investigation steps: verify diagnosis and confirm the outbreak, define a case, describe by person/place/time, generate hypotheses, test with analytical study, implement control, communicate and review.

Occupational and environmental health: exposure assessment, dose-response, latency, and susceptible groups (pregnancy, children, immunosuppressed) guide advice; notifiable diseases must be reported to public health authorities.

Relative risk = incidence in exposed / incidence in unexposed; odds ratio approximates relative risk only when the outcome is rare (roughly <10%).

Incidence rate = new cases / person-time at risk; prevalence = all cases at a point or period / population; prevalence ≈ incidence × mean duration for stable diseases.

Absolute risk reduction = control event rate - treatment event rate; number needed to treat = 1 / absolute risk reduction; number needed to harm = 1 / absolute risk increase.

Confidence interval: 95% CI = estimate ± 1.96 × standard error; a CI excluding the null value corresponds to statistical significance at the 5% level; wide intervals indicate imprecision.

Type I error is rejecting a true null hypothesis (alpha, usually 0.05); type II error is failing to reject a false null (beta, usually 0.20); power = 1 - beta.

P value is the probability of data at least as extreme as observed if the null hypothesis is true; it is not the probability that the null hypothesis is true, nor a measure of effect size.

Mean, median and mode describe central tendency; standard deviation describes spread of normally distributed data, interquartile range is used for skewed data; 95% of a normal distribution lies within mean ± 1.96 SD.

Bias types: selection (non-representative sampling), information/measurement (recall, observer), confounding (a third variable associated with both exposure and outcome); randomisation and adjustment address confounding, not all bias.

Screening test requirements: high sensitivity for the target condition, acceptable to the population, safe, inexpensive, and followed by an effective confirmatory test and treatment pathway.

Lead-time bias makes survival appear longer after screening without changing the time of death; length bias over-represents slow-growing disease; overdiagnosis detects disease that would never cause harm.

Breast cancer screening: mammography every 1-2 years for women aged 50-74 (some programmes start at 40-45); reduces mortality but carries false-positive and overdiagnosis risk.

Colorectal cancer screening: faecal immunochemical test annually or biennially, or colonoscopy every 10 years from age 45-50 to 75; earlier or more frequent in family history or hereditary syndromes.

Cardiovascular risk assessment: use validated equations (SCORE, QRISK, Framingham) based on age, sex, smoking, blood pressure, lipids and diabetes; treat when 10-year risk exceeds the local threshold, commonly 7.5-10%.

Smoking cessation: brief advice at every contact using the 5 A's (ask, advise, assess, assist, arrange); combination nicotine replacement or varenicline plus behavioural support roughly triples quit rates versus willpower alone.

Physical activity guidance: adults need 150-300 minutes of moderate or 75-150 minutes of vigorous activity weekly plus muscle strengthening twice weekly; children need about 60 minutes daily.

Immunisation across the lifespan: annual influenza for older adults and chronic disease, pneumococcal and shingles vaccines for older adults, tetanus boosters every 10 years, and travel vaccines based on destination and risk.

Comprehensive geriatric assessment is multidimensional (medical, functional, cognitive, psychological, social, environmental) and leads to a coordinated plan; it reduces hospitalisation and functional decline in frail older adults.

Frailty screening: Fried phenotype (weight loss, exhaustion, low activity, slow gait, weakness) or FRAIL scale; gait speed and timed up-and-go are practical measures; frailty predicts adverse outcomes better than age alone.

Falls assessment: ask about falls in the past year, assess gait and balance, medication review (sedatives, antihypertensives, anticholinergics), vision, feet and footwear, home hazards, and vitamin D status.

Deprescribing principles: review indication, benefit versus harm, dose, duration and goals of care; taper rather than stop abruptly for benzodiazepines, opioids, antidepressants and beta-blockers.

Delirium versus dementia: delirium has acute onset, fluctuating course and inattention; dementia is chronic and progressive; delirium is a medical emergency and requires identification of the cause (infection, medication, pain, constipation, retention, hypoxia).

Palliative care symptom control: use the World Health Organization analgesic ladder, prescribe anticipatory end-of-life medication for pain, dyspnoea, nausea, respiratory secretions and agitation, and review the route (subcutaneous when unable to swallow).

Opioid conversion and safety: convert using equianalgesic tables, reduce dose by 25-50% for cross-tolerance, co-prescribe laxatives, and be alert to renal impairment (avoid morphine; use oxycodone or fentanyl with caution).

Advance care planning: document preferences for resuscitation, hospital admission and place of care; in many jurisdictions a valid advance decision to refuse treatment is legally binding if it is specific and applies to the current situation.

Skin lesion assessment uses ABCDE (asymmetry, border irregularity, colour variation, diameter >6 mm, evolving) plus the seven-point checklist (major: change in size, shape, colour; minor: diameter ≥7 mm, inflammation, oozing, itch or altered sensation).

Melanoma subtypes: superficial spreading (commonest), nodular (fastest growing), lentigo maligna (sun-damaged elderly), acral lentiginous (palms, soles, nail apparatus); Breslow thickness is the key prognostic factor.

Basal cell carcinoma: pearly edge, telangiectasia, slow growth, rarely metastasises; squamous cell carcinoma: keratotic, tender, may metastasise, especially on lip, ear and in immunosuppression.

Eczema management: emollients liberally, topical corticosteroids by potency and site (mild for face, potent for trunk and limbs), and step-up for flares; topical calcineurin inhibitors are steroid-sparing for sensitive sites.

Psoriasis: well-demarcated erythematous plaques with silvery scale on extensor surfaces; assess severity by body surface area and impact; screen for psoriatic arthritis, metabolic syndrome and depression.

Bacterial skin infection: impetigo (honey-coloured crusts, topical or oral antibiotics), cellulitis (warm, tender, spreading erythema; mark the border and treat with anti-staphylococcal/streptococcal antibiotics), abscess (incision and drainage is definitive).

Fungal infection: dermatophytes cause annular scaly plaques with central clearing; confirm with skin scrapings and potassium hydroxide microscopy; tinea capitis requires oral therapy, and onychomycosis needs confirmation before prolonged treatment.

Minor procedures: obtain informed consent, use aseptic technique, infiltrate local anaesthetic with adrenaline cautiously on digits or where circulation is compromised, send excised specimens for histology, and document site, size, technique and complications.

Four principles: autonomy (respect informed choice), beneficence (act in the patient's interest), non-maleficence (avoid harm) and justice (fair distribution of resources); they are balanced, not ranked absolutely.

Valid informed consent requires capacity, adequate disclosure of material risks and alternatives, comprehension, and voluntariness; consent is a process, and documented discussion matters more than the signature.

Capacity assessment (four-stage): understand the information, retain it, weigh it in the balance, and communicate a decision; capacity is decision-specific and can fluctuate.

Confidentiality may be breached only when required by law, ordered by a court, or justified by a serious public-health or third-party risk; disclose the minimum necessary information and record the reasoning.

Professional boundaries: avoid treating family members where possible, declare conflicts of interest, do not accept inappropriate gifts, and never engage in sexual or exploitative relationships with patients.

Medical error disclosure: an open disclosure of what happened, its consequences, an apology, and what will be done to prevent recurrence is an ethical and often legal duty; never alter records after an incident.

Negligence requires four elements: a duty of care, a breach of the standard of a reasonable practitioner, causation and actual damage; the standard is judged against peers and current evidence.

Certification and death: death is confirmed by absence of circulation, respiration and neurological response; brain-stem death testing follows a defined protocol; completing the death certificate requires identifying the immediate, antecedent and underlying causes.

Appointment systems: open access reduces waiting times for urgent problems, while booked review slots support chronic disease; measure third-next-available appointment as an access indicator.

Audit cycle: choose a standard, collect data, compare against the standard, implement change, re-audit; audit improves care against existing standards, whereas research generates new knowledge.

Key performance indicators in primary care include cervical and breast screening uptake, immunisation coverage, HbA1c control in diabetes, blood pressure control, prescribing costs and emergency admissions.

Workforce and skill mix: define roles for physicians, nurses, pharmacists and community health workers; delegation requires competence, supervision and clear protocols.

Records and information governance: record contemporaneously, sign and date entries, correct errors with a dated addendum rather than deletion, and share information only with consent or lawful basis.

Prescribing safety: maintain a medication list, reconcile at transitions, review high-risk drugs (anticoagulants, insulin, opioids, methotrexate), and use generic names to reduce error.

Complaints handling: acknowledge promptly, investigate fairly, respond in writing with findings and actions, and use themes for system improvement rather than blaming individuals.

Financial stewardship: distinguish cost-effectiveness from cost containment; budget holding and formulary adherence must not override individual clinical need.

Evidence hierarchy: systematic reviews and meta-analyses of randomised trials rank highest for therapy; cohort studies for prognosis; diagnostic accuracy studies for tests; expert opinion ranks lowest.

Critical appraisal of therapy: assess randomisation, allocation concealment, blinding, intention-to-treat analysis, completeness of follow-up, effect size with confidence intervals, and applicability to your patient.

Levels of evidence: Level 1 systematic reviews of randomised trials, Level 2 individual randomised trials, Level 3 non-randomised cohort or case-control, Level 4 case series, Level 5 expert opinion.

GRADE rates certainty as high, moderate, low or very low, and strength of recommendation as strong or weak; strong recommendations apply to most patients, weak ones require shared decision-making.

Clinical practice guidelines: check the date, the evidence base, conflict-of-interest declarations and whether recommendations are conditional; adapt to local resources and patient values.

Quality improvement uses the Model for Improvement (Plan-Do-Study-Act cycles) with small tests of change; statistical process control charts distinguish common-cause from special-cause variation.

Publication and reporting bias: positive studies are more likely to be published and cited; funnel-plot asymmetry and registry comparison suggest reporting bias; search beyond English-language and positive studies.

Shared decision-making integrates best evidence, patient values and clinical context; decision aids improve knowledge and reduce decisional conflict without increasing consultation length substantially.

Acute limb ischemia is a vascular emergency: pain, pallor, pulselessness, paraesthesia, paralysis and perishing cold; urgent vascular referral and heparinisation are required, with a 6-hour window for muscle viability.

Deep vein thrombosis and pulmonary embolism: use a validated clinical probability score (Wells), D-dimer for low/intermediate probability, and compression ultrasound or CT pulmonary angiography for confirmation; start anticoagulation when probability is high.

Back pain red flags: age over 50 with new pain, trauma, cancer history, weight loss, fever, night pain, progressive neurological deficit, saddle anaesthesia or bladder/bowel dysfunction; the last group needs emergency imaging.

Osteoarthritis: clinical diagnosis with activity-related pain, brief morning stiffness and functional limitation; weight loss, exercise and topical or oral non-steroidal anti-inflammatory drugs are core, with arthroplasty for severe disease.

Joint dislocation and reduction: assess neurovascular status before and after reduction, confirm with post-reduction imaging, and immobilise in the appropriate position; shoulder dislocation is the commonest large-joint dislocation.

Head injury: indications for CT include loss of consciousness, amnesia, vomiting, seizure, focal deficit, suspected skull fracture and anticoagulation; observe and provide written head-injury advice with a safety-netting plan.

Sepsis: use a screening tool (qSOFA or NEWS), take cultures before antibiotics, give broad-spectrum antibiotics within 1 hour of recognition, and give 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

Emergency contraception: copper intrauterine device is the most effective option up to 5 days after unprotected intercourse; oral levonorgestrel or ulipristal is used within 72-120 hours depending on the agent and body weight.

Child maltreatment indicators: unexplained or inconsistent injury, delayed presentation, repeated injuries, injury in a non-mobile infant, and inconsistent history; document verbatim, examine fully and follow safeguarding procedures.

Paediatric fluid maintenance uses the Holliday-Segar formula: 100 mL/kg/day for the first 10 kg, 50 mL/kg/day for the next 10 kg, and 20 mL/kg/day thereafter; boluses are 10-20 mL/kg of isotonic crystalloid.

Neonatal jaundice: visible jaundice within 24 hours is always pathological; use bilirubin charts against age in hours; treat with phototherapy or exchange transfusion according to threshold; exclude haemolysis and infection.

Kawasaki disease: fever ≥5 days plus ≥4 of conjunctivitis, mucosal changes, rash, extremity changes and cervical lymphadenopathy; treat with intravenous immunoglobulin and aspirin to prevent coronary artery aneurysms.

Measles, mumps and rubella: measles shows cough, coryza, conjunctivitis and Koplik spots before a descending rash; notify public health and check immunisation status of contacts.

Childhood asthma: diagnosis is supported by variable symptoms, diurnal variation, atopy and response to bronchodilator; spacer with a face mask is preferred for delivering inhaled therapy in young children.

Sudden infant death prevention: supine sleeping, firm flat surface, no bed sharing with smoke or alcohol exposure, room sharing for the first 6 months, and avoiding overheating and head covering.

Adolescent health: use the HEADSS framework (home, education, activities, drugs, sexuality, suicide/depression) for psychosocial assessment; confidentiality and consent rules vary with age and capacity.

Rhesus prophylaxis: give anti-D immunoglobulin to Rh-negative unsensitised women at 28 weeks and within 72 hours of delivery of an Rh-positive infant, and after potentially sensitising events such as miscarriage or amniocentesis.

Folic acid: 400 micrograms daily before conception and through the first trimester; 5 mg daily for women with previous neural tube defect, diabetes, obesity, epilepsy on valproate, or malabsorption.

Abnormal uterine bleeding is classified by PALM-COEIN: polyp, adenomyosis, leiomyoma, malignancy, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic and not otherwise classified.

Ovarian torsion: sudden severe unilateral pain with nausea and vomiting; ultrasound may show an enlarged oedematous ovary with reduced flow; laparoscopic detorsion is urgent to preserve fertility.

Polycystic ovary syndrome (Rotterdam criteria): two of oligo/anovulation, clinical or biochemical hyperandrogenism and polycystic ovarian morphology; lifestyle and metformin or combined oral contraceptives are first-line.

Urinary tract infection in pregnancy: treat asymptomatic bacteriuria because it predisposes to pyelonephritis and preterm birth; avoid nitrofurantoin at term and trimethoprim in the first trimester.

Intimate partner violence: ask routinely and privately, use a non-judgemental approach, provide safety planning and referral, and document findings; do not disclose to the partner.

Contraceptive counselling after 40: combined hormonal contraception can continue to age 50 if no cardiovascular risk factors; progestogen-only and intrauterine methods are suitable alternatives; sterilisation requires informed, non-coerced consent.

Substance use screening: use validated tools such as AUDIT-C for alcohol and a brief intervention based on FRAMES (feedback, responsibility, advice, menu, empathy, self-efficacy); motivational interviewing explores ambivalence without confrontation.

Serotonin syndrome: triad of altered mental state, autonomic instability and neuromuscular hyperactivity (clonus, hyperreflexia) after serotonergic drugs; stop the drug and give supportive care, with benzodiazepines or cyproheptadine.

Neuroleptic malignant syndrome: fever, rigidity, autonomic instability and raised creatine kinase after dopamine antagonists; stop the drug, cool the patient, give fluids and consider dantrolene or bromocriptine.

Eating disorders: anorexia nervosa has low body weight, fear of weight gain and body image disturbance; bulimia has recurrent binges with compensatory behaviour; monitor electrolytes, cardiac rhythm and bone health.

Post-traumatic stress disorder: re-experiencing, avoidance, hyperarousal and negative cognitions lasting over a month after trauma; trauma-focused psychological therapy is first-line, with selective serotonin reuptake inhibitors as adjuncts.

Attention deficit hyperactivity disorder: symptoms of inattention and/or hyperactivity-impulsivity across settings for ≥6 months with impairment; multimodal treatment combines behavioural strategies with medication where indicated.

Perinatal mental health: screen for depression and anxiety antenatally and postnatally (Edinburgh Postnatal Depression Scale); severe illness or psychosis in the postpartum period is a psychiatric emergency.

Somatic symptom and functional disorders: explain the diagnosis positively, avoid unnecessary investigations, schedule regular appointments and focus on function rather than symptom elimination.

Social determinants of health include income, education, employment, housing, early childhood, food security and social support; they shape exposure and access, and are measured by indices such as deprivation scores.

Primary health care (Alma-Ata and Astana) rests on accessibility, community participation, intersectoral collaboration and appropriate technology; universal health coverage is the operational goal.

Health needs assessment: define the population, gather epidemiological and service-use data, consult stakeholders, identify unmet need, prioritise and plan; equity requires weighting by disadvantage.

Communicable disease control: isolate or quarantine according to incubation and infectious periods; ring vaccination and post-exposure prophylaxis are used for contacts of measles, hepatitis and meningococcal disease.

Water, sanitation and hygiene: safe water supply, latrine coverage and hand hygiene are the highest-impact interventions for diarrhoeal disease; oral rehydration salts and zinc reduce child mortality.

Non-communicable disease prevention at population level uses fiscal measures (tobacco and sugar taxes), regulation (salt reduction, advertising restrictions) and built-environment design, which are more effective than individual advice alone.

Community diagnosis: collect demographic, morbidity, mortality and service data plus community perceptions; use it to set priorities and evaluate programmes with indicators of input, process, output and outcome.

Disaster and emergency preparedness: all-hazards approach with risk assessment, surge capacity, stockpiles, communication plans and drills; triage in mass casualty uses colour-coded categories.

Mortality measures: crude death rate = deaths/population; age-standardised rates allow comparison between populations with different age structures; infant mortality rate = deaths under 1 year per 1000 live births.

Maternal mortality ratio = maternal deaths per 100,000 live births; under-5 mortality is a key indicator of child health and development.

Screening programme metrics: detection rate, recall rate, interval cancer rate and stage shift; mortality reduction in a randomised trial is the strongest evidence of benefit.

Study power: increases with larger sample size, larger effect size, lower variance and higher alpha; a negative trial with low power is uninformative rather than proof of no effect.

Intention-to-treat analysis preserves randomisation and avoids bias from dropout; per-protocol analysis estimates efficacy under ideal adherence but can be biased.

Survival analysis: Kaplan-Meier curves estimate survival over time; the log-rank test compares curves; hazard ratio summarises the relative risk over the follow-up period.

Regression choice: linear for continuous outcomes, logistic for binary outcomes (odds ratios), Poisson for counts and Cox proportional hazards for time-to-event data; check assumptions and model fit.

Meta-analysis: assess heterogeneity with I-squared and Cochran Q; use random-effects models when heterogeneity is substantial; explore sources with subgroup and sensitivity analyses; check for publication bias with funnel plots.

Tobacco, alcohol, diet and physical inactivity account for most preventable non-communicable disease; brief intervention at every clinical contact is the highest-yield prevention activity in primary care.

Alcohol limits: many guidelines advise no more than 14 units per week spread over 3 or more days for adults, with alcohol-free days; there is no safe level for cancer risk.

Dietary advice: at least 5 portions of fruit and vegetables daily, at least 30 g of fibre, limited free sugars to under 10% of energy, and salt under 5 g daily for adults.

Obesity: classify by body mass index (≥25 overweight, ≥30 obesity) with waist circumference for central adiposity; a 5-10% weight loss improves glycaemia, blood pressure and lipids.

Immunisation in pregnancy: inactivated influenza and tetanus-diphtheria-pertussis vaccines are recommended in pregnancy; live vaccines are contraindicated; maternal antibodies protect the newborn.

Newborn screening: heel-prick blood spot for congenital hypothyroidism, phenylketonuria, cystic fibrosis and haemoglobinopathies, plus hearing screening and pulse oximetry for critical congenital heart disease.

Screening harms: false positives cause anxiety and unnecessary tests, false negatives give false reassurance, overdiagnosis leads to overtreatment; the balance of benefit and harm must be explicit and communicated.

Health behaviour change models: the transtheoretical stages (precontemplation, contemplation, preparation, action, maintenance) and the COM-B model (capability, opportunity, motivation) guide interventions.

Polypharmacy is commonly defined as five or more regular medicines; use explicit tools (STOPP/START, Beers criteria) to identify potentially inappropriate prescribing in older adults.

Anticholinergic burden from multiple drugs causes confusion, falls, constipation and urinary retention; review and reduce where possible, especially in cognitive impairment.

Osteoporosis: dual-energy X-ray absorptiometry T-score ≤-2.5 defines osteoporosis; treat with bisphosphonates plus calcium and vitamin D, and review falls risk and dental status before starting.

Urinary incontinence: classify as stress, urge, overflow or functional; start with bladder training, pelvic floor exercises, fluid and caffeine review, and treat constipation before drugs or referral.

Pressure ulcers: assess risk with a validated scale, reposition regularly, use pressure-redistributing surfaces, keep skin clean and dry, and optimise nutrition; staging describes tissue depth, not healing potential.

Palliative care communication: use the SPIKES framework (setting, perception, invitation, knowledge, empathy, strategy/summary) for breaking bad news; check understanding and respond to emotion before giving more information.

Last days of life: recognise dying, stop non-essential medication, prescribe anticipatory drugs for pain, dyspnoea, secretions, nausea and agitation, provide mouth care, and support family and carers.

Bereavement: grief is usually self-limiting; complicated grief persists beyond 12 months with functional impairment; screen and refer for specialist support when indicated.

Urticaria and angioedema: wheals lasting under 24 hours with no residual mark; chronic urticaria lasts over 6 weeks; antihistamines are first-line, and angioedema with airway involvement is an emergency.

Drug eruptions: morbilliform eruption is commonest; red flags are mucosal involvement, blistering, fever, eosinophilia and systemic organ involvement (Stevens-Johnson syndrome/toxic epidermal necrolysis), requiring immediate withdrawal of the drug and urgent referral.

Shingles: dermatomal vesicular rash with pain; antiviral therapy is most effective within 72 hours of rash onset; ophthalmic involvement (Hutchinson sign) needs urgent ophthalmology review.

Scabies: itchy papules and burrows in web spaces, wrists and genitalia; treat the patient and all close contacts simultaneously with topical permethrin or oral ivermectin, and wash bedding and clothing hot.

Acne: comedones, papules and pustules; topical retinoid plus benzoyl peroxide is first-line; avoid systemic tetracyclines in pregnancy and in children under 12.

Skin biopsy and excision: choose the site, use local anaesthetic, orient the ellipse along skin tension lines, handle specimens carefully, and send in formalin with clinical details; document in the notes.

Cryotherapy and curettage: used for warts, actinic keratoses and some benign lesions; avoid on pigmented lesions without diagnosis; warn about blistering, hypopigmentation and scarring.

Wound care: clean with saline, debride non-viable tissue, choose dressings by exudate level and wound bed, and review regularly; signs of infection are spreading erythema, warmth, pus and systemic upset.

Consent in children: assess competence (Gillick-type) and involve parents; a competent child may consent to treatment, and refusal of life-saving treatment by a minor can be overridden by a court.

Consent in emergencies: treat under the doctrine of necessity when the patient lacks capacity and treatment is immediately necessary to save life or prevent serious harm; document the reasoning.

Research ethics: institutional review board approval, informed consent, risk minimisation, confidentiality, and special protection for vulnerable groups (children, prisoners, pregnant women, cognitively impaired).

Conflicts of interest: declare financial and non-financial interests, including gifts, sponsorship and referral arrangements; the patient's interest overrides personal or institutional gain.

Fitness to practise: concerns about health, conduct or performance that put patients at risk must be reported to the regulator; personal health problems should be managed through occupational health.

Documentation: record date, time, who was present, what was discussed, decisions made and safety-netting advice; the record is a legal document and may be disclosed in litigation.

Telemedicine: verify identity, confirm the patient's location, obtain consent, maintain confidentiality, document advice, and arrange in-person review when examination is required.

Organ and tissue donation: donation after brain-stem death or circulatory death requires confirmed consent or family authorisation according to local law; the treating clinician must be separate from the transplant team.

Patient safety in primary care: incident reporting systems, significant event analysis, and a blame-free culture improve learning; medication errors and delayed diagnosis are the commonest reported incidents.

Access and demand management: measure demand, capacity and backlog; use telephone or digital triage to redirect demand, and protect continuity for patients with complex needs.

Team-based care: regular multidisciplinary meetings, shared care plans and clear role definitions reduce duplication and improve chronic disease outcomes.

Digital health records: coded data enables audit and recall; free-text alone limits search; ensure interoperability and backup, and follow data protection law.

Prescribing budget indicators: generic prescribing rate, cost per prescribing unit and antibiotic prescribing volume; compare with peers, but review outliers clinically rather than punitively.

Recruitment and retention: clear job plans, supervision, continuing professional development and manageable workload are the main determinants of retention in primary care.

Patient feedback: use surveys and complaints as quality data; response rates and selection bias limit interpretation; triangulate with clinical indicators.

Business continuity: plan for staff absence, power and IT failure, and emergency surge; test the plan and keep contact lists current.

Asking a focused clinical question uses PICO: population, intervention, comparator and outcome; it converts a clinical uncertainty into a searchable question.

Searching evidence: use PubMed, Cochrane Library and guideline databases; apply filters for study type; appraise abstracts for relevance before retrieving full text.

Diagnostic test appraisal: sensitivity, specificity, likelihood ratios and the post-test probability; a likelihood ratio above 10 or below 0.1 markedly changes probability.

Likelihood ratio for a positive test = sensitivity / (1 - specificity); for a negative test = (1 - sensitivity) / specificity; likelihood ratios are independent of prevalence.

Number needed to treat is the inverse of absolute risk reduction; it is more clinically meaningful than relative risk reduction because it reflects baseline risk.

Guideline appraisal uses AGREE II domains: scope and purpose, stakeholder involvement, rigour of development, clarity, applicability and editorial independence.

Clinical audit versus research: audit measures practice against an existing standard and does not need research ethics approval in most settings; research tests a hypothesis and generates new knowledge.

Knowledge translation: passive dissemination of guidelines changes practice little; interactive education, reminders, audit and feedback, and clinical decision support produce modest but measurable improvement.

The biopsychosocial model integrates biological, psychological and social dimensions; it explains symptom presentations that biomedical assessment alone cannot account for.

The patient-centred approach uses shared decision-making and agenda setting; asking 'what matters most to you today?' and negotiating a shared agenda improves satisfaction and adherence.

Continuity of care is associated with improved preventive care, better chronic disease control, fewer emergency admissions and lower costs; measure it with the usual provider of care index.

The consultation should include safety netting: specify what to do if symptoms worsen, when to return, and how to access urgent care; document the advice given.

Population-based practice: register-based recall for chronic disease and screening, risk stratification of the practice list, and proactive outreach to non-attenders.

The inverse care law states that availability of good care tends to vary inversely with need; equity audits compare uptake in deprived and affluent groups.

Team-based primary care with nurses, pharmacists and community health workers extends capacity; task-shifting requires training, protocols and supervision.

Referral and coordination: write clear referral letters with the clinical question, relevant results and treatment tried; follow up results and close the loop with the patient.

Atrial fibrillation: assess stroke risk with CHA2DS2-VASc and bleeding risk with HAS-BLED; anticoagulate when stroke risk is significant; rate control or rhythm control according to symptoms and duration.

Lipid management: statins reduce cardiovascular events; use risk scores to decide intensity; check baseline liver enzymes and lipids, and repeat lipids 8-12 weeks after starting therapy.

Gout: acute attack treated with non-steroidal anti-inflammatory drugs, colchicine or corticosteroids; urate-lowering therapy is indicated for recurrent attacks, tophi or renal disease, with prophylaxis during initiation.

Peptic ulcer and Helicobacter pylori: test with urea breath test or stool antigen, treat with proton pump inhibitor-based triple or quadruple therapy, and confirm eradication.

Chronic obstructive pulmonary disease: smoking cessation and inhaled bronchodilators are the mainstay; pulmonary rehabilitation improves symptoms and reduces admissions; long-term oxygen for chronic severe hypoxaemia.

Liver disease: abnormal liver enzymes require history (alcohol, drugs, viral risk), viral serology, ultrasound and metabolic screen; non-alcoholic fatty liver disease is the commonest cause in primary care.

Anticoagulation safety: monitor renal function, review interacting drugs, and use bridging only when indicated; for warfarin, target INR is usually 2.0-3.0.

Diabetes review: check HbA1c, blood pressure, lipids, renal function, urine albumin-to-creatinine ratio, foot examination and retinal screening annually; offer structured education and self-management support.

Acute scrotum: testicular torsion is a surgical emergency with sudden severe pain, high-riding testis and absent cremasteric reflex; do not delay exploration for imaging if suspicion is high.

Biliary disease: biliary colic causes right upper quadrant pain after fatty meals; cholecystitis adds fever and persistent pain with a positive Murphy sign; ultrasound is first-line.

Acute pancreatitis diagnosis requires two of: characteristic pain, lipase or amylase more than three times the upper limit of normal, and imaging findings; early fluid resuscitation and analgesia are key.

Anorectal disease: hemorrhoids, fissure and abscess are common; perianal abscess needs urgent incision and drainage; fistula and malignancy require specialist referral.

Skin abscess and cellulitis: incision and drainage for abscess, antibiotics for surrounding cellulitis; consider methicillin-resistant Staphylococcus aureus where prevalent.

Thyroid nodule: assess with ultrasound and fine-needle aspiration; suspicious features include microcalcification, irregular margins and taller-than-wide shape; refer for surgery when malignant.

Postoperative fever by day: day 1-2 atelectasis, day 3-5 urinary or wound infection, day 5-7 anastomotic leak or abscess, day 7-10 deep vein thrombosis; investigate with cultures and imaging.

Trauma secondary survey: head-to-toe examination, log-roll, and imaging guided by findings; do not miss the 'lethal six' (airway obstruction, tension pneumothorax, massive haemothorax, flail chest, cardiac tamponade, haemorrhage).

Screening uptake inequity: lower uptake in deprived, minority and mobile populations widens health inequalities; targeted outreach and translated information improve participation.

Notifiable diseases include measles, tuberculosis, meningococcal disease, hepatitis A, cholera and rabies depending on jurisdiction; notification allows contact tracing and outbreak control.

Vaccination programme evaluation uses coverage, disease incidence, seroprevalence and adverse event reporting; a fall in coverage below herd immunity threshold predicts outbreaks.

Maternal and child health programmes: antenatal care, skilled birth attendance, postnatal visits, exclusive breastfeeding promotion and immunisation are the core high-impact package.

Environmental health: air pollution, unsafe water, lead and pesticides are assessed by exposure measurement and regulation; children and pregnant women are most susceptible.

Health promotion planning uses the PRECEDE-PROCEED model: assess social, epidemiological, behavioural and environmental needs, then implement and evaluate.

Community participation: engage local leaders and community health workers to improve acceptability and sustainability; measure participation, not only outputs.

Outbreak communication: give clear, consistent, timely messages, address uncertainty, counter misinformation and coordinate with public health authorities.

Cognitive screening in older adults: use the Mini-Mental State Examination or Montreal Cognitive Assessment, adjust for education, and confirm functional impact; screen for depression and delirium.

Medication review in the frail: consider goals of care, life expectancy, time to benefit and adverse effects; stopping preventive drugs may be appropriate in advanced frailty or terminal illness.

Nutrition and hydration in dementia: offer finger foods, maintain oral care, and consider feeding assistance; artificial feeding does not improve survival or quality of life in advanced dementia.

Pain assessment in cognitive impairment: use observational tools (PAINAD, Abbey) for facial expression, vocalisation, body language, behaviour change and physiological signs.

Advance care planning conversations: explore values and goals, identify a surrogate decision-maker, document preferences and review regularly; the conversation matters as much as the document.

Palliative emergencies: superior vena cava obstruction, spinal cord compression, hypercalcaemia, haemorrhage and terminal agitation require rapid assessment, steroids or specific treatment, and clear communication with the family.

Hospice and home palliative care: multidisciplinary teams provide symptom control, psychological and spiritual support, and bereavement care; early referral improves quality of life and can reduce hospital use.

Cultural and spiritual care: ask about beliefs and rituals, accommodate dietary and prayer needs, and involve chaplaincy or community leaders when requested.