Family Medicine
Family medicine overlaps general internal medicine but is distinguished by prevention, chronic-disease follow-up, multimorbidity and continuity. Questions often ask for the "most appropriate screening" or the "next step in the asymptomatic patient".
Core rules
- Colorectal cancer screening from age 50 (colonoscopy or fecal immunochemical test); mammography every two years for ages 50–74; cervical cytology from age 25 every three years in Israel.
- Hypertension: confirm with repeat or home measurements before starting treatment; first-line agents are ACE inhibitors/ARBs, calcium-channel blockers and thiazides.
- Type 2 diabetes: individualized HbA1c targets; metformin first; add SGLT2 inhibitors or GLP-1 receptor agonists where cardiovascular or renal disease is present.
- Lipid management: calculate cardiovascular risk rather than treating a single LDL figure.
- Smoking cessation: brief advice plus nicotine replacement, varenicline or bupropion.
- Polypharmacy: review against Beers criteria in older adults.
Worked example
A 58-year-old smoker has blood pressure 148/94 mmHg on two occasions, LDL 160 mg/dL and no diabetes. Reasoning: confirm with home or ambulatory measurements, calculate ten-year cardiovascular risk, give lifestyle advice, start a statin if risk is high, and begin an ACE inhibitor or thiazide. Offer smoking-cessation pharmacotherapy at the same visit.
Traps that cost marks
- Treating white-coat hypertension on a single reading.
- Ordering PSA without a shared decision about benefits and harms.
- Over-screening patients with limited life expectancy.
- Missing drug interactions, especially in elderly patients on anticoagulants.
Traps that cost marks
- Assuming the patient has already been screened elsewhere.