Kuwait Board Family Medicine cheat sheet

The four principles of family medicine: the physician is committed to the person rather than to a particular body of knowledge; the physician is a skilled clinician; the physician is a community-based resource; the physician is a resource to a defined practice population.

Patient-centred care 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 about time and resources.

The biopsychosocial model (Engel) evaluates biological, psychological, and social contributors; use it when symptoms exceed what the biomedical findings explain.

Continuity of care types: relational (an ongoing relationship with one clinician), informational (shared records), and management continuity (consistent care plans). Relational continuity is the family medicine hallmark.

The patient-centred clinical method uses FIFE: Feelings, Ideas, Function, Expectations - elicit these alongside the biomedical history.

Consultation models: Pendleton's tasks, the Calgary-Cambridge guide (initiating, gathering information, building relationship, explanation/planning, closing), and Neighbour's five checkpoints (connecting, summarising, handing over, safety netting, housekeeping).

Anticipatory care means proactively addressing predictable health needs across the life course rather than waiting for presentations.

Somatisation is common in primary care; up to a third of symptoms remain medically unexplained, and a positive diagnosis of functional illness improves outcomes compared with repeated investigation.

Hypertension diagnosis requires repeated elevated readings; ambulatory or home monitoring is preferred for confirmation. Target is generally <140/90 mmHg, with tighter targets (<130/80) in diabetes or CKD if tolerated.

Type 2 diabetes: HbA1c ≥6.5% (48 mmol/mol) is diagnostic; 5.7–6.4% indicates prediabetes. Metformin is first-line, with SGLT2 inhibitors or GLP-1 agonists added when ASCVD, heart failure, or CKD is present.

Statin therapy: high-intensity (atorvastatin 40–80 mg) lowers LDL by ≥50%; use ASCVD risk scores to guide initiation, and treat to LDL <1.8 mmol/L in established cardiovascular disease.

COPD diagnosis requires post-bronchodilator FEV1/FVC <0.70. Management combines smoking cessation, vaccination, inhaled bronchodilators, and pulmonary rehabilitation; long-term oxygen improves survival only in chronic hypoxaemia.

Asthma control is assessed by symptom frequency, night waking, reliever use, and activity limitation; step-up or step-down therapy accordingly, and check inhaler technique at every visit.

Heart failure with reduced ejection fraction (≤40%) benefits from the four pillars: ACE inhibitor/ARB or ARNI, beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor.

Hyperthyroidism presents with weight loss, tremor, heat intolerance, and tachycardia; TSH is low with elevated free T4. Hypothyroidism shows the reverse, with high TSH and low free T4.

Chronic kidney disease is defined by eGFR <60 mL/min/1.73 m² or markers of kidney damage (e.g., albuminuria) for >3 months; stage by eGFR and albuminuria category.

Growth monitoring uses WHO charts for 0–5 years and local/CDC charts thereafter; crossing two major centile lines warrants assessment.

Developmental milestones: sits unsupported ~6–8 months, walks ~12–15 months, two-word phrases ~18–24 months, and three-word sentences ~24–36 months.

Immunisation schedules vary by country; in Kuwait the childhood schedule includes BCG, hepatitis B, DTaP, IPV/OPV, Hib, MMR, and varicella, with boosters in school age.

Fever in an infant under 3 months is a red flag requiring urgent assessment and septic screen; the risk of serious bacterial infection is highest in this age group.

Acute otitis media: most cases in children over 2 years resolve spontaneously; antibiotics (amoxicillin) are indicated for young infants, severe symptoms, or bilateral infection.

Bronchiolitis is a clinical diagnosis (coryza, cough, wheeze, crackles in infants <2 years); management is supportive - oxygen, hydration, and feeding support.

Red flags for child maltreatment include injury inconsistent with developmental stage, delay in seeking care, and repeated injuries; mandatory reporting applies in most jurisdictions.

Adolescent health: HEADSS assessment covers Home, Education/Employment, Activities, Drugs, Sexuality, and Suicide/depression.

Antenatal care: first visit confirms pregnancy, estimates gestation (LMP or ultrasound), screens for anaemia, blood group and Rh, infections (HIV, hepatitis B, syphilis), and offers folic acid 400 µg daily pre-conception and in the first trimester.

Gestational diabetes screening is typically done at 24–28 weeks with an oral glucose tolerance test; risk factors include obesity, previous GDM, and family history.

Pre-eclampsia is defined by new hypertension after 20 weeks plus proteinuria or end-organ dysfunction; delivery is the definitive treatment.

Cervical screening: start at age 21–25 and repeat every 3–5 years depending on test type (cytology vs HPV testing); stop around age 65 if prior results are normal.

Mammography screening is generally offered every 1–2 years from age 40–50 to 69–74, depending on national guidance.

Contraceptive effectiveness: typical-use failure rates are highest for barrier methods and lowest for implants and intrauterine devices (long-acting reversible contraception).

Menopause is diagnosed clinically after 12 months of amenorrhoea; hormone therapy is the most effective treatment for vasomotor symptoms and should be individualised.

Postpartum care includes screening for postpartum depression (e.g., Edinburgh Postnatal Depression Scale), breastfeeding support, and contraception counselling.

Comprehensive geriatric assessment is multidimensional (medical, functional, psychological, social) and improves outcomes in frail older adults.

Frailty can be identified with the Clinical Frailty Scale or Fried phenotype; it predicts adverse outcomes and guides treatment intensity.

Falls assessment includes gait and balance testing, medication review, vision and hearing check, and home hazard assessment; multifactorial intervention reduces falls.

Polypharmacy is commonly defined as ≥5 medications; use tools such as STOPP/START or Beers criteria to identify potentially inappropriate prescribing.

Delirium is an acute fluctuating disturbance of attention and cognition; use the 4AT or CAM for screening, and treat the underlying cause.

Dementia screening tools include the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA); MoCA is more sensitive to mild cognitive impairment.

Urinary incontinence types: stress (leak with cough/sneeze), urge (sudden urge), overflow (retention), and functional (mobility/environment).

Advance care planning and goals-of-care discussions should be documented for older adults with serious illness; they reduce unwanted interventions at end of life.

Depression screening uses the PHQ-9 (9 items, score 0–27); ≥10 suggests moderate depression and warrants further assessment.

Generalised anxiety screening uses the GAD-7 (7 items, score 0–21); ≥10 suggests moderate anxiety.

First-line treatment for mild-to-moderate depression is psychological therapy (CBT) or an SSRI; SSRIs are first-line pharmacotherapy.

Suicide risk assessment: ask directly about ideation, plan, intent, and means; screen for access to lethal means and prior attempts.

Bipolar disorder: mania requires elevated/irritable mood plus increased energy for ≥1 week with ≥3 of the BAD criteria (distractibility, insomnia, grandiosity, flight of ideas, agitation, pressured speech, risky behaviour).

Alcohol use disorder screening uses AUDIT or AUDIT-C; brief intervention (5–15 minutes of feedback and advice) reduces hazardous drinking.

Opioid use disorder is treated with opioid agonist therapy (methadone or buprenorphine), which reduces mortality and improves retention in care.

Postpartum depression screening uses the Edinburgh Postnatal Depression Scale (EPDS); a score ≥10 or any positive answer to the self-harm item warrants further evaluation.

Anaphylaxis: intramuscular adrenaline 0.5 mg (0.01 mg/kg in children) into the anterolateral thigh, repeated every 5 minutes as needed; adjuncts include oxygen, fluids, and antihistamines.

Acute coronary syndrome: obtain 12-lead ECG within 10 minutes of arrival; aspirin 300 mg chewed and prompt reperfusion for STEMI.

Stroke: use FAST (Face, Arm, Speech, Time); thrombolysis window is generally up to 4.5 hours and thrombectomy up to 24 hours in selected patients.

Sepsis: use qSOFA (respiratory rate ≥22, altered mentation, systolic BP ≤100) as a prompt; start antibiotics and fluids early.

Acute asthma: assess severity by speech, respiratory rate, heart rate, oxygen saturation, and peak flow; give oxygen, salbutamol, ipratropium, and systemic corticosteroids.

Hypoglycaemia in a conscious patient: 15–20 g fast-acting oral carbohydrate, recheck in 15 minutes; in an unconscious patient give IV glucose or IM glucagon.

Burns: estimate surface area with the Rule of Nines (head 9%, each arm 9%, each leg 18%, trunk 36%, perineum 1%); fluids are indicated for burns >10–15% TBSA.

Triage systems (e.g., Manchester Triage, ESI) prioritise by acuity, not arrival order; document time of arrival, triage category, and reassessment.

Informed consent for procedures must cover indication, alternatives, risks, benefits, and the opportunity to ask questions; document the discussion.

Local anaesthetic maximum doses: lidocaine 3 mg/kg without adrenaline, 7 mg/kg with adrenaline; bupivacaine 2 mg/kg.

Wound cleaning uses normal saline or tap water; avoid hydrogen peroxide and alcohol in open wounds as they impair healing.

Sutures: face 5–0 to 6–0, trunk and limbs 3–0 to 4–0; remove facial sutures in 4–5 days, trunk and limbs in 7–14 days.

Abscess incision and drainage: use a linear incision over the point of maximal fluctuance, pack if large, and consider antibiotics for systemic signs or immunosuppression.

Joint aspiration and injection: use aseptic technique; the knee is approached superolateral or superomedial to the patella; avoid injecting through infected skin.

Nail avulsion and ingrown toenail procedures: use a digital block with lidocaine without adrenaline, and consider partial nail avulsion with matricectomy for recurrence.

Cryotherapy for warts and skin lesions: freeze 10–30 seconds with a 1–2 mm halo, repeat every 2–4 weeks; avoid in dark skin to reduce hypopigmentation risk.

Osteoarthritis management: exercise, weight loss, topical NSAIDs for knee/hand OA, and intra-articular corticosteroid for flares; paracetamol has limited efficacy.

Acute low back pain: red flags include age <20 or >50 at onset, trauma, fever, weight loss, night pain, and neurological deficit; imaging is not routine.

Carpal tunnel syndrome: nocturnal numbness in median nerve distribution, positive Tinel and Phalen tests; night splints and corticosteroid injection are first-line.

Psoriasis: well-demarcated erythematous plaques with silvery scale on extensor surfaces; associated with psoriatic arthritis, metabolic syndrome, and cardiovascular risk.

Eczema management: emollients, topical corticosteroids, and avoidance of triggers; use the lowest effective potency and step up during flares.

Cellulitis: non-purulent, tender, warm, erythematous spreading lesion; treat with flucloxacillin or cephalexin; mark the border to monitor progression.

Melanoma ABCDE: Asymmetry, Border irregularity, Colour variation, Diameter >6 mm, Evolution; urgent referral for suspected melanoma.

Gout: acute monoarthritis with hyperuricaemia; treat flares with NSAIDs, colchicine, or corticosteroids; urate-lowering therapy is for recurrent or tophaceous disease.

Screening criteria (Wilson and Jungner): important health problem, accepted treatment, facilities for diagnosis and treatment, latent stage, suitable test, agreed policy, and cost-effective.

Leading modifiable risk factors for non-communicable disease: tobacco, unhealthy diet, physical inactivity, harmful alcohol use, and obesity.

Colorectal cancer screening: faecal immunochemical test annually or colonoscopy every 10 years from age 45–50 to 75, depending on national guidance.

Smoking cessation: combination of behavioural support and pharmacotherapy (nicotine replacement, varenicline, or bupropion) is most effective.

Physical activity guidelines: 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week plus muscle-strengthening twice weekly.

Vaccination of older adults: annual influenza, pneumococcal vaccination, and shingles vaccine per national schedule.

Cardiovascular risk assessment uses tools such as QRISK or the ASCVD Pooled Cohort Equations; risk scores guide statin and antihypertensive decisions.

Health promotion uses the Ottawa Charter strategies: build healthy public policy, create supportive environments, strengthen community action, develop personal skills, and reorient health services.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

Positive predictive value depends on prevalence: PPV = sensitivity × prevalence / [(sensitivity × prevalence) + ((1 − specificity) × (1 − prevalence))].

Relative risk = incidence in exposed / incidence in unexposed; odds ratio approximates RR when the outcome is rare.

Number needed to treat = 1 / absolute risk reduction; NNT is the reciprocal of the difference in event rates between groups.

Study designs: randomised controlled trial (causal inference), cohort (incidence and risk factors), case-control (rare outcomes), and cross-sectional (prevalence).

Bias types: selection, information, confounding, and recall bias; randomisation and blinding reduce confounding and information bias.

Confidence intervals: a 95% CI excluding the null value (1 for ratios, 0 for differences) corresponds to a statistically significant result at p < 0.05.

Levels of evidence: systematic reviews of RCTs sit at the top; expert opinion and case reports sit at the bottom.

Four ethical principles: autonomy, beneficence, non-maleficence, and justice; apply them when values conflict.

Informed consent requires capacity, adequate information, voluntariness, and a decision; document the discussion and the patient's decision.

Confidentiality can be breached only when required by law, when there is serious risk to others, or with the patient's consent; disclose the minimum necessary information.

Capacity assessment: the patient must understand, retain, weigh, and communicate the decision; if capacity is absent, act in the patient's best interests.

Breaking bad news: use the SPIKES framework (Setting, Perception, Invitation, Knowledge, Empathy, Strategy and Summary).

Medical error disclosure: disclose promptly and honestly, explain what happened, apologise, and describe what will be done to prevent recurrence.

Patient safety tools: SBAR (Situation, Background, Assessment, Recommendation) for handover; WHO surgical safety checklist; incident reporting systems.

Boundary violations and conflicts of interest must be declared and managed; the patient's interests always take priority over personal or financial gain.

Primary care attributes: first contact, accessibility, continuity, comprehensiveness, coordination, and community orientation.

Quality improvement models: Plan-Do-Study-Act (PDSA) cycles, Lean, and Six Sigma; measure baseline and re-measure after change.

Clinical audit cycle: define standards, measure current practice, compare with standards, implement change, and re-audit.

Key performance indicators in primary care include cervical screening uptake, diabetes HbA1c control, blood pressure control, and vaccination coverage.

Electronic health records improve continuity and safety but require attention to data quality, privacy, and interoperability.

Health system building blocks (WHO): service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance.

Universal health coverage means all people receive needed health services without financial hardship; measure through service coverage and catastrophic spending indicators.

Root cause analysis is used after serious incidents to identify system failures rather than individual blame; it supports a just culture.

Screening for intimate partner violence: ask privately, use a validated tool, and provide safety planning and referral; mandatory reporting depends on jurisdiction.

Antimicrobial stewardship: prescribe only when bacterial infection is likely, use the narrowest effective agent, and complete the course; avoid antibiotics for viral upper respiratory infections.

Chronic pain management: use a biopsychosocial approach, stepwise analgesia, and avoid long-term opioids unless clearly indicated and monitored.

Travel medicine: review destination, duration, and activities; provide routine and travel vaccines, malaria prophylaxis, and advice on food and water safety.

Refugee and migrant health: screen for tuberculosis, hepatitis B, HIV, and anaemia; assess vaccination status and mental health needs.

Palliative care: use the WHO analgesic ladder; address physical, psychological, social, and spiritual needs; discuss goals of care early.

Patient education and self-management support improve outcomes in diabetes, asthma, and hypertension; use teach-back to confirm understanding.

Referral communication should include the reason for referral, relevant history, investigations, treatment tried, and the specific question being asked.