PGIM MD Family Medicine cheat sheet

Acute otitis media in children: first-line is high-dose amoxicillin 80-90 mg/kg/day; add amoxicillin-clavulanate for recent amoxicillin use, purulent conjunctivitis, or treatment failure at 48-72 hours.

Community-acquired pneumonia: CURB-65 (Confusion, Urea >7 mmol/L, Respiratory rate >=30, Blood pressure systolic <90 or diastolic <=60, Age >=65) - 0-1 treat outpatient, 2 short admission, >=3 consider ICU.

Type 2 diabetes: metformin remains first-line unless contraindicated; add an SGLT2 inhibitor or GLP-1 receptor agonist when atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease coexists.

Hypertension: confirm with out-of-office measurement; start two-drug combination (e.g., ACE inhibitor/ARB plus thiazide or calcium channel blocker) when BP >=20/10 mmHg above target.

Asthma: step-up only after checking adherence and inhaler technique; SMART (single maintenance and reliever therapy) with low-dose ICS-formoterol reduces exacerbations versus SABA-only regimens.

Anticoagulation: CHA2DS2-VASc >=2 in men or >=3 in women with atrial fibrillation warrants oral anticoagulation; DOACs preferred over warfarin except in mechanical valves or moderate-severe mitral stenosis.

Depression: PHQ-9 scores 5-9 mild, 10-14 moderate, 15-19 moderately severe, >=20 severe; offer structured psychotherapy or antidepressant for moderate or worse, reassess at 4-6 weeks.

Low back pain: red flags (saddle anaesthesia, bladder dysfunction, fever, cancer history, progressive deficit) mandate urgent imaging; otherwise avoid imaging within first 6 weeks without red flags.

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP). Positive predictive value = TP/(TP+FP) and depends on prevalence, rising as prevalence rises.

Screening test criteria: important condition, accepted treatment, recognizable latent stage, suitable test, test acceptable to population, agreed policy on whom to treat - Wilson and Jungner principles.

Herd immunity threshold = 1 - 1/R0; measles R0 12-18 requires roughly 92-95% coverage, while influenza R0 ~1.3 needs only about 25%.

Levels of prevention: primordial (risk-factor avoidance in society), primary (pre-disease), secondary (early detection), tertiary (disability limitation), quaternary (avoiding overmedicalization).

Incidence measures new cases per population at risk per time; prevalence measures all existing cases and equals incidence x average duration for stable disease.

Notifiable disease reporting and outbreak investigation steps: verify diagnosis, define case, find cases, characterize by person/place/time, form hypothesis, test with analytic study, control, communicate.

Screening for colorectal cancer: faecal immunochemical test annually or colonoscopy every 10 years from age 45-50; cervical screening via HPV testing every 5 years from age 25-30.

Randomization reduces selection and confounding bias; allocation concealment prevents foreknowledge of assignment; blinding reduces measurement and performance bias.

Intention-to-treat analysis preserves randomization but dilutes effect; per-protocol analysis estimates efficacy but risks bias from post-randomization dropout.

Randomized controlled trial, cohort, case-control, cross-sectional: decreasing strength for causal inference; case-control is efficient for rare outcomes but cannot yield incidence.

Sample size for a two-proportion comparison: n per group = (z_alpha/2 + z_beta)^2 x [p1(1-p1) + p2(1-p2)] / (p1 - p2)^2.

Number needed to treat = 1/absolute risk reduction; number needed to harm = 1/absolute risk increase.

Confidence interval width narrows with larger sample size and lower variability; a 95% CI excluding the null corresponds to p < 0.05 for a two-sided test.

Bias types: selection, information (recall, misclassification), confounding; confounding is addressed by randomization, restriction, matching, stratification, or multivariable adjustment.

Critical appraisal of a therapy paper: validity (randomization, concealment, blinding, follow-up completeness), results (effect size, precision), applicability (population, setting, outcome relevance).

Four principles: autonomy (respect informed choice), beneficence (act in patient's interest), non-maleficence (avoid harm), justice (fair distribution of resources).

Informed consent requires capacity, adequate disclosure, comprehension, voluntariness, and authorization; emergency exception applies when immediate treatment prevents serious harm and no proxy exists.

Confidentiality may be breached with patient consent, statutory duty (notifiable disease, gunshot wounds where required), or serious imminent risk to identifiable others.

Capacity assessment: patient understands information, retains it, weighs it, and communicates a choice; a decision need not be 'reasonable' to be capacitous.

Resource allocation frameworks include cost-effectiveness (cost per QALY), equity, and rule of rescue; QALY = years of life x utility weight (0 = death, 1 = perfect health).

Clinical governance pillars: clinical effectiveness, patient safety, patient experience, audit and quality improvement, staff development, risk management.

Medical error disclosure: full, prompt, and honest explanation to the patient, apology, documentation, and system-level reporting without punitive blame.

Four principles: autonomy (respect informed choice), beneficence (act in patient's interest), non-maleficence (avoid harm), justice (fair distribution of resources).

Informed consent requires capacity, adequate disclosure, comprehension, voluntariness, and authorization; emergency exception applies when immediate treatment prevents serious harm and no proxy exists.

Confidentiality may be breached with patient consent, statutory duty (notifiable disease, gunshot wounds where required), or serious imminent risk to identifiable others.

Capacity assessment: patient understands information, retains it, weighs it, and communicates a choice; a decision need not be 'reasonable' to be capacitous.

Resource allocation frameworks include cost-effectiveness (cost per QALY), equity, and rule of rescue; QALY = years of life x utility weight (0 = death, 1 = perfect health).

Clinical governance pillars: clinical effectiveness, patient safety, patient experience, audit and quality improvement, staff development, risk management.

Medical error disclosure: full, prompt, and honest explanation to the patient, apology, documentation, and system-level reporting without punitive blame.