OMSB Family Medicine (OEFM) cheat sheet

Hypertension diagnosis: office BP ≥140/90 mmHg on two occasions; home or ambulatory threshold ≥135/85 mmHg; drug therapy is indicated for ≥140/90 or high cardiovascular risk.

Type 2 diabetes: metformin is first-line unless contraindicated by severe renal impairment or acidosis; individualized A1c target is usually <7% for nonpregnant adults.

Clinical ASCVD requires high-intensity statin therapy; aim for LDL reduction ≥50% and LDL <1.8 mmol/L in very high-risk patients.

Asthma: use an inhaled corticosteroid-containing controller; SABA-only treatment is no longer preferred because it increases exacerbation risk.

COPD: post-bronchodilator FEV1/FVC <0.70 confirms persistent airflow limitation in a symptomatic adult with compatible exposures.

CKD: eGFR <60 mL/min/1.73 m² or albuminuria ≥3 mg/mmol for >3 months; ACE inhibitor or ARB is indicated for significant albuminuria.

Overt hypothyroidism: elevated TSH with low free T4; start levothyroxine and recheck TSH 6-8 weeks after dose change.

Iron deficiency anemia: low ferritin supports diagnosis; investigate gastrointestinal blood loss in men and postmenopausal women.

Infant <3 months with temperature ≥38.0°C: urgent sepsis evaluation, blood and urine cultures, lumbar puncture unless contraindicated, and empiric IV antibiotics.

Bronchiolitis: supportive care with hydration, nasal suction, and oxygen if SpO2 <90-92%; routine bronchodilators, steroids, and antibiotics are not recommended.

Acute otitis media: amoxicillin is first-line; observation for 48-72 hours is acceptable in selected children ≥2 years with nonsevere illness and reliable follow-up.

Dehydration: oral rehydration solution 50 mL/kg for mild and 100 mL/kg for moderate dehydration over 3-4 hours; severe dehydration needs IV fluids.

Newborn weight loss >10% warrants feeding assessment and evaluation; most infants regain birth weight by 2 weeks of age.

Live vaccines such as MMR and varicella are contraindicated in significant immunosuppression; inactivated vaccines are generally safe.

Croup: single-dose dexamethasone 0.15-0.6 mg/kg; nebulized epinephrine is added for moderate or severe stridor at rest.

Pediatric asthma: inhaled corticosteroid controller plus SABA reliever; step up or down according to symptom control and exacerbation risk.

Preconception folic acid 400 mcg daily through the first trimester; 5 mg daily if prior neural tube defect, diabetes, obesity, or antiepileptic use.

Preeclampsia: new BP ≥140/90 after 20 weeks plus proteinuria or maternal organ dysfunction; severe features require delivery regardless of gestational age.

Gestational diabetes screening at 24-28 weeks with 75 g OGTT; thresholds are fasting ≥5.1, 1-hour ≥10.0, and 2-hour ≥8.5 mmol/L.

Stable unruptured tubal ectopic pregnancy with hCG <5000 IU/L and small mass may be treated with methotrexate if serial hCG follow-up is reliable.

Cervical screening commonly starts at age 21-25; cytology every 3 years or HPV testing every 5 years; stop at 65 after adequate negative screening.

Combined oral contraceptives are contraindicated with migraine with aura, smoking at age ≥35, prior VTE, and breastfeeding <6 weeks.

Menopause hormone therapy treats vasomotor symptoms; estrogen alone is used after hysterectomy, while a progestogen is required with a uterus.

Postpartum hemorrhage: uterine atony is most common; give oxytocin, uterine massage, and tranexamic acid, then escalate to further measures.

Anaphylaxis: IM epinephrine 0.5 mg of 1:1000 solution into the anterolateral thigh; repeat every 5-15 minutes if needed; adjuncts never delay epinephrine.

STEMI: chew aspirin 300 mg and arrange reperfusion; primary PCI within 90 minutes or fibrinolysis within 30 minutes when PCI is unavailable.

Acute stroke: noncontrast CT excludes hemorrhage; thrombolysis within 4.5 hours in selected patients; thrombectomy up to 24 hours in selected large-vessel occlusion.

Sepsis: measure lactate, obtain cultures, and give broad-spectrum antibiotics within 1 hour; 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

DKA: IV fluids and insulin infusion after potassium is ≥3.3 mmol/L; bicarbonate is avoided unless pH <6.9.

Status epilepticus: benzodiazepine first-line; second-line options include levetiracetam, fosphenytoin, or valproate.

Opioid overdose: naloxone titrated to adequate respiration; observe for renarcotization because naloxone has a shorter half-life than many opioids.

Severe acute asthma: oxygen, repeated SABA, ipratropium, and systemic corticosteroids; IV magnesium is added for severe cases not responding to initial therapy.

Ottawa ankle rules: ankle radiography is indicated with malleolar pain plus inability to bear weight for 4 steps or bone tenderness at the posterior malleolus or fibular tip.

Low back pain red flags include age >50 with new pain, cancer history, weight loss, fever, IV drug use, trauma, progressive deficit, and bowel or bladder dysfunction.

Gout: joint aspiration identifies urate crystals; acute treatment is NSAID, colchicine, or corticosteroid; urate-lowering therapy is usually started after the flare.

Osteoarthritis: exercise, weight loss, and topical NSAID are core; intra-articular steroid helps flares; routine opioids are avoided.

Carpal tunnel syndrome: nocturnal splint and steroid injection are initial options; surgery is considered for severe or refractory symptoms.

Open fracture: give antibiotics and tetanus prophylaxis, cover with a sterile dressing, and arrange urgent debridement and fixation.

Anterior shoulder dislocation is most common; check the axillary nerve, obtain post-reduction imaging, and immobilize according to local protocol.

Compartment syndrome: pain out of proportion and pain on passive stretch are early signs; urgent fasciotomy is required once diagnosed.

Depression: PHQ-9 supports assessment; psychotherapy or an SSRI is first-line for moderate-severe illness; continue 6-12 months after remission.

Suicide risk: ask directly about thoughts, plan, intent, and access to means; imminent risk with plan or intent requires emergency evaluation and means restriction.

Bipolar mania: mood stabilizer such as lithium or valproate, often with an antipsychotic; antidepressant monotherapy can precipitate mania.

Alcohol withdrawal: benzodiazepines guided by a withdrawal scale; give thiamine before glucose; monitor for delirium tremens and correct electrolytes.

Panic attack: exclude medical mimics; SSRI plus CBT is first-line; long-term benzodiazepine use is avoided.

Psychosis: urgent assessment and antipsychotic treatment; exclude substance-induced and medical causes before attributing to a primary psychiatric disorder.

OCD: SSRI plus CBT with exposure and response prevention; higher SSRI doses are often needed than for depression.

Postpartum depression: Edinburgh scale supports screening; SSRIs compatible with breastfeeding are options; postpartum psychosis is a psychiatric emergency.

Colorectal cancer screening for average risk starts at age 45 and continues to 75; options include colonoscopy every 10 years or annual FIT.

Tuberculosis: sputum smear and culture, chest radiography, and nucleic acid amplification; multidrug directly observed therapy and isolation until smear-negative.

Immediate notification to public health authorities is required for suspected cholera, plague, yellow fever, diphtheria, poliomyelitis, measles, and viral hemorrhagic fever.

Smoking cessation: ask, advise, assess, assist, and arrange follow-up; varenicline, bupropion, or nicotine replacement improve success.

Obesity: BMI ≥30 defines obesity; lifestyle is foundational, pharmacotherapy may be added, and bariatric surgery is considered at BMI ≥40 or ≥35 with comorbidity.

Adult immunization: annual influenza; pneumococcal vaccination for age ≥65 or risk conditions; tetanus booster every 10 years.

Antenatal screening includes rubella immunity, HIV, syphilis, and hepatitis B surface antigen.

Travel medicine: yellow fever vaccine for endemic areas, malaria prophylaxis according to resistance, and attention to food and water safety.

Melanoma ABCDE: asymmetry, border irregularity, color variation, diameter >6 mm, and evolution; evolving lesions are the most concerning feature.

Nonpurulent cellulitis is usually streptococcal or staphylococcal; oral cephalexin is an option; mark the border, elevate the limb, and review at 48 hours.

Acne: topical retinoid for comedonal acne; add benzoyl peroxide or clindamycin for inflammatory lesions; isotretinoin for severe nodulocystic disease.

Plaque psoriasis: topical corticosteroid plus vitamin D analog; methotrexate or biologics for severe disease; screen for metabolic syndrome.

Atopic dermatitis: emollients and topical corticosteroids are mainstays; avoid irritants; antihistamines may help sleep-related itch.

Scabies: permethrin 5% to the whole body, repeat after 7 days; treat close contacts and wash bedding in hot water.

Tinea capitis and onychomycosis need oral terbinafine; topical azoles are used for localized tinea corporis or pedis.

Stevens-Johnson syndrome and TEN: mucosal involvement and blistering after a drug trigger; stop the culprit drug and provide urgent supportive care.

Acute bacterial sinusitis: symptoms >10 days or severe symptoms; amoxicillin is first-line; saline irrigation is adjunctive.

Strep pharyngitis: Centor or McIsaac score supports testing; penicillin or amoxicillin for 10 days prevents rheumatic fever.

Epiglottitis: drooling, tripod posture, and stridor; do not examine the throat or lay the patient flat; secure the airway urgently.

Acute angle-closure glaucoma: severe eye pain, halos, nausea, and fixed mid-dilated pupil; urgent intraocular pressure lowering and ophthalmology review.

Conjunctivitis: viral is watery and bacterial is purulent; avoid contact lens use and emphasize hand hygiene.

Otitis externa: topical antibiotic plus steroid; keep the ear dry; systemic antibiotics are reserved for severe or spreading infection.

Allergic rhinitis: intranasal corticosteroid is first-line; add antihistamine; avoid prolonged decongestant nasal sprays.

Sudden sensorineural hearing loss: urgent systemic corticosteroids and MRI; prognosis worsens with delayed treatment.

Falls assessment includes gait and balance, vision, orthostatic BP, medications, footwear, home hazards, and vitamin D status; exercise reduces recurrence.

Delirium: acute fluctuating inattention; identify infection, drugs, pain, constipation, urinary retention, and metabolic causes; avoid restraints.

Dementia: screen cognition and exclude reversible causes; cholinesterase inhibitor for mild-moderate Alzheimer disease; memantine for moderate-severe disease.

Polypharmacy review: Beers criteria flag anticholinergics, benzodiazepines, and NSAIDs in older adults; deprescribe when harm outweighs benefit.

Urinary incontinence: stress incontinence uses pelvic floor training; urge incontinence uses bladder training and antimuscarinic or beta-3 agonist therapy.

Palliative cancer pain: follow the WHO ladder; morphine is first-line for severe pain; prescribe a bowel regimen with regular opioids.

Advance care planning: clarify goals, document CPR status, and identify a substitute decision-maker while the patient has capacity.

Pressure ulcers: reposition, offload pressure, optimize nutrition, and use moist wound care; stage reflects depth of tissue injury.

Informed consent requires capacity, adequate disclosure, voluntariness, and documentation; emergency treatment may proceed without consent when life-threatening.

Confidentiality: disclose only with patient consent or legal requirement; share the minimum necessary information.

Capacity requires understanding, appreciation, reasoning, and expression of choice; it is decision-specific and not identical to legal competence.

Evidence hierarchy: systematic reviews and meta-analyses > randomized trials > cohort studies > case-control studies > case series.

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); positive predictive value depends heavily on disease prevalence.

Number needed to treat = 1/absolute risk reduction; ARR = control event rate minus treatment event rate.

Publication bias occurs when negative or null studies are less likely to be published; funnel plot asymmetry suggests it.

Conflict of interest should be disclosed and managed; disclosure does not automatically disqualify a clinician or researcher.