MCPS Family Medicine cheat sheet

Hypertension: diagnose with ≥2 readings ≥140/90 on separate occasions; first-line in non-Black patients without CKD is thiazide, ACEi/ARB, or CCB; in Black patients or CKD, thiazide or CCB first.

Type 2 diabetes: A1c ≥6.5% or FPG ≥126 mg/dL or 2-h OGTT ≥200 mg/dL or random ≥200 with symptoms; metformin first-line unless contraindicated; add SGLT2i or GLP-1 RA if ASCVD, HF, or CKD.

ACS: aspirin 325 mg chewed, nitroglycerin, and ECG within 10 minutes; STEMI → reperfusion (PCI within 90 min at PCI center); NSTEMI → risk-stratify with TIMI/GRACE, early invasive if high-risk.

COPD: post-bronchodilator FEV1/FVC <0.70 confirms; GOLD ABE groups guide initial therapy; LAMA/LABA for most; add ICS if eosinophils ≥300 or frequent exacerbations with asthma features.

Heart failure: HFrEF (EF ≤40%) → ARNI/ACEi/ARB + beta-blocker + MRA + SGLT2i (four pillars); HFpEF → SGLT2i, diuretics, treat comorbidities.

Community-acquired pneumonia: CURB-65 (Confusion, Urea >7 mmol/L, RR ≥30, BP <90/60, age ≥65) scores 0–1 outpatient, 2 short admission, ≥3 ICU consideration; empiric amoxicillin or doxycycline for outpatients.

AKI: KDIGO criteria - creatinine rise ≥0.3 mg/dL in 48 h or ≥1.5× baseline in 7 days or urine output <0.5 mL/kg/h for 6 h; distinguish prerenal (FENa <1%), intrinsic, postrenal.

Anemia: microcytic (MCV <80) → iron deficiency, thalassemia, anemia of chronic disease; normocytic → acute blood loss, CKD, hemolysis; macrocytic → B12/folate, alcohol, hypothyroidism, MDS.

Newborn screening: heel prick at 24–72 h of life; repeat at 1–2 weeks for preterm/sick infants; covers congenital hypothyroidism, PKU, galactosemia, sickle cell, CF, and hearing.

Growth: use WHO charts for 0–2 years and CDC for ≥2 years; failure to thrive = weight <3rd percentile or crossing ≥2 major percentile lines downward.

Vaccine schedule (US): DTaP, IPV, Hib, PCV, HBV at 2, 4, 6 months; MMR and varicella at 12–15 months and 4–6 years; Tdap and HPV at 11–12 years; influenza annually from 6 months.

Febrile seizures: simple = generalized, <15 min, once in 24 h, age 6 months–5 years; no routine EEG, imaging, or anticonvulsant; antipyretics do not prevent recurrence.

Kawasaki disease: ≥5 days fever plus 4 of 5 (conjunctivitis, mucosal changes, rash, extremity changes, cervical lymphadenopathy); treat with IVIG 2 g/kg + aspirin; risk of coronary aneurysms.

Bronchiolitis: RSV most common; peak age 2–6 months; wheezing/crackles, tachypnea; supportive care (oxygen, hydration); no routine bronchodilators, steroids, or antibiotics.

Otitis media: diagnose with bulging TM or otorrhea; observation for 48–72 h in age ≥6 months with nonsevere illness; amoxicillin 80–90 mg/kg/day first-line if treating.

Dehydration in children: mild <5% weight loss, moderate 5–10%, severe >10%; use ORS 50 mL/kg for mild and 100 mL/kg for moderate over 4 h; IV isotonic fluids for severe.

Prenatal care: first visit by 8–10 weeks; dating ultrasound if LMP uncertain; screen for aneuploidy at 11–14 weeks (nuchal translucency + serum) or cell-free DNA from 10 weeks.

Gestational diabetes: screen at 24–28 weeks with 1-h 50-g GCT (≥140 mg/dL → 3-h 100-g OGTT); Carpenter-Coustan criteria: ≥95/180/155/140 mg/dL, two or more abnormal.

Preeclampsia: BP ≥140/90 after 20 weeks plus proteinuria (≥300 mg/24 h or P/Cr ≥0.3) or end-organ dysfunction; severe features include BP ≥160/110, platelets <100k, AST/ALT >2×, creatinine >1.1, pulmonary edema, visual/cerebral symptoms; delivery is definitive.

Postpartum hemorrhage: uterine atony most common; give oxytocin 10 IU IM/IV, then carboprost, methylergonovine (avoid in hypertension), misoprostol; tranexamic acid within 3 h.

Contraception: LARC (IUD, implant) most effective; combined OCPs contraindicated with migraine with aura, smoking age ≥35, hypertension, VTE history; progestin-only safe in most of these.

Cervical cancer screening: start at 21; 21–29 cytology every 3 years; 30–65 cytology every 3 years, HPV every 5 years, or co-test every 5 years; stop at 65 if adequate prior negative screening.

Menopause: diagnosis clinical (12 months amenorrhea); HT for vasomotor symptoms - estrogen alone if hysterectomy, estrogen + progestin if uterus present; lowest effective dose, reassess annually.

Ectopic pregnancy: risk factors include prior ectopic, PID, tubal surgery, IUD in situ; diagnose with beta-hCG and transvaginal ultrasound; methotrexate if unruptured, mass <3.5 cm, no fetal cardiac activity, hCG <5000.

Acute appendicitis: Alvarado score (migration, anorexia, nausea, tenderness, rebound, fever, leukocytosis, shift) ≥7 suggests; CT or ultrasound for diagnosis; laparoscopic appendectomy is standard.

Bowel obstruction: air-fluid levels on upright film; most from adhesions; initial management NPO, NG decompression, IV fluids, serial exams; operate for strangulation signs (fever, tachycardia, peritoneal signs, rising lactate).

Cholecystitis: RUQ pain, Murphy sign, fever, leukocytosis; RUQ ultrasound first; early laparoscopic cholecystectomy within 72 h preferred; antibiotics cover gram-negative and anaerobes.

Hernia: indirect inguinal passes lateral to inferior epigastrics and into scrotum; direct passes medial; femoral below inguinal ligament, higher strangulation risk; repair symptomatic or incarcerated hernias.

Trauma: ATLS primary survey ABCDE; FAST for unstable patients; permissive hypotension in penetrating trauma until hemorrhage control; massive transfusion protocol 1:1:1.

Perioperative risk: Revised Cardiac Risk Index (ischemic heart disease, HF, cerebrovascular disease, insulin-dependent diabetes, creatinine >2, high-risk surgery) predicts major cardiac events; beta-blockers not routinely started on day of surgery.

Surgical site infection: most from skin flora (S. aureus); prevent with preoperative chlorhexidine, appropriate timing of prophylaxis within 60 min of incision, normothermia, glycemic control, avoid shaving.

Breast cancer: screening mammography every 1–2 years ages 50–74; triple assessment (exam, imaging, core biopsy) for suspicious mass; sentinel node biopsy for clinically node-negative disease.

Ottawa ankle rules: X-ray if pain in malleolar zone plus bone tenderness at posterior edge of distal 6 cm of tibia/fibula or inability to bear weight 4 steps both immediately and in ED.

Knee effusion: immediate hemarthrosis suggests ACL tear or fracture; tense effusion with fever suggests septic arthritis - arthrocentesis: >50,000 WBC/mm³ and >90% PMNs is septic until proven otherwise.

Fracture description: location, pattern (transverse, oblique, spiral, comminuted), displacement, angulation, rotation, shortening, intra-articular involvement, open vs closed.

Compartment syndrome: pain out of proportion, pain with passive stretch, paresthesia, pallor, pulselessness (late); pressure >30 mmHg or within 30 of diastolic → fasciotomy.

Low back pain: red flags include age >50 with new pain, cancer history, fever, IV drug use, trauma, night pain, bowel/bladder dysfunction, saddle anesthesia; imaging only with red flags or neurologic deficit.

Osteoarthritis: weight-bearing radiographs show joint space narrowing, osteophytes, subchondral sclerosis, cysts; treatment exercise, weight loss, acetaminophen/NSAIDs, intra-articular steroids; arthroplasty for severe.

Carpal tunnel syndrome: median nerve compression; nocturnal paresthesias in thumb/index/middle; Phalen and Tinel signs; EMG/NCS confirm; splinting, steroid injection, surgery if severe.

Pediatric fractures: Salter-Harris I–V (SALTR: Slipped, Above, Lower, Through, cRush); supracondylar humerus fracture risks cubitus varus and brachial artery injury.

Major depression: ≥5 of 9 symptoms for ≥2 weeks including depressed mood or anhedonia; first-line SSRIs, psychotherapy, or combination; assess suicide risk at every visit.

Bipolar disorder: mania = elevated/irritable mood plus ≥3 of 7 symptoms for ≥1 week or hospitalization; treat acute mania with mood stabilizer (lithium, valproate) plus atypical antipsychotic; avoid antidepressants alone.

Schizophrenia: ≥2 of delusions, hallucinations, disorganized speech, grossly disorganized behavior, negative symptoms for ≥6 months with ≥1 month active; first-line atypical antipsychotics; monitor metabolic effects.

Substance use: AUDIT-C screens alcohol; CAGE ≥2 suggests; withdrawal risks seizures and delirium tremens - treat with benzodiazepines, thiamine before glucose; opioid use disorder → buprenorphine or methadone.

Anxiety: GAD = excessive worry ≥6 months plus ≥3 of 6 symptoms; first-line SSRIs/SNRIs and CBT; benzodiazepines short-term only.

Delirium vs dementia: delirium is acute, fluctuating, with inattention; dementia is chronic progressive; use CAM (Confusion Assessment Method) for delirium; treat underlying cause.

Eating disorders: anorexia nervosa = low BMI, fear of weight gain, body image disturbance; medical complications include bradycardia, hypokalemia, osteoporosis; refeeding syndrome risk.

Suicide risk: ask directly about ideation, plan, intent, means; highest risk in older men, prior attempts, access to firearms; safety planning and means restriction reduce risk.

Screening principles: condition common and serious, detectable early, effective treatment, acceptable test, and favorable cost-benefit; lead-time bias inflates survival without changing mortality.

Study designs: RCT best for causation; cohort for incidence and relative risk; case-control for rare diseases and odds ratio; cross-sectional for prevalence; ecologic for group-level associations.

Outbreak investigation: establish case definition, find cases, characterize by time/place/person, form hypothesis, test with analytic study, implement control, communicate.

Immunization: herd immunity threshold depends on R0 (e.g., measles R0 12–18, needs ~92–95% coverage); cold chain and catch-up schedules maintain population protection.

Social determinants: income, education, housing, food security, and neighborhood influence health outcomes; screen for them and refer to community resources.

Notifiable diseases: report immediately for suspected anthrax, botulism, cholera, diphtheria, measles, plague, polio, rabies, smallpox, and viral hemorrhagic fevers; others per local schedule.

Biostatistics: sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); PPV depends on prevalence; number needed to treat = 1/ARR; 95% CI excludes 1 for significant RR/OR and 0 for mean difference.

Prevention levels: primordial (risk factor reduction), primary (prevent disease before onset), secondary (early detection), tertiary (limit disability), quaternary (avoid overmedicalization).

Pharmacokinetics: first-pass metabolism reduces oral bioavailability; half-life determines dosing interval; steady state in ~4–5 half-lives; loading dose = Vd × target concentration / bioavailability.

Cytochrome P450: CYP3A4 metabolizes most drugs; inhibitors include grapefruit, ketoconazole, macrolides, ritonavir; inducers include rifampin, carbamazepine, phenytoin, St. John's wort.

Warfarin: monitor INR; target 2–3 for most indications, 2.5–3.5 for mechanical mitral valve; vitamin K reverses; major bleeding → 4-factor PCC plus vitamin K.

ACE inhibitors: cough from bradykinin, angioedema, hyperkalemia, AKI; contraindicated in pregnancy; ARBs have less cough but same pregnancy risk.

NSAIDs: inhibit COX, risk GI ulcer, AKI, hypertension, cardiovascular events; avoid in CKD, heart failure, and third trimester; add PPI if high GI risk.

Antibiotics: aminoglycosides nephrotoxic and ototoxic; vancomycin requires AUC monitoring; fluoroquinolones risk tendon rupture and QT prolongation; macrolides QT prolongation.

Adverse drug events: always review medication list; anticholinergic burden in elderly (diphenhydramine, oxybutynin) causes confusion and falls; use Beers criteria to deprescribe.

Therapeutic index: narrow-index drugs (digoxin, lithium, warfarin, phenytoin, theophylline, aminoglycosides) require level monitoring; digoxin toxicity worsened by hypokalemia.

Complete blood count: reference ranges vary; anemia defined by hemoglobin below age/sex threshold; thrombocytopenia <150,000/µL; leukocytosis >11,000/µL.

Liver tests: AST/ALT >1000 suggests viral hepatitis, ischemia, or toxin; ALP and GGT rise in cholestasis; albumin and INR reflect synthetic function.

Urinalysis: nitrite and leukocyte esterase suggest UTI; hematuria with dysmorphic RBCs or casts suggests glomerular disease; urine protein-to-creatinine ratio estimates 24-h protein.

Cardiac markers: troponin rises 3–6 h after injury, peaks 12–24 h, remains elevated 7–14 days; CK-MB rises earlier but normalizes faster; use serial troponins with delta criteria.

Coagulation: PT/INR measures extrinsic and common pathway; aPTT measures intrinsic and common; mixing study corrects in factor deficiency, not in inhibitor.

Microbiology: gram stain guides initial therapy; culture before antibiotics when possible; MRSA risk factors include recent hospitalization, IV antibiotics, dialysis, and invasive devices.

Tumor markers: not for screening; CEA for colorectal cancer monitoring, CA-125 for ovarian cancer monitoring, AFP for hepatocellular carcinoma and germ cell tumors, PSA for prostate cancer monitoring.

Acid-base: anion gap = Na − (Cl + HCO3), normal 8–12; high-gap acidosis from MUDPILES; delta-delta = (measured AG − normal AG)/(normal HCO3 − measured HCO3); <1 suggests mixed disorder.

Informed consent: capacity, disclosure of diagnosis, risks, benefits, alternatives, and consequences of refusal; document; emergency exception when patient lacks capacity and delay would harm.

Capacity vs competence: capacity is a clinical determination (understanding, appreciation, reasoning, expressing choice); competence is a legal determination; capacity is decision-specific.

Confidentiality: may disclose with patient consent, when required by law (reportable diseases, gunshot wounds, child/elder abuse), or to prevent serious imminent harm (Tarasoff).

End-of-life: advance directives and POLST guide care; surrogate decision-makers use substituted judgment, then best interests; withdrawing and withholding treatment are ethically equivalent.

Professional boundaries: avoid dual relationships, gifts that influence care, and social media breaches; report impaired colleagues through appropriate channels; maintain patient privacy.

Error disclosure: disclose harmful errors promptly and honestly to patient/family; apologize; explain what happened, consequences, and prevention; document; follow institutional reporting.

Communication: use teach-back for patient education; motivational interviewing (OARS: open questions, affirmations, reflections, summaries) for behavior change; avoid jargon.

Cultural humility: ask about language preference and use qualified interpreters; explore health beliefs; negotiate a care plan respecting autonomy and community values.