- CAP — healthy outpatient first-line
- High-dose amoxicillin, or doxycycline as a single-agent alternative; both cover typical and atypical organisms such as Mycoplasma pneumoniae.
- CAP — outpatient with comorbidities
- A respiratory fluoroquinolone (e.g., levofloxacin) alone, OR a beta-lactam plus a macrolide or doxycycline.
- CURB-65
- Pneumonia severity score: Confusion, Urea elevated, Respiratory rate ≥30, Blood pressure low (SBP <90 or DBP ≤60), age ≥65 — guides outpatient vs hospital care.
- Pneumonia Severity Index (PSI)
- A more detailed validated tool that stratifies pneumonia mortality risk to decide the site of care.
- Atypical CAP organism in young adults
- Mycoplasma pneumoniae — a common atypical cause covered by doxycycline or a macrolide.
- CAP recovery counseling
- Cough and fatigue may persist for several weeks after antibiotics finish; routine repeat imaging is not required if recovery is on track.
- Acute otitis media — first-line
- High-dose amoxicillin; a cephalosporin such as cefdinir for a mild, non-anaphylactic penicillin allergy.
- Acute sinusitis / acute bronchitis
- Usually viral — no antibiotics; treat symptoms. Reserve antibiotics for persistent, severe, or worsening bacterial sinusitis.
- Orbital cellulitis warning signs
- Periorbital swelling, proptosis, and painful or limited eye movement with sinusitis — urgent imaging and admission.
- Infectious mononucleosis clues
- Posterior cervical adenopathy, marked fatigue, splenomegaly; avoid amoxicillin and avoid contact sports while the spleen is enlarged.
- Strep pharyngitis testing
- Use the Centor/McIsaac criteria; do not test or treat patients with clear viral features (cough, rhinorrhea, oral ulcers).
- Low back pain — malignancy red flag
- Night pain unrelieved by rest, plus weight loss — warrants further evaluation/imaging.
- Cauda equina red flags
- Saddle anesthesia, urinary retention or incontinence, bilateral leg weakness — emergent MRI and surgical decompression.
- Uncomplicated cystitis — first-line
- Short-course nitrofurantoin, trimethoprim-sulfamethoxazole (low local resistance), or fosfomycin; reserve fluoroquinolones.
- UTI — when to culture
- Obtain a urine culture when symptoms persist after appropriate first-line therapy, to identify resistant organisms.
- Asymptomatic bacteriuria
- Do NOT treat — except in pregnancy or before a urologic procedure.
- Recurrent cellulitis of one limb
- Treat the underlying cause (chronic lymphedema, tinea pedis) and consider prophylactic antibiotics.
- Freshwater wound coverage
- Add coverage for Aeromonas to usual streptococcal/staphylococcal therapy for cellulitis.
- Acute gout flare — first-line
- NSAIDs, colchicine, or corticosteroids — whichever is safest for the patient.
- Allopurinol during a gout flare
- Continue it without interruption in a patient already established on it; do not stop it during the flare.
- Migraine with aura
- Transient, fully reversible neurologic symptoms (e.g., scintillating scotoma lasting ~20 minutes) preceding headache.
- Medication-overuse headache
- Headache on ≥10–15 days/month from frequent acute medication use; managed by withdrawing the overused drug.
- Acute pancreatitis — top causes
- Gallstones and alcohol account for most cases; diagnose with 2 of 3 (epigastric pain, lipase/amylase ≥3× normal, imaging).
- Ankle sprain — initial care
- Relative rest, ice, compression, elevation, early protected weight-bearing, then functional rehabilitation.
- DVT workup — low Wells score
- A low Wells score plus a negative high-sensitivity D-dimer effectively rules out DVT without imaging.
- DVT with active cancer
- Anticoagulation is required; consider drug interactions and bleeding risk in this population.
- Neonatal hyperacute purulent conjunctivitis
- Within the first days of life suggests gonococcal infection — a medical emergency requiring systemic treatment.
- Acute bronchitis in a smoker
- Beyond symptomatic care, counsel and support smoking cessation — the highest-yield intervention.
- Type 2 diabetes — first-line drug
- Metformin plus lifestyle change — effective, weight-neutral, low hypoglycemia risk; check eGFR before starting.
- Diabetes — typical A1c goal
- Under 7% for most adults; relax to ~7.5–8% in frail patients or recurrent severe hypoglycemia.
- Diabetes add-on — established ASCVD
- A GLP-1 receptor agonist (or SGLT2 inhibitor) for proven cardiovascular benefit, independent of the A1c.
- Diabetes add-on — HFrEF
- An SGLT2 inhibitor — it reduces heart-failure hospitalizations and cardiovascular death.
- Diabetes add-on — albuminuric CKD
- An SGLT2 inhibitor — it slows progression of diabetic kidney disease and lowers albuminuria.
- Diabetes add-on — weight a priority
- A GLP-1 receptor agonist, for meaningful weight loss alongside glucose lowering.
- Sulfonylurea caution
- Glimepiride/glyburide cause hypoglycemia and weight gain; glyburide is hazardous in chronic kidney disease.
- A1c monitoring frequency
- Every 6 months once at goal and stable; every 3 months if therapy changed or not at goal.
- Marked hyperglycemia (A1c ~10%+, symptoms)
- Initiate insulin therapy in addition to metformin and lifestyle measures.
- Stage 2 hypertension — initial therapy
- Start two first-line agents from different classes plus lifestyle change (BP far above goal for one drug).
- First-line antihypertensive classes
- Thiazide diuretic, ACE inhibitor or ARB, and calcium channel blocker (beta-blockers are not preferred first-line without a compelling indication).
- Hypertension in pregnancy — safe agents
- Labetalol, nifedipine, or methyldopa; avoid ACE inhibitors and ARBs (teratogenic).
- HFrEF — the four pillars
- ARNI (or ACEi/ARB), a beta-blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor — all reduce mortality.
- Loop diuretics in heart failure
- Relieve congestion symptomatically but do NOT improve survival.
- Digoxin in HFrEF
- A reasonable adjunct for rate control and symptom reduction (reduces hospitalizations), especially with atrial fibrillation.
- High-intensity statin indications
- Clinical ASCVD, LDL ≥190 mg/dL, or diabetes in adults aged 40–75.
- Asthma step-up after low-dose ICS
- Add a long-acting beta-agonist (LABA) to the inhaled corticosteroid.
- COPD step-up
- Escalate from a single long-acting bronchodilator to dual long-acting therapy (LAMA + LABA) for persistent symptoms.
- GERD without alarm features
- Empiric proton pump inhibitor; reserve endoscopy for dysphagia, weight loss, bleeding, or anemia.
- Osteoporosis — first-line treatment
- A bisphosphonate (e.g., alendronate) with calcium and vitamin D; diagnosis is a DEXA T-score ≤ −2.5 or a fragility fracture.
- Levothyroxine in pregnancy
- Increase the dose for a patient with hypothyroidism — demand rises early in pregnancy.
- Asthma controller in pregnancy
- Continue inhaled corticosteroids — uncontrolled asthma is the bigger risk to the pregnancy.
- Hyperkalemia from RAAS therapy in CKD
- Address the elevated potassium (diet, dose adjustment, potassium binders) before stopping a beneficial ACEi/ARB outright.
- Diabetic kidney disease — best protection
- Blood-pressure control with an ACE inhibitor or ARB, plus an SGLT2 inhibitor, slows progression.
- Knee osteoarthritis clues
- Pain worse with use, brief morning stiffness (<30 minutes), no systemic features; treat with exercise, weight loss, analgesics.
- Depression — inadequate SSRI response
- After an adequate dose and duration, switch agents or augment; reassess diagnosis and adherence.
- Atrial fibrillation + mechanical valve — anticoagulation
- Warfarin is required (DOACs are contraindicated with mechanical valves and rheumatic mitral stenosis).
- Anaphylaxis — first-line treatment
- Intramuscular epinephrine into the anterolateral thigh, immediately; antihistamines and steroids are adjuncts only and never delay it.
- Adult epinephrine dose for anaphylaxis
- 0.3 mg of the 1 mg/mL (1:1000) concentration intramuscularly; the 0.1 mg/mL (1:10,000) form is for IV use in cardiac arrest.
- Anaphylaxis diagnostic criteria
- Acute onset with skin/mucosal involvement PLUS respiratory compromise or hypotension — or ≥2 organ systems after a likely allergen.
- Refractory anaphylaxis on a beta-blocker
- Add intravenous glucagon when hypotension persists despite IM epinephrine and fluids.
- Biphasic anaphylactic reaction
- Return of symptoms hours after initial resolution without re-exposure — observe ~4–6 hours (longer if severe).
- Anaphylaxis discharge plan
- Prescribe and train an epinephrine auto-injector, refer to allergy, and counsel on avoidance.
- ACE-inhibitor angioedema
- Bradykinin-mediated facial/tongue swelling and stridor; stop the ACE inhibitor and protect the airway.
- STEMI — immediate goal
- Urgent reperfusion: primary PCI within 90 minutes, or fibrinolysis if PCI is not available in time.
- Acute coronary syndrome — initial drugs
- Aspirin, a P2Y12 inhibitor, anticoagulation, and a high-intensity statin; nitrates and morphine for ongoing pain.
- Stroke BP for thrombolysis candidate
- Carefully lower a BP above ~185/110 mm Hg to below the thrombolysis threshold before giving the drug.
- qSOFA criteria
- Altered mental status, respiratory rate ≥22, and systolic blood pressure ≤100 mm Hg — flags higher sepsis risk.
- Early sepsis bundle
- Lactate and blood cultures, broad-spectrum antibiotics within the hour, and IV fluid resuscitation — then reassess perfusion.
- Septic shock vasopressor
- Norepinephrine is first-line when fluids do not restore adequate perfusion.
- Diabetic ketoacidosis treatment
- IV fluids, a continuous insulin infusion, and potassium repletion; continue insulin until the anion gap closes, adding dextrose as glucose falls.
- Kussmaul respirations
- Deep, rapid breaths that blow off CO₂ to compensate for the metabolic acidosis of DKA.
- Severe asthma exacerbation signs
- Single-word speech, accessory-muscle use, tripod posture, marked tachypnea — needs aggressive continuous bronchodilators and systemic steroids.
- Severe hyperkalemia — order of treatment
- Calcium (stabilize the myocardium) → insulin/glucose or albuterol (shift) → remove (diuresis, binders, dialysis).
- Definitive hyperkalemia therapy in ESRD
- Hemodialysis when medical management fails in end-stage kidney disease.
- Hematochezia
- Bright red blood per rectum — usually a lower GI source (a brisk upper GI bleed can also cause it).
- Glasgow-Blatchford score
- Risk-stratifies acute upper GI bleeding; a very low score may allow safe outpatient management.
- Seizure vs syncope clue
- Prolonged postictal confusion and tongue biting favor seizure; rapid recovery favors syncope.
- Status asthmaticus disposition
- After improving on continuous albuterol and steroids, observe for relapse before discharge with a clear action plan.
- Anaphylaxis criteria after a sting
- Skin plus respiratory and GI involvement meets criteria even with normal blood pressure — give epinephrine.
- Colorectal cancer screening — start age
- Age 45 for average-risk adults, continued through age 75 (individualized 76–85).
- Normal screening colonoscopy interval
- Repeat in 10 years for an average-risk patient with no polyps.
- FIT (fecal immunochemical test) interval
- Every year; a positive result must be followed by a diagnostic colonoscopy.
- Multitarget stool DNA interval
- Every 3 years for average-risk colorectal cancer screening.
- Flexible sigmoidoscopy interval
- Every 5 years (or every 10 years with annual FIT) as a colorectal screening option.
- Best colorectal screening test
- The one the patient will actually complete — both stool-based and direct-visualization tests are acceptable.
- Screening mammography — start age
- Age 40 for average-risk women, every two years through age 74.
- Dense breasts on mammography
- Reduce mammographic sensitivity and modestly raise risk; may prompt a discussion of supplemental imaging.
- Lung cancer screening eligibility
- Annual low-dose CT for adults 50–80 with a 20 pack-year history who smoke or quit within 15 years.
- Abdominal aortic aneurysm screening
- One-time ultrasound for men aged 65–75 who have ever smoked.
- Cervical cancer screening
- Begin at 21 with cytology every 3 years; from 30, cytology q3y, HPV testing, or co-testing options through 65.
- Hepatitis B vaccine timing
- Recommended at birth to prevent perinatal and early childhood infection.
- MMR and varicella timing
- First dose at 12–15 months of age (second MMR/varicella at 4–6 years).
- Inactivated polio vaccine (IPV) start
- Begins at 2 months of age in the routine childhood series.
- Adult without measles immunity
- Provide MMR vaccination unless contraindicated (pregnancy, significant immunosuppression).
- Most effective smoking cessation
- Combining behavioral counseling with pharmacotherapy (varenicline, bupropion, or nicotine replacement) — better than either alone.
- Prediabetes A1c range
- 5.7%–6.4% — warrants intensive lifestyle intervention and follow-up to prevent progression.
- First prenatal visit labs
- Blood type, Rh status, and an antibody screen, plus other baseline labs (CBC, infectious screens).
- Family history of premature heart disease
- Supports earlier lipid screening to detect familial hyperlipidemia.
- Vaccine reaction to a component
- A history of anaphylaxis to a vaccine component is a contraindication to that vaccine; evaluate alternatives.
- Sensitivity
- The proportion of people WITH disease who test positive (true-positive rate). High sensitivity → a negative result rules disease OUT (SnNout).
- Specificity
- The proportion of people WITHOUT disease who test negative (true-negative rate). High specificity → a positive result rules disease IN (SpPin).
- SnNout
- A SeNsitive test, when Negative, helps rule a disease OUT.
- SpPin
- A SPecific test, when Positive, helps rule a disease IN.
- Lowering a test's cutoff
- Sensitivity increases (more cases caught) and specificity decreases (more false positives).
- Positive predictive value (PPV)
- The probability that a positive test reflects true disease; it rises with disease prevalence (and with a higher pretest probability).
- Negative predictive value (NPV)
- The probability that a negative test reflects no disease; computed from true negatives ÷ (true negatives + false negatives).
- PPV in low-prevalence screening
- Falls — many false positives relative to true positives, producing anxious false alarms when screening rare conditions.
- Sensitivity/specificity vs prevalence
- They are fixed properties of the test and do NOT change with prevalence (unlike predictive values).
- Positive likelihood ratio (LR+)
- How much a positive result raises the odds of disease; a higher LR+ is better for ruling in, and it does not vary with prevalence.
- ROC curve / area under the curve
- A larger area under the ROC curve means greater overall ability to discriminate diseased from non-diseased patients.
- Number needed to treat (NNT)
- The number treated for one to benefit = 1 ÷ absolute risk reduction; a smaller NNT means a more effective therapy.
- Number needed to harm (NNH)
- Patients treated before one is harmed; comparing NNT to NNH weighs benefit against risk (NNT 25 vs NNH 100 favors treatment).
- Absolute vs relative risk reduction
- Relative risk reduction can exaggerate benefit; anchor on absolute measures (ARR and NNT) for clinical context.
- Confidence interval and significance
- A 95% CI for a difference that crosses zero (or 1 for a ratio) means the result is not statistically significant.
- Screening test trade-off
- Screening tests favor high sensitivity (don't miss cases); confirmatory tests favor high specificity (don't false-positive).