Cardiovascular & Respiratory Medicine
The 2022 AAFP clinical practice guideline recommends treating non-pregnant adults with hypertension to a standard blood pressure target below this threshold in mm Hg
What is <140/90 mm Hg?
Rationale: High-quality evidence supports targeting <140/90 mm Hg to reduce mortality and cardiovascular events without excessive risk of serious adverse events
Anterior knee pain in a runner that is worsened by stairs or prolonged sitting, accompanied by patellar crepitus but no joint effusion, is best managed initially with this conservative intervention
What is pelvifemoral physical therapy / exercise therapy (and activity modification)?
Patellofemoral pain syndrome is treated first-line with physical therapy focusing on gluteal, hip abductor, and quadriceps strengthening; routine imaging is not required
The USPSTF gives a Grade B recommendation for routine depression screening in asymptomatic children and adolescents starting at this age
What is age 12?
Rationale: Screening for major depressive disorder is recommended annually for all adolescents aged 12 to 18 using standardized screening tools
To reduce the risk of Sudden Infant Death Syndrome (SIDS), AAP guidelines recommend placing infants to sleep on their back on a firm surface in this room location
What is the parents' (or caregivers') room?
Rationale: Room-sharing without bed-sharing (sleeping in a separate crib in the parents' room) for at least the first 6 months reduces SIDS risk by up to 50%
Sudden, painless vaginal bleeding in the third trimester with a reassuring fetal heart rate trace is the hallmark presentation of this placental anomaly
What is Placenta Previa?
Rationale: Placenta previa presents with painless bleeding as the lower uterine segment stretches, unlike placental abruption which is typically painful with uterine hypertonicity
This class of diabetic/renal medication is recommended to reduce all-cause mortality in patients with Heart Failure with Reduced Ejection Fraction (HFrEF), regardless of whether diabetes is present
What is an SGLT2 inhibitor?
Rationale: SGLT2 inhibitors (such as dapagliflozin or empagliflozin) are now part of first-line guideline-directed medical therapy for symptomatic HFrEF alongside ARNi/ACEi/ARB, beta-blockers, and mineralocorticoid receptor antagonists
Unlike acute tendinitis, chronic overuse conditions like lateral epicondylosis or Achilles tendinopathy are non-inflammatory degenerative conditions best treated with this specific exercise modality
What is eccentric strengthening?
Tendinosis involves microscopic collagen disorganization without acute inflammation; progressive eccentric muscle contractions promote tendon remodeling and recovery
Annual screening for lung cancer with low-dose CT is recommended for adults aged 50–80 who currently smoke or quit within the past 15 years and have at least this pack-year history
What is a 20 pack-year smoking history?
Rationale: USPSTF updated guidelines reduced the smoking threshold to 20 pack-years (down from 30) and lowered the starting age to 50
Screening all newborns for critical congenital heart disease (CCHD) using pulse oximetry should ideally be performed after this post-birth timeframe to minimize false positives
What is 24 hours (or ≥24 hours of life)?
Rationale: Pulse oximetry on the right hand and either foot conducted after 24 hours of life significantly reduces false-positive results from transitional circulation
The 20-mcg/day formulation of this intrauterine contraceptive device is rated by AAFP as more effective than oral medical therapies for reducing heavy menstrual bleeding
What is the Levonorgestrel-releasing IUD (Mirena)?
Rationale: The levonorgestrel IUD reduces menstrual blood loss by 71%–95% and provides higher patient satisfaction than oral progestins or OCPs
According to GOLD guidelines, this once-daily inhaled medication class (e.g., tiotropium or umeclidinium) is the preferred initial monotherapy for stable mild-to-moderate COPD without frequent exacerbations
What is a Long-Acting Muscarinic Antagonist (LAMA)?
Rationale: LAMAs provide superior bronchodilation and symptom reduction compared to short-acting agents and are preferred over LABA monotherapy or combination therapy for initial Group A/GOLD 2 management
Point tenderness 2 cm proximal to the lateral joint line in a cyclist or runner, with pain reproduced during the Noble compression test, identifies this overuse syndrome
What is Iliotibial (IT) Band Syndrome?
IT band syndrome causes friction impingement over the lateral femoral epicondyle; the Noble compression test confirms the diagnosis
The USPSTF recommends initiating a moderate-intensity statin for primary CVD prevention in adults aged 40–75 with 1+ CVD risk factors if their calculated 10-year CVD risk score meets or exceeds this percentage
What is 10% (or ≥10%)?
Rationale: Adults aged 40–75 with a 10-year ASCVD risk ≥10% and at least one risk factor (diabetes, dyslipidemia, hypertension, smoking) obtain a Grade B recommendation for statin therapy
In an infant whose weight drops below the 5th percentile or crosses two major growth percentiles, this non-organic etiology accounts for the vast majority of cases
What is inadequate caloric intake?
Rationale: Inadequate caloric intake (from feeding difficulties, improper formula mixing, or psychosocial factors) accounts for over 90% of growth faltering (failure to thrive) cases in primary care
In women under age 45 with recurrent anovulatory bleeding or failure to respond to medical management, this diagnostic test must be performed to evaluate for endometrial hyperplasia or malignancy
What is an Endometrial Biopsy (EMB)?
Unopposed estrogen in anovulatory cycles increases the risk of endometrial hyperplasia and cancer; tissue sampling via EMB is mandatory for high-risk or non-responsive patients
Moving from a squatting to a standing position or performing the Valsalva maneuver increases the intensity of the midsystolic ejection murmur in this structural heart condition
What is Hypertrophic Cardiomyopathy (HCM)?
Rationale: HCM causes dynamic left ventricular outflow tract obstruction that worsens when preload or afterload decreases (such as standing or Valsalva), causing the systolic murmur to intensify
While the empty can test is sensitive for supraspinatus tears, this physical examination maneuver has a very high specificity of 96% for diagnosing rotator cuff tears
What is the Drop Arm Test?
In the drop arm test, the patient cannot slowly lower the arm from 90° of abduction; its high specificity makes it a strong confirmatory physical finding
The USPSTF gives a Grade B recommendation for one-time screening for Hepatitis C virus (HCV) infection in all asymptomatic adults within this broad age bracket
What is ages 18 to 79?
Rationale: Universal screening for HCV is recommended for all adults aged 18–79 years regardless of identified risk factors
A 3-month-old infant presents with chronic inspiratory stridor that worsens during feeding and in the supine position but has normal weight gain; the condition is caused by supraglottic collapse
What is Laryngomalacia?
Rationale: Laryngomalacia is the most common congenital laryngeal anomaly, causing benign, self-limiting inspiratory stridor that resolves as the airway cartilages mature
To prevent preeclampsia, low-dose aspirin (81 mg/day) should be initiated at 12–16 weeks gestation in pregnant patients who have at least one high-risk factor, such as this chronic vascular condition
What is chronic hypertension (or pregestational diabetes / prior preeclampsia)?
Rationale: USPSTF guidelines recommend low-dose aspirin starting in the late first trimester for women with high-risk conditions to significantly reduce preeclampsia rates and adverse perinatal outcomes
A patient with non-Hodgkin lymphoma presents with progressive exertional dyspnea and facial swelling. Emergency management targets this oncologic compression syndrome
What is Superior Vena Cava (SVC) Syndrome?
SVC syndrome results from extrinsic compression of the superior vena cava by mediastinal tumors or lymph nodes; initial treatments include IV corticosteroids, chemotherapy, radiation, or stenting
When lateral hip pain attributed to greater trochanteric pain syndrome fails to respond to anti-inflammatory drugs and physical therapy, MRI should evaluate for a tear in this muscle tendon
What is a Gluteus Medius tendon tear?
Greater trochanteric pain syndrome refractory to conservative measures is frequently caused by gluteus medius or minimus tendinopathy or tearing, which may require surgical repair
The USPSTF explicitly issues a Grade D recommendation against routine screening for this solid cancer in asymptomatic adolescent and adult males
What is Testicular Cancer?
Rationale: Due to low incidence and high cure rates even at symptomatic stages, routine screening via palpation or clinical exam provides no net benefit and carries harms of false positives
In a febrile child with an acute cough, this specific chest physical examination finding (along with grunting) is most predictive of community-acquired bacterial pneumonia
What are retractions (or abnormal work of breathing / grunting)?
Rationale: Retractions and grunting indicate significant lower respiratory tract involvement and are the strongest physical exam predictors of pediatric pneumonia
In a patient experiencing postpartum hemorrhage due to uterine atony, this second-line uterotonic ergot alkaloid is strictly contraindicated if the patient has preeclampsia or chronic hypertension
What is Methylergonovine (Methergine)?
Rationale: Methylergonovine induces smooth muscle contraction and peripheral vasoconstriction, which can trigger hypertensive crises or stroke in patients with underlying hypertensive disease