Prevention at every visit

Screening, vaccines, tobacco counseling, obesity care, reproductive planning, sleep, stress, and social determinants belong in routine care, not only annual visits.

Common acute visits

URI, sinus/ear/throat complaints, UTI, vaginitis, rash, musculoskeletal pain, fatigue, headache, and abdominal pain are high-volume encounters where focused diagnosis matters more than memorizing one algorithm.

Chronic disease reviews

Hypertension, diabetes, lipids, obesity, anxiety/depression, asthma, thyroid disease, GERD, osteoarthritis, and CKD should be managed as medication-and-monitoring systems, not isolated diagnoses.

Referral timing

Know when you still own the problem, when you co-manage, and when the patient has crossed into specialty-level staging, procedures, or high-risk progression.

Hypertension

Pathophysiology: Chronic elevation in vascular resistance and renal sodium handling drives vascular, cardiac, and kidney injury over time.

Diagnosis: Repeat accurate office BP, home or ambulatory monitoring, and evaluate creatinine/eGFR, potassium, urine albumin, lipids, and ECG when indicated.

First-line treatment: Lifestyle change plus amlodipine (Norvasc), lisinopril (Zestril/Prinivil), losartan (Cozaar), or chlorthalidone (Thalitone) based on comorbidity and pregnancy potential.

Second-line treatment: Combination therapy or spironolactone (Aldactone) for resistant disease; urgent care for hypertensive emergency with end-organ injury.

Type 2 diabetes

Pathophysiology: Insulin resistance plus beta-cell dysfunction causes chronic hyperglycemia and microvascular/ASCVD risk.

Diagnosis: A1c, fasting plasma glucose, or random glucose with symptoms; monitor urine albumin, eGFR, feet, eyes, lipids, and hypoglycemia risk.

First-line treatment: Metformin (Glucophage) with nutrition/activity/weight interventions when tolerated.

Second-line treatment: Semaglutide (Ozempic/Rybelsus), empagliflozin (Jardiance), dapagliflozin (Farxiga), or basal insulin glargine (Lantus/Basaglar) based on phenotype and organ protection needs.

Hyperlipidemia and ASCVD prevention

Pathophysiology: ApoB lipoproteins drive atherosclerosis and plaque rupture, with severe hypertriglyceridemia increasing pancreatitis risk.

Diagnosis: Lipid panel plus ASCVD risk assessment; check A1c, TSH, and secondary causes when needed.

First-line treatment: Atorvastatin (Lipitor) or rosuvastatin (Crestor) with diet and exercise.

Second-line treatment: Ezetimibe (Zetia), bempedoic acid (Nexletol), or PCSK9 therapy such as evolocumab (Repatha) when LDL remains above goal.

Obesity

Pathophysiology: Chronic adiposity alters appetite, insulin signaling, inflammation, sleep, and cardiometabolic risk.

Diagnosis: BMI, waist circumference, weight trajectory, BP, A1c, lipids, liver risk, and sleep apnea screening.

First-line treatment: Intensive lifestyle change, plus semaglutide (Wegovy) or tirzepatide (Zepbound) when medication is appropriate.

Second-line treatment: Liraglutide (Saxenda), phentermine-topiramate (Qsymia), or naltrexone-bupropion (Contrave) in selected patients with monitoring.

Asthma

Pathophysiology: Airway inflammation and hyperresponsiveness cause episodic bronchospasm and variable airflow limitation.

Diagnosis: Symptom pattern, triggers, spirometry when feasible, and response to bronchodilator therapy.

First-line treatment: Albuterol (ProAir HFA/Ventolin) for rescue and inhaled corticosteroid-containing controller therapy such as budesonide-formoterol (Symbicort).

Second-line treatment: Montelukast (Singulair) or prednisone (Deltasone) for worsening disease or exacerbation management.

COPD

Pathophysiology: Chronic airway inflammation and fixed airflow limitation from smoking or exposure cause dyspnea, cough, and exacerbations.

Diagnosis: Post-bronchodilator spirometry, symptom burden, exacerbation history, and oxygenation assessment.

First-line treatment: Tiotropium (Spiriva) or albuterol/ipratropium (Combivent) with smoking cessation.

Second-line treatment: Budesonide-formoterol (Symbicort), prednisone (Deltasone), and azithromycin (Zithromax) when exacerbation triggers suggest bacterial infection.

Sleep apnea

Pathophysiology: Recurrent upper-airway collapse causes intermittent hypoxemia, sleep fragmentation, and cardiometabolic risk.

Diagnosis: STOP-BANG or symptom screening, then sleep study when indicated.

First-line treatment: Weight reduction, sleep-position counseling, and CPAP therapy when moderate or severe disease is confirmed.

Second-line treatment: Oral appliance therapy or ENT/sleep referral when CPAP is not tolerated or anatomy is contributory.

Community-acquired pneumonia

Pathophysiology: Alveolar infection causes inflammation, consolidation, and impaired gas exchange.

Diagnosis: Chest x-ray plus severity assessment, pulse oximetry, and viral testing when appropriate.

First-line treatment: Amoxicillin (Amoxil) or doxycycline (Vibramycin) in appropriate outpatient cases.

Second-line treatment: Amoxicillin-clavulanate (Augmentin) plus azithromycin (Zithromax), or levofloxacin (Levaquin) when broader coverage is needed.

Depression

Pathophysiology: Mood dysregulation affects sleep, appetite, concentration, and function, often with chronic disease overlap.

Diagnosis: PHQ-9, suicide risk assessment, substance use review, and medical cause evaluation when indicated.

First-line treatment: Sertraline (Zoloft) or escitalopram (Lexapro) plus psychotherapy.

Second-line treatment: Bupropion (Wellbutrin XL) or duloxetine (Cymbalta) based on symptoms and comorbidity.

Anxiety

Pathophysiology: Excess threat appraisal and autonomic activation produce persistent worry, panic, and avoidance.

Diagnosis: GAD-7 or panic screening, plus medication/substance and thyroid review when appropriate.

First-line treatment: SSRIs such as sertraline (Zoloft) or escitalopram (Lexapro), along with CBT.

Second-line treatment: Buspirone (Buspar) or venlafaxine (Effexor XR) when symptom pattern or tolerance suggests a different agent.

Osteoarthritis

Pathophysiology: Cartilage degeneration and joint remodeling cause pain, stiffness, and loss of function.

Diagnosis: Clinical pattern with activity-related pain and limited morning stiffness; X-ray may show joint-space narrowing and osteophytes.

First-line treatment: Exercise, weight loss, topical diclofenac (Voltaren), and oral NSAIDs when safe.

Second-line treatment: Intra-articular corticosteroid injections or duloxetine (Cymbalta) for persistent pain.

Low back pain and radiculopathy

Pathophysiology: Mechanical strain, degenerative disease, or nerve-root compression causes axial pain, sciatica, and functional limitation.

Diagnosis: Red-flag screen for cancer/infection/cauda equina, focused neuro exam, and imaging only when indicated by red flags or persistent deficits.

First-line treatment: Activity modification, NSAIDs such as naproxen (Aleve/Naprosyn), and physical therapy.

Second-line treatment: Duloxetine (Cymbalta), short course muscle relaxant such as cyclobenzaprine (Flexeril), or referral for persistent neurologic deficit.

Migraine

Pathophysiology: Neurovascular activation and trigeminovascular signaling drive episodic headache with nausea, photophobia, and disability.

Diagnosis: Typical headache history plus red-flag screening for secondary causes.

First-line treatment: Ibuprofen (Advil/Motrin) or naproxen (Aleve) early in the attack, or sumatriptan (Imitrex) when migraine is established.

Second-line treatment: Preventive therapy such as propranolol (Inderal), topiramate (Topamax), or amitriptyline (Elavil) when attacks are frequent or disabling.

GERD and peptic ulcer disease

Pathophysiology: Reflux from LES dysfunction and acid-peptic injury, often worsened by NSAIDs or H. pylori.

Diagnosis: Symptom pattern, alarm features, and H. pylori testing when ulcer disease is suspected.

First-line treatment: Omeprazole (Prilosec) or pantoprazole (Protonix).

Second-line treatment: Famotidine (Pepcid) or H. pylori eradication regimens when infection is confirmed.

UTI and pyelonephritis

Pathophysiology: Ascending urinary infection causes cystitis or renal parenchymal inflammation, with fever and flank pain in upper tract disease.

Diagnosis: Urinalysis, urine culture, pregnancy test when relevant, and imaging for recurrent or complicated disease.

First-line treatment: Nitrofurantoin (Macrobid) for uncomplicated cystitis or cephalexin (Keflex) when susceptibility and clinical pattern support it.

Second-line treatment: TMP-SMX (Bactrim DS), fosfomycin (Monurol), or ceftriaxone (Rocephin) for more complicated cases or pyelonephritis.

Cellulitis

Pathophysiology: Dermal/subcutaneous bacterial infection causes erythema, warmth, swelling, and pain.

Diagnosis: Clinical exam, with ultrasound if abscess is uncertain and labs when systemic illness is present.

First-line treatment: Cephalexin (Keflex) or dicloxacillin (Dynapen) for nonpurulent disease.

Second-line treatment: TMP-SMX (Bactrim DS), doxycycline (Vibramycin), or clindamycin (Cleocin) when MRSA risk or failure is present.

Otitis media and sinusitis

Pathophysiology: Eustachian tube dysfunction or sinus outflow obstruction leads to bacterial overgrowth after viral URI.

Diagnosis: Bulging TM and middle-ear effusion for otitis media; persistent symptoms, facial pressure, or purulent drainage for sinusitis.

First-line treatment: Amoxicillin (Amoxil) for otitis media or amoxicillin-clavulanate (Augmentin) for bacterial sinusitis when criteria are met.

Second-line treatment: Cefdinir (Omnicef), azithromycin (Zithromax), or doxycycline (Vibramycin) based on age, allergy, and response.

Hypothyroidism and hyperthyroidism

Pathophysiology: Too little thyroid hormone slows metabolism; too much raises adrenergic tone and catabolism.

Diagnosis: TSH and free T4 are central tests; consider thyroid antibodies or uptake scan when etiology is unclear.

First-line treatment: Levothyroxine (Synthroid/Levoxyl) for hypothyroidism or methimazole (Tapazole) for nonpregnant hyperthyroidism.

Second-line treatment: Propylthiouracil for thyroid storm/early pregnancy, or propranolol (Inderal) for symptomatic control while definitive treatment is arranged.

Abnormal uterine bleeding

Pathophysiology: Ovulatory dysfunction, fibroids, polyps, adenomyosis, infection, pregnancy complications, and endometrial pathology can drive heavy or irregular bleeding.

Diagnosis: Pregnancy test, CBC, pelvic exam, and ultrasound; endometrial biopsy when age/risk profile makes hyperplasia or cancer more concerning.

First-line treatment: Combined hormonal contraception or tranexamic acid (Lysteda) when appropriate.

Second-line treatment: Progestin therapy such as medroxyprogesterone (Provera) or levonorgestrel IUD (Mirena) with procedural options for refractory disease.

Vaginitis and cervicitis

Pathophysiology: BV, Candida, trichomoniasis, chlamydia, and gonorrhea are common infectious causes of discharge, odor, burning, and pelvic discomfort.

Diagnosis: Wet mount/pH/KOH where available, NAAT for STI pathogens, and pregnancy testing when treatment choices depend on pregnancy status.

First-line treatment: Metronidazole (Flagyl) for BV/trichomoniasis or fluconazole (Diflucan) for uncomplicated yeast in nonpregnant patients.

Second-line treatment: Clindamycin (Cleocin), azithromycin (Zithromax), or ceftriaxone (Rocephin) when the organism or pregnancy status changes the regimen.

Contraception and menopause

Pathophysiology: Contraception choice depends on ovulation suppression, bleeding profile, and medical eligibility; menopause reflects ovarian estrogen decline.

Diagnosis: Apply CDC U.S. MEC, pregnancy intention, postpartum status, VTE/migraine/hypertension history, and abnormal bleeding history.

First-line treatment: Levonorgestrel IUD (Mirena/Kyleena/Liletta) or etonogestrel implant (Nexplanon) when LARC is acceptable.

Second-line treatment: Combined oral contraceptives or progestin-only pills such as norethindrone (Micronor), and menopausal symptom treatment with vaginal estradiol (Estrace/Vagifem) or systemic hormone therapy when appropriate.

CKD in family practice

Pathophysiology: Progressive nephron loss causes reduced GFR, albuminuria, electrolyte issues, anemia, and cardiovascular risk.

Diagnosis: eGFR trend, urine albumin-creatinine ratio, urinalysis, creatinine, potassium, and renal imaging when obstruction is suspected.

First-line treatment: ACE inhibitor or ARB such as lisinopril (Zestril/Prinivil) or losartan (Cozaar) for albuminuric disease.

Second-line treatment: Empagliflozin (Jardiance) or dapagliflozin (Farxiga), with nephrology referral for rapid progression or advanced CKD.