Family MedicineHypertension in primary care
Pathophysiology: Primary hypertension is sustained elevation of systemic arterial pressure from vascular tone, renal sodium handling, sympathetic activity, endothelial dysfunction, genetics, age, obesity, sleep apnea, diet, alcohol, and medication contributors; chronic pressure load injures brain, heart, kidneys, retina, and arteries.
How Family Medicine assesses it: Assess correct cuff size and technique, repeated office BP, home or ambulatory BP readings, ASCVD risk, diabetes/CKD, pregnancy potential, NSAIDs/decongestants/stimulants/OCPs, alcohol/sodium intake, sleep apnea symptoms, secondary hypertension clues, and symptoms of end-organ injury such as chest pain, dyspnea, neurologic deficit, or vision change.
Diagnosis: Confirm with repeated office measurements and preferably home or ambulatory monitoring; evaluate BMP/CMP with creatinine/eGFR and potassium, urine albumin-creatinine ratio or urinalysis, fasting lipids, A1c/glucose, ECG for LVH/ischemia, TSH when suggested, and aldosterone-renin ratio, renal artery imaging, or sleep study for resistant/secondary patterns.
First-line treatment: Lifestyle therapy includes sodium reduction, DASH-style diet, weight loss, exercise, alcohol reduction, sleep apnea treatment, and smoking cessation. First-line drugs include chlorthalidone (Thalitone), hydrochlorothiazide (Microzide), amlodipine (Norvasc), lisinopril (Zestril/Prinivil), or losartan (Cozaar), selected by comorbidity, kidney function, potassium, pregnancy potential, and adverse effects.
Second-line treatment: If above goal, combine complementary first-line classes such as ACE inhibitor/ARB plus calcium-channel blocker or thiazide-like diuretic; check adherence, home readings, diet sodium, NSAID/stimulant use, and adverse effects before intensifying.
Third-line / advanced care: Resistant hypertension needs secondary-cause workup and often spironolactone (Aldactone) if potassium/eGFR allow; urgent ED transfer is needed for hypertensive emergency with acute target-organ injury. Nephrology/cardiology referral is appropriate for resistant, secondary, or complicated disease.
Progression and follow-up: Poor control increases stroke, MI, heart failure, atrial fibrillation, CKD, retinopathy, peripheral arterial disease, vascular dementia, aortic disease, and medication harm from overly aggressive treatment.
Built from the app's uploaded pharmacology/pathophysiology modules and source library where available, then cross-checked against Mayo Clinic, MedlinePlus, Merck Manual Professional, CDC/USPSTF guidance, specialty guidelines, and DailyMed labels for named drugs.
Family MedicineType 2 diabetes longitudinal management
Pathophysiology: Type 2 diabetes combines insulin resistance, progressive beta-cell dysfunction, hepatic glucose overproduction, adipose inflammation, incretin abnormalities, and renal glucose handling, leading to hyperglycemia, microvascular injury, ASCVD, CKD, neuropathy, infection risk, and acute HHS/DKA in severe stress.
How Family Medicine assesses it: Assess symptoms, A1c history, hypoglycemia, diet/activity, weight, steroid/antipsychotic use, ASCVD/HF/CKD, albuminuria, neuropathy/foot risk, retinopathy screening, BP/lipids, injection technique, affordability, health literacy, and pregnancy potential.
Diagnosis: Use A1c, fasting plasma glucose, random glucose with classic symptoms, or 2-hour OGTT; monitor CMP/eGFR, urine albumin-creatinine ratio, fasting lipids, B12 with chronic metformin, foot monofilament/pulse exam, retinal exam, and ketones/anion gap/VBG or serum osmolality when DKA/HHS is possible.
First-line treatment: Use individualized A1c goal, nutrition/activity/weight plan, and metformin (Glucophage) when tolerated. Prefer GLP-1/GIP therapy such as semaglutide (Ozempic/Rybelsus/Wegovy) or tirzepatide (Mounjaro/Zepbound) for weight/A1c needs, and SGLT2 inhibitors empagliflozin (Jardiance) or dapagliflozin (Farxiga) for heart failure or CKD benefit when appropriate.
Second-line treatment: Add or intensify therapy based on phenotype: basal insulin glargine (Lantus/Basaglar/Semglee) for symptomatic or very uncontrolled disease, prandial insulin lispro (Humalog) or aspart (NovoLog) when needed, DPP-4 inhibitor sitagliptin (Januvia), sulfonylurea glipizide (Glucotrol), or pioglitazone (Actos) only when benefits outweigh risks.
Third-line / advanced care: Use CGM such as Dexcom G7 or FreeStyle Libre, diabetes education, endocrinology referral, pump/concentrated insulin for complex insulin needs, and emergency DKA/HHS protocol with IV fluids, regular insulin, potassium, and trigger treatment.
Progression and follow-up: Follow A1c/CGM, renal function, albuminuria, feet, eyes, BP/lipids, vaccine status, hypoglycemia, affordability, and complications including ASCVD, CKD, retinopathy, neuropathy, foot ulcer, infection, HHS/DKA, and treatment-related hypoglycemia.
Built from the app's uploaded pharmacology/pathophysiology modules and source library where available, then cross-checked against Mayo Clinic, MedlinePlus, Merck Manual Professional, CDC/USPSTF guidance, specialty guidelines, and DailyMed labels for named drugs.
Family MedicineHyperlipidemia and ASCVD prevention
Pathophysiology: Atherogenic apoB-containing lipoproteins enter arterial walls, oxidize, trigger inflammation, and form plaques that can rupture or narrow vessels, producing MI, ischemic stroke, PAD, and aortic disease; severe triglyceride elevation can trigger pancreatitis.
How Family Medicine assesses it: Assess known ASCVD, LDL-C level, diabetes, CKD, hypertension, smoking, family history of premature ASCVD, inflammatory disease, premature menopause/preeclampsia, diet/alcohol, secondary causes such as hypothyroidism/nephrotic syndrome, and medication adherence/tolerance.
Diagnosis: Use fasting or nonfasting lipid panel, ASCVD risk estimate for primary prevention, A1c/glucose, TSH and CMP when secondary causes are possible, urine albumin/eGFR when metabolic disease is present, and coronary artery calcium CT when the primary-prevention decision remains uncertain.
First-line treatment: Lifestyle includes Mediterranean/DASH-style eating, reduced saturated/trans fat, exercise, weight management, tobacco cessation, and BP/diabetes control. Drug therapy uses statins when indicated: atorvastatin (Lipitor), rosuvastatin (Crestor), pravastatin (Pravachol), or simvastatin (Zocor); aspirin (Bayer/Ecotrin) is routine for secondary prevention but selective in primary prevention.
Second-line treatment: If LDL-C remains above risk-based goal or statin intolerance occurs, add ezetimibe (Zetia), bempedoic acid (Nexletol/Nexlizet), or PCSK9 therapy alirocumab (Praluent), evolocumab (Repatha), or inclisiran (Leqvio). Use icosapent ethyl (Vascepa) for selected high-triglyceride patients with ASCVD or diabetes risk.
Third-line / advanced care: Refer to lipid/cardiology for familial hypercholesterolemia, recurrent ASCVD despite therapy, very high LDL-C, severe hypertriglyceridemia, or complex statin intolerance; consider fibrate or omega-3 strategy for pancreatitis prevention when triglycerides are very high.
Progression and follow-up: Monitor lipid response, adherence, myalgias, liver symptoms when present, diabetes risk, ASCVD events, pancreatitis risk with severe triglycerides, and medication interactions.
Built from the app's uploaded pharmacology/pathophysiology modules and source library where available, then cross-checked against Mayo Clinic, MedlinePlus, Merck Manual Professional, CDC/USPSTF guidance, specialty guidelines, and DailyMed labels for named drugs.
Family MedicineObesity and metabolic risk
Pathophysiology: Obesity is a chronic adiposity-based disease involving neurohormonal appetite regulation, genetics, sleep, medications, environment, insulin resistance, inflammation, and ectopic fat, increasing diabetes, MASLD/MASH, OSA, hypertension, infertility, osteoarthritis, and ASCVD risk.
How Family Medicine assesses it: Assess BMI, waist circumference, weight trajectory, BP, A1c/glucose, lipids, ALT/AST, sleep apnea symptoms, depression/eating disorder screen, medications that increase weight, pregnancy plans, joint pain, readiness, food access, and prior weight-loss attempts.
Diagnosis: Diagnose by BMI/clinical adiposity and screen complications with A1c, fasting lipids, CMP/liver enzymes, TSH only when symptoms suggest thyroid disease, urine albumin/eGFR with diabetes/HTN, sleep study for OSA symptoms, and fibrosis scoring/elastography when fatty liver risk is present.
First-line treatment: First-line care is intensive lifestyle treatment: nutrition pattern, calorie strategy, physical activity, sleep, behavioral support, and treatment of weight-promoting medications when possible. Anti-obesity medication may include semaglutide (Wegovy), tirzepatide (Zepbound), liraglutide (Saxenda), orlistat (Alli/Xenical), phentermine-topiramate (Qsymia), or naltrexone-bupropion (Contrave) based on contraindications.
Second-line treatment: Treat complications directly with metformin (Glucophage) for diabetes prevention/diabetes when appropriate, GLP-1/GIP or SGLT2 therapy for diabetes/CKD/HF indications, statin/BP therapy, CPAP for OSA, PT for joint limitation, and behavioral health support for binge eating or depression.
Third-line / advanced care: Refer for obesity medicine/endocrinology, dietitian, bariatric/metabolic surgery evaluation such as sleeve gastrectomy or Roux-en-Y gastric bypass, or multidisciplinary care when BMI/comorbidity criteria, medication failure, or severe complications are present.
Progression and follow-up: Follow weight, waist, BP, A1c, lipids, liver risk, OSA, mood, adverse effects, pregnancy risk with medications, muscle preservation, and long-term recurrence prevention.
Built from the app's uploaded pharmacology/pathophysiology modules and source library where available, then cross-checked against Mayo Clinic, MedlinePlus, Merck Manual Professional, CDC/USPSTF guidance, specialty guidelines, and DailyMed labels for named drugs.
Family MedicineDepression screening and treatment
Pathophysiology: Major depression involves mood, reward, stress-hormone, sleep, inflammatory, genetic, trauma, substance, and psychosocial pathways that cause persistent low mood or anhedonia with cognitive, somatic, functional, and safety effects.
How Family Medicine assesses it: Use PHQ-9, suicide/self-harm assessment, bipolar screen, substance screen, grief/trauma context, sleep, thyroid/anemia/medication mimics, pregnancy/postpartum status, chronic pain, social stressors, and functional impairment.
Diagnosis: Diagnosis is clinical using DSM criteria supported by PHQ-9 severity; consider TSH, CBC, B12, CMP, pregnancy test, medication review, and urgent safety evaluation for suicidality, psychosis, mania, catatonia, or inability to care for self.
First-line treatment: First-line treatment is shared decision-making with psychotherapy such as CBT/interpersonal therapy, exercise/sleep/substance interventions, and SSRI/SNRI when indicated: sertraline (Zoloft), escitalopram (Lexapro), fluoxetine (Prozac), venlafaxine (Effexor XR), or duloxetine (Cymbalta) when pain/anxiety overlap.
Second-line treatment: If inadequate after an adequate trial, optimize dose, switch medication, or augment with bupropion XL (Wellbutrin XL), mirtazapine (Remeron), buspirone (Buspar), lithium (Lithobid), or aripiprazole (Abilify) depending on symptoms, adverse effects, and bipolar risk.
Third-line / advanced care: Refer urgently for active suicidal intent, psychosis, mania, severe functional collapse, pregnancy complexity, treatment resistance, ECT, TMS, ketamine/esketamine (Spravato), intensive outpatient, or inpatient care.
Progression and follow-up: Follow PHQ-9, sleep, function, suicidality, adherence, adverse effects, sexual side effects, weight, recurrence, substance use, chronic disease adherence, and relapse-prevention duration.
Built from the app's uploaded pharmacology/pathophysiology modules and source library where available, then cross-checked against Mayo Clinic, MedlinePlus, Merck Manual Professional, CDC/USPSTF guidance, specialty guidelines, and DailyMed labels for named drugs.
Family MedicineAnxiety disorders in primary care
Pathophysiology: Anxiety disorders reflect threat-circuit sensitization, autonomic arousal, avoidance learning, trauma/substance effects, sleep disruption, and medical mimics, causing excessive worry, panic, somatic symptoms, and avoidance-related disability.
How Family Medicine assesses it: Use GAD-7 or panic symptom review, assess panic attacks/agoraphobia, depression/suicide, bipolar disorder, trauma, caffeine/stimulants/decongestants, substance use, hyperthyroid symptoms, arrhythmia/chest pain, pregnancy, and functional avoidance.
Diagnosis: Diagnosis is clinical using DSM criteria; consider TSH, CBC/CMP, pregnancy test, ECG for palpitations/chest pain, and targeted cardiopulmonary/endocrine testing only when symptoms suggest a mimic.
First-line treatment: First-line care includes CBT/exposure-based therapy, sleep/caffeine reduction, exercise, and SSRI/SNRI such as sertraline (Zoloft), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), venlafaxine XR (Effexor XR), or duloxetine (Cymbalta).
Second-line treatment: For partial response, optimize dose/duration, switch SSRI/SNRI, add buspirone (Buspar) for generalized anxiety, hydroxyzine (Vistaril/Atarax) short-term, propranolol (Inderal) for performance anxiety when safe, or trauma-focused therapy when PTSD features dominate.
Third-line / advanced care: Avoid routine long-term benzodiazepines; limited lorazepam (Ativan) or clonazepam (Klonopin) may be carefully used for short bridging in selected patients. Refer for suicidality, bipolar/psychosis, severe OCD/PTSD, substance use, pregnancy complexity, or treatment resistance.
Progression and follow-up: Follow GAD-7/panic frequency, avoidance, sleep, substance use, medication adverse effects, driving/work impairment, depression/suicide risk, and relapse during taper.
Built from the app's uploaded pharmacology/pathophysiology modules and source library where available, then cross-checked against Mayo Clinic, MedlinePlus, Merck Manual Professional, CDC/USPSTF guidance, specialty guidelines, and DailyMed labels for named drugs.
Family MedicineAcute upper respiratory infection
Pathophysiology: Most acute upper respiratory infections are viral inflammation of nasal, pharyngeal, sinus, and airway mucosa; bacterial sinusitis, streptococcal pharyngitis, influenza, COVID-19, pertussis, pneumonia, and asthma/COPD exacerbation are key differentials.
How Family Medicine assesses it: Assess duration, fever pattern, cough, dyspnea, chest pain, wheeze, sore throat, sinus/tooth pain, ear pain, exposure risk, pregnancy, immunocompromise, COPD/asthma, oxygen saturation, lung exam, hydration, and red flags such as hypoxia, meningismus, drooling, or sepsis.
Diagnosis: Usually clinical. Use COVID/flu/RSV testing when results change isolation or antivirals, rapid strep/NAAT when Centor/McIsaac supports testing, chest X-ray for hypoxia/focal lung findings/tachypnea, and avoid routine antibiotics or sinus imaging in uncomplicated viral illness.
First-line treatment: Supportive care includes fluids, honey for cough when age-appropriate, saline, acetaminophen (Tylenol), ibuprofen (Advil/Motrin), guaifenesin (Mucinex), dextromethorphan (Delsym), intranasal fluticasone (Flonase), and ipratropium nasal (Atrovent) for rhinorrhea. Use nirmatrelvir-ritonavir (Paxlovid) or oseltamivir (Tamiflu) only when criteria and timing are met.
Second-line treatment: Treat confirmed strep with penicillin V (Pen VK) or amoxicillin (Amoxil); treat bacterial sinusitis meeting persistent/severe/worsening criteria with amoxicillin-clavulanate (Augmentin) or doxycycline (Vibramycin) when appropriate.
Third-line / advanced care: Escalate to ED/urgent imaging for hypoxia, respiratory distress, sepsis, dehydration, altered mental status, immunocompromised severe illness, peritonsillar abscess, epiglottitis concern, or pneumonia requiring inpatient care.
Progression and follow-up: Most viral URIs resolve in 7-10 days, cough may persist longer; complications include sinusitis, otitis media, pneumonia, asthma/COPD flare, dehydration, inappropriate antibiotic adverse effects, and missed severe infection.
Built from the app's uploaded pharmacology/pathophysiology modules and source library where available, then cross-checked against Mayo Clinic, MedlinePlus, Merck Manual Professional, CDC/USPSTF guidance, specialty guidelines, and DailyMed labels for named drugs.
Family MedicineUrinary tract infection in adult women
Pathophysiology: Uncomplicated cystitis is bacterial infection of the bladder mucosa, usually Escherichia coli ascending from periurethral flora; pyelonephritis involves renal parenchyma and may cause bacteremia or sepsis.
How Family Medicine assesses it: Assess dysuria, frequency, urgency, suprapubic pain, hematuria, fever/flank pain, nausea/vomiting, pregnancy, diabetes/immunocompromise, kidney stone, urologic abnormality, recurrent UTI, vaginal discharge/STI risk, recent antibiotics, and local resistance/allergy history.
Diagnosis: Uncomplicated cystitis can be diagnosed clinically with urinalysis support; obtain urine culture for pregnancy, pyelonephritis, recurrent/complicated infection, recent antibiotics/resistance risk, persistent symptoms, or treatment failure. Use pregnancy test or STI NAAT when history suggests; imaging is for obstruction, stone, sepsis, or nonresponse.
First-line treatment: Uncomplicated cystitis first-line options include nitrofurantoin (Macrobid) for 5 days when renal function is adequate, TMP-SMX (Bactrim DS) for 3 days when resistance/allergy permit, or fosfomycin (Monurol) single dose. Phenazopyridine (Pyridium/AZO) may be used briefly for dysuria.
Second-line treatment: Use cephalexin (Keflex), amoxicillin-clavulanate (Augmentin), or culture-directed therapy when first-line agents are unsuitable. Pyelonephritis needs urine culture and oral fluoroquinolone such as ciprofloxacin (Cipro) or levofloxacin (Levaquin) only when appropriate, often with initial ceftriaxone if resistance risk exists.
Third-line / advanced care: Escalate/admit for pregnancy pyelonephritis, sepsis, obstruction/stone, vomiting/inability to take PO, renal transplant/immunocompromise, resistant organism, or persistent fever; urology evaluation is needed for recurrent complicated infection or anatomic concern.
Progression and follow-up: Complications include pyelonephritis, bacteremia, renal abscess, recurrent UTI, antibiotic resistance, C difficile, yeast vaginitis, and missed STI/vaginitis if symptoms are atypical.
Built from the app's uploaded pharmacology/pathophysiology modules and source library where available, then cross-checked against Mayo Clinic, MedlinePlus, Merck Manual Professional, CDC/USPSTF guidance, specialty guidelines, and DailyMed labels for named drugs.
Family MedicineLow back pain initial evaluation
Pathophysiology: Most acute low back pain is mechanical from muscle/ligament strain, disc/facet degeneration, or nonspecific pain sensitization; dangerous causes include fracture, malignancy, infection, cauda equina, inflammatory disease, abdominal/aortic disease, and severe radiculopathy.
How Family Medicine assesses it: Assess onset/trauma, neurologic symptoms, bowel/bladder retention or incontinence, saddle anesthesia, fever, cancer history, injection drug use, steroid/osteoporosis risk, anticoagulation, night pain, weight loss, occupational demands, psychosocial yellow flags, and focused neurologic exam.
Diagnosis: Do not image uncomplicated acute low back pain. Use MRI lumbar spine for cauda equina, infection, malignancy, progressive neurologic deficit, or persistent radiculopathy when intervention is considered; X-ray/CT for trauma/fracture risk; ESR/CRP/CBC for infection/malignancy clues.
First-line treatment: First-line care is reassurance, staying active, heat, time-limited NSAID such as ibuprofen (Advil/Motrin) or naproxen (Aleve/Naprosyn) when safe, acetaminophen (Tylenol) as adjunct, and early PT/exercise for persistent or recurrent pain.
Second-line treatment: Short-term cyclobenzaprine (Flexeril) or methocarbamol (Robaxin) may help selected acute spasm; duloxetine (Cymbalta), gabapentin (Neurontin), or pregabalin (Lyrica) is reserved for chronic/neuropathic patterns after diagnosis is clear. Avoid routine opioids, benzodiazepines, and systemic steroids for nonspecific back pain.
Third-line / advanced care: Urgent ED/spine referral for cauda equina, progressive motor deficit, epidural abscess, fracture instability, cancer cord compression, or severe refractory radiculopathy; consider epidural steroid injection/surgery only for selected imaging-confirmed radiculopathy/stenosis.
Progression and follow-up: Most improves within weeks; monitor pain, function, work status, neurologic changes, medication adverse effects, chronicity risk, opioid exposure, deconditioning, and recurrence prevention.
Built from the app's uploaded pharmacology/pathophysiology modules and source library where available, then cross-checked against Mayo Clinic, MedlinePlus, Merck Manual Professional, CDC/USPSTF guidance, specialty guidelines, and DailyMed labels for named drugs.
Family MedicineOsteoarthritis long-term care
Pathophysiology: Osteoarthritis is whole-joint disease involving cartilage loss, subchondral bone remodeling, synovitis, osteophytes, meniscal/ligament change, muscle weakness, pain sensitization, age, obesity, trauma, and genetics.
How Family Medicine assesses it: Assess affected joints, pain pattern, morning stiffness duration, swelling, function, falls, obesity, prior injury, inflammatory signs, joint instability, occupational limits, kidney/GI/CV risk for NSAIDs, and patient goals.
Diagnosis: Usually clinical for hands/knees/hips; weight-bearing X-ray helps when diagnosis is unclear, severity guides referral, or surgery is considered. ESR/CRP, RF/anti-CCP, uric acid, aspiration, or MRI is reserved for inflammatory, crystal, infection, trauma, or atypical disease.
First-line treatment: Core treatment is exercise/PT, weight loss when relevant, assistive devices/bracing, heat/cold, topical diclofenac (Voltaren), acetaminophen (Tylenol) selectively, and oral NSAID such as naproxen (Aleve/Naprosyn) or ibuprofen (Advil/Motrin) only when renal/GI/CV risk is acceptable.
Second-line treatment: Consider duloxetine (Cymbalta) for chronic knee/hip OA pain, intra-articular triamcinolone (Kenalog) for flares, capsaicin for selected hand/knee symptoms, and fall-prevention/strength training. Avoid chronic opioids when possible.
Third-line / advanced care: Orthopedics referral for severe pain/function loss despite conservative therapy, deformity, advanced radiographic disease, or joint replacement evaluation; urgent referral for suspected septic arthritis, fracture, or rapidly destructive joint disease.
Progression and follow-up: Follow pain, function, walking tolerance, sleep, falls, NSAID toxicity, BP/kidney/GI effects, injection frequency, disability, and readiness for surgical discussion.
Built from the app's uploaded pharmacology/pathophysiology modules and source library where available, then cross-checked against Mayo Clinic, MedlinePlus, Merck Manual Professional, CDC/USPSTF guidance, specialty guidelines, and DailyMed labels for named drugs.
Family MedicineMigraine initial management
Pathophysiology: Migraine is a recurrent neurovascular brain disorder involving trigeminovascular activation, CGRP signaling, cortical spreading depression, sensory hypersensitivity, genetics, hormones, sleep, stress, and environmental triggers.
How Family Medicine assesses it: Assess headache onset, duration, unilateral/pulsating quality, nausea, photophobia/phonophobia, aura, menstrual pattern, disability, triggers, medication overuse, pregnancy, neurologic deficits, thunderclap onset, cancer/immunosuppression, fever, papilledema, and red flags using SNOOP features.
Diagnosis: Diagnose clinically using migraine criteria; neuroimaging is not needed for stable typical migraine with normal exam. Use MRI/CT urgently for thunderclap, new focal deficit, papilledema, cancer/infection risk, pregnancy/postpartum red flags, trauma, or major pattern change.
First-line treatment: Acute treatment includes early NSAID such as ibuprofen (Advil/Motrin) or naproxen (Aleve/Naprosyn), acetaminophen (Tylenol), antiemetic metoclopramide (Reglan) or prochlorperazine (Compazine), and triptan such as sumatriptan (Imitrex) or rizatriptan (Maxalt) when no vascular contraindication exists.
Second-line treatment: If inadequate, try another triptan or add gepant/ditan such as ubrogepant (Ubrelvy), rimegepant (Nurtec ODT), or lasmiditan (Reyvow). Preventive therapy is considered for frequent/disabling attacks: topiramate (Topamax), propranolol (Inderal), metoprolol (Toprol XL), amitriptyline (Elavil), venlafaxine (Effexor XR), CGRP monoclonal antibodies erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), or atogepant (Qulipta).
Third-line / advanced care: Refer to neurology for refractory migraine, hemiplegic/brainstem aura, medication overuse, chronic migraine needing onabotulinumtoxinA (Botox), pregnancy complexity, or diagnostic uncertainty; ED evaluation for thunderclap or neurologic deficit.
Progression and follow-up: Track headache days, acute medication days, disability, aura changes, medication overuse, triggers, menstrual relation, adverse effects, pregnancy plans, and response after 8-12 weeks of prevention.
Built from the app's uploaded pharmacology/pathophysiology modules and source library where available, then cross-checked against Mayo Clinic, MedlinePlus, Merck Manual Professional, CDC/USPSTF guidance, specialty guidelines, and DailyMed labels for named drugs.
Family MedicineGERD and dyspepsia
Pathophysiology: GERD results from reflux of gastric contents due to lower esophageal sphincter dysfunction, hiatal hernia, impaired clearance, delayed emptying, obesity, pregnancy, and diet/medications; dyspepsia may reflect functional disease, peptic ulcer, H pylori, medication injury, biliary disease, or malignancy.
How Family Medicine assesses it: Assess heartburn/regurgitation, epigastric pain, NSAID/aspirin use, alarm features such as dysphagia, odynophagia, bleeding, anemia, weight loss, persistent vomiting, family GI cancer, age, pregnancy, and cardiac symptoms that can mimic reflux.
Diagnosis: Typical GERD can be treated empirically. Test for H pylori with stool antigen or urea breath test in dyspepsia when appropriate. EGD is indicated for alarm features, dysphagia, GI bleeding, weight loss, persistent vomiting, Barrett risk with chronic reflux, or symptoms refractory to adequate PPI trial.
First-line treatment: Lifestyle care includes weight loss when relevant, head-of-bed elevation, avoiding late meals, tobacco cessation, and trigger review. Use antacids/alginates, famotidine (Pepcid), or PPI such as omeprazole (Prilosec), esomeprazole (Nexium), or pantoprazole (Protonix) for an 8-week trial when indicated.
Second-line treatment: If persistent symptoms, confirm correct PPI timing before breakfast, increase to twice daily temporarily, switch PPI, treat H pylori with guideline regimen such as bismuth quadruple therapy, and review NSAIDs, bisphosphonates, iron, potassium, and GLP-1-related delayed gastric emptying.
Third-line / advanced care: Refer to GI for alarm features, refractory symptoms, suspected Barrett esophagus, strictures, eosinophilic esophagitis, ulcer complications, need for pH impedance/manometry, or anti-reflux procedure evaluation.
Progression and follow-up: Complications include esophagitis, stricture, Barrett esophagus, aspiration, chronic cough/laryngitis, ulcer bleeding, missed cardiac disease, C difficile/fracture/kidney concerns with prolonged PPI use, and recurrent symptoms after stopping therapy.
Built from the app's uploaded pharmacology/pathophysiology modules and source library where available, then cross-checked against Mayo Clinic, MedlinePlus, Merck Manual Professional, CDC/USPSTF guidance, specialty guidelines, and DailyMed labels for named drugs.
Family MedicineContraception counseling
Pathophysiology: Contraception counseling matches pregnancy prevention, menstrual control, reproductive goals, medical eligibility, thrombotic risk, drug interactions, STI risk, and patient preference to a safe method.
How Family Medicine assesses it: Assess pregnancy possibility, last menstrual period, postpartum/breastfeeding status, migraine with aura, hypertension, smoking age over 35, VTE/thrombophilia, breast cancer, liver disease, bariatric surgery, antiseizure/rifampin interactions, STI risk, menstrual goals, privacy, and future fertility timing.
Diagnosis: Use urine pregnancy test when pregnancy is uncertain, BP before estrogen-containing methods, STI NAAT when risk is present, Pap/HPV only if due, and CDC medical eligibility criteria to determine method safety; pelvic exam is not required for most hormonal methods but is needed for IUD placement.
First-line treatment: Offer shared decision-making with same-day start when eligible. Highly effective options include levonorgestrel IUD (Mirena/Liletta/Kyleena), copper IUD (Paragard), etonogestrel implant (Nexplanon), depot medroxyprogesterone (Depo-Provera), progestin-only norethindrone (Micronor), drospirenone (Slynd), or combined pills/patch/ring such as ethinyl estradiol/levonorgestrel (Aviane) or etonogestrel/ethinyl estradiol ring (NuvaRing).
Second-line treatment: Emergency contraception options include copper IUD, levonorgestrel (Plan B One-Step), or ulipristal (ella) depending on timing/BMI/contraindications. Manage side effects by switching dose/progestin/route, treating breakthrough bleeding, or choosing nonhormonal/barrier methods.
Third-line / advanced care: Refer for complex medical eligibility, difficult IUD insertion/removal, sterilization counseling, severe adverse effects, suspected pregnancy/ectopic, or contraception in active cancer/thrombosis/transplant settings.
Progression and follow-up: Follow satisfaction, bleeding, BP for estrogen methods, DMPA bone/weight considerations, IUD strings/symptoms, STI prevention, medication interactions, reproductive goals, and warning signs such as severe pelvic pain or VTE symptoms.
Built from the app's uploaded pharmacology/pathophysiology modules and source library where available, then cross-checked against Mayo Clinic, MedlinePlus, Merck Manual Professional, CDC/USPSTF guidance, specialty guidelines, and DailyMed labels for named drugs.
Family MedicineTobacco use disorder
Pathophysiology: Tobacco use disorder is nicotine dependence driven by nicotinic receptor reward pathways, withdrawal avoidance, conditioning, stress, social cues, and product engineering; combustible tobacco causes cancer, COPD, ASCVD, pregnancy harm, and postoperative/wound complications.
How Family Medicine assesses it: Ask every patient about current and past tobacco/nicotine product use, amount, time to first use, quit attempts, triggers, withdrawal, readiness, pregnancy, psychiatric/substance comorbidity, household exposure, lung cancer screening eligibility, and contraindications to medications.
Diagnosis: Clinical diagnosis uses DSM-5 tobacco use disorder features or dependence measures such as time to first cigarette; carbon monoxide testing is optional. Assess pack-years for lung cancer screening, BP/cardiac history for medication choice, and depression/suicide history when using varenicline or bupropion.
First-line treatment: Use brief counseling plus pharmacotherapy unless contraindicated. First-line options include combination nicotine replacement therapy with patch (Nicoderm CQ) plus gum/lozenge (Nicorette/Commit), varenicline (Chantix), or bupropion SR (Zyban/Wellbutrin SR). Provide quit date or reduce-to-quit plan, trigger plan, and quitline/text/app support.
Second-line treatment: If relapse occurs, extend duration, combine varenicline with NRT in selected patients, switch medication, intensify behavioral counseling, address alcohol/cannabis/mental health triggers, and treat withdrawal/weight-gain concerns.
Third-line / advanced care: Refer to tobacco treatment specialist, behavioral health, or pulmonary/cardiology prevention program for repeated relapse, pregnancy complexity, severe psychiatric instability, or high medical risk; screen eligible adults for lung cancer with low-dose CT per USPSTF criteria.
Progression and follow-up: Follow abstinence, slips, withdrawal, mood/suicidality, sleep/vivid dreams, BP, nicotine toxicity, weight, COPD/asthma control, ASCVD risk, cancer screening, and household secondhand exposure.
Built from the app's uploaded pharmacology/pathophysiology modules and source library where available, then cross-checked against Mayo Clinic, MedlinePlus, Merck Manual Professional, CDC/USPSTF guidance, specialty guidelines, and DailyMed labels for named drugs.
Family MedicineAlcohol use disorder screening
Pathophysiology: Alcohol use disorder and unhealthy alcohol use reflect reward circuitry, tolerance, withdrawal physiology, genetic risk, trauma/psychiatric comorbidity, and social context; harms include liver disease, pancreatitis, hypertension, cancer, arrhythmias, neuropathy, injury, fetal alcohol exposure, and medication interactions.
How Family Medicine assesses it: Screen with AUDIT-C or single-question screen, quantify drinks/week and binge pattern, assess DSM-5 criteria, withdrawal history/seizures/DTs, liver disease, pancreatitis, falls/injuries, depression/suicide, pregnancy, driving/work safety, and concurrent opioids/benzodiazepines.
Diagnosis: Use AUDIT-C/AUDIT and clinical interview; labs can support harm assessment with CMP/AST/ALT/bilirubin, CBC/MCV, INR, GGT when useful, hepatitis screening when indicated, pregnancy test when relevant, and CIWA-Ar only for withdrawal monitoring, not screening.
First-line treatment: Provide brief intervention, motivational interviewing, harm-reduction or abstinence goal, thiamine when malnutrition/withdrawal risk exists, and medication for moderate/severe AUD when appropriate: naltrexone oral (Revia) or injection (Vivitrol) if no opioid use/severe liver failure, or acamprosate (Campral) when renal function allows.
Second-line treatment: Alternatives include disulfiram (Antabuse) for highly supervised abstinence, gabapentin (Neurontin) or topiramate (Topamax) in selected off-label situations, plus CBT, mutual-help groups, contingency management, or integrated mental health care.
Third-line / advanced care: Medically supervised withdrawal or ED/inpatient care is needed for severe withdrawal history, seizures/DTs, unstable vitals, pregnancy, serious comorbidity, suicidality, polysubstance sedatives, or inability to maintain hydration/safety.
Progression and follow-up: Follow drinking days, heavy drinking days, cravings, liver enzymes, mood/suicide risk, sleep, medication adherence, opioid interaction with naltrexone, relapse triggers, injuries, BP, and family/social safety.
Built from the app's uploaded pharmacology/pathophysiology modules and source library where available, then cross-checked against Mayo Clinic, MedlinePlus, Merck Manual Professional, CDC/USPSTF guidance, specialty guidelines, and DailyMed labels for named drugs.
Family MedicinePreventive immunizations
Pathophysiology: Preventive immunization primes adaptive immunity before exposure, reducing severe disease, transmission, cancer risk for HPV/hepatitis B, pregnancy complications, and outbreaks; schedules vary by age, pregnancy, immune status, occupation, travel, and prior vaccines.
How Family Medicine assesses it: Review vaccine records, age, pregnancy, immunocompromise, asplenia, diabetes, CKD/liver/lung/heart disease, smoking, sexual risk, occupational exposure, travel, prior reactions, Guillain-Barre history when relevant, allergies, and live-vaccine contraindications.
Diagnosis: No disease diagnosis is required; reconcile records in the state registry/EHR, identify gaps using the current CDC adult/child schedule, and use targeted serology only when documentation is absent and immunity status matters, such as hepatitis B, varicella, or measles in select patients.
First-line treatment: Use current CDC schedule: annual influenza, updated COVID-19 vaccination, Tdap once then Td/Tdap boosters, RSV vaccine for eligible older or pregnant patients, pneumococcal PCV20 or PCV15/PPSV23 strategy by age/risk, recombinant zoster vaccine Shingrix, HPV vaccine Gardasil 9 through routine/catch-up/shared decision ages, and hepatitis B vaccination for adults by age/risk.
Second-line treatment: Special-risk vaccines include meningococcal ACWY/B, Hib for asplenia/transplant indications, hepatitis A for risk/travel/liver disease, MMR/varicella when nonimmune and not contraindicated, mpox for risk groups, and travel vaccines through travel medicine.
Third-line / advanced care: Defer or specialist-review live vaccines in severe immunocompromise/pregnancy, evaluate anaphylaxis to prior vaccine/component, and coordinate post-exposure prophylaxis or immunoglobulin for rabies, hepatitis B, varicella, measles, or tetanus-prone wounds when indicated.
Progression and follow-up: Follow completion of multi-dose series, adverse events, documentation, future due dates, pregnancy timing, immunocompromise changes, and missed opportunities during chronic disease visits.
Built from the app's uploaded pharmacology/pathophysiology modules and source library where available, then cross-checked against Mayo Clinic, MedlinePlus, Merck Manual Professional, CDC/USPSTF guidance, specialty guidelines, and DailyMed labels for named drugs.
Family MedicineCancer screening coordination
Pathophysiology: Cancer screening coordination is prevention care that detects precancer or early asymptomatic cancer before symptoms, using age/risk-based tests where benefit outweighs overdiagnosis, false positives, radiation, procedural harm, anxiety, and downstream biopsy risk.
How Family Medicine assesses it: Assess age, sex organs present, family history, genetic syndromes, smoking pack-years, prior abnormal tests/polyps, immunosuppression, DES exposure, HPV status, life expectancy, comorbidities, patient preferences, and whether symptoms require diagnostic rather than screening evaluation.
Diagnosis: Use USPSTF/CDC/specialty-aligned screening: mammography for eligible breast cancer screening, colorectal screening with FIT annually, stool DNA-FIT, CT colonography, sigmoidoscopy, or colonoscopy by risk and prior results; cervical cytology/HPV testing by age/history; annual low-dose CT for eligible smoking history; and individualized PSA discussion for prostate screening.
First-line treatment: Coordinate shared decisions, order the right screening test, ensure bowel prep/navigation when colonoscopy is chosen, track results, and close the loop on abnormal findings. Continue HPV vaccination when eligible and address tobacco cessation, hepatitis B/C, obesity, alcohol, sun protection, and occupational risks.
Second-line treatment: Abnormal screens require disease-specific follow-up: diagnostic mammogram/ultrasound and biopsy for suspicious breast findings, colonoscopy after positive stool test, colposcopy for abnormal cervical screening, Lung-RADS follow-up or pulmonology/thoracic referral after LDCT findings, and urology evaluation after concerning PSA/DRE.
Third-line / advanced care: Refer genetics/high-risk clinic for BRCA/Lynch/polyposis patterns, very strong family history, young cancers, or multiple primaries; stop screening when harms exceed benefit because of limited life expectancy or patient preference after informed discussion.
Progression and follow-up: Track completion, results, pathology, recall intervals, incidental findings, over-screening, under-screening, anxiety, insurance/access barriers, and conversion of positive screening tests into timely diagnostic care.
Built from the app's uploaded pharmacology/pathophysiology modules and source library where available, then cross-checked against Mayo Clinic, MedlinePlus, Merck Manual Professional, CDC/USPSTF guidance, specialty guidelines, and DailyMed labels for named drugs.