What are the key components to include when creating a quiz on common primary care presentations?

Primary Care Quiz: Essential Components and Structure

A comprehensive primary care quiz should focus on the most common presenting conditions—upper respiratory tract infections, hypertension, diabetes, depression/anxiety, and back pain—while testing clinical reasoning through patient-centered scenarios that assess history-taking, physical examination skills, diagnostic approach, and evidence-based management. 1

Core Clinical Presentations to Include

Most Common Conditions (Clinician-Reported)

• Upper respiratory tract infection (most common globally) 1
• Hypertension (second most common presentation) 1
• Diabetes mellitus (routine monitoring and acute complications) 1
• Depression and anxiety disorders (particularly common in developed countries) 1, 2
• Musculoskeletal complaints (back pain, arthritis) 1
• Dermatitis and skin conditions 1
• Acute otitis media 1

Most Common Patient-Reported Symptoms

• Cough and respiratory symptoms 1
• Back pain 1
• Abdominal symptoms 1
• Pharyngitis 1
• Fever 1
• Headache 1
• Fatigue 1

Essential History-Taking Components

Chronic Disease Management Questions

For hypertension and diabetes cases, include:

• "Know your numbers" assessment: BMI, blood pressure (target <120/80), A1C (target <5.7 for normal, <7 for diabetics), lipid panel (LDL-C <100, HDL-C >50, triglycerides <100), eGFR (>90 normal), and UACR (<30 normal) 3
• Lifestyle factors: tobacco use (single most important modifiable risk factor), alcohol consumption (≤1 drink/day for women, ≤2 drinks/day for men), diet, exercise, and sleep patterns 3
• Medication adherence and side effects 3
• Social determinants of health: employment, housing stability, food security, and health literacy 3

Substance Use Assessment

Include motivational interviewing scenarios:

• Open-ended questions: "What do you like about using [substance]?" rather than confrontational approaches 3
• Elicit patient concerns: "How does it feel when you hear that [substance] may be causing [symptom]?" 3
• Assess readiness to change: "What makes you think about stopping?" 3
• Avoid judgmental language: Never ask "Don't you see that your [behavior] is hurting your family?" 3

HIV and Sexual Health History

For appropriate cases, test knowledge of:

• Sexual practices and exposure sites (asked in open, nonjudgmental manner) 3
• Partner HIV status and disclosure 3
• Injection drug use practices and needle sharing 3
• Screening for domestic violence and sexual abuse (particularly important in women) 3

Physical Examination Skills

Key Examination Components

Test recognition of critical findings:

• Vital signs interpretation: height, weight, BMI calculation, blood pressure technique, waist circumference (women ≤88 cm, men ≤102 cm) 3
• Body habitus assessment: evidence of wasting, obesity, lipohypertrophy (dorsocervical fat pad, gynecomastia, visceral fat), or lipoatrophy (facial, extremity, or buttock fat loss) 3
• Cardiovascular examination: peripheral vascular disease assessment, pulse intensity grading (0=absent, 1=diminished, 2=normal, 3=bounding) 3, 4
• Lymph node examination: distinguish persistent generalized lymphadenopathy from focal/rapidly progressive adenopathy requiring biopsy 3

Documentation Standards

Include questions on appropriate documentation:

• One-click templates are acceptable only when they accurately reflect the actual encounter 4
• Avoid cloned documentation where entries are worded exactly like previous entries 4
• Document examination quality (optimal, fair, suboptimal, poor) as this affects reliability 4

Diagnostic Approach and Screening

Laboratory Interpretation

Test understanding of:

• Hypertension diagnosis: home blood pressure monitoring with proper technique, not single office readings 3, 5
• Diabetes screening: A1C, fasting plasma glucose (FPG 70-100 normal, >140 risky), time in range (TIR, target 100%) 3
• Cardiovascular risk: lipid panel interpretation, ASCVD risk calculation 5
• Renal function: eGFR and UACR for diabetes and hypertension patients 3

Preventive Care Priorities

Include questions on:

• Immunization status: childhood vaccinations, Tdap, hepatitis A/B, HPV, influenza, pneumococcal, varicella zoster 3
• Cancer screening: last eye exam (dilated funduscopic), dental visit, age-appropriate cancer screening 3
• Smoking cessation counseling (clinician encouragement is frequently cited motivator) 3, 5

Management and Treatment Decisions

Hypertension Management Algorithm

Test stepwise approach:

1. Stage 1 hypertension (130-139/80-89): lifestyle modifications first (weight reduction, DASH diet, sodium restriction, physical activity, alcohol moderation) 5
2. Calculate ASCVD risk to determine medication need 5
3. Medication selection: avoid beta-blockers in asthma patients; prefer calcium channel blockers or ACE inhibitors/ARBs 5
4. Avoid therapeutic inertia: intensify therapy when targets not met 5

Diabetes Management Priorities

Include scenarios testing:

• Comprehensive education: self-monitoring blood glucose, dietary counseling, target A1C <7% 5
• Microalbuminuria screening: initiate ACE inhibitor if positive 5
• Medication adherence assessment at each visit 5
• Lifestyle modifications even when medications needed 5

Substance Use Treatment

Test knowledge of:

• Motivational interviewing techniques: elicit patient's own concerns rather than confrontation 3
• Benzodiazepine tapering: slow taper over months in selected motivated patients without seizure history 3
• Referral indications: comorbid chronic pain requiring opioids, co-occurring alcohol/benzodiazepine abuse 3

Patient Education and Shared Decision-Making

Communication Skills

Test ability to:

• Elicit patient priorities through open-ended questions 3
• Provide education at every visit without covering all topics at once 3
• Use plain language: "good cholesterol" for HDL-C, "bad cholesterol" for LDL-C 3
• Encourage patient belief they can control health outcomes 3
• Avoid judgmental language 3

Health Literacy Considerations

Include scenarios requiring:

• Tailoring to individual patient: evaluate health literacy level 3
• Account for social determinants: socioeconomic factors affecting care access 3
• Repeat and reinforce key concepts 3

Common Pitfalls to Test

Clinical Reasoning Errors

Include questions identifying:

• Therapeutic inertia: failure to intensify therapy when targets not met 5
• Inadequate follow-up intervals: leading to poor adherence 5
• Overlooking medication adherence: must assess at each visit 5
• Neglecting lifestyle modifications: even when medications needed 5
• Confrontational substance use counseling: using judgmental language 3

Documentation Errors

Test recognition of:

• Excessive template use: standardizing away unique patient aspects 4
• Cloned documentation: entries worded exactly like previous notes 4
• Inaccurate macro-generated findings: not reflecting actual examination 4

Question Format Recommendations

Case-Based Scenarios

Structure questions around:

• Common presenting symptoms (cough, back pain, fatigue) leading to diagnosis 1
• Chronic disease management (hypertension, diabetes follow-up) 1, 2
• Preventive care opportunities (vaccination, screening) 3
• Behavioral health integration (depression screening, substance use) 3, 1

Clinical Reasoning Assessment

Test ability to:

• Distinguish patient-reported from clinician-diagnosed conditions 1
• Prioritize interventions based on morbidity and mortality impact 6
• Identify needs-based care delivery rather than protocol-driven approaches 6
• Recognize when specialist referral is indicated 3