Top 10 Most Common Family Medicine Cases
The most frequently encountered conditions in family medicine are hypertension, diabetes mellitus, hyperlipidemia, upper respiratory infections, musculoskeletal pain, gastroesophageal reflux disease, asthma, urinary tract infections, skin infections, and depression. These conditions represent the core of primary care practice and require systematic approaches to diagnosis and management 1, 2.
1. Hypertension
- Target blood pressure <140/90 mmHg for most patients, with goals individualized based on age and comorbidities 3
- Measure blood pressure in both arms at initial evaluation to identify subclavian artery stenosis 3
- Assess for orthostatic changes, particularly in older adults with diabetes 3
- Monitor serum potassium levels for patients on ACE inhibitors, ARBs, or diuretics 3
- High-risk patients with hypertension (without diabetes) show reduced mortality with aggressive treatment, but also increased harms 4
- Cardiovascular events are rare in patients meeting criteria for hypertensive urgency 4
2. Diabetes Mellitus
- Obtain CBC with differential, CMP, hemoglobin A1C, fasting lipid profile, and urinalysis with albumin-to-creatinine ratio annually 3
- Monitor vitamin B12 levels for patients on metformin 3
- Perform comprehensive diabetic foot examination including skin inspection, assessment for deformities, and 10-gram monofilament testing 3
- Teach daily foot inspection and proper footwear selection 3
- Aggressive blood pressure targets are not recommended in patients with diabetes, especially older persons 4
- Screen for cognitive impairment using validated tools in older adults with diabetes 3
3. Hyperlipidemia
- Obtain fasting lipid profile annually 3
- Monitor lipid management every 4-12 weeks after any statin dose change, then annually 3
- Emphasize Mediterranean or DASH diet for cardiovascular risk reduction 3
- Assess family history of early coronary heart disease (MI in first-degree relative before age 55 in males, age 65 in females) 5
4. Upper Respiratory Infections
- Use delayed antibiotic prescriptions to reduce antibiotic use in patients with acute respiratory infection symptoms 4
- Nasal irrigation (not steam inhalation) is beneficial for chronic sinus symptoms 4
- Acute sinusitis caused by Haemophilus influenzae, penicillin-susceptible Streptococcus pneumoniae, or Moraxella catarrhalis may require ciprofloxacin 6
- Azithromycin cures 97% of chlamydia cases despite slightly higher failure rate than doxycycline 4
5. Musculoskeletal Pain and Tendinopathies
- Diclofenac is most likely to be effective for hip or knee osteoarthritis among available NSAIDs 4
- Hip radiography is not helpful for diagnosing hip osteoarthritis 4
- Opioid benefits in chronic low back pain are limited and not clearly superior to NSAIDs 4
- Relative rest, cryotherapy (10-minute applications of melting ice water through wet towel), and eccentric strengthening exercises are the foundation of tendinopathy treatment 5
- NSAIDs provide short-term pain relief but have no effect on long-term outcomes 5
- Most overuse tendinopathies (80%) fully recover within 3-6 months 5
6. Gastroesophageal Reflux Disease (GERD)
- High-dose proton pump inhibitor therapy for one week is the diagnostic/therapeutic approach of choice for suspected GERD-induced chest pain 7
- The PPI test has excellent sensitivity/specificity and provides economic savings by reducing diagnostic procedures 7
- Barium studies, endoscopy, and esophageal manometry have little value in diagnosing GERD-induced chest pain 7
- GERD may be associated with atrial fibrillation development due to anatomic proximity of esophagus and left atrium 8
7. Asthma
- Combination of fluticasone and salmeterol is preferred to fluticasone alone in patients with moderate to severe asthma 4
- Assess for exercise intolerance and respiratory symptoms during physical examination 5
- Consider obstructive pulmonary disease in differential diagnosis 5
8. Urinary Tract Infections
- Ciprofloxacin is indicated for UTIs caused by E. coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus mirabilis, and other susceptible organisms 6
- Acute uncomplicated cystitis in females caused by E. coli or Staphylococcus saprophyticus responds to ciprofloxacin 6
- Chronic bacterial prostatitis caused by E. coli or Proteus mirabilis requires extended treatment 6
- Perform urinalysis with culture and susceptibility testing before initiating therapy 6
9. Skin and Soft Tissue Infections
- Ciprofloxacin is effective for skin infections caused by E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus aureus, and Streptococcus pyogenes 6
- Examine skin for seborrheic dermatitis, folliculitis, fungal infections, psoriasis, and prurigo nodularis 5
- Assess for evidence of cellulitis, abscesses, or wound infections requiring drainage 5
10. Depression and Mental Health
- Screen for depression, posttraumatic stress disorder, and domestic violence at initial evaluation and periodic intervals 5
- Depression prevalence is twice as high in women with HIV infection and more prevalent with violence or victimization 5
- Assess changes in mood, libido, sleeping patterns, appetite, concentration, and memory 5
- Screen for cognitive impairment using validated tools in older adults 3
- Provide counseling on tobacco cessation, alcohol consumption, and anxiety 3
Essential Preventive Care Components
- Update immunizations according to CDC ACIP guidelines: annual influenza vaccine, pneumococcal vaccines, zoster vaccine, tetanus-diphtheria-pertussis booster, and COVID-19 vaccination 3
- Measure height, weight, BMI, and waist circumference at each visit 3
- Provide diet and nutrition guidance emphasizing Mediterranean or DASH diet 3
- Recommend moderate-intensity aerobic exercise and resistance training 3
- Use oral syringes rather than medicine cups to measure liquid medications for children 4
- Recommend abrupt smoking cessation preceded by two weeks of nicotine replacement via patch rather than slow phasing out 4