High Guru Family Medicine Review

Introduction

• Host: Rahul, practicing pediatric critical care physician and medical educator.
• Focus: USMLE Step 1, Shelf exams, Step 2 CK.
• Teaching Methodology: Evidence-based learning, vignette-focused learning, integration across organ systems.

Overview of High Guru

• Integration of multiple organ systems.
• Test-taking strategy emphasis.
• Focus on mental grind and peak test-taking psychology.

USMLE Step 2 CK Preparation

• Triad of preparation: accountability, clinical reasoning, positivity.
• Non-linear studying process.
• Community support and shared success stories.

USPSTF Screening Guidelines

• 40-74 years: Breast cancer screening.
• 45-75 years: Colon cancer screening.
• 50-80 years: Lung cancer screening for long-term smokers.
• 65-75 years: AAA screening for ever smokers.
• 65 years+: Osteoporosis screening, earlier if risk factors present.
• Guidelines for Transgender individuals: Follow cisgender screening guidelines.

Key Concepts

• Disease Prevention Pyramid:
  • Primary Prevention: Prevent disease onset (e.g., smoking cessation).
  • Secondary Prevention: Screening tests (e.g., colonoscopy).
  • Tertiary Prevention: Treat disease to prevent morbidity.
  • Quaternary Prevention: Prevent overmedication (e.g., reducing unnecessary medications).
• Characteristics of Ideal Screening Program:
  • Common disease, long asymptomatic phase, correctable if identified early.

Hypertension Screening and Diagnosis

• Definition: Blood pressure >140/90 mmHg.
• Confirmatory methods: Ambulatory monitoring, home monitoring, or multiple office visits.
• Secondary causes: Renal artery stenosis, hyperaldosteronism, Cushing's, pheochromocytoma, OSA.

Diabetes and Dyslipidemia Screening

• Early screening for those with obesity or family history.

Important Screening Guidelines

• Colon Cancer: Age 45 to 75, colonoscopy every 10 years, earlier if family history.
• Breast Cancer: Age 40 to 74, mammography every 1-2 years.
• Osteoporosis: DEXA scan start at age 65, earlier if risk factors.
• Lung Cancer: Low-dose CT scan for smokers age 50-80.
• AAA Screening: For smokers, one-time at age 65.

Osteoporosis Treatment and Prevention

• Medications:
  • Bisphosphonates: First line, risk of osteonecrosis of the jaw.
  • Denosumab: Inhibits RANK-L.
  • Teriparatide: PTH analogue, activates osteoblasts.
  • SERM (raloxifene): Agonist to bone, antagonist to breast.

Cervical Cancer Screening

• Start at age 21, every 3-5 years.
• Co-testing with HPV starting at age 30.
• Earlier screening for high-risk patients (e.g., HIV positive).

Test-Taking Strategies

• Use age and risk factors to determine appropriate screenings.
• Apply USPSTF guidelines based on vignette details.

Conclusion

• Emphasis on the importance of preventative health measures.
• Encourage community engagement and resource sharing.