FAMILY MEDICINE - ACUTE COMPLAINTS + DERMATOLOGY / MSK

YEAR 3 | PAGE 31F - RED FLAGS -> LIKELY SYNDROME -> MINIMUM USEFUL TESTING -> SAFE

PLAN — THE OUTPATIENT EXAM TRAP

The wrong answer is often not a wrong diagnosis - it is the right test or treatment used too early. In ambulatory care, first decide whether the patient is sick enough to need ED/hospital escalation, then use focused history and exam to separate self-limited disease from conditions that justify testing, antibiotics, imaging, procedures or specialty referral.

C. COMMON AMBULATORY PRESENTATIONS - FIRST DECISION

Presentation	Red flags / discriminators	Family-medicine next-step logic
Cough / URI / sore throat	Hypoxemia, severe dyspnea, focal lung findings, dehydration, immunocompromise; viral pattern vs pneumonia vs asthma/COPD vs strep.	Avoid automatic antibiotics or imaging. Test/treat when the pretest probability or severity justifies it; escalate respiratory distress.
Dysuria / urinary symptoms	Pregnancy, fever/flank pain, obstruction, male anatomy, STI symptoms, recurrent/complicated history.	Separate uncomplicated cystitis from pyelonephritis, STI/prostatitis or obstruction; choose urine testing/culture based on complexity.
Headache / dizziness	Thunderclap, focal deficit, fever/meningismus, trauma, pregnancy/postpartum, new older-age pattern, papilledema.	Do not image every headache. Red flags change the sequence; otherwise classify the syndrome and treat appropriately.
Abdominal / GI symptoms	Peritoneal signs, GI bleed, dehydration, weight loss, persistent vomiting, pregnancy possibility, age-specific risk.	Rule out time-sensitive disease before labeling functional or self-limited illness; use targeted labs/imaging only when they change management.
Low back / joint pain	Neurologic deficit, bowel/bladder dysfunction, fever, cancer/infection risk, trauma, inflammatory clues, hot swollen joint.	Mechanical pain usually needs conservative care first; red flags, suspected fracture, infection or neurologic compromise justify urgent imaging/workup.
Rash / skin lesion	Mucosal involvement, systemic toxicity, rapidly progressive pain, immunocompromise, concerning pigmented lesion, cellulitis vs abscess.	Describe morphology + distribution before naming the disease; drain when appropriate, biopsy/refer suspicious lesions and escalate severe reactions.
Ear / eye / sinus complaints	Vision loss, severe eye pain, orbital findings, mastoid signs, neurologic deficit, severe systemic illness.	Differentiate self-limited/inflammatory disease from bacterial infection and vision-threatening pathology; avoid reflex antibiotics.
Minor injury / wound	Neurovascular compromise, tendon injury, foreign body, open fracture, bite, contamination, tetanus status.	Assess function and neurovascular status first; decide imaging, irrigation/closure, prophylaxis and follow-up.

D. DERMATOLOGY + MSK - PATTERN BEFORE LABEL

Problem	What separates the options	High-yield action
Inflammatory vs infectious skin disease	Pruritus vs pain, warmth, fluctuance, scale, vesicles, distribution, systemic symptoms.	Do not call every red lesion cellulitis; abscess usually requires drainage, while inflammatory disease needs the correct anti-inflammatory strategy.
Pigmented / changing lesion	ABCDE-type change, bleeding/ulceration, ugly-duckling pattern, risk factors.	Suspicious lesions need biopsy/referral rather than reassurance from one benign feature.
Hot swollen joint	Septic arthritis vs crystal disease vs inflammatory flare.	When infection is plausible, synovial fluid analysis precedes steroid injection; do not be reassured by a history of gout alone.
Shoulder / knee pain	Trauma, ROM pattern, instability, strength, effusion, mechanical symptoms, referred pain.	Use anatomy + examination to localize before ordering MRI; many presentations start with conservative treatment.
Back pain	Mechanical pattern vs radiculopathy vs cauda equina, fracture, infection, malignancy.	Imaging is not routine without red flags or persistent/progressive concerning features.

D. DERMATOLOGY + MSK - PATTERN BEFORE LABEL

SUPERVISED OFFICE SKILLS: wound irrigation/closure, skin biopsy/cryotherapy, joint aspiration/injection, cervical specimen collection, wet mount/urinalysis, peak-flow/spirometry interpretation and point-of-care testing should be learned through school/clinic supervision and local protocols. Dirty Medicine - Dermatology on USMLE / COMLEX Geeky Medics - Knee Joint Examination OSCE Guide Geeky Medics - Shoulder Examination OSCE Guide 2026/27 clerkship-expanded edition - verify school and official exam updates before testing