Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) Family Medicine, Primary Care, and Health Promotion Syllabus

What is the most common cause of acute cough lasting less than 3 weeks in outpatients?

Viral upper respiratory infection (the common cold).

What is the Centor/McIsaac criteria used for, and name its components?

Estimating likelihood of group A strep pharyngitis. Components: fever, tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough (+ age adjustment).

What are the alarm ('red flag') symptoms in a patient with low back pain that warrant imaging?

Saddle anesthesia, bowel/bladder dysfunction, progressive neuro deficit, fever, IV drug use, history of cancer, unexplained weight loss, or significant trauma.

What is the first-line treatment for uncomplicated acute cystitis in a non-pregnant woman?

Nitrofurantoin x5 days, OR TMP-SMX x3 days, OR fosfomycin single dose.

Describe the classic appearance and distribution of atopic dermatitis (eczema) in adults.

Pruritic, erythematous, scaly, lichenified patches in flexural areas (antecubital and popliteal fossae, neck, wrists).

What is the ABCDE rule for evaluating a suspicious pigmented skin lesion for melanoma?

Asymmetry, Border irregularity, Color variation, Diameter > 6 mm, Evolving/change over time.

What is the typical clinical presentation of psoriasis (vulgaris)?

Well-demarcated erythematous plaques with silvery scale on extensor surfaces (elbows, knees), scalp; may show Auspitz sign (pinpoint bleeding on scale removal).

What distinguishes basal cell carcinoma morphology from squamous cell carcinoma?

BCC: pearly/translucent papule with rolled borders and telangiectasias, rarely metastasizes. SCC: scaly, ulcerated, indurated lesion or non-healing sore, higher metastatic potential.

What is the first-line non-opioid analgesic recommended for chronic musculoskeletal pain in primary care?

Acetaminophen and/or NSAIDs; combined with non-pharmacologic therapy (exercise, physical therapy).

What does the WHO analgesic ladder recommend for escalating cancer pain management?

Step 1: non-opioids (NSAIDs/acetaminophen) +/- adjuvants. Step 2: weak opioids (e.g., codeine, tramadol). Step 3: strong opioids (e.g., morphine) for severe pain, +/- adjuvants at each step.

Per CDC opioid guidelines, what morphine milligram equivalent (MME)/day threshold prompts heightened caution and reassessment?

50 MME/day or more warrants caution and reassessment; avoid or carefully justify reaching 90 MME/day or more.

What are the components of the geriatric '5 Ms' framework?

Mind (cognition/mood), Mobility, Medications, Multicomplexity, and what Matters most (patient goals).

Name the most common modifiable risk factors for falls in older adults.

Polypharmacy (esp. psychoactive drugs), muscle weakness/gait instability, vision impairment, orthostatic hypotension, and environmental hazards.

What is the diagnostic triad ('3 D's') often distinguished in geriatric cognitive/behavioral assessment?

Delirium (acute, fluctuating, inattention), Dementia (chronic, progressive), and Depression (pseudodementia) — must be differentiated.

What are the four key features of delirium per DSM/CAM criteria?

Acute onset with fluctuating course, inattention, plus either disorganized thinking OR altered level of consciousness.

What is polypharmacy and which screening tool helps identify potentially inappropriate medications in the elderly?

Polypharmacy: use of 5 or more medications. The Beers Criteria (and STOPP/START) identify potentially inappropriate medications in older adults.

What domains are included in a functional assessment using the basic ADLs (Katz index)?

Bathing, Dressing, Toileting, Transferring, Continence, and Feeding.

What activities are assessed by the Instrumental ADLs (IADLs)?

Shopping, Housekeeping, Accounting/finances, Food preparation, Transportation, Telephone use, and Medication management (SHAFT mnemonic plus phone).

What is the Medicare eligibility criterion for hospice care?

A terminal illness with a life expectancy of 6 months or less if the disease runs its usual course, certified by two physicians, with the patient electing comfort-focused care over curative treatment.

How does palliative care differ from hospice care?

Palliative care provides symptom and comfort management at ANY stage of serious illness and can be given alongside curative treatment. Hospice is comfort-only care for terminally ill patients with prognosis of 6 months or less.

What are the most common symptoms requiring management in end-of-life care, and a first-line treatment for terminal dyspnea?

Pain, dyspnea, nausea, secretions, and delirium. First-line for terminal dyspnea: low-dose opioids (e.g., morphine).

What is the difference between a living will and a durable power of attorney for health care?

A living will specifies the patient's own treatment wishes (e.g., resuscitation) for future scenarios. A durable POA (health care proxy) designates a surrogate to make decisions when the patient lacks capacity.

What are the four elements required to assess decision-making capacity?

The patient can: (1) understand relevant information, (2) appreciate the situation/consequences, (3) reason/manipulate information rationally, and (4) communicate a choice.

Define incidence vs prevalence.

Incidence = number of NEW cases over a time period / population at risk. Prevalence = total EXISTING cases (new + old) / total population at a point in time.

How are sensitivity and specificity calculated?

Sensitivity = TP / (TP + FN) — ability to detect disease. Specificity = TN / (TN + FP) — ability to identify those without disease.

How do positive and negative predictive values relate to disease prevalence?

PPV = TP/(TP+FP) increases as prevalence rises; NPV = TN/(TN+FN) decreases as prevalence rises. Sensitivity/specificity are prevalence-independent.

What measures of association are reported in cohort studies vs case-control studies?

Cohort studies report relative risk (RR) and can measure incidence. Case-control studies report odds ratios (OR) because incidence cannot be directly measured.

How are absolute risk reduction (ARR) and number needed to treat (NNT) calculated?

ARR = control event rate − treatment event rate. NNT = 1 / ARR.

What are the levels of disease prevention with an example of each?

Primary: prevent disease onset (vaccination, smoking cessation). Secondary: early detection (screening, e.g., mammography). Tertiary: reduce complications of established disease (cardiac rehab, diabetic foot care).

Define a confounding variable and one method to control for it.

A confounder is associated with both the exposure and outcome, distorting the apparent association. Controlled by randomization, matching, restriction, stratification, or multivariable regression.

What are the five domains of the social determinants of health (Healthy People framework)?

Economic stability, Education access and quality, Health care access and quality, Neighborhood and built environment, and Social and community context.