Saudi Board Family Medicine Part 1 Complete Review Guide 2026–2027

4. SPIKES: Setting, Perception, Invitation, Knowledge, Emotions, then Strategy and Summary.
5. Stages of change: precontemplation, contemplation, preparation (plans to act within a month and has taken steps), action, maintenance.
6. Capacity means the patient understands, retains, weighs and communicates a choice. If present, respect the decision even when treatment is refused.
7. After a medical error: honest disclosure, apology and explanation of next steps, then report the incident.
8. Lung cancer screening (USPSTF 2021): annual low-dose CT at age 50–80 with at least 20 pack-years who smoke now or quit within 15 years.
9. AAA: one-time ultrasound for men aged 65–75 who ever smoked. A diameter of 3.0–3.9 cm is followed every 3 years.
10. Colorectal cancer: average-risk screening starts at 45. Any positive FIT needs colonoscopy.
11. First-degree relative with colorectal cancer before 60: colonoscopy from age 40 or 10 years before the youngest diagnosis, repeated every 5 years.
12. Cervical (USPSTF 2018): cytology every 3 years at 21–29; stop after 65 if prior screening was adequate and negative.
13. Breast (USPSTF 2024): mammography every 2 years at age 40–74 for average-risk women.
14. Osteoporosis: DXA for women 65 and older. A T-score of −2.5 or lower means osteoporosis; first-line treatment is alendronate.
15. Screen adults aged 35–70 with overweight or obesity for prediabetes and diabetes. Without symptoms, diagnosis needs two abnormal results.
16. Statin for primary prevention at 40–75 with at least one risk factor and 10-year risk of 10% or more. Do not start aspirin for primary prevention at 60 or older.
17. Tetanus: a contaminated wound with 3 or more prior doses and the last over 5 years ago needs Td or Tdap only, without immune globulin.
18. PPV = true positives ÷ all positives. Specificity = true negatives ÷ all without disease.
19. LR+ = sensitivity ÷ (1 − specificity). For post-test probability, convert to odds, multiply by LR, then convert back.
20. NNT = 1 ÷ absolute risk reduction (ARR). Relative risk reduction (RRR) = ARR ÷ control risk.
21. A 95% CI for a ratio that excludes 1 means p < 0.05. Type I error is a false positive; type II error misses a real difference.
22. Intention-to-treat analysis preserves randomisation. Allocation concealment prevents selection bias at enrolment.
23. COPD needs post-bronchodilator FEV1/FVC below 0.70. Asthma reversibility is an FEV1 rise of 12% and 200 mL or more.
24. Stop metformin at eGFR below 30. Add an SGLT2 inhibitor in CKD with eGFR 20 or more and ACR 20 mg/mmol or more, even without diabetes.

Common mistakes in this chapter

• ✕ Early reassurance or imaging to settle anxiety is often chosen. The right step is to explore the patient's concern first and avoid imaging without red flags.
• ✕ Sensitivity is confused with PPV. Sensitivity does not change with prevalence, but PPV falls when prevalence is low, as in primary care.
• ✕ SnNout and SpPin are often reversed. A negative highly sensitive test rules disease out, and a positive highly specific test rules it in.
• ✕ Lead-time bias is confused with length-time bias. Lead time lengthens measured survival without delaying death; length time over-detects slow-growing tumours.
• ✕ Using the odds ratio for a cohort study is a common error. Cohort studies give relative risk; case-control studies give the odds ratio.
• ✕ Diagnosing CKD from one eGFR reading is wrong. Repeat within 3 months to confirm chronicity and exclude acute kidney injury.
• ✕ Stopping allopurinol during a gout flare is often chosen. It should continue, and the flare is treated separately.
• ✕ A child or relative is not a suitable interpreter. Use a professional interpreter whenever one is available, for accuracy and confidentiality.