Common Ambulatory Clinic Cases at JFK IM

1. Hypertension

• Initial diagnosis and workup

• Resistant hypertension

• Medication titration

• Home BP monitoring

• Hypertensive urgency follow-up

Questions attendings often ask:

• BP goal for diabetics?

• First-line agents in CKD?

• When do you suspect secondary hypertension?

2. Type 2 Diabetes Mellitus

• New diagnosis

• HbA1c management

• Insulin initiation

• GLP-1 agonists and SGLT2 inhibitors

• Diabetic nephropathy screening

Common pimp questions:

• When do you start insulin?

• Which medications have cardiovascular benefit?

• Annual screening recommendations?

3. Hyperlipidemia

• ASCVD risk calculation

• Statin intensity selection

• Primary vs secondary prevention

Questions:

• When is high-intensity statin indicated?

• LDL goal after MI?

• Statin use in diabetics?

4. Hospital Follow-Up Visits

Very common in continuity clinic.

Examples:

• CHF admission follow-up

• COPD exacerbation

• Pneumonia discharge

• AKI recovery

Questions:

• What medications need reconciliation?

• What labs should be repeated?

• What red flags require readmission?

5. COPD & Asthma

• Inhaler escalation

• Smoking cessation

• Exacerbation prevention

Questions:

• GOLD classification?

• Triple therapy indications?

• Pneumococcal vaccine recommendations?

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1. Airflow Limitation (Grades 1–4)
GOLD 1 (Mild): FEV₁ ≥ 80% predicted
GOLD 2 (Moderate): 50% ≤ FEV₁ < 80% predicted
GOLD 3 (Severe): 30% ≤ FEV₁ < 50% predicted
GOLD 4 (Very Severe): FEV₁ < 30% predicted
2. Clinical Assessment (Groups A, B, E)
Group A: Low symptom burden, no history of hospitalizations, and ≤ 1 moderate exacerbation per year.
Group B: High symptom burden, no history of hospitalizations, and ≤ 1 moderate exacerbation per year.
Group E: High risk of exacerbations (defined as ≥ 2 moderate exacerbations or ≥ 1 hospital admission within a year), regardless of symptom severity.
3. Measuring Symptoms
= mMRC: The modified Medical Research Council scale evaluates breathlessness on a scale of 0 to 4.
= CAT: The COPD Assessment Test provides a more comprehensive score of daily impact (0 to 40). Scores <10 indicate lower symptom impact, while scores ≥ 10 signify higher impact.

6. Heart Failure

• GDMT optimization

• Volume assessment

• Follow-up after hospitalization

Questions:

• Four pillars of HFrEF therapy?

• When is spironolactone indicated?

• SGLT2 inhibitors in heart failure?

7. Thyroid Disease

• Hypothyroidism

• Subclinical hypothyroidism

• Hyperthyroidism workup

Questions:

• TSH monitoring interval?

• Causes of low TSH?

• When to treat subclinical disease?

8. Chronic Kidney Disease

• CKD staging

• Proteinuria evaluation

• BP and diabetes management

Questions:

• ACE inhibitor indications?

• Nephrology referral criteria?

• CKD-MBD screening?

9. Preventive Medicine

A major focus of outpatient training.

Know:

• Colon cancer screening

• Breast cancer screening

• Lung cancer screening

• Osteoporosis screening

• USPSTF recommendations

10. Vaccinations

Frequently tested in ambulatory settings. Community discussions among ambulatory-care trainees consistently identify vaccine schedules as high-yield.

Know:

• Pneumococcal vaccines

• Shingrix

• Influenza

• COVID boosters

• Hepatitis B

11. Obesity & Weight Loss

Especially important now because of GLP-1 medications.

Questions:

• Indications for semaglutide/tirzepatide

• BMI criteria for pharmacotherapy

• Bariatric surgery criteria

12. Mental Health

• Depression screening (PHQ-9)

• Anxiety

• Insomnia

Questions:

• First-line SSRIs?

• Suicide risk assessment?

• When to refer psychiatry?

High-Yield Preventive Screening Numbers to Memorize

TopicKey Number

1. Colon cancer45–75 years

2. Lung cancerAge 50–80, ≥20 pack-years

3. AAA screeningMen 65–75 who ever smoked

4. OsteoporosisWomen ≥65

5. Diabetes screeningAdults 35–70 with overweight/obesity

6. BP screeningEvery adult

If I were starting JFK IM next week...

I would review:

1. HTN (ACC/AHA)

2. Diabetes (ADA 2026)

3. Hyperlipidemia (ASCVD)

4. Heart Failure (4 pillars)

5. COPD GOLD guidelines

6. Vaccination schedules

7. USPSTF screening recommendations

8. CKD staging and management