Master Family Medicine
for SMLE

What the SMLE Tests in Family Medicine

Family Medicine on the SMLE tests the ability to manage undifferentiated presentations across all ages in a community setting, with emphasis on chronic disease monitoring, acute infection management, preventive care, and appropriate referral. Candidates must demonstrate knowledge of evidence-based screening intervals (e.g., cervical smear every 3–5 years, abdominal aortic aneurysm ultrasound once at age 65 for men), first-line pharmacotherapy for common conditions (e.g., metformin for type 2 diabetes, ACE inhibitors for hypertension with CKD), and recognition of red flags requiring urgent specialist input (e.g., unilateral headache with jaw claudication for giant cell arteritis). The exam also assesses understanding of UK-style QOF targets (e.g., HbA1c ≤ 58 mmol/mol in diabetes, BP ≤ 140/90 in CKD) and appropriate use of scoring systems (e.g., CURB-65 for pneumonia, ABCD2 for TIA risk).

High-Yield Concepts

• Hypertension management in primary care: First-line for age <55: ACE inhibitor (ramipril 2.5 mg) or ARB. For age ≥55 or black patients: calcium channel blocker (amlodipine 5 mg). Target clinic BP <140/90 (or <130/80 if CKD, diabetes, or CVD). Offer ambulatory BP monitoring to confirm diagnosis if clinic BP ≥140/90.
• Type 2 diabetes monitoring and targets: HbA1c target ≤ 53 mmol/mol (7%) for most; ≤ 58 mmol/mol (7.5%) if on sulfonylurea/insulin or frail. First-line metformin (start 500 mg once daily, titrate to 2 g). Annual foot check (monofilament + pulses), retinal screening, and urine ACR for nephropathy.
• Acute sore throat: Centor criteria and antibiotics: Centor criteria: fever >38°C, tonsillar exudate, tender cervical nodes, absence of cough. Score ≥3: consider rapid strep test or treat with phenoxymethylpenicillin 500 mg QDS for 10 days. Avoid amoxicillin if glandular fever suspected (rash risk).
• COPD exacerbation management: Increase bronchodilator (salbutamol via spacer) and start prednisolone 30 mg once daily for 5 days. Add doxycycline 200 mg stat then 100 mg daily for 5 days if purulent sputum and clinical signs of infection. Refer if pH <7.35 or PaO2 <8 kPa on ABG.
• Childhood immunisation schedule (UK): 8 weeks: 6-in-1 (DTaP/IPV/Hib/HepB), rotavirus, MenB. 12 weeks: 6-in-1 second dose, pneumococcal (PCV13). 16 weeks: 6-in-1 third dose, MenB second, rotavirus second. 1 year: Hib/MenC, MMR, PCV13 booster, MenB booster. 3 years 4 months: MMR second, DTaP/IPV preschool.
• Depression screening and first-line treatment: Use PHQ-9 for severity (score ≥10 suggests major depression). First-line: SSRI (sertraline 50 mg daily or fluoxetine 20 mg daily). Warn of initial anxiety and 2-week lag. Review at 2 weeks (suicide risk) and 4 weeks. Refer to IAPT if mild to moderate; refer to CMHT if severe with psychosis or high suicide risk.
• Abdominal aortic aneurysm screening: One-time ultrasound for men aged 65. If AAA 3.0–4.4 cm: annual surveillance. If 4.5–5.4 cm: 3-monthly. Refer to vascular surgery if ≥5.5 cm (or rapid expansion >1 cm/year). Women not routinely screened, but consider if risk factors (smoking, FH).
• Antenatal screening and common issues: Offer combined screening (NT + bloods) at 11–14 weeks for Down’s, Edwards’, Patau’s. Oral glucose tolerance test at 24–28 weeks if BMI >30 or previous GDM. Treat GDM with metformin or insulin if needed. For nausea: first-line cyclizine 50 mg TDS or prochlorperazine 5 mg TDS.

Common Traps in Family Medicine Questions

• Confusing NICE hypertension targets (clinic <140/90) with ABPM targets (daytime average <135/85).
• Using amoxicillin for sore throat without checking glandular fever risk in young adults (causes rash).
• Starting antidepressant at too high a dose (e.g., sertraline 100 mg) without a 2-week titration, increasing side effects and dropout.
• Forgetting to check urine ACR annually in all diabetics, not just those with hypertension.
• Recommending aspirin for primary prevention in type 2 diabetes without assessing bleeding risk (no longer routine per NICE).
• Interpreting PHQ-9 score alone without considering functional impairment and risk of self-harm.

How to Revise Family Medicine for the SMLE

For Family Medicine on the SMLE, prioritise memorising specific numerical targets (BP, HbA1c, cholesterol, eGFR thresholds) and first-line drug choices by age/ethnicity. Questions often present a clinical vignette with a single abnormal value (e.g., BP 148/92 in a 60-year-old) and ask for the next appropriate step—not just diagnosis but whether to repeat, monitor, or start treatment. Practise applying screening intervals (e.g., when to start mammography at age 50, stop at 71) and recognising red flags in common presentations (e.g., headache with vomiting and papilloedema for raised ICP). Focus on UK guidelines (NICE, SIGN) and avoid US-centric cut-offs. Review the QOF registers and annual review checklists for diabetes, COPD, and CKD, as these are frequently used as question frameworks.

Practise it: MedLumen has 50 Family Medicine questions for the SMLE, each with a full explanation and references.