Adult Medicine
Core concepts
Adult medicine questions test organized reasoning about common chronic disease, acute presentations, and drug safety. Know the diagnostic thresholds that anchor care: diabetes (A1c ≥6.5%, fasting glucose ≥126, or 2-hour OGTT ≥200), hypertension (≥130/80 by current US guidance, confirmed on repeat measurement), and hyperlipidemia risk stratification by 10-year ASCVD risk. Understand guideline-directed therapy for heart failure with reduced ejection fraction (the four pillars: ARNI/ACEi/ARB, beta-blocker, MRA, SGLT2 inhibitor), COPD vs asthma differentiation by spirometry and reversibility, and community-acquired pneumonia severity scoring to decide inpatient vs outpatient care.
Traps
- Choosing treatment before confirming the diagnosis when a single abnormal value is borderline; repeat testing is often the answer.
- Missing contraindications: ACE inhibitors in bilateral renal artery stenosis or pregnancy, metformin in severe renal impairment, NSAIDs in CKD or heart failure.
- Confusing DKA (ketosis, anion gap acidosis, normal-ish glucose possible in euglycemic DKA with SGLT2 inhibitors) with hyperosmolar hyperglycemic state (profound hyperglycemia, high osmolality, minimal ketosis).
- Forgetting that asymptomatic bacteriuria should not be treated except in pregnancy or before urologic procedures.
Worked example / rule of thumb
A 58-year-old with new fasting glucose of 130 mg/dL: do not label diabetes on one value-repeat or obtain A1c. If A1c returns 6.9%, diabetes is confirmed and management begins with lifestyle plus metformin unless contraindicated. Rule of thumb: treat the patient in front of you, but confirm the number behind the diagnosis.
High-yield associations
Alcohol use screening (AUDIT-C), statin therapy for anyone with clinical ASCVD, and vaccination status in every chronic-disease visit.