Internal Medicine for the Family Physician
Core concepts
The family physician is examined on common adult disease managed in the community, not on tertiary subspecialty detail. Prioritise: hypertension and its complications; type 2 diabetes including complications screening; ischaemic heart disease and heart failure; asthma and COPD overlap; thyroid disease; anaemia; chronic kidney disease staging by eGFR; and acid-base and electrolyte interpretation.
Question traps
- Thresholds. Know numerical cut-offs precisely - HbA1c ≥6.5% for diabetes diagnosis, eGFR <60 for CKD stage 3, and the fact that a single raised BP reading never diagnoses hypertension.
- First-line therapy. Distinguish first-line from add-on. In uncomplicated hypertension in most patients, a thiazide-like diuretic, ACE inhibitor/ARB, or calcium channel blocker is appropriate; beta-blockers are not first-line unless there is a compelling indication.
- Contraindications. ACE inhibitors in bilateral renal artery stenosis and pregnancy; metformin in significant renal impairment; beta-blockers in decompensated heart failure.
- Screening intervals. Diabetic retinopathy, foot, and renal screening are annual; lipid checks vary by risk.
- Compelling indications override the usual first-line choice - e.g. ACE inhibitor in diabetic nephropathy, beta-blocker post-myocardial infarction.
Worked rule of thumb
When a question asks "best next step," first ask whether the diagnosis is established. If not, the answer is usually the confirmatory test (e.g. ambulatory BP monitoring, repeat HbA1c, spirometry), not treatment. If established and uncontrolled, the answer is usually adherence review, lifestyle, then escalation.
Exam technique
Read the stem for the single abnormality. Stems often include normal values to distract; anchor on the one value outside range and connect it to the most likely mechanism.