Internal Medicine
Core concepts
Internal medicine questions on the Albanian state exam reward a structured approach: recognize the syndrome, localize the organ system, then apply first-line management. Master the diagnostic criteria for diabetes, hypertension grading, acute coronary syndrome pathways, heart failure classification (NYHA and echocardiographic ejection fraction), COPD vs asthma differentiation (reversibility, smoking history, eosinophils), and the classic presentations of thyroid disease, anemia (microcytic/normocytic/macrocytic with iron studies), and chronic kidney disease staging by eGFR.
Common traps
Questions often test next best step rather than diagnosis - e.g., suspected ST-elevation MI requires immediate reperfusion, not a troponin wait. Watch for distractors that confuse diabetic ketoacidosis (ketones, anion gap, low bicarbonate) with hyperosmolar hyperglycemic state (higher osmolality, less ketosis). Anemia questions bait with ferritin: ferritin is an acute-phase reactant and may be falsely normal in inflammation, so combine with transferrin saturation. Heart failure questions may test when to add an aldosterone antagonist versus a loop diuretic.
Worked example
A 58-year-old smoker with polyuria and weight loss has glucose 320 mg/dL, pH 7.28, bicarbonate 12, positive ketones. Rule of thumb: DKA = hyperglycemia + ketosis + metabolic acidosis with anion gap; treatment begins with isotonic saline, then insulin infusion, and potassium replacement once K is below the upper reference - never start insulin before checking potassium.
Rule of thumb
Treat the patient's physiology (ABC, glucose, potassium, acid-base) before chasing a single lab value.