Internal Medicine in Family Practice
What candidates must know
Family-physician internal medicine rewards breadth with triage logic: recognise the common presentation, decide whether it is safe to manage in the community, and know the red flags that demand referral or admission. Core concepts include hypertension staging and treatment thresholds, type 2 diabetes targets (individualised HbA1c, annual retinal, renal and foot checks, statin and ACE-inhibitor/ARB where indicated), asthma versus COPD differentiation by reversibility and smoking history, heart failure with reduced versus preserved ejection fraction, and the primary-care approach to thyroid disease, anaemia (microcytic vs macrocytic workup) and chronic kidney disease staging by eGFR and albuminuria.
Traps in questions
- Thresholds and targets, not absolutes: a fit 55-year-old and a frail 85-year-old have different BP and glycaemic targets. Questions often test individualisation.
- Drug-of-choice sequencing: e.g. ACE-inhibitor first-line in diabetic nephropathy; avoid NSAIDs in CKD; metformin held before contrast.
- Symptom clusters that mimic benign disease: weight loss, night sweats, haemoptysis, unexplained anaemia - always consider malignancy and screen.
- Polypharmacy: the correct answer is frequently "review and deprescribe" rather than "add another agent".
Rule of thumb
For any chronic-disease vignette, ask: Is this stable, or is there a red flag? Stable → optimise, educate, screen for complications. Red flag (chest pain, stroke symptoms, severe hyperglycaemia, decompensated heart failure) → escalate.
Worked example
A 62-year-old with type 2 diabetes, eGFR 55, ACR 45 mg/mmol, BP 150/92. The best next step is to start an ACE-inhibitor/ARB (renoprotective with albuminuria) and intensify BP control, while continuing metformin with dose review - not merely to add a second oral hypoglycaemic.