Internal Medicine and Allied Specialties
What you must understand
Internal medicine questions are built on pattern recognition plus a decision step. Learn the diagnostic criteria you can apply mechanically: the CURB-65 and qSOFA scores, the criteria for diabetic ketoacidosis and hyperosmolar state, the Child–Pugh and MELD scores, the Duke criteria for endocarditis, the Wells score for pulmonary embolism, and the classification of acute kidney injury. Understand the first-line management for common emergencies - acute coronary syndrome, stroke within the thrombolysis window, status epilepticus, severe asthma, upper gastrointestinal bleeding, and hyperkalaemia with ECG changes.
Traps that appear
Vignettes deliberately include a normal or misleading investigation early in the illness. Do not anchor on a single value; weigh the whole picture. Distinguish transudative from exudative effusions with Light's criteria, nephrotic from nephritic presentations, and restrictive from obstructive spirometry. Watch for drug-induced disease: a patient on a new medication with rash, eosinophilia and renal impairment suggests interstitial nephritis. In cardiology, remember that a normal ECG does not exclude acute coronary syndrome, and that left bundle branch block changes the interpretation of chest pain.
Worked rule of thumb
For any acute presentation, ask three questions in order: Is the patient unstable? (resuscitate first), What is the most likely single diagnosis? (choose the one that explains the most findings), and What is the next best step? Questions usually ask the next step, not the definitive diagnosis. A useful heuristic: if the vignette has already given the diagnosis, the answer is management; if not, the answer is the most specific test.
Study strategy
Group conditions by syndrome (chest pain, breathlessness, jaundice, joint pain, fever of unknown origin) and rehearse the discriminating features within each group.