Pharmacotherapy of major disease states and internal medicine (ID, cardiology, oncology, ICU, paediatrics, geriatrics)
This domain tests applied therapeutics across the hospital's case mix. The exam rarely asks for a definition; it gives a patient with a comorbidity and a laboratory value and asks what you change and why.
Infectious diseases
Sepsis: recognise, take cultures without delaying antibiotics, give broad-spectrum cover within one hour in septic shock, measure lactate clearance, then de-escalate at 48–72 h on culture results. Know empirical regimens for febrile neutropenia (antipseudomonal beta-lactam ± aminoglycoside/vancomycin by risk), the MASCC score for low-risk patients, and the difference between colonisation and infection when a urine culture grows something.
Cardiology
ACS: aspirin plus a P2Y12 inhibitor, parenteral anticoagulation, timing of invasive strategy. HFrEF: the four pillars (ARNI/ACE inhibitor, beta-blocker, MRA, SGLT2 inhibitor) started early and titrated, with potassium and renal function as the real-world limiters. Atrial fibrillation: CHA₂DS₂-VASc for the decision, DOAC preferred, dose by age/weight/renal function, interaction check on P-gp and CYP3A4.
Oncology and ICU
Antiemetic prophylaxis by emetic risk (5-HT₃ antagonist + dexamethasone ± NK₁ antagonist). Tumour lysis syndrome, extravasation and oral chemotherapy adherence. ICU: analgesia-sedation-delirium bundle, ARDS management, stress ulcer and VTE prophylaxis, and drug dosing under continuous renal replacement therapy.
Paediatrics and geriatrics
Children: mg/kg or mg/m² with maximum-dose ceilings, weight-based resuscitation, avoid codeine and tramadol, watch excipients (propylene glycol, benzyl alcohol, ethanol). Older adults: STOPP/START criteria, anticholinergic burden, deprescribing, fall risk, hyponatraemia work-up.
Worked example
A 74-year-old woman with HFrEF (EF 30%), eGFR 26 mL/min/1.73 m², potassium 5.3 mmol/L, on no heart-failure therapy. Reasoning: start an SGLT2 inhibitor (benefit preserved at low eGFR) and a beta-blocker at low dose; defer the MRA and the ARNI until potassium falls below 5.0 mmol/L; review NSAIDs and potassium supplements; recheck potassium and creatinine in 1–2 weeks. Answering "start all four pillars today" ignores the hyperkalaemia.
Traps
- Quoting guideline therapy while missing the patient-specific contraindication in the stem.
- Forgetting renal dose adjustment for antibiotics and DOACs.
- Overlooking interactions in the oncology patient (azoles, anticonvulsants, dexamethasone).
- Treating a positive culture without clinical signs of infection.