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Egyptian Board Family Medicine study materials
Egyptian Board Family Medicine study resources

Egyptian Board Family Medicine: Internal Medicine in Family Practice

Egyptian Board Family Medicine · Work through your exam, one topic at a time.

All guide sections

Internal Medicine in Family Practice

Internal medicine is the largest clinical slice of family practice: hypertension, diabetes, dyslipidaemia, anaemia, thyroid disease, chronic kidney disease and common infections. The Board tests control targets, safe prescribing in pregnancy and comorbidity, complication screening and recognition of the red flags that demand referral.

Core rules

  • Hypertension: diagnose with office BP of 140/90 mmHg or more on at least two occasions, ideally confirmed by home readings (135/85 or more) or ambulatory monitoring. Treat to below 140/90, and below 130/80 in diabetes or CKD if tolerated. First-line classes are thiazide-like diuretics, ACE inhibitors or ARBs, and calcium channel blockers. Never combine an ACE inhibitor with an ARB.
  • Type 2 diabetes: diagnose with HbA1c 6.5% or more, fasting plasma glucose 7.0 mmol/L (126 mg/dL) or more, or 2-hour OGTT 11.1 mmol/L or more. Individualise the target (about 7%; lower in the young, 8% in frail elderly). Metformin is first line unless eGFR is below 30. Add an SGLT2 inhibitor or GLP-1 receptor agonist when there is atherosclerotic disease, heart failure or CKD. Annual retinal screening, foot examination, urine albumin-creatinine ratio and lipids are mandatory.
  • CKD: stage by eGFR and albuminuria; stop NSAIDs, dose-adjust drugs, refer when eGFR falls below 30 or decline is rapid.
  • Antibiotic stewardship: viral upper respiratory infection needs no antibiotic; for sore throat, use Centor or McIsaac scoring and consider penicillin when three or more criteria are present.

Worked example

A 52-year-old man with BMI 31 has HbA1c 8.4% on metformin 1 g twice daily, BP 148/92 mmHg, urine ACR 45 mg/g and eGFR 68. Reasoning: he has albuminuric CKD, so add an ACE inhibitor or ARB titrated upwards plus an SGLT2 inhibitor for renal and cardiovascular protection, start a statin, target BP below 130/80, and recheck potassium and ACR in two to four weeks. Simply raising metformin is wrong: it is already at optimal dose and the glycaemic gap needs a second agent.

Traps that cost marks

  • Diagnosing hypertension on one reading.
  • Prescribing ACE inhibitors or statins to a woman who may become pregnant.
  • Chasing HbA1c while ignoring albuminuria and fundus.
  • Treating asymptomatic bacteriuria in non-pregnant adults.