Internal Medicine in Family Practice
The domain tests safe primary-care management of common adult medical problems: hypertension, diabetes, dyslipidaemia, thyroid disease, asthma and COPD, infections and cardiovascular risk. The exam favours decisions about investigation, initial treatment, monitoring and referral thresholds.
Core rules
- Confirm hypertension on repeated readings; assess total cardiovascular risk and target-organ damage.
- In diabetes, individualise HbA1c targets; metformin remains first-line unless contraindicated; check renal function, urine albumin and feet.
- ACE inhibitors or ARBs are preferred in hypertension with diabetes and albuminuria, but check creatinine and potassium.
- Statins are based on risk, not merely cholesterol level; secondary prevention is high intensity.
- Breathlessness needs systematic differentiation: cardiac, pulmonary, anaemia, anxiety and deconditioning.
Worked example
A 58-year-old man with type 2 diabetes has BP 158/96 mmHg on two visits, HbA1c 8.4%, eGFR 62 and urine albumin-creatinine ratio 45 mg/mmol. He is already on metformin. The reasoning: confirm adherence and diet; add an ACE inhibitor or ARB for BP and albuminuria; review creatinine and potassium in 1–2 weeks; intensify glucose therapy if targets unmet; add a statin; arrange retinal and foot checks. Avoid a thiazide first if albuminuria is the key issue, though combination therapy may later be needed.
Traps
Treating one high reading; using ACE inhibitors in bilateral renal artery stenosis or pregnancy; missing hypothyroidism behind fatigue; and attributing dyspnoea to anxiety without cardiopulmonary assessment.