Adult Medicine and Common Chronic Diseases
Adult medicine and common chronic diseases tests structured management of hypertension, type 2 diabetes, dyslipidaemia, asthma/COPD, chronic kidney disease and cardiovascular prevention in primary care. The focus is diagnosis, risk stratification, individualised targets, adherence and complication screening.
Core rules
- Confirm hypertension with repeated office readings or ambulatory/home monitoring; treat to a target usually below 140/90 mmHg, individualised in older or frail adults.
- Type 2 diabetes: HbA1c target commonly below 7% for most; add agents with proven cardiovascular or renal benefit when CVD, heart failure or CKD is present, independent of HbA1c.
- Check urine albumin-to-creatinine ratio and eGFR at least annually; review feet, eyes, lipids and blood pressure.
- Asthma: confirm variable airflow obstruction; review inhaler technique and adherence before stepping up. COPD: confirm post-bronchodilator obstruction and stop smoking.
Worked example
A 52-year-old man with type 2 diabetes has HbA1c 8.4% on metformin. Ask about adherence and diet, check BP, lipids, eGFR and urine ACR. He has albuminuria. Rather than simply increasing metformin, add an SGLT2 inhibitor with renal benefit and review in three months. Reasoning: the result is above target and CKD changes drug choice.
Traps
Chasing HbA1c without adherence review; missing silent CKD; applying tight targets to frail older adults; diagnosing asthma without spirometry; and forgetting statin and blood pressure optimisation.