Internal Medicine
Internal Medicine tests safe, structured assessment of common adult presentations: chest pain, breathlessness, fever, syncope, altered consciousness, and decompensated chronic disease. The exam favours acute coronary syndrome, heart failure, diabetes emergencies, acute kidney injury, sepsis, and anticoagulation complications.
Core rules
- Start with ABCDE and focused history; reproduce the time course and risk factors.
- For chest pain, obtain a 12-lead ECG within 10 minutes and interpret ST elevation in contiguous leads.
- In diabetes, check capillary glucose and ketones; DKA needs fluids first, then insulin and potassium replacement.
- In AKI, compare creatinine with baseline, review medications, and assess volume status and urine output.
- Sepsis: recognise organ dysfunction, take cultures, give broad-spectrum antibiotics early, and measure lactate.
Worked example
A 58-year-old man has 40 minutes of central crushing chest pain, sweating, and nausea. ECG shows 3 mm ST elevation in V2-V4. The reasoning is: symptoms plus contiguous ST elevation equal STEMI; do not wait for troponin. Give aspirin, arrange urgent reperfusion, and monitor for arrhythmia.
Traps that cost marks
- Missing atypical ACS in diabetes, older adults, and women.
- Giving insulin before fluid resuscitation in DKA.
- Treating creatinine alone without assessing baseline and volume.
- Forgetting potassium in DKA and digoxin toxicity.
- Using oxygen routinely in non-hypoxaemic patients.