Internal Medicine (Therapy)
Internal medicine in the Kazakhstani attestation tests one skill above all: converting a set of complaints into a verified diagnosis using explicit criteria, then into a treatment plan consistent with the national clinical protocols. Recurring topics are arterial hypertension, acute coronary syndrome, type 2 diabetes, COPD and asthma, community-acquired pneumonia, chronic kidney disease, anaemia and peptic ulcer disease.
Criteria before conclusions
- Hypertension: office BP ≥140/90 mm Hg confirmed by repeat visits, home monitoring or 24-hour ABPM; grade 1 is 140–159/90–99, grade 2 is 160–179/100–109, grade 3 is ≥180/≥110.
- Type 2 diabetes: HbA1c ≥6.5%, fasting glucose ≥7.0 mmol/L or 2-hour OGTT ≥11.1 mmol/L, confirmed by a second test unless hyperglycaemia is unambiguous.
- Suspected ACS: 12-lead ECG within 10 minutes of first medical contact plus high-sensitivity troponin.
- Heart failure with reduced ejection fraction: all four pillars (ACE inhibitor or ARNI, beta-blocker, mineralocorticoid receptor antagonist, SGLT2 inhibitor) unless contraindicated.
Worked example
A 58-year-old man has BP 162/98 on three visits, BMI 31, smokes, HbA1c 7.8%, eGFR 62. Reasoning: grade 2 hypertension with high total cardiovascular risk (smoking plus diabetes) means drug treatment starts immediately alongside lifestyle change; the preferred first step is a two-drug single-pill combination of an ACE inhibitor or ARB with a dihydropyridine calcium antagonist or a thiazide-like diuretic; metformin is started because eGFR is 62; a statin is indicated; review at four weeks, target below 130/80 if tolerated.
Traps that cost marks
- Treating a white-coat elevation without ambulatory confirmation, or failing to look for secondary hypertension in a young or resistant case.
- Starting an ACE inhibitor in pregnancy, or without checking potassium and creatinine.
- Labeling dyspnoea as COPD without spirometry.
- Stopping a beta-blocker abruptly in ischaemic heart disease.