Internal Medicine
Internal Medicine in this licensing examination tests common adult presentations, chronic disease control, acute medical emergencies, and evidence-based prescribing. The exam favours systematic assessment and safe disposition over rare diagnoses.
Core rules
- Start with ABCDE and vital signs; instability changes the order of investigation.
- For chest pain, obtain ECG within 10 minutes and troponin; consider aortic dissection, pulmonary embolism, and pneumothorax before discharge.
- For dyspnoea, classify by onset, oxygen saturation, chest radiograph, and natriuretic peptide when heart failure is suspected.
- Diabetes care uses HbA1c for diagnosis and monitoring, but symptoms plus random glucose or fasting glucose can confirm.
- Acute kidney injury requires volume status, urinalysis, electrolytes, and review of nephrotoxic drugs.
Worked example
A 58-year-old man has 40 minutes of central chest pressure, diaphoresis, and ST depression in leads V4–V6. The first actions are monitoring, aspirin, nitroglycerin if blood pressure permits, and urgent cardiology referral. ST depression is not benign: it suggests ischaemia and requires serial troponins and risk stratification.
Traps
Do not attribute dyspnoea only to anxiety; do not give extensive fluids in suspected heart failure; do not treat hyperglycaemia without checking potassium and renal function.