General Medicine: Safe Triage to Guideline Treatment
General Medicine in the Myanmar MMLE tests whether you can move from a common presenting symptom to a safe, guideline-based plan. Expect prioritized differentials for fever, breathlessness, chest pain, altered consciousness, and jaundice, plus chronic care for hypertension, diabetes, tuberculosis, HIV, and malaria. The examiner rewards systematic stabilization, documented reasoning, and correct first-line therapy using national programme standards.
Core rules
- Start with ABC and bedside glucose in any acutely unwell or confused patient; hypoglycaemia and hypoxia mimic many medical diagnoses.
- For fever in Myanmar, stratify by exposure and warning signs: malaria rapid diagnostic test in endemic areas, dengue warning signs (abdominal pain, persistent vomiting, bleeding, lethargy), and TB screening for cough lasting more than two weeks.
- Use directly observed therapy (DOTS) for drug-susceptible TB; do not start empiric second-line drugs without referral.
- In STEMI, give aspirin 300 mg chewed and arrange reperfusion; do not delay for a non-diagnostic troponin.
Worked example
A 58-year-old smoker has 40 minutes of central crushing chest pain, sweating, BP 110/70, and ST elevation in II, III, and aVF. Reasoning: inferior STEMI. Give aspirin, oxygen only if hypoxic, analgesia, and arrange primary PCI or thrombolysis per local protocol. Check for right ventricular infarction before nitrates, because hypotension can worsen.
Traps
Missing ACS in women, older adults, and people with diabetes; using NSAIDs in suspected dengue; stopping anti-TB drugs for minor transaminase rises without applying severity criteria; and failing to adjust malaria treatment for severe disease.