Medicine
The Medicine domain of the MDC PQE tests applied clinical judgement in adult internal medicine: recognizing emergencies, choosing initial investigations, prescribing safely, and defending the next action in a vignette. The emphasis is on patient safety and reasoning, not on rare diagnoses.
Core rules
- Begin with ABCDE and stability; treat before completing a full history if the patient is unwell.
- Build a short problem representation: age, time course, key positives, key negatives, risk factors.
- Order investigations only when the result will change management.
- Prescribe by indication, dose, route, renal/hepatic function, allergy history, and interactions.
- Reassess after every intervention and document the reasoning.
Worked example
A 58-year-old man has 40 minutes of crushing central chest pain, sweating, and nausea. ECG shows 2 mm ST elevation in leads II, III, and aVF. What is the immediate priority? The reasoning is inferior STEMI with possible right ventricular involvement. Give aspirin 300 mg chewed, a P2Y12 inhibitor, anticoagulation per local protocol, analgesia, and arrange urgent reperfusion. Give oxygen only if hypoxic. Avoid nitrates if he is hypotensive or has right ventricular infarction. The answer is not “admit for troponin”; it is reperfusion plus antithrombotic therapy.
Traps
- Treating a single abnormal number without assessing the patient.
- Missing atypical ACS in women, older adults, or people with diabetes.
- Forgetting renal dose adjustment and drug interactions.
- Prescribing antibiotics for a likely viral illness.
- Failing to document allergy status, consent, and review findings.