Internal Medicine
Internal Medicine
Internal Medicine tests diagnostic reasoning and safe management of adult disease, with emphasis on conditions common in West Africa: hypertension, diabetes, tuberculosis, HIV, sickle cell disease, and peptic ulcer disease.
Core rules and concepts
- Hypertension: clinic BP ≥140/90 mmHg on repeated readings; confirm with ambulatory or home monitoring before labelling.
- Diabetes: fasting glucose ≥7.0 mmol/L, 2-hour OGTT ≥11.1 mmol/L, or random ≥11.1 mmol/L with symptoms; HbA1c ≥6.5% where validated.
- TB: sputum GeneXpert MTB/RIF is first-line; smear microscopy is less sensitive in HIV.
- HIV: follow the national serial algorithm; confirm before starting ART.
- Pretest probability drives test interpretation; a positive test in a low-prevalence group has a lower positive predictive value.
Worked example
A 55-year-old man presents with polyuria, polydipsia, and 5 kg weight loss. Random glucose is 14 mmol/L and urine ketones are negative. This meets diagnostic criteria for diabetes. Check renal function, lipids, BP, and urine albumin; start metformin and lifestyle advice; screen for TB if cough or weight loss persists. Do not repeat the glucose to "confirm" when classic symptoms and a random glucose ≥11.1 mmol/L are present.
Traps
- Diagnosing hypertension from one reading.
- Treating asymptomatic bacteriuria except in pregnancy or before urological procedures.
- Missing TB in HIV because of a negative smear.
- Ignoring drug interactions, such as rifampicin with oral contraceptives.