Internal Medicine / Therapeutics: General Adult Care
General therapeutic reasoning starts with a structured clinical assessment: complaint, history, risk factors, physical examination, then a targeted work-up. Candidates should master the syndromic approach to fever, weight loss, fatigue, edema, and dyspnea, and know when a finding is a red flag requiring urgent referral. Understand the principles of evidence-based prescribing: start low, titrate, review interactions, and reassess. Know the difference between curative, symptomatic, and palliative goals of care, and how comorbidity (renal or hepatic impairment, frailty, polypharmacy) changes drug choice and dose.
Traps in questions: confusing a symptom with a diagnosis; forgetting to exclude dangerous mimics before treating benign causes; ignoring drug-induced causes of new symptoms (cough from ACE inhibitors, edema from calcium-channel blockers, hyperglycemia from steroids). Another common trap is choosing a test that confirms rather than one that excludes a life-threatening condition first.
Rule of thumb: before any new drug, check renal and hepatic function and the existing medication list; before any new symptom, ask "could this be a drug effect?" For example, a patient on an ACE inhibitor with a new dry cough and no other findings: the highest-yield step is stopping the drug and reassessing, not ordering a chest CT.
Key concepts: differential diagnosis hierarchy, red flags, comorbidity-adjusted prescribing, deprescribing, and goals-of-care communication.