Internal Medicine – MCCQE1 High-Yield Notes

Internal Medicine is the largest and most heavily tested specialty in the MCCQE1 exam. Mastering these high-yield topics is essential for IMGs preparing for Canadian medical licensure.

🔑 Key Topics for MCCQE1

Chest pain approach: ACS, STEMI vs NSTEMI, unstable angina management
Heart failure: HFrEF vs HFpEF, NYHA classification, treatment (ACEi/ARB, beta-blocker, diuretics)
Hypertension: diagnosis, lifestyle modifications, first-line medications by comorbidity
Atrial fibrillation: rate vs rhythm control, anticoagulation (CHA₂DS₂-VASc score)
Diabetes mellitus Type 2: diagnosis criteria, HbA1c targets, metformin first-line
Thyroid disorders: hypothyroidism, hyperthyroidism, thyroid storm management
Pneumonia: CAP vs HAP, CURB-65 score, empiric antibiotics
COPD: GOLD classification, bronchodilators, acute exacerbation management
Asthma: severity classification, stepwise management, acute severe asthma
Acute kidney injury: prerenal vs intrinsic vs postrenal, RIFLE criteria
Chronic kidney disease: staging (GFR), complications, indications for dialysis
Anemia approach: microcytic (iron deficiency, thalassemia), normocytic, macrocytic (B12, folate)
DVT/PE: Wells score, anticoagulation, massive PE management
Stroke: ischemic vs hemorrhagic, tPA criteria, secondary prevention
Sepsis: SIRS criteria, sepsis-3 definition, septic shock management bundle

⚠️ High-Yield Clinical Pearls

STEMI: Door-to-balloon time <90 min, aspirin + P2Y12 inhibitor immediately
Heart Failure exacerbation: IV furosemide first, check BNP, avoid NSAIDs
DKA: Anion gap acidosis, glucose >11, ketones – give IV fluids first, then insulin
Hypothyroidism: Levothyroxine on empty stomach, check TSH after 6 weeks
PE massive: Hypotension + tachycardia + hypoxia → thrombolytics if no CI
AKI prerenal: BUN:Cr ratio >20, FeNa <1%, responds to IV fluids

📊 Quick Reference Table

Condition	First-line Treatment	Key Drug/Action
Hypertension + DM	ACE inhibitor or ARB	Renal protection
Heart Failure rEF	ACEi + BB + diuretic	Reduce mortality
Type 2 DM	Metformin	First-line always
CAP mild	Amoxicillin	Outpatient
CAP moderate	Azithromycin + beta-lactam	Inpatient
DVT/PE	LMWH then DOAC	Anticoagulation

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