Internal Medicine
Pass the boards. Become a better physician.
A high-yield rapid-review guide built for clinical thinking — pattern, next step, trap.
Built for Internal Medicine residency. The chapters are ward-medicine fundamentals, so they keep earning their place on your phone long after the exam.
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The IM Rapid Review Guide
- High-yield chapters built for clinical thinking, not recall.
- Same structure as the GI bleed chapter above — useful on every ward rotation, not just for the exam.
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Why this exists
A high-yield guide focused on the things that actually move the needle:
- understanding medicine
- pathophysiology → symptoms → treatment
- pattern recognition
- next-step thinking
- high-yield internal medicine
How the boards actually work
The boards are a clinical reasoning exam wearing the costume of a knowledge exam — it tests judgment, not trivia.
What gets rewarded
- Recognizing the pattern. Sausage finger → psoriatic arthritis. Currant jelly sputum → Klebsiella. Bird-beak swallow → achalasia.
- Knowing the first step. “Next step” outnumbers “what is the diagnosis.” The exam wants the specific drug — IM epinephrine, calcium gluconate, NAC.
- Separating look-alikes. UC vs Crohn’s. Cushing vs Conn’s. The four dementias. TTP / HUS / ITP / DIC.
What loses marks
- Overthinking. The straightforward answer is usually correct.
- Picking the most aggressive option. Sometimes the right answer is observe.
- Memorizing diagnoses without management. The exam asks what’s next, not what to call it.
How to study medicine intelligently
Six principles. None of them clever — just what actually works.
The exam tests the textbook picture far more often than the curveball.
Own SOB, chest pain, abdominal pain, headache, weakness — you’ve covered most of the paper.
After every case: what would I do at 3am? That’s the question the exam is really asking.
DKA · hyperkalemia · anaphylaxis · GI bleed · stroke · status epilepticus. Templates that answer half the exam.
Every admission is a vignette someone already wrote. Treat it that way.
Cramming gives confidence and loses the traps. Understanding does the opposite.
The 6-week plan
Six weeks, six themes, designed to build on each other. 1–2 hours per day of focused study. Adjust the pace, not the structure.
Cardiology
Focus: ACS, heart failure, arrhythmias, valvular disease, hypertensive emergencies.
Respiratory & Infectious Disease
Focus: pneumonia (CAP, HAP, atypical), COPD, asthma, PE, TB, sepsis, infective endocarditis.
Master: matching the organism to the vignette and picking the right antibiotic.
GI & Hepatology
Focus: IBD, GI bleed, cirrhosis and its complications, pancreatitis, hep B serology, H. pylori.
Master: UC vs Crohn’s, variceal vs non-variceal bleed, hep B serology in 60 seconds.
Endocrine & Renal
Focus: DKA, thyroid disorders, electrolyte emergencies, AKI, nephritic vs nephrotic, secondary hypertension.
Master: treating hyperkalemia and DKA in the right order; nephritic vs nephrotic at a glance.
Neurology & Rheumatology
Focus: stroke and TIA, the four dementias, MS, MG, GBS, seizures, RA, SLE, spondyloarthritides, vasculitis.
Master: stroke timing, dementia differentiation, autoimmune pattern recognition.
Integration
Focus: heme, oncology screening, ethics and end-of-life, mock exam.
Trap to avoid: learning new content. Week 6 is for consolidation, not expansion.
Themes that keep coming back
The patterns that repeatedly show up. Internalize these and you’ve already done more than most.
1 · “Next step” beats “diagnosis”
Half the exam asks what to do, not what to call it. Every vignette is a clinical decision.
2 · Drug–disease pairs
- Statins → myopathy
- ACE inhibitors → dry cough
- Levofloxacin → tendon rupture
- Lithium + ACE-i → toxicity
- Antipsychotics → neuroleptic malignant syndrome
3 · The differentiation pairs
- UC vs Crohn’s
- Cushing vs Conn’s
- The four dementias
- TTP vs HUS vs ITP vs DIC
- MI vs pericarditis vs aortic dissection
Build a one-line discriminator for each.
4 · Classic vignettes worth knowing cold
- Currant jelly sputum
- Sausage fingers
- Bird-beak esophagus
- Crescent sign on CT
- Schistocytes on smear
- Honeycombing on HRCT
- RBC casts in urine
5 · The acute-medicine algorithms
DKA · hyperkalemia · anaphylaxis · GI bleed · stroke · status epilepticus · hypertensive emergency. Know the sequence cold.
6 · First-line treatments with named drugs
- IM epinephrine → anaphylaxis
- Calcium gluconate first → hyperkalemia
- N-acetylcysteine (NAC) → paracetamol overdose
- Pirfenidone → IPF
- Levodopa → Parkinson’s
7 · When the answer is “do less”
- Observe ITP without bleeding
- Hold warfarin if INR is 4 without bleeding
- NSAIDs and exercise for mechanical low back pain
8 · The small but reliable scorers
Hep B serology · transfusion reactions · acid–base interpretation. Not exciting. Still tested. Don’t skip.
Sample chapter: Upper GI bleed
One chapter from the guide. The same structure as every other chapter inside.
The pattern
A patient presents with hematemesis, coffee-ground vomiting, or melena. Two stories matter:
The first is the cirrhotic. Alcoholic background, jaundice, ascites. Brisk hematemesis. Variceal bleed until proven otherwise.
The second is the older patient on NSAIDs or antiplatelets. Coffee-ground vomiting or melena. Often more hemodynamically stable. Peptic ulcer until proven otherwise.
Knowing which story you’re in changes the management before the scope ever arrives.
How to think
The instinct in any GI bleed is to reach for the scope. That’s wrong. The first decisions are resuscitation and risk stratification, in that order.
Resuscitate first because GI bleeds kill through hypovolemia, not through delayed diagnosis. Two large-bore IV lines, fluids, type and crossmatch, hemoglobin.
Transfuse to a target of 7 g/dL in most patients; higher targets increase mortality in non-massive bleeds. In acute STEMI specifically, maintain Hb above 10 g/dL to avoid worsening myocardial demand. Otherwise the restrictive 7 g/dL target applies even with stable cardiac disease.
Then split the case in your head. If there’s any reason to suspect varices (known cirrhosis, alcohol use, stigmata of chronic liver disease), assume variceal until endoscopy says otherwise. If the story is NSAIDs, antiplatelets, or H. pylori-shaped, assume peptic ulcer.
This split matters because the empirical drugs are different, and you start them before endoscopy.
What to do next
For every upper GI bleed:
- Resuscitate. IV access, fluids, blood if needed (target Hb 7 g/dL; >10 g/dL only in acute STEMI).
- IV PPI. Pantoprazole 80 mg bolus, then 8 mg/hr infusion (or 40 mg IV twice daily if no infusion available).
- Hold antiplatelets and anticoagulants. Reverse if actively bleeding.
- Endoscopy within 24 hours. Urgently if unstable.
If variceal is suspected, add:
- IV octreotide (or terlipressin where available). 50 mcg bolus, then 50 mcg/hr.
- IV ceftriaxone 1 g daily for 7 days. This is the intervention that changes mortality.
- Endoscopic band ligation at scope. Sclerotherapy is second-line.
If peptic ulcer is confirmed at endoscopy:
- Continue PPI.
- Test for H. pylori and treat if positive. First-line is bismuth quadruple therapy for 14 days (PPI + bismuth subsalicylate + tetracycline + metronidazole). Clarithromycin-based triple therapy is no longer first-line given rising resistance.
- Stop the offending NSAID. Restart antiplatelets only when bleeding has stopped and the cardiovascular risk is reassessed.
Exam trap
The exam loves the cirrhotic with a UGI bleed where the obvious answer looks like “endoscopy” or “octreotide” but the highest-impact intervention is ceftriaxone. If ceftriaxone is in the options, it’s often what they want. Antibiotics in variceal bleeding is one of the few interventions where the mortality data is strong, and the exam knows it.
The second trap is the hemodynamically stable patient with coffee-ground vomiting where the question is “next step.” Resuscitation isn’t needed; the answer is the PPI plus arranging endoscopy. Don’t over-treat a stable patient.
Common mistakes residents make
Four patterns that keep coming up in real prep, not just on the exam.
- Studying recall banks before understanding patterns. You’ll get the trap questions wrong and the easy ones right.
- Memorizing diagnoses without management. The exam asks what’s next.
- Skipping the boring stuff. Hep B serology, acid–base, transfusion reactions: small topics with reliable marks.
- Cramming the last week. Six weeks of pattern-building beats one week of panic. Trust the plan.
After you submit: Hussa will message you on WhatsApp within 24h with payment and download details.
Written by Hussa AlOuda, MD. Internal Medicine, themoc.co.
Last reviewed · June 2026