Year 4 Internal Medicine: Exam Revision Roadmap

A structured, clinical-case-focused revision sequence for Year 4 IMED: respiratory, cardiovascular, infectious disease, renal, gastroenterology, haematology, neurology, endocrine, rheumatology and cross-cutting emergencies, with a method for answering cases.

MBChB Year 4 · Clinical and case-based revision

Use this roadmap to work through Internal Medicine systematically. For each topic, revise the core notes, practise clinical scenarios, explain your differential diagnoses, and justify investigations and management. The order prioritises common clinical presentations and links conditions that are often confused or occur together.

  1. Respiratory medicine — approach to cough and dyspnoea; pneumonia; pulmonary tuberculosis; PCP; asthma; COPD; bronchiectasis and lung abscess; pleural effusion and empyema; pneumothorax; pulmonary embolism; lung cancer; interstitial lung disease; respiratory failure and ABG interpretation; pulmonary oedema and ARDS; pulmonary hypertension and cor pulmonale.
  2. Cardiovascular medicine — cardiovascular history and examination; hypertension and hypertensive emergencies; heart failure; acute coronary syndrome and myocardial infarction; rheumatic heart disease and valvular lesions; infective endocarditis; arrhythmias and ECG interpretation; pericarditis, effusion and tamponade; cardiomyopathies; peripheral vascular disease; shock.
  3. Infectious diseases and tropical medicine — approach to fever; HIV and opportunistic infections; TB; malaria and severe malaria; meningitis and encephalitis; sepsis and septic shock; enteric fever; skin and soft-tissue infections; viral hepatitis; antimicrobial selection and resistance; fungal and parasitic infections.
  4. Renal medicine — approach to renal symptoms and urinalysis; acute kidney injury; chronic kidney disease; nephrotic and nephritic syndromes; glomerulonephritis; fluid balance; sodium and potassium disorders; acid–base disorders; diabetic kidney disease; UTI and pyelonephritis; dialysis indications; renal complications of hypertension.
  5. Gastroenterology and hepatology — abdominal symptoms and jaundice; dyspepsia and peptic ulcer disease; upper GI bleeding; chronic liver disease and cirrhosis; ascites and spontaneous bacterial peritonitis; hepatic encephalopathy; viral hepatitis; pancreatitis; inflammatory bowel disease; malabsorption; oesophageal disorders; hepatorenal syndrome.
  6. Haematology — interpretation of FBC and blood film; approach to anaemia; iron deficiency; megaloblastic anaemia; haemolysis; sickle cell disease; thalassaemia; leukaemias and lymphomas; myeloma; platelet disorders; coagulation disorders; transfusion reactions.
  7. Neurology — neurological history and examination; stroke and TIA; seizures and status epilepticus; meningitis and encephalitis; peripheral neuropathy; Guillain–Barré syndrome; myasthenia gravis; Parkinsonism; dementia and delirium; headache red flags; spinal cord compression; raised intracranial pressure.
  8. Endocrinology and metabolism — diabetes mellitus; DKA and HHS; hypoglycaemia; hypothyroidism and thyrotoxicosis; thyroid storm and myxoedema coma; adrenal insufficiency and Cushing syndrome; calcium and parathyroid disorders; pituitary disease; obesity and metabolic syndrome.
  9. Rheumatology — rheumatoid arthritis; SLE; gout and other crystal arthropathies; osteoarthritis; systemic sclerosis; vasculitis; inflammatory myopathies; septic arthritis; spondyloarthritis.
  10. Cross-cutting IMED topics — clinical pharmacology; older patients and delirium; poisoning and adverse drug effects; fluid and electrolyte emergencies; anaphylaxis; acid–base interpretation; medical dermatology; nutrition and vitamin deficiencies; occupational and environmental medicine.

How to answer a clinical scenario

For every case, practise this sequence:

  1. Stabilise first: identify airway, breathing, circulation, disability and exposure concerns; treat immediate threats.
  2. Summarise the problem: age, key symptoms, duration, important risk factors and positive findings.
  3. Give the leading diagnosis and explain the clues supporting it.
  4. Rank the differentials: include dangerous alternatives that must not be missed.
  5. Choose investigations and state what each will help confirm, exclude or assess for severity.
  6. Manage in order: immediate treatment, definitive treatment, monitoring, complications and follow-up.

Clinical connections matter

Conditions are not isolated. Pneumonia may lead to sepsis, pleural effusion or respiratory failure. Heart failure may be precipitated by hypertension, myocardial infarction, arrhythmia, infection, anaemia or renal dysfunction. Diabetes links to DKA, kidney disease, neuropathy and cardiovascular disease. Cirrhosis links to ascites, variceal bleeding, encephalopathy and hepatorenal syndrome. When a note points to a related topic, revise the connection rather than memorising the conditions separately.

Start here: Cardiovascular medicine

Respiratory revision is followed by Cardiovascular Medicine. Begin with the approach to cardiovascular symptoms and examination, then proceed to hypertension, heart failure, acute coronary syndrome, valvular disease, infective endocarditis, ECGs and arrhythmias, pericardial disease, cardiomyopathy and shock.

Related reading: Hypertension · Heart failure · Heart murmurs · Rheumatic heart disease · Cardiology clinical question bank.

Revision aid for medical students. Use current Kenyan protocols and local senior-clinician guidance for patient care.

Compiled by Ompath Study · Ompath Study · shared for MBChB students at Mount Kenya University and other universities.