Adult Internal Medicine

Core Generalist#

Knowledge#

CG.K.1#

Illustrate a working knowledge of anatomy and physiology

CG.K.2#

Discuss differential diagnosis, appropriate investigations and initial management for common, undifferentiated clinical presentations

CG.K.3#

Describe clinical presentation, differential diagnosis, investigations, initial management, principles of ongoing management, potential complications of the disease and its management, for common and important conditions

Skills#

CG.S.1#

For common and important conditions and presentations, with consideration of clinical services capability:

  • recognise the presentation of illness
  • establish a provisional diagnosis
  • plan and arrange appropriate investigations
  • initiate appropriate medical management for uncomplicated disease
  • monitor for complications
  • recognise if there are complications, or if procedural intervention is required, provide initial emergency management and refer appropriately

CG.S.2#

Perform and interpret the following diagnostic and therapeutic procedures:

  • ECG
  • emergency electrocardiograph and cardioversion
  • fundoscopy
  • urine analysis
  • urine microscopy
  • glucometers
  • spirometry
  • arterial blood sampling
  • nebulisers, spacers and turbo-inhalers
  • supplemental oxygen
  • re-breathing mask
  • CPAP/BIPAP
  • oxygen concentrators
  • pericardiocentesis
  • intercostal catheter thrombolytic therapy
  • orogastric tube
  • needle thoracentesis
  • pleural tap
  • underwater drain
  • lumbar puncture
  • sigmoidoscopy/proctoscopy (under supervision)
  • ascitic tap
  • assist with focussed assessment with sonography for trauma - FAST Scan

Attributes#

At.1#

Accountability

At.2#

Adaptability

At.15#

Reflection

Advanced Specialised#

Knowledge#

AS.K.1#

Describe the clinical presentation, initial investigations, initial management, potential complications and disease associations, therapeutic options, adverse effects of disease management and indications for referral for the following less common or more complex conditions

AS.K.2#

Explain the interpretation and significance of relevant investigations and reports

Skills#

AS.S.1#

For the less common or more complex, acute and chronic conditions with consideration of clinical services capability:

  • recognise the presentation
  • establish a provisional diagnosis
  • plan and arrange appropriate initial investigation
  • initiate empiric therapy
  • discuss broad therapeutic options
  • refer appropriately
  • provide ongoing management.

AS.S.2#

Perform and interpret one or more advanced diagnostic and/or therapeutic procedure according to community need, eg exercise stress testing, Holter monitoring, endoscopy

Attributes#

At.1#

Accountability

At.2#

Adaptability

At.15#

Reflection

Presentations and conditions#

  • Common, undifferentiated clinical presentations

    • chest pain
    • palpitations
    • fever/pyrexia of unknown origin/night sweats
    • chronic fatigue/lethargy
    • syncope/collapse/loss of consciousness
    • acute and chronic confusional states
    • breathlessness
    • hemoptysis
    • weight loss
    • vomiting
    • abdominal pain
    • jaundice
    • functional decline
    • weakness
    • deformity/swelling
    • oedema
    • hematuria
    • recurrent unexplained presentation.

  • Cardiac conditions, including:

    • hypertension
    • arrhythmia including supraventricular arrhythmias, ventricular arrhythmias
    • ischaemic heart disease
    • cardiac failure including acute left ventricular failure (LVF), congestive heart failure, chronic left ventricular failure and cor pulmonale
    • pericardial disease
    • cardiomyopathy
    • peripheral vascular disease including arterial and venous ulcers
    • rheumatic heart disease
    • cardiovascular manifestations of systemic and chronic disease
    • congenital heart disease
    • acute coronary syndromes including ST Elevation Myocardial Infarction (STEMI), Non - STEMI

  • Nephrology conditions, including:

    • acid-base imbalance
    • electrolyte abnormalities
    • acute and recurrent urinary tract infections including pyelonephritis, cystitis, prostatitis, urethritis
    • acute and chronic glomerulonephritis
    • vascular disease of the kidney including polyarteritis nodosa, hypersensitivity vasculitis, haemolytic uraemic syndrome and atypical haemolytic uraemic syndrome, renal artery stenosis
    • urinary tract calculi
    • acute and chronic renal failure
    • complications of renal replacement therapy
    • acute tubular necrosis
    • renovascular disease
    • diabetic nephropathy
    • renal calculus disease and obstructive uropathy
    • drug-related nephrotoxicity
    • renal hypertension
    • glomerulonephritis
    • tubulo-interstitial kidney disease
    • polycystic kidney disease

  • Thoracic and sleep medicine conditions, including:

    • asthma
    • acute respiratory failure
    • chronic obstructive airways disease including Chronic Obstructive Pulmonary Disease (COPD), Chronic respiratory failure
    • respiratory infections including acute and chronic bronchitis, pneumonia, psittacosis
    • occupational/environmental lung disease including occupational asthma, asbestos related pleural and parenchymal disease (benign and malignant), interstitial lung disease from exposure to organic and inorganic dusts, coal workers pneumoconiosis
    • sleep apnoea
    • neoplasia
    • pulmonary embolism
    • pleural disease
    • spontaneous pneumothorax
    • hypersensitivity pneumonitis including farmer’s lung, bird fancier’s lung
    • interstitial lung disease including sarcoidosis, Wegener’s granulomatosis, cryptogenic fibrosing alveolitis
    • pneumothorax
    • pulmonary hypertension
    • diffuse lung disease
    • sleep apnoea
    • lung cancer
    • cystic fibrosis
    • bronchiectasis
    • tuberculosis
    • pulmonary vasculitides
    • hemoptysis

  • Infectious diseases, including:

    • zoonoses such as: Q fever, leptospirosis, brucellosis, rabies, toxoplasmosis
    • bacterial infections such as: meningococcal meningitis/ septicaemia, other meningitides, typhoid, pneumonia, tuberculosis, leprosy, melioidosis
    • fungal infections such as athlete’s foot
    • hepatitis
    • viral infections such as: influenza, Ross River Fever, measles, mumps, varicella, Epstein-Barr virus, dengue, rubella, herpes
    • protozoal infections such as: malaria, giardiasis
    • worms such as: round worms, hook worms, fluke worms, pin worms
    • sexually transmitted disease such as: gonorrhoea, syphilis, NGU/chlamydia, herpes, genital warts, HIV/AIDS
    • osteomyelitis
    • septic arthritis
    • TB
    • HIV
    • hepatitis viruses
    • EBV/CMV/Toxo
    • meningococcaemia
    • infections in the immunocompromised host
    • necrotising fasciitis
    • fever in the returning traveller – including malaria, dengue fever, parasitic infections

  • Gastroenterology conditions, including:

    • Common gastrointestinal symptoms including weight loss, abdominal pain, dysphagia, iron deficiency anaemia, acute/chronic diarrhoea, nausea and vomiting
    • Gastrointestinal emergencies including acute gastrointestinal haemorrhage, liver failure, hepatic encephalopathy, acute colitis
    • Upper gastrointestinal disease including gastro-oesophageal reflux disease, peptic ulcer, helicobacter pylori associated ulcers, Non-steroidal Anti-inflammatory Drugs (NSAID) induced conditions including functional dyspepsia, gastric carcinoma, Barrett’s oesophagus
    • Hepatobiliary disease such as: alcoholic liver disease, fatty liver, chronic liver disease (cirrhosis) and complications, ascites, liver failure, haemochromatosis, gall bladder disorders, gallstones, biliary obstruction
    • Pancreatic disease including acute pancreatitis and complications, chronic pancreatitis and complications, pseudocyst formulation and complications
    • Small and large bowel diseases including coeliac disease, irritable bowel syndrome, constipation, appendicitis, diverticulosis/ diverticulitis, lactose intolerance, inflammatory bowel disease, malabsorption, malignancy

  • Rheumatology conditions, including:

    • Rheumatological emergencies including acute mono/oligo arthritis, acute polyarthritis, systemic vasculitis
    • Common rheumatological problems including rheumatoid arthritis, osteoarthritis, gout/pseudogout, back pain, soft tissue rheumatism, recognition of arboviral arthropathies, temporal arteritis/polymyalgia rheumatica, seronegative arthropathies, connective tissue disorders including SLE, vasculitis, scleroderma, myositis

  • Endocrinology conditions, including:

    • common endocrinological disorders including diabetes mellitus including gestational diabetes, osteoporosis, polycystic ovary syndrome, thyroid disease and obesity
    • hypothyroidism
    • hyperthyroidism
    • parathyroid disease
    • Addison’s disease
    • Cushing’s syndrome
    • Paget disease
    • benign prostatic disease
    • hypogonadism
    • gender dysphoria
    • endocrine causes of hypertension
    • vitamin D deficiency

  • Neurological conditions, including:

    • migraine
    • abnormal focal neurological signs
    • cerebrovascular accident
    • transient ischaemic attacks,
    • headache
    • epilepsy
    • confusional states and intellectual impairment
    • central nervous system infection
    • space occupying lesions
    • post-concussion syndrome
    • head injuries in sport
    • acoustic neuroma
    • temporal arteritis
    • benign intracranial hypertension
    • peripheral neuropathy
    • Bell’s palsy
    • trigeminal neuralgia
    • motor neurone acquired and hereditary
    • cerebral neoplasia
    • Parkinson’s disease
    • Guillain Barre syndrome
    • multiple sclerosis
    • spinal cord compression
    • cerebellar disorders

  • Haematological conditions, including:

    • anaemia, neutropenia, thrombocytopenia, pancytopenia
    • leucocytosis, polycythaemia, thrombocytosis
    • complications from blood transfusions, and immunosuppression
    • disorders of coagulation or thrombosis
    • bleeding disorders; thrombophilia, haemophilia
    • disseminated intravascular coagulopathy
    • aplastic anaemia/bone marrow failure
    • lymphadenopathy
    • amyloidosis
    • plasma cell dyscrasias/myeloma
    • myelodysplasia
    • myeloproliferative disease
    • haemolytic disorders

  • Immunological conditions, including:

    • allergic disorders: anaphylaxis, food allergy, adverse drug reactions, allergic rhinitis/sinusitis/conjunctivitis, atopic dermatitis, urticaria
    • autoimmune diseases: systemic lupus erythematosus (SLE), progressive systemic sclerosis (PSS), dermatomyositis, polymyositis
    • acquired immunodeficiency syndromes: human immunodeficiency virus (HIV), immunosuppressive drugs, post transplantation.
    • vasculitis

  • Oncological conditions, including:

    • lung, breast, gastrointestinal, prostate, skin, brain, lymphoma, multiple myeloma, leukaemia
    • complications of cancer: uncontrolled pain, malignant hypercalcemia, spinal cord compression (SVC), SVC obstruction, pericardial tamponade
    • complications of cancer therapy: bone marrow suppression, neutropenic sepsis, tumour lysis syndrome, mucositis, graft vs. host disease
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