CONDITION REFERENCES
Condition reference index
Find related reading from common presentations. These are knowledge references, not diagnoses.
Digestive
Gastroenteritis reference
Vomiting, diarrhea, appetite loss, low energy, or dehydration can map to gastroenteritis references.
- Digestive disease: vomiting, diarrhea, constipation, pancreas, parasites, and obstruction
- Vomiting and nausea
- Loose stool and diarrhea
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
- AAHA Clinical Practice Guidelines ↗American Animal Hospital Association
Pancreatitis reference
Vomiting, belly pain, appetite refusal, weakness, or illness after rich food can map to pancreatitis references.
- Vomiting with abdominal pain and suspected pancreatitis patterns
- Digestive disease: vomiting, diarrhea, constipation, pancreas, parasites, and obstruction
- Vomiting and nausea
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
- ACVIM Specialist Resources ↗American College of Veterinary Internal Medicine
Foreign body obstruction reference
Possible foreign object ingestion, repeated vomiting, retching, belly swelling, belly pain, or stool change can map to obstruction references.
- Chewing or swallowing foreign objects
- Bloat and GDV warning signs: swollen belly, dry retching, restlessness, and collapse
- Digestive disease: vomiting, diarrhea, constipation, pancreas, parasites, and obstruction
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
- ACVS Animal Health Topics ↗American College of Veterinary Surgeons
Constipation reference
Difficulty passing stool, straining, no stool for more than a day or two, or painful stool passage can map to constipation references.
- Constipation and straining
- Digestive disease: vomiting, diarrhea, constipation, pancreas, parasites, and obstruction
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
- AAHA Clinical Practice Guidelines ↗American Animal Hospital Association
Skin
Ringworm / dermatophyte reference
Round hair loss, scaling, crusting, or multi-pet skin problems can map to ringworm and dermatophyte references.
- Ringworm and fungal skin lesions: household safety and vet-confirmation clues
- Skin disease: itch, infection, ringworm, mites, fleas, and allergy
- Itching, rash, and hot spots
- CDC Healthy Pets, Healthy People ↗Centers for Disease Control and Prevention
- Cornell Feline Health Center ↗Cornell University College of Veterinary Medicine
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
Bacterial skin infection / pyoderma reference
Redness, hot spots, oozing, crusting, pain, or ongoing licking can map to bacterial skin infection and pyoderma references.
- Skin disease: itch, infection, ringworm, mites, fleas, and allergy
- Itching, rash, and hot spots
- Allergy flares: face rubbing, paw licking, and repeat itching
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
- AAHA Clinical Practice Guidelines ↗American Animal Hospital Association
Allergic dermatitis / flea allergy reference
Itching, licking, rash, face swelling, flea exposure, or recurrent skin flares can map to allergic dermatitis and flea allergy references.
- Skin disease: itch, infection, ringworm, mites, fleas, and allergy
- Allergy flares: face rubbing, paw licking, and repeat itching
- Ticks, fleas, intestinal parasites, and heartworm prevention
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
- CAPC Pet Owner Resources ↗Companion Animal Parasite Council
Eye / ear
Conjunctivitis / corneal disease reference
Red eye, eye discharge, squinting, rubbing, watery eye, or cloudiness can map to conjunctivitis and corneal disease references.
- Eye and ear disease: conjunctivitis, keratitis, tearing, cataract, mites, and otitis
- Red eye, squinting, and discharge
- Eye redness, squinting, discharge, and first-aid boundaries
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
- AAHA Clinical Practice Guidelines ↗American Animal Hospital Association
Cataract / eye cloudiness reference
Cloudy eyes, vision change, or bumping into objects can map to cataract and eye-cloudiness references.
- Eye and ear disease: conjunctivitis, keratitis, tearing, cataract, mites, and otitis
- Red eye, squinting, and discharge
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
- AAHA Clinical Practice Guidelines ↗American Animal Hospital Association
Otitis / ear mites reference
Head shaking, ear discharge, odor, pain when touched, or balance change can map to otitis and ear mite references.
- Eye and ear disease: conjunctivitis, keratitis, tearing, cataract, mites, and otitis
- Ear shaking, odor, and discharge
- Ear odor, scratching, head shaking, and safe cleaning
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
- AAHA Clinical Practice Guidelines ↗American Animal Hospital Association
- CAPC Pet Owner Resources ↗Companion Animal Parasite Council
Urinary / kidney
Feline urinary obstruction / lower urinary tract disease reference
Frequent litter box trips, small urinations, blood in urine, crying, or no urine in cats can map to feline urinary obstruction and lower urinary tract references.
- Cats straining in the litter box and lower urinary warning signs
- Urinary and kidney disease: blockage, cystitis, crystals, stones, UTI, and kidney signs
- Urination changes
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
- International Cat Care Advice ↗International Cat Care / ISFM
Cystitis / urinary tract infection / crystals / stones reference
Frequent small urinations, blood, painful urination, or new urine accidents can map to cystitis, UTI, crystals, and stones references.
- UTI, bladder inflammation, crystals, and stones: urine clues that should not be ignored
- Urinary and kidney disease: blockage, cystitis, crystals, stones, UTI, and kidney signs
- Urination changes
- Cat stress, litter box changes, and urinary warning signs
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
- AAHA Clinical Practice Guidelines ↗American Animal Hospital Association
- International Cat Care Advice ↗International Cat Care / ISFM
Kidney disease reference
Increased thirst, urination change, weight loss, appetite loss, or low energy can map to kidney disease references.
- Kidney disease and kidney failure warning patterns: thirst, urination, weight, appetite, and vomiting
- Urinary and kidney disease: blockage, cystitis, crystals, stones, UTI, and kidney signs
- Drinking much more and urinating more
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
- ACVIM Specialist Resources ↗American College of Veterinary Internal Medicine
Infectious
Feline panleukopenia
In young or incompletely vaccinated cats, vomiting, diarrhea, appetite loss, or weakness makes severe infectious disease such as panleukopenia a reference concern.
- Cornell Feline Health Center ↗Cornell University College of Veterinary Medicine
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
- WSAVA Global Guidelines ↗World Small Animal Veterinary Association
Feline herpesvirus upper respiratory disease
Sneezing, nasal discharge, eye discharge, or red eyes in cats can map to feline upper respiratory disease references including herpesvirus.
- Infectious diseases: cat and dog red flags
- Respiratory disease: sneezing, discharge, cough, and breathing effort
- Sneezing, nasal discharge, and upper respiratory signs
- Cornell Feline Health Center ↗Cornell University College of Veterinary Medicine
- International Cat Care Advice ↗International Cat Care / ISFM
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
Feline calicivirus-associated respiratory or oral disease
In cats, respiratory signs with drooling, oral pain, or appetite refusal can map to calicivirus-related reference content.
- Infectious diseases: cat and dog red flags
- Respiratory disease: sneezing, discharge, cough, and breathing effort
- Dental and oral disease: tartar, gingivitis, stomatitis, periodontal disease, and bad breath
- Cornell Feline Health Center ↗Cornell University College of Veterinary Medicine
- International Cat Care Advice ↗International Cat Care / ISFM
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
Feline infectious peritonitis reference
In cats, ongoing low energy, appetite loss, weight loss, belly enlargement, or fever-like signs can map to complex infectious disease references such as FIP.
- Infectious diseases: cat and dog red flags
- Feverish behavior and marked lethargy
- Digestive disease: vomiting, diarrhea, constipation, pancreas, parasites, and obstruction
- Cornell Feline Health Center ↗Cornell University College of Veterinary Medicine
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
FeLV/FIV reference
Recurrent low energy, weight loss, oral disease, infection-like signs, or enlarged lymph-node areas in cats can map to FeLV/FIV reference content.
- Infectious diseases: cat and dog red flags
- Dental and oral disease: tartar, gingivitis, stomatitis, periodontal disease, and bad breath
- Tumors and cancer: lumps, mammary tumors, lymphoma, skin, oral, and internal masses
- Cornell Feline Health Center ↗Cornell University College of Veterinary Medicine
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
Canine distemper reference
In young or incompletely vaccinated dogs, nasal or eye discharge, cough, fever-like signs, diarrhea, or neurologic signs can map to distemper references.
- Infectious diseases: cat and dog red flags
- Respiratory disease: sneezing, discharge, cough, and breathing effort
- Puppy and kitten first-year health checkpoints
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
- WSAVA Global Guidelines ↗World Small Animal Veterinary Association
Canine parvovirus reference
Vomiting, watery or bloody diarrhea, appetite refusal, or weakness in young or incompletely vaccinated dogs can map to parvovirus references.
- Infectious diseases: cat and dog red flags
- Puppies and kittens with vomiting or diarrhea
- Digestive disease: vomiting, diarrhea, constipation, pancreas, parasites, and obstruction
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
- WSAVA Global Guidelines ↗World Small Animal Veterinary Association
- AVMA Pet Owner Resources ↗American Veterinary Medical Association
Kennel cough / canine infectious respiratory disease reference
Cough in dogs, especially after boarding, daycare, or dog-group exposure, can map to kennel cough or infectious respiratory disease references.
- Infectious diseases: cat and dog red flags
- Respiratory disease: sneezing, discharge, cough, and breathing effort
- Coughing and kennel-cough-like illness
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
- WSAVA Global Guidelines ↗World Small Animal Veterinary Association
Canine influenza reference
Cough, nasal discharge, fever-like signs, or low energy after dog-group exposure can map to canine influenza and infectious respiratory references.
- Infectious diseases: cat and dog red flags
- Respiratory disease: sneezing, discharge, cough, and breathing effort
- Coughing and kennel-cough-like illness
- AVMA Pet Owner Resources ↗American Veterinary Medical Association
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
- WSAVA Global Guidelines ↗World Small Animal Veterinary Association
Respiratory
Upper respiratory infection reference
Sneezing, nasal discharge, eye or nose discharge, cough, or fever-like signs can map to upper respiratory infection references.
- Respiratory disease: sneezing, discharge, cough, and breathing effort
- Sneezing, nasal discharge, and upper respiratory signs
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
- Cornell Feline Health Center ↗Cornell University College of Veterinary Medicine
- International Cat Care Advice ↗International Cat Care / ISFM
Bronchitis / pneumonia reference
Cough, fast breathing, fever-like signs, low energy, or exercise intolerance can map to bronchitis and pneumonia references.
- Respiratory disease: sneezing, discharge, cough, and breathing effort
- Coughing and kennel-cough-like illness
- Persistent cough, exercise intolerance, and possible heart-lung problems
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
- ACVIM Specialist Resources ↗American College of Veterinary Internal Medicine
Feline asthma / lower airway disease reference
Wheezing, cough, breathing effort, or exercise intolerance in cats can map to feline asthma and lower airway disease references.
- Respiratory disease: sneezing, discharge, cough, and breathing effort
- Persistent cough, exercise intolerance, and possible heart-lung problems
- Cornell Feline Health Center ↗Cornell University College of Veterinary Medicine
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
- ACVIM Specialist Resources ↗American College of Veterinary Internal Medicine
Bone / injury
Fracture / sprain / trauma reference
Hit-by-car, falls, bleeding, wounds, limping, or not bearing weight can map to fracture, sprain, and trauma references.
- Bone, joint, spine, and trauma disease: fracture, sprain, luxation, arthritis, and IVDD
- Limping and lameness
- Bite wounds, punctures, and infection risk
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
- ACVS Animal Health Topics ↗American College of Veterinary Surgeons
Arthritis / patellar luxation / hip disease reference
Recurrent limping, worse after activity, reluctance to jump, difficulty rising, or chronic pain can map to arthritis, patella, and hip references.
- Bone, joint, spine, and trauma disease: fracture, sprain, luxation, arthritis, and IVDD
- Arthritis, stiffness, and reduced mobility
- Limping and lameness
- ACVS Animal Health Topics ↗American College of Veterinary Surgeons
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
Intervertebral disc / spinal neurologic reference
Back pain, weak rear legs, reluctance to walk, sudden pain, or neurologic signs can map to spinal and intervertebral disc references.
- Bone, joint, spine, and trauma disease: fracture, sprain, luxation, arthritis, and IVDD
- Limping and lameness
- ACVS Animal Health Topics ↗American College of Veterinary Surgeons
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
Dental / oral
Dental tartar / gingivitis / periodontal disease reference
Bad breath, loose teeth, trouble chewing, drooling, or mouth bleeding can map to dental tartar, gingivitis, and periodontal disease references.
- Dental and oral disease: tartar, gingivitis, stomatitis, periodontal disease, and bad breath
- Dental pain, drooling, and mouth odor
- Dental prevention and home mouth checks
- AAHA: Dog and Cat Dental Disease ↗American Animal Hospital Association
- American Veterinary Dental College ↗American Veterinary Dental College
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
Stomatitis / oral pain reference
Drooling, appetite refusal, oral pain, mouth bleeding, or oral swelling can map to stomatitis and oral pain references.
- Dental and oral disease: tartar, gingivitis, stomatitis, periodontal disease, and bad breath
- Dental pain, drooling, and mouth odor
- AAHA: Dog and Cat Dental Disease ↗American Animal Hospital Association
- American Veterinary Dental College ↗American Veterinary Dental College
Toxins / accidents
Toxin exposure: medication, chocolate, onion, grapes, lilies, rodenticide, cleaners reference
Medication, chocolate, grape, onion, lily exposure in cats, rodenticide, or cleaner exposure maps directly to toxin and accident references.
- Toxins and accidents: medication, foods, lilies, rodenticide, cleaners, heat, and trauma
- Possible poisoning
- Household toxins, plants, and accidental exposure
- ASPCA Animal Poison Control ↗ASPCA
- FDA Animal & Veterinary Resources ↗U.S. Food and Drug Administration
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
Heatstroke / heat injury and accident reference
Heat exposure, fast breathing, weakness, collapse, hit-by-car, or falls can map to heat injury and accident references.
- Toxins and accidents: medication, foods, lilies, rodenticide, cleaners, heat, and trauma
- Heat exposure and overheating
- Flat-faced dog breathing, snoring, and heat risk
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
- WSAVA Global Guidelines ↗World Small Animal Veterinary Association
Parasites
Intestinal parasites: roundworm, tapeworm, hookworm, coccidia reference
Worm-like segments, diarrhea, soft stool, young age, or uncertain prevention can map to intestinal parasite references.
- Intestinal parasites: worms, rice-like segments, diarrhea, and household risk
- Parasite disease: fleas, ticks, mites, worms, coccidia, and heartworm
- Fleas, ticks, and worms
- Ticks, fleas, intestinal parasites, and heartworm prevention
- CAPC Pet Owner Resources ↗Companion Animal Parasite Council
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
External parasites: fleas, ticks, mites reference
Itching, hair loss, flea dirt, tick exposure, itchy ears, or crusting can map to flea, tick, ear mite, or mange references.
- Parasite disease: fleas, ticks, mites, worms, coccidia, and heartworm
- Ticks, fleas, intestinal parasites, and heartworm prevention
- Ear shaking, odor, and discharge
- CAPC Pet Owner Resources ↗Companion Animal Parasite Council
- CDC Healthy Pets, Healthy People ↗Centers for Disease Control and Prevention
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
Heartworm reference
Uncertain prevention, mosquito exposure, cough, exercise intolerance, or breathing change can map to heartworm references.
- Parasite disease: fleas, ticks, mites, worms, coccidia, and heartworm
- Ticks, fleas, intestinal parasites, and heartworm prevention
- Cardiovascular disease: enlarged heart, cardiomyopathy, valve disease, heart failure, and hypertension
- American Heartworm Society Pet Owner Resources ↗American Heartworm Society
- CAPC Pet Owner Resources ↗Companion Animal Parasite Council
Tumors
Tumor / mammary tumor / lymphoma / skin tumor reference
New lumps, rapid growth, ulceration, mammary lumps, or enlarged lymph-node areas can map to tumor-related references.
- Tumors and cancer: lumps, mammary tumors, lymphoma, skin, oral, and internal masses
- New lumps, bumps, and swelling
- ACVIM Specialist Resources ↗American College of Veterinary Internal Medicine
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
Behavior / neuro
Anxiety / aggression / separation-related behavior reference
Anxiety, hiding, sudden aggression, separation-related changes, or behavior change can map to behavior references while prompting medical rule-out.
- Behavior and neurologic problems: anxiety, aggression, inappropriate urination, seizures, vestibular signs, and cognitive change
- Sudden behavior change, pacing, confusion, or staring
- Travel, boarding, and stress-related changes
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
- ACVIM Specialist Resources ↗American College of Veterinary Internal Medicine
Inappropriate urination: behavior or urinary disease reference
New inappropriate urination may be behavioral stress or urinary disease, so it maps to both behavior and urinary references.
- Behavior and neurologic problems: anxiety, aggression, inappropriate urination, seizures, vestibular signs, and cognitive change
- Cat stress, litter box changes, and urinary warning signs
- Urinary and kidney disease: blockage, cystitis, crystals, stones, UTI, and kidney signs
- International Cat Care Advice ↗International Cat Care / ISFM
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
Epilepsy / seizure reference
Seizure, rigid body, repeated episodes, collapse, or disorientation after an episode can map to seizure and epilepsy references.
- Seizures, tremors, head tilt, and vestibular signs: safety first
- Behavior and neurologic problems: anxiety, aggression, inappropriate urination, seizures, vestibular signs, and cognitive change
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
- ACVIM Specialist Resources ↗American College of Veterinary Internal Medicine
Vestibular signs / cognitive dysfunction reference
Head tilt, circling, balance loss, abnormal eye movement, getting lost, or day-night reversal can map to vestibular and cognitive references.
- Seizures, tremors, head tilt, and vestibular signs: safety first
- Behavior and neurologic problems: anxiety, aggression, inappropriate urination, seizures, vestibular signs, and cognitive change
- Senior pets with night waking, confusion, or house-soiling changes
- Senior pet wellness, pain clues, and quality-of-life tracking
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
- ACVIM Specialist Resources ↗American College of Veterinary Internal Medicine
Heart
Cardiomyopathy / valve disease / heart failure / hypertension reference
Cough, exercise intolerance, fast breathing, ascites/pleural fluid/pulmonary edema clues, collapse, or abnormal gum color can map to cardiovascular disease references.
- Heart failure fluid buildup: ascites, pleural fluid, pulmonary edema, and resting breathing checks
- Heart disease and heart failure warning signs: cough, resting breathing, fainting, and fatigue
- Cardiovascular disease: enlarged heart, cardiomyopathy, valve disease, heart failure, and hypertension
- Persistent cough, exercise intolerance, and possible heart-lung problems
- ACVIM Specialist Resources ↗American College of Veterinary Internal Medicine
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
- Merck Veterinary Manual: When to See a Veterinarian ↗Merck Veterinary Manual
Endocrine
Obesity / weight management reference
Weight gain, reduced activity tolerance, or long-term diet-management concerns can map to obesity and weight management references.
- Thyroid, Cushing-like, and adrenal patterns: weight, coat, thirst, appetite, and weakness
- Endocrine and metabolic disease: obesity, diabetes, thyroid, Cushing, and adrenal concerns
- Weight change, nutrition, and body condition
- WSAVA Global Guidelines ↗World Small Animal Veterinary Association
- AAHA Clinical Practice Guidelines ↗American Animal Hospital Association
Diabetes reference
Increased thirst and urination, weight loss, appetite change, or low energy can map to diabetes references.
- Endocrine and metabolic disease: obesity, diabetes, thyroid, Cushing, and adrenal concerns
- Weight loss, big thirst, and possible diabetes warning signs
- Drinking much more and urinating more
- ACVIM Specialist Resources ↗American College of Veterinary Internal Medicine
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
Thyroid / Cushing / adrenal disease reference
Weight, thirst, urination, appetite, energy, or coat changes can map to thyroid, Cushing-like, and adrenal references.
- Thyroid, Cushing-like, and adrenal patterns: weight, coat, thirst, appetite, and weakness
- Endocrine and metabolic disease: obesity, diabetes, thyroid, Cushing, and adrenal concerns
- Weight change, nutrition, and body condition
- ACVIM Specialist Resources ↗American College of Veterinary Internal Medicine
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
Reproductive
Pyometra reference
An unspayed female with low energy, vaginal discharge, vomiting, fever-like signs, or increased thirst can map to pyometra references.
- Pyometra and reproductive emergencies: intact females, discharge, thirst, vomiting, and weakness
- Reproductive disease: pyometra, mastitis, false pregnancy, testicular, and prostate concerns
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
- ACVIM Specialist Resources ↗American College of Veterinary Internal Medicine
Mastitis / false pregnancy / mammary concern reference
Mammary swelling or pain, mammary lumps, possible pregnancy, or postpartum concerns can map to mastitis, false pregnancy, and mammary references.
- Reproductive disease: pyometra, mastitis, false pregnancy, testicular, and prostate concerns
- Tumors and cancer: lumps, mammary tumors, lymphoma, skin, oral, and internal masses
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
- ACVIM Specialist Resources ↗American College of Veterinary Internal Medicine
Testicular / prostate concern reference
Testicle swelling or pain, straining to urinate or defecate, or rear-end discomfort can map to testicular and prostate references.
- Merck Veterinary Manual: Pet Owners Overview ↗Merck Veterinary Manual
- ACVIM Specialist Resources ↗American College of Veterinary Internal Medicine