AIIMS PG (DM/MCh) Entrance General Medicine and Medical Super-Specialties Syllabus

General Medicine and Medical Super-Specialties syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for General Medicine and Medical Super-Specialties in AIIMS PG (DM/MCh) Entrance, not a summary of it.

1. 1

   Cardiology

   5 topics

   • Ischemic Heart Disease
     • Acute coronary syndromes: STEMI, NSTEMI, unstable angina
     • Coronary angiography and revascularization (PCI, CABG)
     • Secondary prevention and antiplatelet therapy
   • Heart Failure
     • HFrEF vs HFpEF pathophysiology and classification
     • Guideline-directed medical therapy (ARNI, SGLT2i, beta-blockers)
     • Device therapy: CRT and ICD indications
   • Arrhythmias and Electrophysiology
     • Atrial fibrillation: rate vs rhythm control and anticoagulation
     • Supraventricular and ventricular tachycardias
     • Bradyarrhythmias and pacemaker indications
   • Valvular and Structural Heart Disease
     • Rheumatic and degenerative valve lesions
     • Echocardiographic assessment of severity
     • TAVI and percutaneous interventions
   • Cardiomyopathies and Pericardial Disease
     • Dilated, hypertrophic and restrictive cardiomyopathy
     • Constrictive pericarditis and cardiac tamponade
2. 2

   Nephrology

   5 topics

   • Acute Kidney Injury
     • Prerenal, intrinsic and postrenal etiologies
     • KDIGO staging and biomarkers
     • Indications for renal replacement therapy
   • Chronic Kidney Disease
     • Staging, progression and complications
     • Mineral bone disease and anemia management
   • Glomerular Diseases
     • Nephritic vs nephrotic syndromes
     • Lupus nephritis and ANCA-associated vasculitis
     • Renal biopsy interpretation
   • Dialysis and Transplantation
     • Hemodialysis and peritoneal dialysis principles
     • Immunosuppression and graft rejection
   • Fluid, Electrolyte and Acid-Base Disorders
     • Sodium and potassium disorders
     • Metabolic acidosis and alkalosis with anion gap analysis
3. 3

   Neurology

   5 topics

   • Cerebrovascular Disease
     • Ischemic stroke: thrombolysis and thrombectomy
     • Intracerebral and subarachnoid hemorrhage
   • Seizure Disorders and Epilepsy
     • Classification and EEG correlation
     • Antiepileptic drug selection and status epilepticus
   • Movement Disorders
     • Parkinson disease and parkinsonism
     • Tremor, dystonia and chorea
   • Neuromuscular and Demyelinating Disease
     • Multiple sclerosis and NMO spectrum
     • Myasthenia gravis and Guillain-Barre syndrome
   • Headache and Neurodegeneration
     • Migraine and secondary headaches
     • Dementia syndromes and cognitive assessment
4. 4

   Endocrinology

   4 topics

   • Diabetes Mellitus
     • Type 1 and Type 2 pathophysiology
     • Pharmacotherapy and insulin regimens
     • Acute complications: DKA and HHS
   • Thyroid Disorders
     • Hypothyroidism and hyperthyroidism
     • Thyroid nodule and cancer evaluation
   • Pituitary and Adrenal Disorders
     • Acromegaly, prolactinoma and hypopituitarism
     • Cushing syndrome and Addison disease
   • Calcium and Bone Metabolism
     • Hyper- and hypoparathyroidism
     • Osteoporosis and vitamin D disorders
5. 5

   Gastroenterology and Hepatology

   4 topics

   • Liver Disease
     • Cirrhosis and portal hypertension
     • Viral hepatitis and acute liver failure
     • Hepatocellular carcinoma surveillance
   • Inflammatory Bowel Disease
     • Crohn disease vs ulcerative colitis
     • Biologic and immunomodulator therapy
   • Pancreaticobiliary Disease
     • Acute and chronic pancreatitis
     • Cholangitis and biliary obstruction
   • Gastrointestinal Bleeding and Motility
     • Upper and lower GI bleed management
     • GERD, achalasia and functional disorders

General Medicine and Medical Super-Specialties flashcards for AIIMS PG (DM/MCh) Entrance

25 of 51 cards from the General Medicine and Medical Super-Specialties deck — real questions with worked answers.

1. What ECG criterion defines STEMI in two contiguous leads (in leads other than V2-V3)?

   New ST-elevation at the J-point of at least 1 mm (0.1 mV) in two contiguous leads. For V2-V3: at least 2 mm in men 40+, at least 2.5 mm in men under 40, and at least 1.5 mm in women.

2. In acute coronary syndrome, which artery occlusion is suggested by ST-elevation in leads II, III, and aVF?

   The right coronary artery (inferior MI). Associated RV infarction is suggested by ST-elevation in right-sided lead V4R, and these patients are preload-dependent (avoid nitrates).

3. What is the door-to-balloon target time for primary PCI in STEMI, and the door-to-needle target for fibrinolysis?

   Door-to-balloon (first medical contact to device) within 90 minutes (or 120 min if transferred). Door-to-needle for fibrinolytics within 30 minutes.

4. Define Type 2 myocardial infarction.

   MI secondary to an imbalance between myocardial oxygen supply and demand (e.g., from anemia, hypotension, tachyarrhythmia, coronary spasm) rather than acute atherothrombotic plaque rupture (Type 1).

5. List the four stages (A-D) of heart failure in the ACC/AHA classification.

   A: at risk, no structural disease/symptoms. B: structural disease, no symptoms. C: structural disease with prior/current symptoms. D: refractory/advanced HF needing specialized interventions.

6. What four drug classes form guideline-directed medical therapy (the "four pillars") for HFrEF?

   ARNI (or ACEi/ARB), beta-blocker, mineralocorticoid receptor antagonist (MRA), and SGLT2 inhibitor.

7. What is the formula for ejection fraction and the cutoffs defining HFrEF, HFmrEF, and HFpEF?

   EF = stroke volume / end-diastolic volume. HFrEF: EF 40% or less. HFmrEF (mildly reduced): EF 41-49%. HFpEF (preserved): EF 50% or greater.

8. Which biomarker is used to diagnose and prognosticate heart failure, and what physiology raises it?

   BNP / NT-proBNP, released from ventricular myocytes in response to wall stretch/volume overload. Levels are lowered by obesity and raised in renal failure and atrial fibrillation.

9. State the CHA2DS2-VASc components and the points assigned.

   Congestive HF (1), Hypertension (1), Age 75+ (2), Diabetes (1), Stroke/TIA/thromboembolism (2), Vascular disease (1), Age 65-74 (1), Sex category female (1).

10. Differentiate the mechanism of typical atrial flutter from AVNRT.

    Typical atrial flutter is a macro-reentrant circuit around the tricuspid annulus (cavotricuspid isthmus dependent), giving sawtooth flutter waves at ~300/min. AVNRT is micro-reentry within the AV node using fast and slow pathways, narrow-complex tachycardia.

11. What is the ECG hallmark of Wolff-Parkinson-White syndrome, and which AV nodal blockers are contraindicated in pre-excited atrial fibrillation?

    Short PR interval with a delta wave (slurred QRS upstroke) due to an accessory pathway. In pre-excited AF, avoid AV nodal blockers (adenosine, verapamil, diltiazem, beta-blockers, digoxin) which can accelerate conduction down the accessory pathway and cause VF; use procainamide or cardioversion.

12. What defines long QT and what is the characteristic associated ventricular arrhythmia?

    Prolonged corrected QT (QTc over 450 ms men, 460-470 ms women). It predisposes to torsades de pointes, a polymorphic VT, treated acutely with IV magnesium.

13. Give the Sgarbossa criteria for diagnosing MI in the presence of LBBB.

    Concordant ST-elevation 1 mm or more (5 points), concordant ST-depression 1 mm or more in V1-V3 (3 points), and excessively discordant ST-elevation 5 mm or more (2 points). Score 3+ is specific for MI.

14. What is the indication for transcatheter vs surgical aortic valve replacement in severe aortic stenosis, and the classic symptom triad?

    Symptomatic severe AS (mean gradient 40+ mmHg, valve area under 1 cm2, jet velocity 4+ m/s). TAVR favored in older/high-risk patients, SAVR in younger/low-risk. Classic triad: angina, syncope, exertional dyspnea/heart failure.

15. What auscultatory findings distinguish mitral stenosis?

    Loud S1, opening snap after S2, and a low-pitched mid-diastolic rumble at the apex with presystolic accentuation (if in sinus rhythm). A shorter A2-to-opening-snap interval indicates more severe stenosis.

16. How does the murmur of hypertrophic obstructive cardiomyopathy change with Valsalva and squatting?

    The systolic murmur INCREASES with maneuvers that decrease preload/afterload (Valsalva strain, standing) and DECREASES with squatting/handgrip (increased afterload/venous return). This opposes the behavior of aortic stenosis.

17. What is the most common cause of mitral regurgitation requiring surgery in developed countries, and the indication for intervention in chronic primary MR?

    Degenerative/myxomatous disease (mitral valve prolapse). Intervene when symptomatic, or asymptomatic with LVEF 60% or less, LV end-systolic diameter 40 mm or more, new AF, or pulmonary hypertension.

18. Differentiate the four major cardiomyopathy types by their primary functional abnormality.

    Dilated: systolic dysfunction with chamber dilation. Hypertrophic: diastolic dysfunction, asymmetric septal hypertrophy. Restrictive: impaired ventricular filling with preserved/near-normal EF. Arrhythmogenic RV: fibrofatty RV replacement causing arrhythmias.

19. What distinguishes constrictive pericarditis from restrictive cardiomyopathy hemodynamically?

    Constriction shows ventricular interdependence (discordant LV/RV systolic pressures with respiration), pericardial knock, septal bounce, and equalization of diastolic pressures with normal BNP and pericardial calcification. Restriction shows concordant pressures, high BNP, and biatrial enlargement.

20. What is Beck's triad of cardiac tamponade, and the key echo finding?

    Hypotension, muffled heart sounds, and elevated JVP (distended neck veins). Echo shows diastolic right-ventricular and right-atrial collapse; pulsus paradoxus (over 10 mmHg inspiratory drop in SBP) is the clinical hallmark.

21. Give the KDIGO definition (criteria) for acute kidney injury.

    Any of: rise in serum creatinine of 0.3 mg/dL or more within 48 hours; rise to 1.5 times baseline within 7 days; or urine output under 0.5 mL/kg/hr for 6 hours.

22. How do FENa and urine osmolality help distinguish prerenal azotemia from acute tubular necrosis?

    Prerenal: FENa under 1%, urine osmolality over 500 mOsm/kg, BUN/Cr ratio over 20:1, bland sediment. ATN: FENa over 2%, urine osmolality near 300 (isosthenuria), muddy brown granular casts. FENa = (UNa x PCr)/(PNa x UCr) x 100.

23. What are the absolute (emergent) indications for dialysis in AKI? (mnemonic AEIOU)

    Acidosis (refractory metabolic), Electrolytes (refractory hyperkalemia), Intoxications (dialyzable toxins), Overload (refractory volume overload/pulmonary edema), Uremia (pericarditis, encephalopathy, bleeding).

24. State the CKD GFR (G) staging categories per KDIGO.

    G1: 90+ (with kidney damage), G2: 60-89, G3a: 45-59, G3b: 30-44, G4: 15-29, G5: under 15 (kidney failure). Albuminuria categories A1 (<30), A2 (30-300), A3 (>300 mg/g).

25. Which equation is used to estimate GFR and what variables does the 2021 CKD-EPI creatinine equation use?

    CKD-EPI 2021 uses serum creatinine, age, and sex (the race coefficient was removed). Cystatin C-based equations improve accuracy. Cockcroft-Gault estimates creatinine clearance using age, weight, sex, and creatinine.

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