AIIMS PG (DM/MCh) Entrance Pediatrics, Obstetrics-Gynecology and Allied Specialties Syllabus

Per the WHO/India National Immunization Schedule, which vaccines are given at birth?

BCG, OPV-0 (zero dose), and Hepatitis B (birth dose) are given at birth.

At what ages is the DPT/pentavalent primary series and its boosters given in the Indian schedule?

Primary series (Pentavalent: DPT+HepB+Hib) at 6, 10, and 14 weeks. Boosters: DPT 1st booster at 16-24 months, DPT 2nd booster at 5-6 years.

What are the contraindications to BCG vaccination?

Symptomatic HIV infection, congenital/acquired immunodeficiency, generalized eczema or skin infection at the site, and active untreated tuberculosis. (Asymptomatic HIV-exposed infants in high TB-burden areas may still receive it.)

Which live vaccines must be deferred in pregnancy?

All live attenuated vaccines: MMR, varicella, live OPV, yellow fever, BCG, and intranasal influenza (LAIV). Tdap and inactivated influenza are recommended during pregnancy.

Define a high-risk pregnancy and give three major maternal risk factors.

A pregnancy with conditions that increase risk to mother/fetus. Major factors include: maternal age <18 or >35, previous cesarean/uterine scar, hypertensive disorders, diabetes, previous pregnancy loss, multiple gestation, and grand multiparity.

What blood pressure and proteinuria thresholds define pre-eclampsia?

BP ≥140/90 mmHg on two occasions ≥4 hrs apart after 20 weeks gestation, PLUS proteinuria ≥300 mg/24 hr (or protein:creatinine ≥0.3, or dipstick ≥1+), or end-organ dysfunction even without proteinuria.

What is HELLP syndrome?

A severe variant of pre-eclampsia: Hemolysis, Elevated Liver enzymes, Low Platelets. It indicates severe disease and mandates delivery; can occur with normal/mildly elevated BP.

What is the drug of choice for preventing and treating eclamptic seizures, and the antidote for its toxicity?

Magnesium sulfate is first-line for seizure prophylaxis/treatment. Antidote for magnesium toxicity (loss of reflexes, respiratory depression) is calcium gluconate IV.

Differentiate placenta previa from abruptio placentae by bleeding characteristics.

Placenta previa: painless, bright red, recurrent bleeding; soft non-tender uterus; placenta over/near internal os. Abruptio placentae: painful bleeding (may be concealed), tense/tender 'woody' uterus, often with hypertension/trauma.

What is the definition of preterm labor and the gestational threshold of viability?

Preterm labor = regular contractions with cervical change before 37 completed weeks. Viability threshold is generally considered around 24 weeks (24-28 weeks = periviable).

What is the purpose and timing of antenatal corticosteroids in preterm labor?

Betamethasone or dexamethasone given to mothers at risk of preterm delivery between 24-34 weeks to accelerate fetal lung maturity (surfactant), reducing RDS, IVH, and NEC. Maximal benefit 24 hrs-7 days after administration.

What does the quadruple/triple marker screen test for, and what pattern suggests Down syndrome?

Maternal serum quad screen (15-20 wks): AFP, hCG, estriol (uE3), inhibin A. Down syndrome (Trisomy 21): low AFP, low estriol, HIGH hCG, HIGH inhibin A.

What are the components of the fetal biophysical profile (BPP) and the scoring?

Five components, each scored 0 or 2 (max 10): fetal breathing movements, gross body movements, fetal tone, amniotic fluid volume, and reactive non-stress test (NST). 8-10 reassuring; ≤4 abnormal.

What is the gold-standard non-invasive prenatal screening test for aneuploidy and what does it analyze?

Non-invasive prenatal testing (NIPT) analyzes cell-free fetal DNA in maternal plasma (from ~10 weeks), with very high sensitivity for trisomy 21, 18, 13, and sex chromosome aneuploidies. It is a screening, not diagnostic, test.

Compare chorionic villus sampling (CVS) and amniocentesis for prenatal diagnosis.

CVS: done at 10-13 weeks, samples placental villi, earlier diagnosis, slightly higher miscarriage risk, cannot detect neural tube defects. Amniocentesis: done at 15-20 weeks, samples amniotic fluid, detects NTDs (AFP), karyotyping.

What is the most common gynecologic malignancy worldwide vs. the most common in developed countries?

Worldwide (including India), cervical cancer is most common; in developed countries, endometrial (corpus uteri) cancer is most common. Ovarian cancer has the highest mortality of gynecologic cancers.

Which HPV types cause the majority of cervical cancers, and what is the principal prevention strategy?

HPV types 16 and 18 cause ~70% of cervical cancers. Prevention: HPV vaccination (bivalent/quadrivalent/9-valent) ideally before sexual debut, plus screening with Pap smear/HPV DNA testing.

What tumor marker is most associated with epithelial ovarian cancer, and which marker with germ cell tumors?

CA-125 is elevated in epithelial ovarian cancer. Germ cell tumors: AFP (yolk sac/endodermal sinus tumor), beta-hCG (choriocarcinoma, dysgerminoma), LDH (dysgerminoma).

What is a complete hydatidiform mole's karyotype and its malignant potential?

Complete mole: usually 46,XX (entirely paternal, diploid; empty ovum fertilized), no fetal tissue, 'snowstorm' on ultrasound, markedly elevated hCG, ~15-20% risk of progressing to gestational trophoblastic neoplasia.

What hormonal axis governs the menstrual cycle, and what triggers the LH surge causing ovulation?

The hypothalamic-pituitary-ovarian (HPO) axis (GnRH → FSH/LH → estrogen/progesterone). A sustained rise in estradiol from the dominant follicle exerts positive feedback, triggering the LH surge that causes ovulation (~day 14).

What are the Rotterdam criteria for diagnosing polycystic ovary syndrome (PCOS)?

2 of 3: 1) oligo/anovulation, 2) clinical or biochemical hyperandrogenism, 3) polycystic ovaries on ultrasound (≥12 follicles 2-9 mm or ovarian volume >10 mL). Other causes must be excluded.

What is the most common cause of primary amenorrhea with absent uterus but normal female secondary sexual characteristics?

Mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome) — 46,XX with absent uterus/upper vagina but functioning ovaries (normal secondary sexual characteristics). Differentiate from androgen insensitivity (46,XY, testes, no pubic/axillary hair).

What is the leading cause of irreversible blindness worldwide, and what is the leading cause of preventable blindness?

Glaucoma is the leading cause of irreversible blindness worldwide; cataract is the leading cause of reversible/preventable blindness (and the leading overall cause in developing countries).

Differentiate the presentation of acute angle-closure glaucoma from primary open-angle glaucoma.

Acute angle-closure: sudden painful red eye, halos around lights, mid-dilated fixed pupil, hard eye, nausea — ophthalmic emergency. Open-angle: painless, gradual peripheral vision loss with increased cup-to-disc ratio, often asymptomatic until late.

What is the Rinne and Weber test pattern in conductive vs. sensorineural hearing loss?

Conductive loss: Rinne negative (bone > air) in affected ear; Weber lateralizes TO the affected ear. Sensorineural loss: Rinne positive (air > bone); Weber lateralizes AWAY from the affected (to the good) ear.

What is the most common cause of acute otitis media and the most common cause of vertigo overall?

Acute otitis media: most common bacterial cause is Streptococcus pneumoniae (then H. influenzae, M. catarrhalis). Most common cause of vertigo overall is benign paroxysmal positional vertigo (BPPV), due to canalith debris (otoconia).

What is the most common malignancy of the head and neck, and its strongest risk factors?

Squamous cell carcinoma is the most common head and neck malignancy. Strongest risk factors are tobacco and alcohol use (synergistic); HPV (type 16) is a major risk factor for oropharyngeal SCC.

What dermatologic condition shows a 'herald patch' followed by a 'Christmas tree' distribution?

Pityriasis rosea — begins with a single herald patch, then a generalized eruption of oval scaly plaques along skin cleavage lines giving a 'Christmas tree' pattern on the back. Self-limiting.

What is the difference between psoriasis and lichen planus by the classic clinical signs?

Psoriasis: well-demarcated erythematous plaques with silvery scale, Auspitz sign (pinpoint bleeding on scale removal), Koebner phenomenon, extensor surfaces. Lichen planus: pruritic Purple Polygonal Papules/Plaques with Wickham striae, flexor surfaces, 'P's of LP.

Per the DSM-5, how long must symptoms persist to diagnose a major depressive episode vs. schizophrenia?

Major depressive episode: ≥5 symptoms (incl. depressed mood or anhedonia) for ≥2 weeks. Schizophrenia: ≥2 characteristic symptoms with continuous signs ≥6 months (with ≥1 month of active-phase symptoms).

What is the classification (Salter-Harris) of physeal (growth plate) fractures, and which type is most common?

Salter-Harris I-V: I=through physis, II=physis+metaphysis (most common), III=physis+epiphysis, IV=metaphysis+physis+epiphysis, V=crush injury (worst prognosis). Mnemonic SALTR: Slip, Above, Lower, Through, Rammed/cRush.