DNB CET Medicine and Allied Clinical Specialties Syllabus

Differentiate nephritic from nephrotic syndrome.

Nephritic: hematuria, RBC casts, hypertension, mild-moderate proteinuria, oliguria. Nephrotic: heavy proteinuria (greater than 3.5 g/day), hypoalbuminemia, edema, hyperlipidemia.

What is the classic presentation and timing of post-streptococcal glomerulonephritis?

Nephritic syndrome (hematuria, edema, hypertension) 1-3 weeks after pharyngitis (or 3-6 weeks after skin infection) with group A Strep, low C3, and elevated ASO titre.

List the classic tetrad/criteria used to diagnose sepsis (qSOFA) at the bedside.

qSOFA: respiratory rate greater than or equal to 22/min, altered mentation (GCS less than 15), and systolic BP less than or equal to 100 mmHg; greater than or equal to 2 suggests poor prognosis. Sepsis = suspected infection + SOFA increase greater than or equal to 2; septic shock = vasopressor need + lactate greater than 2 despite fluids.

How is malaria definitively diagnosed, and which species causes severe/cerebral malaria?

Peripheral blood smear (thick and thin) or rapid diagnostic test (antigen). Plasmodium falciparum causes most severe and cerebral malaria.

What is the classic temperature pattern and 'rose spots' associated with which tropical fever?

Typhoid (enteric) fever: stepwise rising fever, relative bradycardia (Faget sign), and rose spots on the trunk; diagnosed by blood culture (Widal is supportive only).

What CD4 count defines AIDS, and at what CD4 do you start Pneumocystis (PCP) prophylaxis in HIV?

AIDS is defined by CD4 less than 200 cells/microL (or an AIDS-defining illness). PCP prophylaxis (co-trimoxazole) is started when CD4 falls below 200 cells/microL.

In acute ischemic stroke, what is the time window for IV thrombolysis with alteplase?

Within 4.5 hours of symptom onset, after excluding hemorrhage on CT and confirming no contraindications; mechanical thrombectomy extends to 24 hours in selected large-vessel occlusions.

Differentiate a generalized tonic-clonic seizure from a focal (partial) seizure.

Generalized seizures involve both hemispheres from onset with loss of consciousness (e.g., tonic-clonic). Focal seizures start in one brain region; awareness may be retained (focal aware) or impaired (focal impaired awareness).

What is the first-line drug for status epilepticus, and what is the definition?

Status epilepticus = a seizure lasting greater than or equal to 5 minutes or repeated seizures without recovery of consciousness. First-line: IV benzodiazepine (lorazepam or diazepam); then load with a second-line agent (e.g., phenytoin/levetiracetam/valproate).

Contrast myasthenia gravis and Lambert-Eaton myasthenic syndrome.

Myasthenia gravis: anti-AChR antibodies, weakness worsens with activity, often ocular onset, associated thymoma. Lambert-Eaton: anti-VGCC antibodies, weakness improves with repeated effort, associated with small-cell lung cancer, autonomic features.

List the major developmental milestones at approximately 6 months, 9 months, and 12 months of age.

6 months: sits with support, rolls over, transfers objects, babbles. 9 months: sits without support, crawls, pincer grasp developing, says 'mama/dada' nonspecifically. 12 months: stands/walks with support, mature pincer grasp, 1-2 meaningful words.

What is the standard age and route for the BCG, OPV-0, and Hepatitis B birth-dose vaccines under India's UIP?

At birth (or as early as possible): BCG (intradermal), OPV-zero dose (oral), and Hepatitis B birth dose (intramuscular).

Which vaccines are given at 6, 10, and 14 weeks in India's Universal Immunization Programme?

At 6, 10, 14 weeks: Pentavalent (DPT+HepB+Hib), OPV, fIPV, Rotavirus vaccine, and PCV (pneumococcal conjugate).

Define birth asphyxia and the score used to assess a newborn at 1 and 5 minutes.

Birth asphyxia is failure to establish breathing at birth causing hypoxia. The APGAR score (Appearance, Pulse, Grimace, Activity, Respiration; each 0-2, max 10) is assessed at 1 and 5 minutes.

Outline the first steps (initial 30 seconds / golden minute) of neonatal resuscitation.

Provide warmth, position the airway and clear secretions if needed, dry and stimulate; if apneic/gasping or HR less than 100, begin positive-pressure ventilation within the first minute ('golden minute').

How are the grades of hypoxic-ischemic encephalopathy (HIE) classified using the Sarnat staging?

Sarnat: Stage 1 (mild) - hyperalert, normal tone, no seizures; Stage 2 (moderate) - lethargy, hypotonia, seizures common; Stage 3 (severe) - stupor/coma, flaccid, suppressed brainstem reflexes.

Differentiate marasmus from kwashiorkor.

Marasmus: severe wasting from energy/protein deficit, very low weight, no edema, 'old man' facies. Kwashiorkor: predominantly protein deficiency with bilateral pedal edema, hepatomegaly, dermatosis, and 'flaky paint' skin/hair changes.

What anthropometric cutoff defines severe acute malnutrition (SAM) in children 6-59 months?

Weight-for-height/length less than -3 SD (severe wasting), and/or MUAC less than 11.5 cm, and/or bilateral pitting pedal edema.

In IMNCI, what are the three classification (triage) colour categories for sick children?

Pink = severe/urgent, needs urgent referral or admission; Yellow = needs specific treatment at the facility; Green = home management with advice.

Name the deficiency and clinical features for vitamin A and vitamin D in children.

Vitamin A deficiency: night blindness, Bitot's spots, xerophthalmia, keratomalacia. Vitamin D deficiency: rickets - bowed legs, rachitic rosary, widened wrists, delayed fontanelle closure.

What is the classic triad of congenital rubella syndrome?

Sensorineural deafness, cataracts (and other eye defects), and congenital heart disease (commonly patent ductus arteriosus).

Describe the inheritance and a key clinical feature each of Down syndrome, Turner syndrome, and Klinefelter syndrome.

Down (trisomy 21): hypotonia, flat facies, single palmar crease, congenital heart disease. Turner (45,X): short stature, webbed neck, gonadal dysgenesis (female). Klinefelter (47,XXY): tall, gynecomastia, small testes, infertility (male).

What histopathological finding is characteristic of psoriasis (a papulosquamous disorder)?

Epidermal hyperplasia with parakeratosis, Munro microabscesses (neutrophils in stratum corneum), thinned suprapapillary plates, and dilated dermal papillary capillaries; clinically the Auspitz sign (pinpoint bleeding on scale removal).

Differentiate pemphigus vulgaris from bullous pemphigoid (vesiculobullous disorders).

Pemphigus vulgaris: intraepidermal flaccid bullae, positive Nikolsky sign, anti-desmoglein (desmoglein 3) antibodies. Bullous pemphigoid: subepidermal tense bullae, negative Nikolsky, anti-BP180/BP230 (basement membrane) antibodies, elderly.

Contrast tuberculoid and lepromatous leprosy.

Tuberculoid (paucibacillary): few well-defined anesthetic hypopigmented patches, few/no bacilli, strong cell-mediated immunity, lepromin positive. Lepromatous (multibacillary): numerous symmetrical lesions, abundant bacilli, weak immunity, lepromin negative.

What is the WHO multidrug therapy (MDT) regimen for multibacillary leprosy?

Rifampicin (monthly supervised), clofazimine (monthly supervised + daily), and dapsone (daily) for 12 months.

Differentiate impetigo from erysipelas (cutaneous bacterial infections).

Impetigo: superficial epidermal infection with honey-colored crusts (Staph aureus/Strep pyogenes). Erysipelas: well-demarcated, raised, fiery-red plaque involving upper dermis/lymphatics, usually Group A Strep, with fever.

State the DSM-5 minimum duration criteria for a major depressive episode and a manic episode.

Major depressive episode: greater than or equal to 5 symptoms (including depressed mood or anhedonia) for at least 2 weeks. Manic episode: elevated/irritable mood plus increased activity/energy for at least 1 week (or any duration if hospitalization needed).

List the core (first-rank) features used to diagnose schizophrenia.

Delusions, hallucinations (often auditory), disorganized speech, grossly disorganized/catatonic behavior, and negative symptoms (flat affect, avolition, alogia); symptoms for at least 6 months (with at least 1 month active phase).

What is the antidote and key features of opioid overdose, and the management of delirium tremens in alcohol withdrawal?

Opioid overdose: pinpoint pupils, respiratory depression, reduced consciousness; reverse with naloxone. Delirium tremens (severe alcohol withdrawal, 48-72 h): confusion, autonomic instability, hallucinations, seizures; treat with benzodiazepines and thiamine.