FMGE Internal Medicine Syllabus

Internal Medicine syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Internal Medicine in FMGE, not a summary of it.

1. 1

   Ischemic heart disease

   3 topics

   • Acute coronary syndrome
     • STEMI
     • NSTEMI
     • Unstable angina
   • Stable angina
   • Chronic ischemic heart disease
2. 2

   Asthma

   4 topics

   • Pathophysiology
   • Clinical Features
   • Diagnosis
   • Management
     • Inhaled Corticosteroids
     • Bronchodilators
     • Biologics
3. 3

   Gastroenterology

   5 topics

   • Gastrointestinal bleeding
     • Upper gastrointestinal bleeding (peptic ulcer disease, esophageal varices)
     • Lower gastrointestinal bleeding (diverticulosis, colorectal cancer)
   • Liver diseases
     • Hepatitis (viral hepatitis, alcoholic hepatitis)
     • Cirrhosis
     • Non-alcoholic fatty liver disease (NAFLD)
     • Hepatocellular carcinoma
   • Inflammatory bowel disease (IBD)
     • Crohn's disease
     • Ulcerative colitis
   • Gastrointestinal infections
     • Gastroenteritis (viral, bacterial)
     • Clostridium difficile infection
     • Parasitic infections
   • Pancreatic diseases
     • Acute pancreatitis
     • Chronic pancreatitis
     • Pancreatic cancer
4. 4

   Acute kidney injury (AKI)

   6 topics

   • Prerenal causes of AKI
   • Intrinsic causes of AKI
   • Postrenal causes of AKI
   • Clinical features of AKI
   • Diagnosis of AKI
   • Management of AKI
5. 5

   Diabetes mellitus

   5 topics

   • Type 1 diabetes
   • Type 2 diabetes
   • Diabetic ketoacidosis (DKA)
   • Hyperosmolar hyperglycemic state (HHS)
   • Diabetic complications
     • Retinopathy
     • Nephropathy
     • Neuropathy
6. 6

   Anemia

   4 topics

   • Iron deficiency anemia
   • Megaloblastic anemia
     • Vitamin B12 deficiency
     • Folate deficiency
   • Hemolytic anemia
     • Autoimmune hemolytic anemia
     • Hereditary spherocytosis
   • Aplastic anemia
7. 7

   Infectious Diseases

   5 topics

   • Bacterial Infections
     • Sepsis
     • Pneumonia (community-acquired)
     • Pneumonia (hospital-acquired)
     • Urinary Tract Infection (UTI)
     • Skin and Soft Tissue Infections
     • Tuberculosis
   • Viral Infections
     • Human Immunodeficiency Virus (HIV)
     • Viral Hepatitis (Hepatitis B)
     • Viral Hepatitis (Hepatitis C)
     • Influenza
     • Herpes Simplex Virus (HSV)
     • Varicella-Zoster Virus (VZV)
   • Fungal Infections
     • Candidiasis
     • Aspergillosis
     • Cryptococcosis
     • Histoplasmosis
   • Parasitic Infections
     • Malaria
     • Leishmaniasis
     • Toxoplasmosis
     • Schistosomiasis
   • Antimicrobial Therapy
     • Antibiotics (Penicillins)
     • Antibiotics (Cephalosporins)
     • Antibiotics (Fluoroquinolones)
     • Antifungals
     • Antivirals
     • Antiparasitic Drugs
8. 8

   Rheumatology

   4 topics

   • Rheumatoid arthritis
     • Pathophysiology
     • Clinical features
     • Diagnosis (rheumatoid factor, anti-CCP antibodies)
     • Management (disease-modifying antirheumatic drugs, biologics)
   • Systemic lupus erythematosus (SLE)
     • Clinical features
     • Diagnosis (antinuclear antibodies, anti-dsDNA antibodies)
     • Management (corticosteroids, immunosuppressants)
   • Spondyloarthropathies
     • Ankylosing spondylitis
     • Psoriatic arthritis
     • Reactive arthritis
     • Enteropathic arthritis
   • Vasculitis
     • Giant cell arteritis
     • Takayasu arteritis
     • Polyarteritis nodosa
     • Granulomatosis with polyangiitis (Wegener's granulomatosis)
9. 9

   Geriatrics

   3 topics

   • Geriatric syndromes
     • Falls
     • Delirium
     • Dementia
     • Urinary incontinence
     • Frailty
   • Polypharmacy
     • Rational prescribing in elderly patients
     • Drug interactions
     • Adverse drug reactions
   • Geriatric assessment
     • Comprehensive geriatric assessment (CGA)
     • Functional assessment
     • Cognitive assessment
10. 10

    Vaccinations

    3 topics

    • Childhood vaccinations
      • DTaP
      • MMR
      • Varicella
    • Adult vaccinations
      • Influenza
      • Pneumococcal
      • Herpes Zoster
    • Travel vaccinations

Internal Medicine flashcards for FMGE

19 of 50 cards from the Internal Medicine deck — real questions with worked answers.

1. In acute coronary syndrome (ACS), what ECG and biomarker findings distinguish STEMI, NSTEMI, and unstable angina?

   STEMI: ST-segment elevation (or new LBBB) with elevated troponin. NSTEMI: no ST elevation (ST depression/T inversion) with elevated troponin. Unstable angina: ischemic symptoms/ECG changes but normal cardiac troponin.

2. What is the immediate initial drug management ('MONA-B') for a patient presenting with acute coronary syndrome?

   Morphine (for pain), Oxygen (if SpO2 <90%), Nitrates, Aspirin (loading 300 mg chewed), plus a second antiplatelet (e.g., clopidogrel/ticagrelor) and Beta-blocker; anticoagulation (heparin) is also given.

3. What is the preferred reperfusion strategy for STEMI and the key time targets?

   Primary PCI is preferred; target door-to-balloon time <90 minutes. If PCI is unavailable within 120 minutes, give fibrinolysis (door-to-needle <30 minutes), ideally within 12 hours of symptom onset.

4. Define stable angina and describe its characteristic clinical features.

   Stable angina is predictable retrosternal chest pain/pressure provoked by exertion or emotion and relieved within minutes by rest or sublingual nitroglycerin, caused by fixed coronary atherosclerotic stenosis (typically >70%).

5. What is the underlying pathophysiology of chronic ischemic heart disease (stable angina)?

   A mismatch between myocardial oxygen supply and demand due to fixed atherosclerotic narrowing of coronary arteries; flow is adequate at rest but becomes insufficient when demand rises during exertion.

6. What is the first-line antianginal drug class for symptom control in stable angina, and which drugs reduce mortality?

   Beta-blockers are first-line for symptom control (also calcium channel blockers/nitrates). Mortality-reducing therapy includes aspirin and statins (plus management of risk factors).

7. What is the most common cause of acute upper gastrointestinal bleeding, and how is upper vs lower GI bleed clinically distinguished?

   Peptic ulcer disease is the most common cause of upper GI bleed. Upper GI bleed (proximal to ligament of Treitz) presents with hematemesis and melena; lower GI bleed presents with hematochezia (fresh blood per rectum).

8. What is the management approach for acute variceal upper GI bleeding?

   Resuscitate (IV fluids/blood), give a vasoactive drug (octreotide/terlipressin), prophylactic antibiotics (e.g., ceftriaxone), and perform urgent endoscopic band ligation; balloon tamponade or TIPS if refractory.

9. Name the major complications of cirrhosis (liver disease).

   Portal hypertension with esophageal varices, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, coagulopathy, and hepatocellular carcinoma.

10. What scoring systems are used to assess prognosis in chronic liver disease?

    Child-Pugh score (bilirubin, albumin, INR, ascites, encephalopathy) and the MELD score (bilirubin, creatinine, INR) used to assess severity and prioritize transplant.

11. Compare ulcerative colitis and Crohn's disease in terms of distribution and depth of involvement.

    Ulcerative colitis: continuous mucosal inflammation limited to the colon, starting at the rectum. Crohn's disease: transmural, skip-lesion (patchy) inflammation that can affect any part of the GI tract (mouth to anus), commonly the terminal ileum.

12. What are characteristic extra-features distinguishing Crohn's disease (e.g., on imaging/histology) from ulcerative colitis?

    Crohn's: non-caseating granulomas, fistulae, strictures, perianal disease, 'cobblestone' appearance, and 'string sign' on barium. UC: crypt abscesses, pseudopolyps, lead-pipe colon, and increased toxic megacolon/colorectal cancer risk.

13. What is the most common cause of acute infectious bloody diarrhea (dysentery), and which organism causes pseudomembranous colitis?

    Shigella (and enterohemorrhagic E. coli, Campylobacter, Salmonella, Entamoeba histolytica) cause dysentery. Clostridioides difficile (often after antibiotics) causes pseudomembranous colitis.

14. State Ranson's/severity markers and the two most common causes of acute pancreatitis.

    Most common causes are gallstones and alcohol. Diagnosis: serum lipase/amylase >3x upper limit plus characteristic epigastric pain radiating to the back; severity assessed by Ranson criteria, APACHE II, or CT severity index.

15. List the prerenal causes of acute kidney injury (AKI).

    Decreased renal perfusion: hypovolemia (hemorrhage, vomiting, diarrhea, burns), hypotension/shock, heart failure, cirrhosis (hepatorenal), renal artery stenosis, and drugs like NSAIDs and ACE inhibitors/ARBs.

16. What are the major intrinsic (renal) causes of AKI?

    Acute tubular necrosis (ischemic or nephrotoxic, the most common intrinsic cause), acute interstitial nephritis, glomerulonephritis, and vascular causes (vasculitis, thrombotic microangiopathy).

17. What are the postrenal causes of AKI?

    Obstruction to urine flow: bilateral ureteric obstruction (stones, tumors, retroperitoneal fibrosis), bladder outlet obstruction (BPH, prostate cancer), or urethral obstruction/blocked catheter.

18. What are the clinical features of acute kidney injury?

    Oliguria/anuria, rising urea and creatinine, fluid overload (edema, pulmonary edema), electrolyte disturbances (hyperkalemia, metabolic acidosis), nausea, confusion, and in severe cases uremic pericarditis or encephalopathy.

19. How are prerenal AKI and intrinsic (ATN) AKI distinguished using urine indices?

    Prerenal: BUN:creatinine ratio >20:1, FENa <1%, urine osmolality >500, concentrated urine. ATN: BUN:creatinine ~10-15:1, FENa >2%, urine osmolality <350, with muddy brown granular casts.

See more Internal Medicine flashcards →

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