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FMGE Internal Medicine Syllabus

The Internal Medicine syllabus for FMGE in full: 10 chapters, 42 topics and 85 sub-topics, every one listed below, plus 50 Internal Medicine flashcards with answers.

10Chapters
42Topics
85Sub-topics
50Flashcards

Internal Medicine syllabus: all 10 chapters

Expand any chapter to see its topics and sub-topics.

  1. Ischemic heart disease

     3 topics
    • Acute coronary syndrome
      • STEMI
      • NSTEMI
      • Unstable angina
    • Stable angina
    • Chronic ischemic heart disease

  2. Asthma

     4 topics
    • Pathophysiology
    • Clinical Features
    • Diagnosis
    • Management
      • Inhaled Corticosteroids
      • Bronchodilators
      • Biologics

  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. 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. Diabetes mellitus

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

  6. Anemia

     4 topics
    • Iron deficiency anemia
    • Megaloblastic anemia
      • Vitamin B12 deficiency
      • Folate deficiency
    • Hemolytic anemia
      • Autoimmune hemolytic anemia
      • Hereditary spherocytosis
    • Aplastic anemia

  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. 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. 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. Vaccinations

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

FMGE Internal Medicine flashcards — 50 questions with 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.

  20. What are the emergency (life-threatening) indications for dialysis in AKI?

    AEIOU: severe Acidosis (refractory metabolic acidosis), Electrolyte disturbance (refractory hyperkalemia), Intoxication (dialyzable toxins), Overload (refractory fluid/pulmonary edema), and Uremia (encephalopathy, pericarditis).

Show the other 30 Internal Medicine flashcards

  1. What is the pathophysiologic basis distinguishing Type 1 from Type 2 diabetes mellitus?

    Type 1: autoimmune destruction of pancreatic beta cells causing absolute insulin deficiency (insulin-dependent). Type 2: insulin resistance with relative insulin deficiency and progressive beta-cell dysfunction.

  2. What are the diagnostic criteria for diabetes mellitus?

    Any of: fasting plasma glucose >=126 mg/dL, 2-hour OGTT glucose >=200 mg/dL, HbA1c >=6.5%, or random glucose >=200 mg/dL with classic symptoms. (A repeat confirmatory test is needed if asymptomatic.)

  3. What is the first-line oral pharmacologic agent for Type 2 diabetes and its mechanism?

    Metformin, a biguanide that decreases hepatic gluconeogenesis and improves peripheral insulin sensitivity; it does not cause hypoglycemia or weight gain.

  4. What is the diagnostic triad of diabetic ketoacidosis (DKA)?

    Hyperglycemia (>250 mg/dL), high anion-gap metabolic acidosis (pH <7.3, bicarbonate <18), and ketosis/ketonemia. Most common in Type 1 diabetes.

  5. Outline the management of diabetic ketoacidosis.

    IV fluids (normal saline first), IV insulin infusion, and potassium replacement (insulin drives K+ into cells); correct precipitating cause. Add dextrose when glucose falls to ~200-250 mg/dL to continue insulin until ketones clear.

  6. How does hyperosmolar hyperglycemic state (HHS) differ from DKA?

    HHS (typically Type 2 DM) shows extreme hyperglycemia (often >600 mg/dL), very high serum osmolality (>320), profound dehydration, and altered mental status, with minimal/absent ketosis and no significant acidosis.

  7. List the chronic microvascular and macrovascular complications of diabetes mellitus.

    Microvascular: retinopathy, nephropathy, and neuropathy. Macrovascular: coronary artery disease, stroke, and peripheral vascular disease. Also diabetic foot ulcers and increased infection risk.

  8. What is the classic blood-film and lab picture of iron deficiency anemia?

    Microcytic hypochromic anemia (low MCV, low MCH) with low serum ferritin and serum iron, high TIBC, and low transferrin saturation; the most common cause of anemia worldwide.

  9. What causes megaloblastic anemia and what are its hematologic hallmarks?

    Vitamin B12 or folate deficiency impairing DNA synthesis; macrocytic anemia (high MCV) with hypersegmented neutrophils and megaloblasts in the marrow. B12 deficiency may add neurological signs (subacute combined degeneration).

  10. What laboratory findings indicate hemolytic anemia?

    Anemia with elevated reticulocyte count, raised indirect (unconjugated) bilirubin and LDH, low haptoglobin; peripheral smear may show schistocytes, spherocytes, or sickle cells. Direct Coombs test identifies autoimmune hemolysis.

  11. What defines aplastic anemia and its characteristic finding?

    Bone marrow failure causing pancytopenia (anemia, leukopenia, thrombocytopenia) with a hypocellular ('empty', fatty) bone marrow and low reticulocyte count, without abnormal cells.

  12. What is the empiric first-line antibiotic concept for community-acquired pneumonia and meningitis?

    CAP: amoxicillin or a macrolide (atypical cover); severe cases beta-lactam + macrolide. Bacterial meningitis: empiric ceftriaxone + vancomycin (add ampicillin if Listeria suspected) plus dexamethasone.

  13. Name a classic viral infection cause for each: hepatitis transmitted enterally, mononucleosis, and dengue.

    Enterally transmitted hepatitis: Hepatitis A and E (fecal-oral). Infectious mononucleosis: Epstein-Barr virus (EBV). Dengue: dengue virus transmitted by Aedes aegypti mosquito.

  14. What is the most common opportunistic fungal infection in immunocompromised/HIV patients and its treatment?

    Candidiasis (oral/esophageal) is common; Cryptococcus neoformans causes meningitis in advanced HIV (treated with amphotericin B + flucytosine then fluconazole). Invasive aspergillosis is treated with voriconazole.

  15. What protozoan causes malaria, how is it diagnosed, and which species is most dangerous?

    Plasmodium species transmitted by female Anopheles mosquito; diagnosed by peripheral blood smear (thick and thin films) or rapid antigen test. Plasmodium falciparum causes the most severe/cerebral malaria.

  16. What is the principle of empiric vs definitive (de-escalation) antimicrobial therapy?

    Empiric therapy is broad-spectrum, started before culture results based on likely pathogens; once culture and sensitivity return, therapy is de-escalated (narrowed) to the most effective, narrowest-spectrum agent (antimicrobial stewardship).

  17. What are the diagnostic hallmarks (clinical and serologic) of rheumatoid arthritis?

    Symmetric inflammatory polyarthritis of small joints (MCP, PIP, wrist) with morning stiffness >1 hour, sparing the DIP joints; positive rheumatoid factor and anti-CCP antibodies, with raised ESR/CRP and erosions on X-ray.

  18. What are the characteristic features and key autoantibodies of systemic lupus erythematosus (SLE)?

    Multisystem disease with malar (butterfly) rash, photosensitivity, arthritis, serositis, nephritis, and cytopenias. ANA is sensitive (screening); anti-dsDNA and anti-Smith antibodies are specific. Affects mainly young women.

  19. What unifies the spondyloarthropathies, and which gene is associated?

    Seronegative (RF-negative) inflammatory arthritides involving the axial skeleton/sacroiliitis and enthesitis, strongly associated with HLA-B27. They include ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and enteropathic arthritis.

  20. How are vasculitides classified by vessel size, with one example of each?

    Large vessel: giant cell (temporal) arteritis, Takayasu arteritis. Medium vessel: polyarteritis nodosa, Kawasaki disease. Small vessel: granulomatosis with polyangiitis (ANCA-associated), Henoch-Schonlein purpura (IgA vasculitis).

  21. What are the classic 'geriatric giants' (geriatric syndromes)?

    The geriatric giants include immobility, instability (falls), incontinence, and impaired cognition/intellect (delirium and dementia); also frailty, pressure ulcers, and iatrogenesis.

  22. What is polypharmacy and why is it a concern in the elderly?

    Polypharmacy is the concurrent use of multiple medications (commonly >=5); in the elderly it increases the risk of adverse drug reactions, drug-drug interactions, falls, non-adherence, and prescribing cascades. Tools like the Beers criteria identify potentially inappropriate medications.

  23. What is a comprehensive geriatric assessment (CGA)?

    A multidimensional, interdisciplinary evaluation of an older adult's medical, functional (ADL/IADL), cognitive, psychological, nutritional, and social status to develop a coordinated care and follow-up plan.

  24. Name key live-attenuated vaccines that are part of childhood immunization and a contraindication.

    Live vaccines include BCG, oral polio (OPV), measles/MMR, rotavirus, and varicella. They are generally contraindicated in pregnancy and in significant immunocompromise.

  25. Which adult vaccinations are routinely recommended, especially for older or high-risk adults?

    Annual influenza vaccine, pneumococcal vaccine (e.g., for age >=65 or chronic disease), tetanus-diphtheria (Td/Tdap) boosters, herpes zoster (shingles) vaccine for older adults, and COVID-19; hepatitis B for at-risk groups.

  26. Which vaccines are commonly required or recommended for international travelers?

    Depending on destination: yellow fever (mandatory for some countries, with certificate), typhoid, hepatitis A and B, meningococcal (e.g., for Hajj), Japanese encephalitis, rabies (pre-exposure), and cholera; plus malaria chemoprophylaxis (not a vaccine).

  27. What ECG leads localize an inferior wall myocardial infarction, and which artery is usually involved?

    Inferior MI shows ST elevation in leads II, III, and aVF, usually due to occlusion of the right coronary artery (RCA). It may be complicated by bradycardia/heart block and right ventricular involvement.

  28. What is the most common organism causing spontaneous bacterial peritonitis (SBP) and its diagnostic ascitic fluid criterion?

    E. coli is the most common cause. Diagnosis: ascitic fluid polymorphonuclear (neutrophil) count >=250 cells/mm3; treated empirically with a third-generation cephalosporin (e.g., cefotaxime).

  29. What is the formula and significance of the corrected reticulocyte count / anemia classification by MCV?

    Anemia is classified by MCV as microcytic (<80 fL: iron deficiency, thalassemia), normocytic (80-100 fL: acute blood loss, hemolysis, chronic disease), and macrocytic (>100 fL: B12/folate deficiency). A reticulocyte response indicates marrow activity (hemolysis/blood loss vs hypoproliferative anemia).

  30. What is the Wells/CURB-65 type concept—name the CURB-65 criteria used to assess pneumonia severity.

    CURB-65: Confusion, Urea >7 mmol/L, Respiratory rate >=30, Blood pressure (systolic <90 or diastolic <=60), and age >=65. Each scores 1 point; higher scores indicate greater severity and need for hospital/ICU admission.

Same Internal Medicine syllabus in other exams

The Internal Medicine outline above is identical in these 3 exams:

FMGE Internal Medicine FAQ

What is in the FMGE Internal Medicine syllabus?

FMGE Internal Medicine is split into 10 chapters: Ischemic heart disease, Asthma, Gastroenterology, Acute kidney injury (AKI), Diabetes mellitus, Anemia, Infectious Diseases, Rheumatology, Geriatrics and Vaccinations. Together they contain 42 topics and 85 sub-topics.

How many chapters are in FMGE Internal Medicine?

10 chapters, containing 42 topics and 85 sub-topics. The largest chapter is Acute kidney injury (AKI), with 6 topics.

Are there flashcards for FMGE Internal Medicine?

Yes — a 50-card Internal Medicine deck, printed in full in the flashcards section of this page and available in the Examius app with spaced repetition. The free plan covers one exam of your choice, including its flashcards; Examius Pro, a one-time purchase, unlocks every other exam and deck.