MBBS 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 MBBS, 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 MBBS

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

1. Define acute coronary syndrome (ACS) and list the three clinical entities it encompasses.

   ACS is a spectrum of conditions caused by acute myocardial ischemia from reduced coronary blood flow. The three entities are: (1) unstable angina (UA), (2) non-ST-elevation myocardial infarction (NSTEMI), and (3) ST-elevation myocardial infarction (STEMI).

2. What is the core pathophysiological event underlying most cases of acute coronary syndrome?

   Rupture or erosion of a vulnerable (lipid-rich, thin fibrous cap) atherosclerotic plaque, exposing thrombogenic material that triggers platelet aggregation and thrombus formation, causing partial or complete coronary occlusion.

3. Distinguish unstable angina from NSTEMI on the basis of biomarkers and ECG.

   Both show ischemic symptoms without ST elevation (often ST depression/T-wave inversion). Unstable angina has NORMAL cardiac troponin (no myocardial necrosis), whereas NSTEMI has ELEVATED troponin indicating myocyte necrosis.

4. Which ECG finding defines STEMI, and what is the typical territory-to-artery correlation for an inferior STEMI?

   STEMI is defined by new ST-segment elevation in two contiguous leads (with reciprocal changes). An inferior STEMI shows ST elevation in leads II, III, and aVF, usually due to occlusion of the right coronary artery (RCA).

5. What is the gold-standard biomarker for diagnosing myocardial infarction, and what is its time course?

   Cardiac troponin (T or I) is the gold standard. It rises within 3-4 hours of injury, peaks at 24-48 hours, and remains elevated for 7-14 days. High-sensitivity troponin allows earlier detection.

6. State the initial medical management mnemonic 'MONA-BASH' components for ACS.

   Morphine, Oxygen (only if $SpO_2 < 90\%$), Nitrates, Aspirin, plus Beta-blocker, ACE inhibitor, Statin, Heparin (anticoagulation) and a second antiplatelet (P2Y12 inhibitor).

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

   Primary percutaneous coronary intervention (PCI) is preferred. Target door-to-balloon time $\leq 90$ minutes. If PCI is unavailable, fibrinolysis should be given within 30 minutes (door-to-needle) and ideally within 12 hours of symptom onset.

8. Define stable angina and describe its classic clinical triad.

   Stable angina is predictable, exertional chest discomfort due to fixed coronary stenosis causing demand-supply mismatch. Classic triad: (1) substernal chest discomfort, (2) provoked by exertion/emotional stress, (3) relieved within minutes by rest or sublingual nitroglycerin.

9. What is the underlying pathophysiology of stable angina versus unstable angina?

   Stable angina results from a FIXED atherosclerotic stenosis (usually $>70\%$) causing ischemia only when myocardial oxygen demand rises. Unstable angina results from an acute, dynamic event—plaque rupture with non-occlusive thrombus—causing ischemia at rest.

10. What is the first-line investigation to confirm stable angina in a patient able to exercise, and what defines a positive result?

    Exercise (treadmill) ECG stress testing. A positive (ischemic) result is horizontal or downsloping ST-segment depression $\geq 1$ mm. CT coronary angiography is increasingly first-line for anatomical assessment.

11. List the first-line anti-anginal drug classes for symptomatic relief in stable angina.

    Beta-blockers and/or calcium channel blockers are first-line. Short-acting sublingual nitrates are used for acute relief. Second-line options include long-acting nitrates, ivabradine, nicorandil, and ranolazine.

12. Which two drug classes reduce mortality (prognostic benefit) in chronic ischemic heart disease, beyond symptom control?

    Antiplatelet therapy (aspirin, or clopidogrel) and statins (high-intensity) improve prognosis. ACE inhibitors are added in patients with diabetes, hypertension, LV dysfunction, or prior MI.

13. Define chronic (stable) ischemic heart disease and name its major modifiable risk factors.

    A chronic condition of myocardial ischemia from established coronary atherosclerosis. Major modifiable risk factors: smoking, hypertension, diabetes mellitus, dyslipidemia (high LDL), obesity, physical inactivity, and an atherogenic diet.

14. What is Prinzmetal (variant) angina and its characteristic ECG finding?

    Angina caused by coronary artery vasospasm, occurring typically at rest and at night, in patients who may have normal/near-normal coronary arteries. ECG shows transient ST-segment ELEVATION during the episode that resolves with vasospasm relief.

15. Name three mechanical complications of acute myocardial infarction and their typical timing.

    (1) Papillary muscle rupture → acute mitral regurgitation (days 3-5); (2) ventricular septal rupture → VSD (days 3-5); (3) free wall rupture → tamponade (days 3-7). Earlier complications include arrhythmias and cardiogenic shock.

16. Differentiate upper from lower gastrointestinal bleeding by anatomical landmark and typical presentation.

    The landmark is the ligament of Treitz (duodenojejunal flexure). Upper GI bleeding (proximal) presents with hematemesis and/or melena. Lower GI bleeding (distal) typically presents with hematochezia (fresh blood per rectum).

17. List the two most common causes of upper GI bleeding.

    (1) Peptic ulcer disease (the most common cause), and (2) esophageal/gastric variceal bleeding (in portal hypertension). Other causes: Mallory-Weiss tear, erosive gastritis/esophagitis, and malignancy.

18. What scoring systems are used to risk-stratify upper GI bleeding, and what does each assess?

    The Glasgow-Blatchford score (pre-endoscopy) assesses need for intervention/admission; a score of 0 may allow outpatient management. The Rockall score (uses endoscopy findings) predicts rebleeding and mortality.

19. Outline the acute management priorities for a patient with variceal upper GI bleeding.

    Resuscitate (ABC, IV access, fluids/blood, restrictive transfusion to Hb $\geq 7$ g/dL), give a vasoactive drug (terlipressin/octreotide), prophylactic antibiotics, then urgent endoscopic variceal band ligation. Balloon tamponade or TIPS if refractory.

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