NEET PG Internal Medicine Syllabus

What are the clinical features and complications of acute kidney injury?

Often oliguria (<400 mL/day) or anuria, rising creatinine/urea. Complications: fluid overload/pulmonary edema, HYPERKALEMIA (most dangerous), metabolic acidosis, hyperphosphatemia/hypocalcemia, uremia (encephalopathy, pericarditis, platelet dysfunction).

What are the indications for emergency dialysis in AKI (mnemonic AEIOU)?

A — severe metabolic Acidosis refractory to therapy; E — Electrolyte disturbance, especially refractory Hyperkalemia; I — Intoxication (dialyzable poisons: salicylates, lithium, methanol, ethylene glycol); O — fluid Overload refractory to diuretics; U — Uremic complications (pericarditis, encephalopathy, bleeding).

What is the general supportive management of AKI?

Identify and treat the cause; optimize volume status and renal perfusion; STOP nephrotoxic drugs (NSAIDs, ACEi/ARB, aminoglycosides, contrast); adjust drug doses to renal function; correct hyperkalemia and acidosis; treat hyperkalemia urgently; and initiate dialysis for AEIOU indications.

How is the pathophysiology of type 1 diabetes different from type 2 diabetes?

Type 1: autoimmune destruction of pancreatic beta cells → ABSOLUTE insulin deficiency (anti-GAD/islet antibodies, HLA-associated, ketosis-prone). Type 2: insulin resistance with relative insulin deficiency and progressive beta-cell dysfunction, strongly linked to obesity and metabolic syndrome; not autoimmune and less ketosis-prone.

What are the diagnostic glycemic thresholds for diabetes mellitus?

Any one: fasting plasma glucose >=126 mg/dL (7.0 mmol/L); 2-hour OGTT glucose >=200 mg/dL (11.1 mmol/L); HbA1c >=6.5%; or random glucose >=200 mg/dL with classic symptoms. Asymptomatic results need confirmation on a repeat test.

What is the first-line and stepwise pharmacologic management of type 2 diabetes?

Lifestyle modification plus METFORMIN first-line. Add agents with cardio-renal benefit: SGLT2 inhibitors (heart failure/CKD) and GLP-1 agonists (ASCVD, weight loss). Other agents: sulfonylureas, DPP-4 inhibitors, pioglitazone; insulin when other agents fail or glucose is very high.

What are the diagnostic criteria and key management steps for diabetic ketoacidosis (DKA)?

Triad: hyperglycemia (>250 mg/dL), high anion-gap metabolic acidosis (pH <7.3, HCO3 <18), and ketonemia/ketonuria. Management: aggressive IV fluids first, then IV regular insulin infusion, and POTASSIUM replacement (insulin drives K+ into cells). Find and treat the precipitant (infection, missed insulin).

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

HHS occurs in type 2 diabetes: profound hyperglycemia (often >600 mg/dL), severe hyperosmolarity (>320 mOsm/kg), and marked dehydration with altered mental status, but MINIMAL or NO ketosis/acidosis (residual insulin prevents ketogenesis). It has higher mortality; treatment is aggressive fluids, insulin, and electrolyte correction.

What are the microvascular and macrovascular complications of diabetes?

Microvascular: retinopathy, nephropathy (microalbuminuria → CKD), and neuropathy (peripheral sensory, autonomic). Macrovascular: coronary artery disease, stroke, and peripheral arterial disease. Also diabetic foot ulcers and increased infection risk. Tight glycemic and BP control plus ACEi/ARB and statins reduce complications.

What are the laboratory findings and causes of iron deficiency anemia?

Microcytic, hypochromic anemia with LOW ferritin, low serum iron, HIGH total iron-binding capacity (TIBC), and low transferrin saturation. Causes: chronic blood loss (GI bleeding, menorrhagia), inadequate intake, malabsorption, increased demand (pregnancy). In older adults, occult GI malignancy must be excluded.

What distinguishes vitamin B12 deficiency from folate deficiency in megaloblastic anemia?

Both cause macrocytic anemia with hypersegmented neutrophils and high MCV. B12 (cobalamin) deficiency ALSO causes neurological signs (subacute combined degeneration of the cord, paresthesias) and methylmalonic acid is elevated. Folate deficiency has no neuro signs and normal methylmalonic acid; both have elevated homocysteine.

What laboratory findings indicate hemolytic anemia and how are causes classified?

Findings: elevated indirect (unconjugated) bilirubin, raised LDH, LOW haptoglobin, reticulocytosis. Intravascular hemolysis adds hemoglobinuria. Classification: intrinsic (hereditary — G6PD deficiency, hereditary spherocytosis, sickle cell, thalassemia) vs extrinsic/acquired (autoimmune — positive direct Coombs test, microangiopathic, infections).

What is the pathophysiology and characteristic finding of aplastic anemia?

Aplastic anemia is bone marrow failure from stem-cell injury (idiopathic/autoimmune, drugs, radiation, viruses, benzene) causing PANCYTOPENIA (anemia, leukopenia, thrombocytopenia) with reticulocytopenia. Bone marrow biopsy shows a HYPOCELLULAR marrow replaced by fat, with no infiltration or fibrosis.

Give examples of bacteria classified by Gram stain and oxygen requirement that are high-yield in internal medicine.

Gram-positive cocci: Staphylococcus (catalase+), Streptococcus/Enterococcus (catalase-). Gram-negative rods: E. coli, Klebsiella, Pseudomonas (aerobe). Anaerobes: Clostridium, Bacteroides. Atypicals (no cell wall/intracellular): Mycoplasma, Chlamydia, Legionella. Acid-fast: Mycobacterium tuberculosis.

What are the key features of viral hepatitis B versus hepatitis C?

Hepatitis B: DNA virus, transmitted parenterally/sexually/perinatally; HBsAg = active infection, anti-HBs = immunity, HBeAg = high infectivity; vaccine available. Hepatitis C: RNA virus, mainly bloodborne (IV drug use); high rate of CHRONIC infection and cirrhosis/HCC; NO vaccine but curable with direct-acting antivirals.

What are common fungal infections and their first-line treatments?

Candidiasis (oral/esophageal/invasive) — fluconazole or echinocandin for invasive disease. Aspergillosis — voriconazole. Cryptococcal meningitis (HIV) — amphotericin B + flucytosine then fluconazole. Pneumocystis jirovecii pneumonia (immunocompromised) — TMP-SMX. Dermatophytes — topical/oral azoles or terbinafine.

What are major parasitic infections relevant to internal medicine and their hallmark features?

Malaria (Plasmodium, cyclical fever, thick/thin smear) — artemisinin-based therapy. Amebiasis (Entamoeba histolytica) — bloody dysentery + liver abscess, metronidazole. Giardiasis — foul fatty diarrhea, metronidazole. Helminths cause eosinophilia. Visceral leishmaniasis (kala-azar) — fever, splenomegaly, pancytopenia.

What principles guide rational antimicrobial therapy?

Use empiric therapy based on likely organisms and local resistance, then DE-ESCALATE to targeted therapy once cultures/sensitivities return. Choose narrowest effective spectrum, correct dose/route/duration, consider tissue penetration and organ function, obtain cultures BEFORE antibiotics when possible, and practice stewardship to limit resistance.

What are the diagnostic and clinical features of rheumatoid arthritis?

Chronic symmetric inflammatory polyarthritis of small joints (MCP, PIP, wrists) with prolonged morning stiffness (>1 hour), sparing the DIP joints. Serology: rheumatoid factor and anti-CCP (more specific). Deformities: ulnar deviation, swan-neck, boutonniere. Treated with DMARDs (methotrexate first-line) and biologics.

What are the classic clinical and serologic features of systemic lupus erythematosus (SLE)?

Multisystem autoimmune disease: malar (butterfly) rash, photosensitivity, oral ulcers, arthritis, serositis, lupus nephritis, cytopenias, neuropsychiatric features. Serology: ANA (sensitive, screening), anti-dsDNA and anti-Smith (specific). Anti-dsDNA and low complement (C3/C4) track disease/nephritis activity.

What defines the spondyloarthropathies and their shared features?

A group including ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and IBD-associated arthritis. Shared features: HLA-B27 association, SERONEGATIVE (RF-negative), axial/sacroiliac involvement, enthesitis, dactylitis, and extra-articular features (uveitis, mucocutaneous lesions). AS shows 'bamboo spine' on imaging.

How are the vasculitides classified by vessel size with key examples?

Large-vessel: giant cell (temporal) arteritis, Takayasu arteritis. Medium-vessel: polyarteritis nodosa, Kawasaki disease. Small-vessel ANCA-associated: granulomatosis with polyangiitis (c-ANCA/PR3), eosinophilic GPA and microscopic polyangiitis (p-ANCA/MPO). Immune-complex small-vessel: IgA vasculitis (Henoch-Schonlein).

What are the common geriatric syndromes ('the geriatric giants')?

Multifactorial conditions in the elderly: falls, frailty, delirium (acute confusion), dementia, urinary incontinence, immobility, pressure ulcers, polypharmacy, sensory impairment, and malnutrition. They share multiple contributing causes and require comprehensive rather than single-disease management.

What is polypharmacy and what tools help reduce inappropriate prescribing in the elderly?

Polypharmacy is the concurrent use of multiple medications (commonly >=5), raising risks of adverse drug events, interactions, falls, and non-adherence. Tools: the BEERS Criteria (potentially inappropriate medications in older adults) and STOPP/START criteria (drugs to stop and beneficial drugs to start) guide deprescribing.

What is comprehensive geriatric assessment (CGA)?

A multidimensional, interdisciplinary evaluation of an older person's medical, functional (ADLs/IADLs), cognitive (e.g. MMSE/MoCA), psychological (mood/depression), nutritional, and social/environmental domains. It produces a coordinated care plan to maximize function and independence, reducing hospitalization and institutionalization.

What are the live versus inactivated vaccines important in the childhood schedule?

Live attenuated: BCG, oral polio (OPV), MMR, varicella, rotavirus, yellow fever (contraindicated in pregnancy and significant immunocompromise). Inactivated/subunit/toxoid: DPT, inactivated polio (IPV), hepatitis B, Hib, pneumococcal conjugate, inactivated influenza, and HPV.

What are the key recommended adult vaccinations?

Influenza (annual), Td/Tdap (tetanus booster every 10 years, one Tdap), pneumococcal (PCV/PPSV23 for elderly and high-risk), hepatitis B, HPV (up to recommended age), zoster (shingles) vaccine for older adults, and MMR/varicella catch-up if non-immune.

Which vaccines are commonly required or recommended for international travelers?

Yellow fever (mandatory for endemic regions, certificate required), typhoid, hepatitis A and B, oral cholera, rabies (pre-exposure for high-risk), Japanese encephalitis, and meningococcal (mandatory for Hajj pilgrims). Routine vaccines should also be up to date; malaria needs chemoprophylaxis, not a vaccine routinely.

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

Inferior MI shows ST changes in leads II, III, and aVF, most commonly from occlusion of the RIGHT CORONARY ARTERY. It may be associated with right ventricular infarction (so avoid nitrates/preload reduction) and with bradyarrhythmias/heart block.

What is the calculation for the fractional excretion of sodium (FENa) and how is it interpreted in AKI?

FENa (%) = (urine Na x plasma creatinine) / (plasma Na x urine creatinine) x 100. FENa <1% suggests PRERENAL AKI (avid sodium retention with intact tubules); FENa >2% suggests intrinsic AKI such as acute tubular necrosis. (Unreliable if the patient is on diuretics.)