PGIMER Entrance Community Medicine, Medicine and Surgery Syllabus

What is the demographic cycle stage describing high birth rate with falling death rate (population explosion)?

The Early Expanding stage (Stage 2) of the demographic cycle—high birth rate persists while death rate declines, causing rapid population growth.

In cardiology, what ECG changes indicate ST-elevation myocardial infarction (STEMI), and which artery occlusion causes inferior wall MI?

STEMI shows ST-segment elevation in contiguous leads with reciprocal changes. Inferior wall MI (leads II, III, aVF) is usually due to Right Coronary Artery (RCA) occlusion.

What is the classic triad of right heart failure (cor pulmonale) signs and the most common cause?

Raised JVP, hepatomegaly, and pedal/dependent edema. The most common cause is chronic lung disease (COPD) leading to pulmonary hypertension.

In respiratory medicine, how do obstructive and restrictive lung diseases differ on spirometry (FEV1/FVC ratio)?

Obstructive (asthma, COPD): FEV1/FVC ratio REDUCED (<0.7). Restrictive (fibrosis, sarcoidosis): FEV1/FVC ratio NORMAL or increased, with both FEV1 and FVC reduced and low total lung capacity.

What is the curb-65 score used for, and name its components.

CURB-65 assesses severity/mortality in community-acquired pneumonia. Components: Confusion, Urea >7 mmol/L, Respiratory rate ≥30, Blood pressure (SBP<90 or DBP≤60), age ≥65 years.

In endocrinology, what are the diagnostic criteria for diabetes mellitus (any one)?

Fasting plasma glucose ≥126 mg/dL; OR 2-hour OGTT ≥200 mg/dL; OR HbA1c ≥6.5%; OR random glucose ≥200 mg/dL with classic symptoms.

What is the most common cause of hyperthyroidism, and what antibody is associated with it?

Graves' disease is the most common cause. It is associated with TSH receptor stimulating antibodies (TRAb / thyroid-stimulating immunoglobulin).

Differentiate the lab findings in diabetic ketoacidosis (DKA) vs. hyperosmolar hyperglycemic state (HHS).

DKA: glucose usually 250-600 mg/dL, marked ketosis/acidosis (low pH, low bicarbonate), seen in type 1 DM. HHS: very high glucose (>600 mg/dL), minimal/no ketosis, high serum osmolality, normal/mild acidosis, seen in type 2 DM.

What electrolyte disturbance is characteristic of Addison's disease (primary adrenal insufficiency)?

Hyponatremia and hyperkalemia (due to aldosterone deficiency), often with hypoglycemia and hyperpigmentation (due to high ACTH/MSH).

In nephrology, what is the difference between nephritic and nephrotic syndrome?

Nephritic: hematuria, RBC casts, hypertension, mild proteinuria, oliguria (inflammatory). Nephrotic: heavy proteinuria (>3.5 g/day), hypoalbuminemia, edema, hyperlipidemia (podocyte/membrane damage).

What are the most common causes of acute kidney injury classified as pre-renal, renal, and post-renal?

Pre-renal: hypovolemia/hypotension (dehydration, shock). Intrinsic renal: acute tubular necrosis (ischemia, nephrotoxins). Post-renal: obstruction (stones, BPH, tumors).

In gastroenterology, what organism causes most peptic ulcers, and what is its triple-therapy treatment?

Helicobacter pylori. Triple therapy = a proton pump inhibitor + clarithromycin + amoxicillin (or metronidazole) for 10-14 days.

What is the difference between Crohn's disease and ulcerative colitis in terms of bowel involvement?

Crohn's: any part of GI tract (mouth to anus), skip lesions, transmural inflammation, granulomas. Ulcerative colitis: confined to colon/rectum, continuous involvement, mucosal/submucosal only, no skip lesions.

In neurology, what is the difference between an upper motor neuron (UMN) and lower motor neuron (LMN) lesion?

UMN: spasticity, hyperreflexia, positive Babinski, no significant atrophy, no fasciculations. LMN: flaccidity, hyporeflexia, marked atrophy, fasciculations, negative Babinski.

What is the classic CSF finding in bacterial meningitis vs. viral meningitis?

Bacterial: high neutrophils, high protein, LOW glucose, turbid CSF, high opening pressure. Viral: lymphocytes, mildly raised protein, NORMAL glucose, clear CSF.

What is the treatment of choice for cerebral/falciparum malaria, and the causative species?

Plasmodium falciparum. Treatment of choice is intravenous artesunate (artemisinin-based therapy).

In the phases of wound healing, name the three classic overlapping phases in order.

1) Inflammatory (hemostasis + inflammation, days 0-3), 2) Proliferative (granulation, angiogenesis, epithelialization, days 3-21), 3) Remodeling/maturation (collagen remodeling, scar maturation, weeks to months).

What is the difference between healing by primary and secondary intention?

Primary intention: clean wound edges approximated (e.g., sutured), minimal scarring, fast. Secondary intention: wound left open, heals by granulation tissue, contraction, and re-epithelialization, with more scarring.

Classify the types of shock with one example of each.

Hypovolemic (hemorrhage), Cardiogenic (MI), Distributive (septic, anaphylactic, neurogenic), and Obstructive (cardiac tamponade, tension pneumothorax, massive PE).

What is the hemodynamic profile (preload, cardiac output, SVR) of septic shock vs. cardiogenic shock?

Septic (distributive): low preload/SVR, high or normal cardiac output (warm shock), low SVR. Cardiogenic: high preload, LOW cardiac output, HIGH SVR (cold, clammy).

What is the maintenance IV fluid composition and the 'rule' for fluid resuscitation in trauma (ATLS)?

Initial resuscitation: 1 L (adult) of warmed isotonic crystalloid (Ringer's lactate/normal saline) as a bolus, then reassess; balanced crystalloids and blood products for ongoing hemorrhage. Maintenance: dextrose-saline with potassium based on requirements.

What is the Parkland formula for fluid resuscitation in burns?

Parkland formula: 4 mL x body weight (kg) x % total body surface area (TBSA) burned = total crystalloid (Ringer's lactate) over 24 hours; half given in first 8 hours from time of burn, remaining half over next 16 hours.

In surgical oncology principles, what does the TNM staging system stand for?

T = primary Tumor size/extent, N = regional lymph Node involvement, M = distant Metastasis. It standardizes cancer staging and guides prognosis and treatment.

What is the most common type of surgical-site/wound infection organism, and what defines a 'clean-contaminated' wound?

Staphylococcus aureus is the most common SSI organism. Clean-contaminated wound = elective entry into a hollow viscus (respiratory, GI, GU tract) under controlled conditions without significant spillage.

What is Charcot's triad and Reynolds' pentad in cholangitis?

Charcot's triad (ascending cholangitis): fever with chills, RUQ pain, jaundice. Reynolds' pentad adds hypotension (shock) and altered mental status (confusion), indicating suppurative cholangitis.

What is the classic presentation and management principle of acute appendicitis?

Periumbilical pain migrating to right iliac fossa (McBurney's point), anorexia, fever, with rebound tenderness/guarding. Management is appendicectomy (open or laparoscopic) with antibiotics.

In trauma management, what is the primary survey sequence (ATLS)?

ABCDE: Airway (with C-spine control), Breathing, Circulation (with hemorrhage control), Disability (neurologic/GCS), Exposure/Environment control.

In antenatal care, how many antenatal visits and which key tests/supplements are recommended in India?

At least 4 ANC visits (WHO 2016 recommends 8 contacts). Key: Iron-folic acid supplementation, tetanus toxoid (2 doses/booster), Hb, blood group, blood pressure, urine, and ultrasound. Folic acid is given periconceptionally to prevent neural tube defects.

What are the stages of labour and their definitions?

First stage: onset of true labour to full cervical dilatation (10 cm). Second stage: full dilatation to delivery of baby. Third stage: delivery of baby to expulsion of placenta. (Fourth stage: 1-2 hours postpartum monitoring.)

What is the most common cause of postpartum hemorrhage (PPH), and the first-line uterotonic drug?

Uterine atony is the most common cause of PPH. First-line uterotonic is oxytocin (active management of third stage of labour).

In contraception, what is the mechanism of combined oral contraceptive pills and the Pearl Index concept?

COCs mainly inhibit ovulation by suppressing LH/FSH surge; also thicken cervical mucus and thin endometrium. Pearl Index = number of pregnancies per 100 woman-years of use—lower index means more effective method.

In neonatology, what are the five components of the APGAR score?

Appearance (color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. Each scored 0-2, assessed at 1 and 5 minutes; total out of 10.