PMDC National Licensing Examination Medicine and Allied Syllabus

Medicine and Allied syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Medicine and Allied in PMDC National Licensing Examination, not a summary of it.

1. 1

   Cardiology

   5 topics

   • Ischemic Heart Disease
   • Heart Failure
   • Arrhythmias
   • Hypertension
   • Valvular and Rheumatic Heart Disease
2. 2

   Respiratory Medicine

   4 topics

   • Asthma and COPD
   • Pneumonia and Respiratory Infections
   • Tuberculosis
   • Pleural Effusion and Pneumothorax
3. 3

   Gastroenterology and Hepatology

   4 topics

   • Peptic Ulcer Disease and GI Bleeding
   • Chronic Liver Disease and Hepatitis
   • Inflammatory Bowel Disease
   • Jaundice Approach
4. 4

   Nephrology

   4 topics

   • Acute Kidney Injury
   • Chronic Kidney Disease
   • Glomerular Diseases
   • Fluid and Electrolyte Disorders
5. 5

   Endocrinology

   3 topics

   • Diabetes Mellitus and Complications
   • Thyroid Disorders
   • Adrenal and Pituitary Disorders
6. 6

   Neurology

   4 topics

   • Stroke and TIA
   • Seizures and Epilepsy
   • Headache and Meningitis
   • Peripheral Neuropathies
7. 7

   Infectious Diseases

   3 topics

   • Malaria, Typhoid and Dengue
   • HIV/AIDS
   • Sepsis and Fever Approach
8. 8

   Dermatology and Psychiatry

   3 topics

   • Common Skin Disorders
   • Mood and Anxiety Disorders
   • Psychosis and Substance Use

Medicine and Allied flashcards for PMDC National Licensing Examination

23 of 52 cards from the Medicine and Allied deck — real questions with worked answers.

1. What ECG change defines an ST-elevation myocardial infarction (STEMI) versus NSTEMI?

   STEMI shows persistent ST-segment elevation (>=1 mm in two contiguous limb leads or >=2 mm in chest leads), reflecting complete coronary occlusion; NSTEMI has ST depression or T-wave inversion without persistent ST elevation, indicating partial occlusion, but still raised troponin.

2. Which cardiac biomarker is most specific and sensitive for myocardial infarction, and when does it rise and peak?

   Cardiac troponin (I or T) is most specific/sensitive; it rises within 3-6 hours of injury, peaks at 12-24 hours, and stays elevated for up to 7-10 days.

3. What is the time-critical reperfusion target for primary PCI in STEMI?

   Primary PCI should ideally be performed within 90 minutes of first medical contact (door-to-balloon time); if PCI is unavailable within 120 minutes, give fibrinolysis within 30 minutes (door-to-needle).

4. List the initial 'MONA'/acute drug management of acute coronary syndrome.

   Morphine (for pain), Oxygen (only if SpO2 <90%), Nitrates (GTN), Aspirin 300 mg, plus a second antiplatelet (e.g., ticagrelor/clopidogrel), anticoagulation, and a statin and beta-blocker.

5. Which coronary artery occlusion corresponds to inferior MI, and what ECG leads show changes?

   Right coronary artery (RCA in ~80%) causes inferior MI, with ST elevation in leads II, III, and aVF.

6. What is Dressler syndrome?

   A delayed (2-10 weeks post-MI) autoimmune pericarditis with fever, pleuritic chest pain, pericardial effusion, and raised ESR, caused by an immune reaction to myocardial antigens.

7. Define heart failure with reduced ejection fraction (HFrEF) vs preserved ejection fraction (HFpEF) by LVEF.

   HFrEF: LVEF <=40% (systolic failure, impaired contraction). HFpEF: LVEF >=50% (diastolic failure, impaired filling). LVEF 41-49% is mildly reduced (HFmrEF).

8. Which biomarker is used to diagnose and rule out heart failure?

   BNP or NT-proBNP; elevated levels support heart failure, and a normal level has high negative predictive value to rule it out.

9. Name the four drug classes proven to reduce mortality in HFrEF (the 'four pillars').

   1) ACE inhibitors/ARBs or ARNI (sacubitril-valsartan), 2) Beta-blockers, 3) Mineralocorticoid receptor antagonists (spironolactone/eplerenone), 4) SGLT2 inhibitors (dapagliflozin/empagliflozin).

10. What are the classic features of left-sided versus right-sided heart failure?

    Left-sided: pulmonary congestion - dyspnea, orthopnea, paroxysmal nocturnal dyspnea, crackles. Right-sided: systemic congestion - raised JVP, peripheral edema, hepatomegaly, ascites.

11. Describe the NYHA functional classification of heart failure.

    Class I: no limitation. Class II: slight limitation, symptoms on ordinary activity. Class III: marked limitation, symptoms on less-than-ordinary activity. Class IV: symptoms at rest.

12. What ECG finding characterizes atrial fibrillation?

    Irregularly irregular rhythm with absent P waves and a fibrillatory (chaotic) baseline; variable R-R intervals.

13. What scoring systems guide anticoagulation and bleeding risk in atrial fibrillation?

    CHA2DS2-VASc score estimates stroke risk (to decide anticoagulation); HAS-BLED score estimates bleeding risk.

14. What is the first-line management of an unstable patient with any tachyarrhythmia and signs of shock?

    Immediate synchronized DC cardioversion (electrical cardioversion).

15. What ECG pattern defines complete (third-degree) heart block?

    Complete AV dissociation: P waves and QRS complexes are independent (no relationship), with a slow escape rhythm; treated with pacing.

16. Which arrhythmia is associated with a delta wave and short PR interval, and what is the syndrome?

    Wolff-Parkinson-White syndrome, due to an accessory pathway (bundle of Kent) causing pre-excitation - delta wave, short PR, and wide QRS.

17. Name the drug of choice to terminate stable paroxysmal SVT (AVNRT) acutely.

    IV adenosine (after vagal maneuvers fail); it transiently blocks the AV node.

18. How is hypertension defined by office blood pressure (e.g., per common Stage classification)?

    Stage 1 hypertension: BP >=140/90 mmHg (clinic) or >=135/85 (home/ambulatory). Stage 2: >=160/100 clinic. Normal: <120/80 mmHg.

19. List the major end-organ damage caused by chronic hypertension.

    Heart (LVH, heart failure, MI), brain (stroke, encephalopathy), kidney (nephropathy, CKD), eyes (hypertensive retinopathy), and vessels (aneurysm, dissection).

20. What is the recommended first-line antihypertensive approach by age/ethnicity (ACD rule)?

    Age <55 and non-Black: ACE inhibitor/ARB (A). Age >=55 or Black African/Caribbean: Calcium channel blocker (C). Thiazide-like diuretic (D) added next. Step up by combining A+C, then A+C+D.

21. Define a hypertensive emergency versus urgency.

    Hypertensive emergency: severely elevated BP (often >180/120) WITH acute end-organ damage, requiring IV agents and controlled reduction. Urgency: severe BP without acute end-organ damage, managed with oral agents over hours-days.

22. Name common secondary causes of hypertension to screen for in young or resistant patients.

    Renal artery stenosis, chronic kidney disease, primary hyperaldosteronism (Conn syndrome), pheochromocytoma, Cushing syndrome, coarctation of the aorta, and obstructive sleep apnea.

23. What murmur and characteristics define aortic stenosis?

    An ejection systolic, crescendo-decrescendo murmur at the right upper sternal border radiating to the carotids, with a slow-rising low-volume pulse and narrow pulse pressure; classic triad: angina, syncope, dyspnea.

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