UPSC CMSE General Medicine Syllabus

What is Wolff-Parkinson-White syndrome?

A pre-excitation syndrome with an accessory pathway (bundle of Kent); ECG shows a short PR interval and a delta wave, predisposing to supraventricular tachycardia.

Give the Framingham/standard definition of heart failure.

A clinical syndrome in which the heart cannot pump blood sufficiently to meet the body's metabolic demands, or can do so only at elevated filling pressures.

Differentiate left-sided and right-sided heart failure by their predominant symptoms.

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

Which drug classes improve mortality in heart failure with reduced ejection fraction (HFrEF)?

ACE inhibitors/ARBs (or ARNI), beta-blockers, mineralocorticoid receptor antagonists (spironolactone), and SGLT2 inhibitors.

What is the role of B-type natriuretic peptide (BNP) in heart failure?

BNP (and NT-proBNP) is released by stretched ventricular myocardium; elevated levels support the diagnosis of heart failure and correlate with severity.

What is the pathophysiologic hallmark distinguishing COPD from asthma?

COPD causes largely irreversible (or only partially reversible) airflow obstruction, whereas asthma obstruction is typically reversible. COPD = chronic bronchitis + emphysema.

Define chronic bronchitis clinically.

A productive cough for at least 3 months in each of 2 consecutive years, not due to other causes.

What is the spirometry hallmark of an obstructive lung disease like COPD?

A reduced FEV1/FVC ratio (<0.70), with reduced FEV1.

What is the most common cause of COPD and the most effective intervention?

Cigarette smoking is the leading cause; smoking cessation is the single most effective intervention to slow disease progression.

What is the pathophysiology of asthma?

Chronic airway inflammation with bronchial hyperresponsiveness causing reversible bronchoconstriction, mucosal edema, and mucus hypersecretion; often allergic/Th2-mediated.

What is the first-line reliever and the preferred long-term controller for asthma?

Reliever: short-acting beta-2 agonist (SABA, e.g., salbutamol). Controller: inhaled corticosteroid (ICS), often combined with a long-acting beta-2 agonist (LABA).

Name the classic triad/spirometry sign that confirms asthma reversibility.

A >=12% (and >=200 mL) improvement in FEV1 after bronchodilator administration confirms reversible airflow obstruction.

What is the most common bacterial cause of community-acquired pneumonia?

Streptococcus pneumoniae (pneumococcus).

What does the CURB-65 score assess in pneumonia?

Severity and need for hospitalization: Confusion, Urea >7 mmol/L, Respiratory rate >=30, Blood pressure (SBP<90 or DBP<=60), Age >=65; each scores 1 point.

Differentiate typical from atypical pneumonia.

Typical (e.g., S. pneumoniae): lobar consolidation, productive cough, high fever. Atypical (e.g., Mycoplasma, Legionella, Chlamydophila): gradual onset, dry cough, extrapulmonary symptoms, diffuse interstitial infiltrates.

What organism causes tuberculosis and what is the classic histopathologic lesion?

Mycobacterium tuberculosis; the hallmark lesion is a caseating granuloma with epithelioid cells, Langhans giant cells, and central caseous necrosis.

What is the standard first-line drug regimen for drug-sensitive pulmonary TB (intensive phase)?

2 months of Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol (RIPE/HRZE), followed by 4 months of Rifampicin and Isoniazid (RH).

Match each first-line anti-TB drug to its main toxicity: Isoniazid, Rifampicin, Pyrazinamide, Ethambutol.

Isoniazid: peripheral neuropathy (give pyridoxine/B6) and hepatotoxicity. Rifampicin: orange body fluids, hepatotoxicity, enzyme induction. Pyrazinamide: hyperuricemia/gout, hepatotoxicity. Ethambutol: optic neuritis (color vision loss).

What is the most useful microbiological test for diagnosing active pulmonary TB?

Sputum smear for acid-fast bacilli (Ziehl-Neelsen stain) and culture; nucleic acid amplification (GeneXpert/CBNAAT) which also detects rifampicin resistance.

What are the two main histological types of lung cancer and which is linked most strongly to smoking?

Small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC, including adenocarcinoma, squamous cell, large cell). SCLC and squamous cell carcinoma are most strongly smoking-related; adenocarcinoma is most common in non-smokers.

Which lung cancer is most associated with paraneoplastic syndromes such as SIADH and ectopic ACTH?

Small cell lung carcinoma (SCLC).

What paraneoplastic syndrome (hypercalcemia via PTHrP) is associated with squamous cell carcinoma of the lung?

Hypercalcemia due to secretion of parathyroid hormone-related peptide (PTHrP).

Distinguish a transudative from an exudative pleural effusion using Light's criteria.

Exudate if any: pleural/serum protein ratio >0.5, pleural/serum LDH ratio >0.6, or pleural LDH > two-thirds the upper limit of normal serum LDH. Transudates fail all three (e.g., heart failure, cirrhosis); exudates suggest infection/malignancy.

What is a tension pneumothorax and its emergency treatment?

Air progressively accumulates in the pleural space under positive pressure, shifting the mediastinum and compromising venous return; treat with immediate needle decompression (2nd intercostal space, midclavicular line) followed by chest tube.

What are the two most common causes of peptic ulcer disease?

Helicobacter pylori infection and chronic NSAID use.

How do gastric and duodenal ulcer pain relate to food?

Gastric ulcer pain typically worsens with eating (weight loss). Duodenal ulcer pain is relieved by eating and worsens 2-3 hours after meals or at night (weight stable/gain).

What is the triple therapy regimen for H. pylori eradication?

A proton pump inhibitor plus two antibiotics (clarithromycin and amoxicillin, or metronidazole) for 10-14 days.

Compare Crohn disease and ulcerative colitis in distribution and depth.

Crohn: any part of GI tract (mouth to anus), skip lesions, transmural inflammation, non-caseating granulomas, cobblestoning, fistulae. Ulcerative colitis: continuous involvement starting in the rectum, limited to colon, mucosal/submucosal inflammation, crypt abscesses, no granulomas.

Which hepatitis viruses are transmitted via the fecal-oral route versus blood/body fluids?

Fecal-oral: Hepatitis A and E. Blood/body fluids (parenteral, sexual, vertical): Hepatitis B, C, and D.

What does a positive Hepatitis B surface antigen (HBsAg) with positive HBeAg indicate?

Active Hepatitis B infection with high viral replication and high infectivity (HBeAg indicates active replication).

What is cirrhosis and name three major complications of portal hypertension.

Cirrhosis is irreversible diffuse hepatic fibrosis with regenerative nodules replacing normal architecture. Complications of portal hypertension: esophageal/gastric varices, ascites, splenomegaly (also caput medusae and hepatic encephalopathy).

What scoring systems assess prognosis/severity in cirrhosis?

Child-Pugh score (bilirubin, albumin, INR/PT, ascites, encephalopathy) and the MELD score (bilirubin, INR, creatinine, sodium) used for transplant prioritization.

What are the two most common causes of acute pancreatitis and the key diagnostic enzyme?

Gallstones and alcohol; diagnosis supported by serum lipase (more specific) or amylase elevated >3x the upper limit of normal.

How is upper GI bleeding distinguished from lower GI bleeding clinically?

Upper GI bleed (proximal to ligament of Treitz): hematemesis and melena (black tarry stool); raised blood urea. Lower GI bleed: hematochezia (fresh red blood per rectum). The first-line diagnostic and therapeutic tool for upper GI bleed is endoscopy.