Master Medicine
for FMGE
Access 50+ high-yield questions tailored for the 2026 syllabus. Includes AI-powered explanations and performance tracking.
Core Concepts
Internal Medicine for FMGE requires a strong grasp of disease pathophysiology, risk factors, and the ability to synthesize clinical information for differential diagnosis. Emphasize holistic patient assessment (history, physical, investigations). Understand common medical emergencies and their immediate management. Prioritize infectious diseases, metabolic disorders, and cardiovascular emergencies due to their high prevalence and impact in India. Always consider local epidemiology (e.g., Dengue, Malaria, Typhoid, TB).
Clinical Presentation
- Chest Pain: Myocardial Infarction (ACS: STEMI/NSTEMI), Angina, Pulmonary Embolism, Aortic Dissection, Pericarditis, GERD, Pleurisy.
- Dyspnea: Heart Failure, COPD/Asthma exacerbation, Pneumonia, Pulmonary Embolism, Anemia, Pleural Effusion, Metabolic Acidosis.
- Fever with Rash/Alteration: Sepsis, Meningitis, Dengue, Malaria, Typhoid, Measles, Chikungunya, DKA, Encephalitis.
- Altered Sensorium: Stroke, Hypoglycemia/Hyperglycemia (DKA/HHS), Sepsis, Meningitis/Encephalitis, Hepatic Encephalopathy, Uremia, Drug overdose.
- Abdominal Pain: Acute Pancreatitis, Peptic Ulcer Disease (PUD), Cholecystitis, Appendicitis, Diverticulitis, Bowel Obstruction.
- Edema: Heart Failure (bilateral, pitting, dependent), Chronic Kidney Disease (periorbital, generalized), Liver Cirrhosis (ascites, peripheral), DVT (unilateral leg swelling), Nephrotic Syndrome (pitting, periorbital).
Diagnosis (Gold Standard)
- Acute Coronary Syndrome (ACS): ECG (ST elevation/depression, T-wave inversion), Cardiac Troponins (rise and fall pattern). Angiography for definitive diagnosis and revascularization planning.
- Heart Failure: Clinical criteria (e.g., Framingham), Echocardiography (LVEF < 40% for HFrEF), BNP/NT-proBNP.
- Community-Acquired Pneumonia (CAP): Chest X-ray (lobar infiltrate, consolidation). Sputum culture/Gram stain for specific pathogen.
- Tuberculosis (TB): Sputum AFB microscopy (acid-fast bacilli), GeneXpert MTB/RIF (for MTB and Rifampicin resistance), Culture.
- Diabetes Mellitus (DM): HbA1c ≥ 6.5%, Fasting Plasma Glucose ≥ 126 mg/dL, 2-hour Post-load Glucose ≥ 200 mg/dL (OGTT), Random Plasma Glucose ≥ 200 mg/dL with symptoms.
- Stroke: Non-contrast CT Brain (to rule out hemorrhage), followed by MRI for ischemic changes.
- Meningitis: CSF analysis (lumbar puncture) - cell count, protein, glucose, Gram stain, culture.
- Dengue Fever: NS1 antigen (early phase), IgM/IgG antibodies (later phase), PCR.
- Malaria: Peripheral Blood Smear (gold standard for species identification and parasite count), Rapid Diagnostic Tests (RDTs).
- Liver Cirrhosis: Liver biopsy (definitive), Fibroscan (non-invasive), clinical and imaging correlation.
- Acute Pancreatitis: Serum Amylase/Lipase > 3 times upper limit of normal, characteristic imaging (CT Abdomen).
Management (First Line)
- Acute Coronary Syndrome (ACS): MONA-B (Morphine, Oxygen, Nitrates, Aspirin, Beta-blockers), P2Y12 inhibitors (Clopidogrel/Ticagrelor), High-intensity Statins. Reperfusion therapy (PCI or Fibrinolysis) for STEMI.
- Sepsis/Septic Shock: Early broad-spectrum IV antibiotics (within 1 hour), IV fluid resuscitation (crystalloids 30mL/kg), Vasopressors (Norepinephrine first line) if hypotensive after fluids. Source control.
- Diabetic Ketoacidosis (DKA): IV fluids (0.9% Saline), IV Regular Insulin infusion, Potassium replacement (monitor closely), Bicarbonate for severe acidosis.
- Acute Asthma Exacerbation: Short-acting Beta Agonists (SABA), Systemic Corticosteroids (oral/IV), Oxygen therapy, Ipratropium Bromide.
- Hypertensive Emergency: IV Antihypertensives (Labetalol, Nicardipine, Nitroprusside) for controlled reduction of BP based on end-organ damage.
- Tuberculosis (TB): DOTS (Directly Observed Treatment, Short-course) regimen: Rifampicin, Isoniazid, Pyrazinamide, Ethambutol (RIPE) for 2 months (intensive phase), followed by RI for 4 months (continuation phase).
- Anaphylaxis: IM Adrenaline (epinephrine) 0.3-0.5mg immediately, IV fluids, antihistamines, corticosteroids, oxygen.
- Stroke (Ischemic): IV Thrombolysis (Alteplase) within 4.5 hours for eligible patients, Mechanical Thrombectomy within 6-24 hours. Antiplatelets (Aspirin) for secondary prevention.
Exam Red Flags
- Acute onset, severe "tearing" chest pain radiating to back with pulse deficit: Aortic Dissection.
- Sudden onset dyspnea, pleuritic chest pain, hemoptysis, and risk factors (surgery, immobilization, cancer): Pulmonary Embolism.
- Fever, neck stiffness, photophobia, and altered sensorium: Meningitis.
- Diabetic patient with fruity breath, Kussmaul respiration, abdominal pain, altered sensorium: Diabetic Ketoacidosis (DKA).
- Jaundice, ascites, and altered mental status in a patient with chronic liver disease: Hepatic Encephalopathy.
- Sudden painless vision loss ("curtain falling"): Retinal Artery Occlusion (medical emergency).
- New onset neurological deficit (face, arm, speech) - FAST: Stroke.
- Hypotension unresponsive to fluids, fever, altered sensorium, tachycardia: Septic Shock.
- Headache, fever, thrombocytopenia, rash/petechiae, retro-orbital pain: Dengue Fever (watch for warning signs like persistent vomiting, abdominal pain, mucosal bleeds).
- Fever with chills and rigors, hepatosplenomegaly, anemia: Malaria.
Sample Practice Questions
A 68-year-old male presents to the emergency department with a 3-day history of progressively worsening shortness of breath, orthopnea, and bilateral pitting edema up to his knees. He has a known history of hypertension and Type 2 Diabetes Mellitus. On examination, his blood pressure is 160/95 mmHg, heart rate 110 bpm, respiratory rate 28/min, and oxygen saturation 88% on room air. Auscultation of the lungs reveals bilateral basal crackles. A third heart sound (S3) is audible. His ECG shows sinus tachycardia with left ventricular hypertrophy. Chest X-ray demonstrates cardiomegaly, pulmonary vascular congestion, and bilateral pleural effusions. What is the most likely diagnosis?
A 68-year-old female with a known history of Type 2 Diabetes Mellitus and hypertension is brought to the emergency department by her family due to altered sensorium, increased thirst, and frequent urination for the past 2 days. She has not been taking her medications regularly. On examination, she is drowsy, hypotensive (BP 90/60 mmHg), tachycardic (HR 110 bpm), and has dry mucous membranes. Her blood glucose is 850 mg/dL, serum sodium 152 mEq/L, serum potassium 3.8 mEq/L, serum bicarbonate 26 mEq/L, and plasma osmolality calculated as 340 mOsm/kg. Urine ketones are negative. What is the most likely diagnosis for this patient's presentation?
A 48-year-old male presents with a 3-day history of black, tarry stools (melena), epigastric discomfort, and occasional nausea. He admits to frequent use of over-the-counter NSAIDs for chronic knee pain. On examination, he is pale, and his pulse is 100/min.
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