Internal Medicine and Pediatrics High-Yield Revision

A comprehensive set of high-yield vocabulary and diagnostic flashcards based on Internal Medicine and Pediatrics clinical tables for the UPSC CMS exam.

P pulmonale

Tall P waves denoting right atrial enlargement.

P mitrale

Notched P waves denoting left atrial enlargement.

Normal PR interval duration

$0.12-0.20\,\text{sec}$.

Normal QRS duration

Less than $0.12\,\text{sec}$; prolongation denotes abnormal ventricular conduction.

S1 (First heart sound) mechanism

Closure of mitral and tricuspid valves at the onset of systole.

S2 (Second heart sound) mechanism

Closure of aortic ($A_2$) and pulmonary ($P_2$) valves at the end of systole.

Fixed wide splitting of S2

A characteristic feature of atrial septal defect.

Opening snap (OS)

High pitch, brief duration sound in early diastole caused by the opening of stenosed mitral valve leaflets.

Aortic stenosis murmur

Loud, rasping, mid-systolic murmur at the base radiating to the carotids.

Mitral regurgitation murmur

Blowing, pansystolic murmur at the apex radiating to the axilla.

CHA2DS2-VASc Score

A stroke risk scoring system for non-valvular atrial fibrillation; includes Congestive heart failure, Hypertension, Age, Diabetes, Stroke, Vascular disease, and Sex.

HAS-BLED Score

A bleeding risk scoring system for patients receiving oral anticoagulation; a score of $\geq 3$ requires close monitoring.

Xanthopsia

Altered color vision occurring as an extracardiac manifestation of digoxin toxicity.

Canadian Cardiovascular Society (CCS) Class IV

Angina characterized by the inability to perform any activity without discomfort or angina at rest.

Acute Myocardial Infarction diagnostic criteria

Detection of a rise and/or fall of cardiac biomarker values (preferably troponin) with at least one value above the 99th centile URL plus symptoms, ECG changes, or imaging evidence.

Hypertension Grade 3 (Severe)

Systolic blood pressure $\geq 180\,\text{mmHg}$ and/or diastolic blood pressure $\geq 110\,\text{mmHg}$.

Hypertensive retinopathy Grade 4

Arteriolar thickening, arteriovenous nipping, retinal ischaemia (haemorrhages/exudates), plus papilloedema.

Jones Criteria (Major manifestations)

Used for rheumatic fever diagnosis: Carditis, Polyarthritis, Chorea, Erythema marginatum, and Subcutaneous nodules.

Kussmaul's sign

A paradoxical rise in JVP during inspiration; seen in constrictive pericarditis and cardiac tamponade.

Light's criteria for Exudate

Pleural fluid is an exudate if: protein:serum ratio $> 0.5$, LDH:serum ratio $> 0.6$, or pleural LDH $> 2/3$ upper limit of normal serum LDH.

Type II Respiratory Failure

Hypoxia ($PaO_2 < 8.0\,\text{kPa}$ or $60\,\text{mmHg}$) with hypercapnia ($PaCO_2 > 6\,\text{kPa}$ or $45\,\text{mmHg}$).

BODE index

A multidimensional scoring system used to predict mortality in COPD, based on Body mass index, Obstruction ($FEV_1$), Dyspnoea (MRC scale), and Exercise (6-min walk distance).

Primary Hypothyroidism biochemistry

Elevated TSH and low $T_4$; $T_3$ is not a sensitive indicator.

Cushing's Syndrome classification

ACTH-dependent ($80\%$; e.g., Pituitary adenoma) or Non-ACTH-dependent ($20\%$; e.g., Adrenal adenoma).

Diabetes mellitus diagnostic thresholds

Fasting plasma glucose $\geq 7.0\,\text{mmol/L}$ ($126\,\text{mg/dL}$), HbA1c $\geq 48\,\text{mmol/mol}$, or random/2-hr glucose $\geq 11.1\,\text{mmol/L}$ ($200\,\text{mg/dL}$).

Diabetic Ketoacidosis (Severe) indicators

Blood ketones $> 6\,\text{mmol/L}$, bicarbonate $< 5\,\text{mmol/L}$, pH $< 7.0$, and hypokalaemia on admission.

Microalbuminuria thresholds

Albumin:creatinine ratio (ACR) of $2.5-30\,\text{mg/mmol}$ in males and $3.5-30\,\text{mg/mmol}$ in females.

SAAG (Serum Ascites Albumin Gradient)

High gradient ($\geq 1.1\,\text{g/dL}$) suggests transudative causes like cirrhosis or heart failure; low gradient ($< 1.1\,\text{g/dL}$) suggests exudative causes like malignancy or TB.

Target cells

Red cells with a central area of haemoglobinisation seen in liver disease, thalassaemia, or post-splenectomy.

Howell-Jolly bodies

Small round nuclear remnants in red cells seen in hyposplenism or post-splenectomy.

Felty's syndrome

The triad of long-standing rheumatoid arthritis, splenomegaly, and neutropenia.

Weber syndrome

A brainstem syndrome involving ipsilateral 3rd nerve palsy and contralateral hemiplegia.

Wallenberg syndrome

Lateral medulla lesion causing ipsilateral 5th, 9th, 10th, 11th nerve palsies, Horner's syndrome, cerebellar signs, and contralateral spinothalamic loss.

Prader-Willi syndrome

An imprinting disorder (Locus 15q11-q13) characterized by obesity, hypogonadism, and learning disability due to lack of paternal contribution.

Apgar Score components

Color, Heart rate, Reflex irritability, Muscle tone, and Respiration.

Mature pincer grasp milestone

Typical achievement age is $12\,\text{months}$.

Early-onset Sepsis (Neonate)

Sepsis occurring up to $72\,\text{hours}$ of life, often associated with perinatal risk factors.

Late Vitamin K Deficiency Bleeding (VKDB)

Incidence occurs at $2-12\,\text{weeks}$ of age; intracranial bleed is the most common presentation.