General Medicine & Common Systemic Pathologies

Syllabus Unit: Clinical Medicine & Surgery

Why it matters

Chapter overview

General Medicine integrates cardiovascular, respiratory, endocrine, infectious and gastrointestinal disease into the single most heavily tested unit of AIIMS PG — cases are rarely single-system, and the exam expects you to move fluently from a bedside sign to the underlying pathophysiology to the exact scoring system or drug regimen that governs management.

Postgraduate Medical Exam Syllabus Clinical Medicine & Surgery 50% weightage

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1Chest Pain / Symptom OnsetPatient presents within the window for reperfusion therapy

2ECG within 10 minutesIdentifies ST elevation vs no ST elevation

3Troponin & Risk StratificationConfirms myocardial necrosis, grades NSTEMI vs unstable angina

4Reperfusion StrategyPrimary PCI <90 min or thrombolysis <30 min

1Cardiovascular & Respiratory Medicine

Acute coronary syndromes and heart failure anchor cardiology, while COPD, asthma and ARDS anchor respiratory medicine — all graded by validated scores AIIMS tests repeatedly.

Learning Objectives

Differentiate STEMI, NSTEMI and unstable angina by ECG changes and troponin status, and state the door-to-balloon/door-to-needle targets.
Classify heart failure by ejection fraction (HFrEF vs HFpEF) and grade functional severity using the NYHA class.
Distinguish COPD from bronchial asthma on spirometry (fixed vs reversible obstruction) and describe GOLD staging.
Apply the Berlin definition of ARDS (onset, bilateral infiltrates, PaO2/FiO2 ratio) to grade its severity.

Key Terms

STEMIST-elevation myocardial infarction — transmural infarction with ST elevation ≥1mm in two contiguous leads; treated with emergent reperfusion (primary PCI within 90 min, or thrombolysis within 30 min if PCI unavailable).

HFpEFHeart failure with preserved ejection fraction (≥50%) driven by diastolic dysfunction, classically in older hypertensive patients, as opposed to HFrEF's systolic pump failure (EF<40%).

GOLD StagingSpirometric classification of COPD severity by post-bronchodilator FEV1 % predicted (GOLD 1 mild ≥80%, to GOLD 4 very severe <30%).

Berlin Definition (ARDS)Diagnostic criteria for ARDS: onset within 1 week of an insult, bilateral opacities not fully explained by cardiac failure/fluid overload, and PaO2/FiO2 ≤300 (mild), ≤200 (moderate) or ≤100 (severe).

Cardiovascular and respiratory medicine share a common exam logic: a clinical syndrome is first recognised, then graded on a validated score, which in turn dictates the exact management pathway — memorising the score's cut-offs is as important as recognising the disease itself.

Acute coronary syndromes

STEMI — transmural ischaemia with ST elevation and troponin rise; needs emergent reperfusion.
NSTEMI — subendocardial ischaemia with troponin rise but no ST elevation; managed medically then risk-stratified for angiography.
Unstable angina — ischaemic symptoms at rest or crescendo pattern, but no troponin rise (no myocardial necrosis).

Exam TipDoor-to-balloon time target for primary PCI is under 90 minutes; if PCI is unavailable within 120 minutes, door-to-needle thrombolysis (e.g. tenecteplase) should start within 30 minutes.

Heart failure

Heart failure is classified by ejection fraction into HFrEF (EF<40%), HFmrEF (EF 40-49%) and HFpEF (EF≥50%), and graded functionally by the NYHA class I (no symptom limitation) through IV (symptoms at rest).

Obstructive airway disease

COPD — fixed obstruction, post-bronchodilator FEV1/FVC < 0.7, usually smoking-related, older age of onset.
Asthma — reversible obstruction, FEV1 improves by ≥12% and 200mL after bronchodilator, often atopic, younger age of onset.

Common MistakeCommon trap: do not confuse COPD's fixed obstruction with asthma's reversible one — a 'reversible' spirometry result argues against a pure COPD diagnosis.

ARDS

ARDS is a non-cardiogenic pulmonary oedema from causes like sepsis, aspiration or pancreatitis, defined by the Berlin criteria and managed with lung-protective ventilation using low tidal volumes (6 mL/kg predicted body weight) to limit ventilator-induced lung injury.