Dr. YSR UNIVERSITY OF HEALTH SCIENCES: A.P.

: VIJAYAWADA -
520008.

3rd MBBS Part - II

GUIDELINES FOR THE SCHEME OF UNIVERSITY EXAMINATION

GENERAL MEDICINE
 GENERAL MEDICINE
Goal:
The broad goal of the teaching of undergraduate students in General medicine and allied subjects is to inoculate
a rational and scientific basis of dealing with diseases and disorders of the general medicine and speciality
systems.

OBJECTIVES
A. KNOWLEDGE:

1.1Describe and discuss the epidemiology,pathogenesis ,clinical and common course of various heart diseases
and their genetic basis.Causes and etiopathogenesis ,clinical evolution of rheumatic fever, infective
endocarditis, congenital heart diseases.

1.2 Describe and discuss causes of heart failure, Its staging, right vs left , systolic vs diastolic
failure ,compensatory mechanisms, exacerbating factors, investigations, imaging findings(2d
echocardiography, angiogram, nuclear medicine testing etc.,),pharmacological and non pharmacological
management.
2.1 Describe and discuss risk factors and epidemiology of atherosclerosis ,it’s pathogenesis (dyslipidemia), its
complications.
2.2 Describe and define various coronary syndromes, its evolution ,natural History and outcomes. Differentiate
stable and unstable angina .Describe assessment and relief of pain in acute coronary syndrome. Enumerate the
indications for and findings of Echo cardiogram, stress testing coronary angiography and describe management
of acute coronary syndrome including acute thrombosis, ptca ,cabg and medical therapy. describe complications
of acute coronary syndrome.
3.1 Define ,discuss and describe various kinds of pneumonia ,their pathogenesis presentation, natural History,
complications. Distinguish community acquired pneumonia ,nosocomial pneumonia and aspirational pneumonia
. Enumerate indications for isolation and hospitalization for patients with pneumonia. Describe supportive
therapy including oxygen use and indications for ventilation.
4.1 Discuss and describe the common causes, pathophysiology and manifestations of fever( bacterial, viral,
parasitic ) in various regions in India. Discuss pathophysiology and manifestations of inflammatory causes of
fever, sepsis syndrome, malaria(including antimalarial drugs and resistance pattern)and fever of unknown
origin .Enumerate indications and use of imaging in febrile syndromes.
5.1 Describe and discuss the etiology pathophysiology of various forms of liver diseases like infective
hepatitis ,alcoholic liver disease, drug induced liver injury, cholelithiasis, cholecystitis.Enumerate the
indications for ultrasound, MRCP,ERCP and describe the findings in liver diseases.
5.2 Describe and discuss pathophysiology, clinical evolution and complications of cirrhosis and portal
hypertension including ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatic
encephalopathy . Describe and discuss the management of all complications of cirrhosis.
6.1 Describe and discuss the symptoms and signs of acute HIV infection and AIDS .Classify HIV /AIDS based
on CDC criteria and relation between CDC count and risk opportunistic infections. Describe and discuss
pathogenesis ,evolution and common features of common HIV related disorders like opportunistic infections,
HIV related malignancies ,HIV related skin and oral lesions and their management.
6.2 Discuss and describe the principles of HAART therapy ,classes of antivirals ,adverse reactions and
interactions.Describe regimens used in postexposure prophylaxis ,prophylactic drugs used to prevent HIV
related opportunistic infections. Enumerate the indications and describe the findings for CT chest, brain and
MRI and chest radiograph.
7.1 Describe the pathophysiology and genetic basis clinical approach of various autoimmune diseases.
Differentiate acute subacute and chronic causes of joint pain and differentiate arthralgia from arthritis , articlular
from periarticular complaints. Describe systemic manifestations of rheumatological diseases and their
treatment . Enumerate the indications and interpret the results of romantic profile.
8.1 Describe and discuss the epidemiology, etiology pathophysiology and genetic basis of hypertension and its
classification into primary and secondary hypertension. Differentiate hypertensive urgency from emergency.
Discuss appropriate diagnostic workup for etiology of hypertension and discuss treatment plan for essential
hypertension and management of hypertensive emergencies.
9.1 Define describe and classify anemia and discuss the morphological characteristics prevalence of each causes
of anemia. Develop a diagnostic plan to determine the cause of anemia and discuss various tests for iron
deficiency anemia, vitamin b 12 and folate deficiency.
9.2 Describe the national programs for anemia prevention and prescribe replacement therapy with Iron, B12
and folate . Describe the indication for blood transfusion and appropriate use of blood components .Describe
indications and interpret the results of bone marrow aspiration and biopsy.
10.1 Define ,describe acute and chronic renal failure. Describe pathophysiology and causes of prerenal ARF
renal and post renal ARF and treatment of acute renal failure.
10.2 Describe etiology of CRF. staging of chronic kidney disease, pathophysiology and clinical findings of
uremia ,significance of proteinuria in CKD, complications of CKD including electrolyte imbalances in CKD
management of CKD and supportive therapy in CKD, indications for dialysis in CKD and indications for renal
replacement therapy .
11.1 Define and classify diabetes mellitus, it’s pathogenesis ,risk factors for type one diabetes and type 2
diabetes.Discuss the pathogenesis of microvascular and macrovascular complications of diabetes .Outline a
therapeutic approach to treatment of type 2 diabetes based on severity and complications , treatment of diabetic
related complications like diabetic ketoacidosis, hyperosmolar nonketotic state and recognition and
management of hypoglycaemic episodes.
12.1 Describe the epidemiology, pathogenesis and genetic basis of hypothyroidism and hyperthyroidism
including iodine deficiency and autoimmune disorders. Discuss principles of thyroid function testing and its
interpretation.
12.2 Describe the pharmacology, indications and adverse reactions of thyroxine and anti thyroid drugs and
discuss the indications for radiotherapy and surgery in the management of thyrotoxicosis. Describe iodization
programs of Government of India.
13.1 Describe the epidemiology and risk factors for common malignancies in India and their genetic basis.
Describe relation between infection and cancers. Differentiate between curative and palliative care in patients
with cancer.Describe the indications for surgery radiation and chemotherapy for common malignancies.
Describe and assess pain in patients with cancer. Describe and enumerate the indications and side effects of
narcotics in pain alleviation .Describe the indications and interpret the results of various investigations used in
common cancers.
14.1 Describe and measure obesity in Indian population and discuss the etiology ,pathophysiology and risk
factors for obesity .Describe the monogenetic forms of obesity. Describe the indications and interpret the results
of tests for secondary causes of obesity. Describe the indications ,pharmacology and side effects of
pharmacotherapy for obesity and describe indications and side effects of bariatric surgery.
15.1 Enumerate, describe and discuss the etiology of upper and lower GI bleeding and discuss the physiological
effects of acute blood loss and volume loss.Enumerate the indications for endoscopy, colonoscopy and other
imaging procedures in the investigations of upper GI bleeding.
15.2 Describe the indications, pharmacology and side effects of pharmacotherapy of pressers in upper GI bleed
and treatment of acid peptic diseases including Helicobacter pylori .Describe the indications for whole blood
component and platelet transfusion and describe the features and management of mismatched transfusion .
16.1 Describe and discuss the etiology of acute and chronic diarrhea including infectious and non infectious
causes bowel.Discuss systemic consequences of acute diarrhea and chronic effects of diarrhea including
malabsorption. Enumerate the indications for stool cultures and requirement of further investigations like
colonoscopy and biopsy in diarrhea. Discuss the pharmacological and side effects of pharmacotherapy for
parasitic, bacterial and viral causes of diarrhea.
16.2 Describe and distinguish clinical presentation of Crohn’s disease and ulcerative colitis and management of
inflammatory bowel diseases Discuss indications for surgery in inflammatory bowel diseases.
17.1 Define and classify headache describe the presenting features , aggravating factors and relieving factors of
headache. Classify migraine and distinguish between classical and non classical forms of migraine .Describe the
indications, pharmacology and side effects of abortive therapy in migraine and prophylactic therapy in
migraine.
17.2 Enumerate indications and describe the findings in CSF in patients with meningitis.Describe the
pharmacology ,dose ,adverse reactions and regimens of drugs used in the treatment of bacterial ,tubercular and
viral meningitis.
18.1 Describe the functional and vascular anatomy of the brain and classify cerebrovascular accidents and
describe the risk factors ,pathogenesis of hemorrhagic and non hemorrhagic stroke. Describe initial supportive
management of patients with CVA and Enumerate indications and describe acute therapy of non hemorrhagic
stroke including thrombolytic therapy . Describe initial management of hemorrhagic stroke and indications for
surgery in a hemorrhagic stroke.
18.2 Describe and distinguish various types of bladder dysfunction seen in CNS diseases. Describe and
distinguish various disorders of speech in CNS diseases and Distinguish between upper and lower motor neuron
diseases.
19.1 Describe the functional anatomy of locomotor system of the brain and classify movement disorders of
brain. Discuss the pharmacology ,dose side effects and interactions used in drug therapy of Parkinson disease.
Enumerate the indications of surgery and use of botulinum toxin in the treatment of movement disorders.
20.1 Enumerate the local poisonous snakes and describe the distinguished marks of each.Describe the initial
approach to the stabilization and management of patients who presents with snake bite, scorpion bite and bee
sting allergy. Indications and describe pharmacology ,dose, adverse reactions and hypersensitivity reactions of
anti snake venom.
21.1 Describe the initial approach to the stabilization of patients who presents with poisoning. Enumerate the
common plant poisons, common corrosives, commonly observed drug overdoses and describe their
toxicology ,clinical features, prognosis and approach to therapy .Enumerate the indications for psychiatric
consultation for patients with suspected suicidal ideations.
22.1 Describe and the etiology, clinical manifestations, diagnosis and clinical approach to various electrolyte
disorders like hyponatremia ,hypernatremia, hypocalcemia ,hypercalcemia, hypokalemia hyperkalemia.
Enumerate the components and describe the genetic basis of multiple endocrine neoplasia syndrome.Enumerate
the causes and describe the clinical and laboratory features of metabolic acidosis, metabolic alkalosis,
respiratory acidosis ,respiratory alkalosis . Interpretation of ABG report.
23.1 Describe the methods of nutritional assessment in adults and calculation of caloric requirement during
illness. Discuss the causes and consequences of protein calorie malnutrition and various common vitamin
deficiencies .Enumerate the indications for enteral and parenteral nutrition in critically ill patients.
24.1 Describe and discuss the epidemiology pathogenesis, clinical evaluation presentation of common diseases
in the elderly like acute confusional states in the elderly,Vascular events in the elderly, depression in the
elderly ,dementia in the elderly, personality changes ,osteoporosis, rehabilitation of CVA rehabilitation of
COPD, rehabilitation of elderly undergoing surgery ,rehabilitation of elderly with degenerative joint
diseases ,rehabilitation of falls, rehabilitation of common fractures , rehabilitation of vision and visual loss ,
management of disability, rehabilitation of hearing loss.Describe ethical issues in the care of elderly.
25.1 Describe the common causes, pathophysiology and manifestations of various zoonotic diseases like
leptospirosis ,rabies and non febrile infectious diseases like tetanus. Enumerate the indications for use of never
technicians in the diagnosis of these infections.
26.1 Describe professional qualities and roles of a physician and discuss the role of non maleficence as a
guiding principle in patient care ,role of autonomy and share responsibility ,role of benifence as a guiding
principle ,role of justice as a guiding principle. Discuss medico legal ,social economic and ethical issues
pertains to organ donation ,confidentiality in patient care , shared responsibility in healthcare.
26.2Descrive medico legal and ethical issues pertains to confidentiality in patient care, surrogate decision
making ,research in human subjects, consent for surgical procedures ,physician and patient
relationship ,physician and industry relationships, in vitro fertilization ,insemination and surrogate motherhood,
medical negligence ,malpractice ,dealing with impaired physicians ,dealing with patients who refuse care and
issues involved in withdrawal of life support.

B.SKILLS
At the end of course the student shall be able to do:
1.Elicit document and present an appropriate history that will establish the diagnosis, cause and severity of heart
failure including: presenting complaints, precipitating and exacerbating factors, risk factors exercise tolerance,
changes in sleep patterns, features suggestive of infective endocarditis.
2.Perform and demonstrate a systematic examination based on the history that will help establish the diagnosis
and estimate its severity including: measurement of pulse, blood pressure and respiratory rate, jugular venous
forms and pulses, peripheral pulses, conjunctiva and fundus, lung, cardiac examination including palpation and
auscultation with identification of heart sounds and murmurs, abdominal distension and splenic palpation
3.Demonstrate peripheral pulse, volume, character, quality and variation in various causes of heart failure
4. Measure the blood pressure accurately, recognise and discuss alterations in blood pressure in valvular heart
disease and other causes of heart failure and cardiac tamponade
5.Demonstrate and measure jugular venous distension.
6.Identify and describe the timing, pitch quality conduction and significance of precordial murmurs and their
variations.
7.Perform and interpret a 12 lead ECG.
8.Assist and demonstrate the proper technique in collecting specimen for blood culture.
9.Administer an intramuscular injection with an appropriate explanation to the patient.
10.Elicit document and present an appropriate history that includes onset evolution, presentation risk factors,
family history, comorbid conditions, complications, medication, history of atherosclerosis, IHD and coronary
syndromes. Perform, demonstrate and document a physical examination including a vascular and cardiac
examination that is appropriate for the clinical presentation.
11.Observe and participate in a controlled environment an ACLS program.
12.Perform and demonstrate in a mannequin BLS.
13.Perform, document and demonstrate a physical examination including general examination and appropriate
examination of the lungs that establishes the diagnosis, complications and severity of disease. Generate
document and present a differential diagnosis based on the clinical features, and prioritise the diagnosis based
on the presentation.
14.Demonstrate in a mannequin and interpret results of an arterial blood gas examination, pleural fluid
aspiration.
15.Perform and interpret a sputum gram stain and AFB
16.Elicit document and present a medical history that helps delineate the aetiology of fever that includes the
evolution and pattern of fever, associated symptoms, immune status, comorbidities, risk factors, exposure
through occupation, travel and environment and medication use.
17.Perform and interpret a sputum gram stain, malarial smear.
18.Assist in the collection of blood and wound cultures. Interpret PPD(montaux).
19.Elicit history and perform a systematic examination that establishes the diagnosis and severity that includes
nutritional status, mental status, jaundice, abdominal distension ascites, features of portosystemic hypertension
and hepatic encephalopathy.
20.Assist in the performance and interpret the findings of an ascitic fluid analysis.
21.Elicit document and present a medical history that helps delineate the aetiology of the current presentation
and includes risk factors for HIV, mode of infection, other sexually transmitted diseases, risks for opportunistic
infections and nutritional status.
22.Demonstrate in a model the correct technique to perform a lumbar puncture.
23.Elicit,document and present a medical history and perform a systematic examination of all joints, muscle and
skin will establish the diagnosis and severity of disease.
24.Perform a systematic examination that includes : an accurate measurement of blood pressure, fundus
examination, examination of vasculature and heart.
25.Describe, perform and interpret a peripheral smear and stool occult blood.
26.Assist in a blood transfusion
27.Elicit document and present a medical history that will differentiate the aetiologies of disease,Perform a
systematic examination that establishes the diagnosis and severity including determination of volume status,
presence of edema and heart failure, features of uraemia and associated systemic disease.
28.Identify the ECG findings in hyperkalemia
29.Describe and discuss the indications for and insert a peripheral intravenous catheter and assist in the
insertion of a central venous or a dialysis catheter.
30. and interpret a capillary blood glucose test . Perform and interpret a urinary ketone estimation with a
dipstick.
31. document and present an appropriate history that will establish the diagnosis cause of thyroid dysfunction
and its severity. Perform and demonstrate a systematic examination based on the history that will help establish
the diagnosis and severity including systemic signs of thyrotoxicosis and hypothyroidism, palpation of the pulse
for rate and rhythm abnormalities neck palpation of the thyroid and lymph nodes and cardiovascular findings.
32.Demonstrate in a mannequin the correct technique for performing breast exam rectal examination and
cervical examination and pap smear.
33.Elicit and document and present an appropriate history and perform, document and demonstrate a physical
examination based on the history that includes general examination, measurement of abdominal obesity, signs
of secondary causes and comorbidities.
34.Order and interpret diagnostic tests based on the clinical diagnosis including blood glucose, lipids, thyroid
function tests etc.
35.Develop, document and present a treatment plan that includes fluid resuscitation, blood and blood
component transfusion, and specific therapy for arresting blood loss
36.Observe cross matching and blood / blood component transfusion
37.Identify common parasitic causes of diarrhea under the microscope in a stool specimen
38.Identify vibrio cholera in a hanging drop specimen.
39.Demonstrate in a mannequin or equivalent the correct technique for performing a lumbar puncture Interpret
the CSF findings when presented with various parameters of CSF fluid analysis.
40.demonstrate & document physical examination that includes general and a detailed neurologic examination
as appropriate, based on the history.
41.Elicit and document and present an appropriate history including onset, progression precipitating and
aggravating relieving factors, associated symptoms that help identify the cause of the movement disorders.
Perform, demonstrate and document a physical examination that includes a general examination and a detailed
neurologic examination using standard movement rating scales.
42.Describe, demonstrate in a volunteer or a mannequin and educate (to other health care workers / patients) the
correct initial management of patient with a snake bite in the field.
43.Choose and interpret the appropriate diagnostic testing in patients with snake bites.
44.Describe the medico legal aspects of suspected suicidal or homicidal poisoning and demonstrate the correct
procedure to write a medico legal report on a suspected poisoning.
45. multidimensional geriatric assessment that includes medical, psycho-social and functional components.
46.Demonstrate respect to patient privacy, maintain confidentiality in patient care, commitment to continued
learning.
47.Demonstrate personal grooming that is adequate and appropriate for health care responsibilities .
Demonstrate altruism.
48.Administer informed consent and appropriately address patient queries to a patient being enrolled in a
research protocol in a simulated environment.

C.ATTITUDE AND COMMUNICATION

1.At the end of course, the student shall be able to:
2.Communicate pharmacologic management of heart failure including sodium restriction, physical activity and
limitations.
3.Counsel and communicate to patients with empathy lifestyle changes in atherosclerosis / post coronary
syndromes .
4.Communicate and counsel patient on family on the diagnosis and therapy of pneumonia and communicate to
patients on pneumococcal and influenza vaccines.
5.Counsel the patient on malarial prevention.
6.Enumerate the indications, precautions and counsel patients on vaccination for hepatitis.
7.Counsel patients on prevention of HIV transmission. Communicate diagnosis, treatment plan and subsequent
follow up plan to patients. Communicate with patients on the importance of medication adherence.
8.Select, prescribe and communicate treatment option for systemic rheumatologic conditions and it’s follow up
and incorporate patient preferences.
9.Develop and communicate to the patient lifestyle modification including weight reduction, moderation of
alcohol intake, physical activity and sodium intake.Incorporate patient preferences in management of
hypertension. Demonstrate impact of hypertension on the quality of life ,work ,family.
10.Communicate and counsel patients with methods to prevent nutritional anemia.Incorporate patient
preferences in the management of anemia.
11.Recognise the impact of CKD on patient’s quality of life well being work and family. Incorporate patient
preferences in to the care of CKD.
12.Demonstrate and counsel patients on the correct technique to administer insulin and self monitoring of blood
glucoses.
13.Write and communicate to the patient appropriately a prescription for thyroxine based on age, sex, and
clinical and biochemical status.
14.Demonstrate an understanding and needs and preferences of patients when choosing curative and palliative
therapy.
15.Communicate and counsel patient on behavioural, dietary and lifestyle modifications and demonstrate an
understanding of patient’s inability to adhere to lifestyle instructions and counsel them in a non - judgemental
way.
16.Counsel patients with migraine and tension headache on lifestyle changes and need for prophylactic therapy.
17.Counsel patient and family about the diagnosis of CVA and therapy in an empathetic manner.
18.Counsel family members of a patient with suspected poisoning about the clinical and medico legal aspects
with empathy.
19.Communicate to the patient and family the diagnosis and treatment of identified infection and Counsel the
patient and family on prevention of various infections due to environmental issues.

D. COMPETENCIES:
The student must demonstrate ability to do the following in relation to common medical problems of the adult
in the community:
1. Demonstrate understanding of the patho-physiologic basis, epidemiological profile, signs and symptoms of
disease and their investigation and management,
2. Competently interview and examine an adult patient and make a clinical diagnosis,
3. Appropriately order and interpret laboratory tests.
4. Initiate appropriate cost-effective treatment based on an understanding of the rational drug prescriptions,
medical interventions required and preventive measures,
5. Follow up of patients with medical problems and refer whenever required,
6. Communicate effectively, educate and counsel the patient and family,
7. Manage common medical emergencies and refer when required,
8. Independently perform common medical procedures safely and understand patient safety issues.
D . INTEGRATION:
The teaching should be aligned and integrated horizontally and vertically in order to provide sound biologic
basis and incorporating the principles of general medicine into a holistic and comprehensive approach to the
care of the patient.

SUMMARY OF TIME ALLOTTED FOR TEACHING-LEARNING METHODS AND STUDENT

ASSESSMENT
IN GENERAL MEDICINE

CURRICULUM COMPONENT TIME ALLOTTED IN HOURS

FIRST PROFESSIONAL TEACHING HOURS
(Early Clinical Exposure)
Lectures 30
Small Group Teaching / Tutorials / Integrated 0
learning / Practical
Self-directed learning 0
AETCOM module (longitudinal programme 34
shared by all departments)
Sports and extracurricular activities (shared) 60

Total 30
(Excluding AETCOM and Sports & EC
Activities)
SECOND PROFESSIONAL TEACHING HOURS
Lectures 25
Small Group Learning (Tutorials / Seminars / -
Integrated learning)
Clinical postings 60
(4 weeks @ 15 hours/week)
Self-directed Learning -
AETCOM module (longitudinal programme 37
shared by all departments)
Total 85
(Excluding AETCOM)

THIRD PROFESSIONAL PART - I TEACHING HOURS

Lectures 25
Tutorials / Seminars / Integrated Teaching 35

Self-directed Learning 5
Clinical posting 72
(4 Weeks @18 hours/week)
AETCOM module (longitudinal programme 25
shared by all departments)
Total 137
(Excluding AETCOM)
THIRD PROFESSIONAL PART – II TEACHING HOURS
Lectures 70
Tutorials / Seminars / Integrated Teaching 125

Self-directed Learning 15
Clinical postings 216
(8+4 Weeks @18 hours/week)
AETCOM module (longitudinal programme 43
shared by all departments)
Total 426
(Excluding AETCOM)
DIVISION OF CURRICULUM PHASE WISE (EXCLUDING CLINICAL POSTINGS)

To be noted:
 The number of hours mentioned above are rough guidelines that can be modified to suit the specific
requirements of a medical college.
 It is recommended that didactic teaching be restricted to less than one third of the total time allotted for
that discipline.
 Greater emphasis is to laid on hands-on training, symposia, seminars, small group discussions, problem-
oriented and problem-based discussions and self-directed learning.
Students must be encouraged to take active part in and share responsibility for their learning.

Books recommended:
For clinics:
1. Hutchison’s Clinical Methods – An integrated approach to clinical practice, 24th Edition, 2018.
2. Macleod’s Clinical Examination, 14th Edition, 2018
3. A Textbook of Symptoms and Physical signs: PHYSICAL DIAGNOSIS by GOLWALLA, 17th
edition,2020.
For Theory
1. Davidson’s Principles and Practice of Medicine, 24th edition, 2022
2 . Kumar and Clark’s Clinical Medicine, 10th Edition, 2020
Reference books
1. Cecil Essentials of Medicine, 10th Edition, 2021.
2. Harrison’s Principles of Internal Medicine, 21st Edition, 2022.
3. Current medical diagnostics and testing, most recent edition (updated annually)
4. API textbook of medicine,11th edition.
 EXAMINATION SCHEME –GENERAL MEDICINE
MARKS DISTRIBUTION AS PER CBME
University Examination Internal Assessment
Theory Practical Theory Practical
200 Marks (Practical + viva) 25 Practical + viva =
Paper – I = 100 M 200 Marks Marks 25 M
Paper – II =100
Practical – 140 M Log book & Record
M Duration of
each paper – 3 Viva – 60 M = 10 M)
Hours 9 AM – 5 PM 35 Marks
Pattern of questions 1. Long Case = 50  Four internal
1. MCQ – 20 – (1 x Marks assessments will be
20) =20 M Duration – 30 conducted
2. Long Answer minutes  One in 2nd MBBS,
Questions/SEQ – 2. Short cases – 2 Nos. one in 3rd MBBS
2 (2x 15) = 30 M (2 x 25) = 5 0 Marks Part – I and two in
3. Short Answer Duration – 10 minutes 3rd MBBS Part – II.
Questions – 10 3. OSCE Stations – 4 Nos.  The final (4th)
(10x5) =50 M (4 x 10) = 40 Marks internal assessment
Duration – 5 shall be conducted
 MCQs paper minutes /Station – 20 in university
will be given minutes pattern
in 1st 20 mins 4. Viva including  Internal assessment
of Instruments, ECG & will be conducted in
examination. X-rays = 60 Marks both theory and
 In SAQs one The candidate should write practical as per CBME
questions on detailed case sheet for long curriculum.
problem- case.
based The candidate should write
learning (PBL) the points in favor of short
and one case.
question on
AETCOM
Pass criteria –Mandatory 50% in theory and Eligibility criteria for
Practical respectively (Not less than 40% in each appearing to university
paper). examinations –
Attendance – Theory - 75%
Practical - 80%
IA Marks - 50% combined
in theory and Practical (not
less than 40% in each) for
eligibility of appearing the
University Examination
Electives attendance – 75%
attendance is mandatory for
appearing final MBBS
examinations.
 A. SCHEME OF UNIVERSITY EXAMINATION

Theory Max. Marks Practical Max Marks

Paper-I 100 Practical exam 140
Paper-II 100 Viva/Orals 60
Total 200 Total 200

University Theory examination

1) University examinations are to be designed with a view to ascertain whether the student has
acquired the necessary knowledge, minimal level of skills, ethical and professional values
with clear concepts of the fundamentals which are necessary for him/her to function
effectively and appropriately as a physician of first contact. Assessment shall be carried out
on an objective basis to the extent possible.
2) Third Professional Part II (Final Professional) examination shall be at the end of the training
(14 months including 2 months of electives) in the subjects of General Medicine, General
Surgery, Obstetrics & Gynaecology and Paediatrics.
3) Nature of the questions will include different types such as Structured Essays (Long
Answer Questions – LAQ), Short Answer Questions (SAQ) and Objective type
questions (e.g., Multiple Choice Questions – MCQ). Marks for each part should be
indicated separately. MCQs shall be accorded a weightage of not more than 20% of the total
theory marks. (University Curriculum Board in its Executive Meeting has decided
weightage of MCQs to be only 20% of the total theory marks). In subjects that have two
papers, the learner must secure at least 40% marks in each of the papers with minimum of
50% of marks in aggregate (both papers together) to pass.
 Paper I consists of GENERAL MEDICINE questions only and Paper II consists of
questions from GENERAL MEDICINE AND PSYCHIATRY, DVL, RESPIRATORY
MEDICINE.
 At least one question in each paper of the clinical specialties should test knowledge –
competencies acquired during the professional development programme (AETCOM).
 Paper-I Time allotted-3 hours Max.marks-100
S. No Type of questions Marks
Two (2) Long Answer Questions (Structured E s s a y 2x 15 = 30 M
I Questions)
Ten (10) short answer questions, including one 10 x 5 = 50 M
II problem-based question and one AETCOM question.

Twenty (20) Objective type Questions - MCQs 20 x 1 = 20M

III

Paper-II Time allotted-3 hours Max.marks-100

S. No Type of questions Marks
Two (2) Long Answer Questions (Structured E s s a y 2x 15 = 30 M
I
Questions)
Ten (10) short answer questions, including one 10 x 5 = 50 M
II problem-based question and one AETCOM question.

III Twenty (20) Objective type Questions - MCQs 20 x 1 = 20 M

SYLLABUS

Paper 1 topics Paper 2 topics

Fundamentals of Medicine - including Clinical
Infectious Diseases – including HIV infection and
genetics, Clinical immunology, Oncology and Pain
sexually transmitted diseases
& palliative care
Alteration in Body temperature – Fever & Febrile Cardiology - Alterations in circulatory function &
syndromes Disorders of Cardio Vascular System
Neurology & Stroke Medicine - Nervous system
Emergency and Critical Care Medicine
dysfunction & Neurologic Disorders
Toxicology – Poisoning, Drug over dose and
Medical Psychiatry
envenomation
Hematology & Transfusion Medicine -
Dermatology - Alterations in skin and
Hematologic alterations, Hematopoietic
Dermatological Disorders
disorders, Disorders of Hemostasis
Nephrology & Urology - Alterations in Renal and
Respiratory Medicine - Alterations in Respiratory
Urinary tract function & Disorders of the Kidney
function & Disorders of Respiratory System
and Urinary Tract
Gastroenterology - Alterations in Gastrointestinal
Rheumatology and bone diseases
function & Disorders of Gastro Intestinal System
Hepatology Aging and Geriatric Medicine
Nutritional factors in diseases - Vitamins &
Endocrinology & Metabolism
Nutrition
Disorders associated with environmental
AETCOM exposure
AETCOM
 WEIGHTAGE OF MARKS

PAPER - I
S. No Topic Marks up to
1 Fundamentals of Medicine - including Clinical genetics, Clinical 5 - 10
immunology, oncology and Pain & palliative care
2 Alteration in Body temperature – Fever & Febrile syndromes 2 - 15
3 Emergency and Critical Care Medicine 2 - 10
4 Toxicology – Poisoning, Drug over dose and envenomation 6 - 15
5 Hematology & Transfusion Medicine - Hematologic alterations, 10 - 20
Hematopoietic disorders, Disorders of Hemostasis
6 Nephrology & Urology - Alterations in Renal and Urinary tract function & 10 - 16
Disorders of the Kidney and Urinary Tract
7 Gastroenterology - Alterations in Gastrointestinal function & Disorders 6 - 10
of Gastro Intestinal System
8 Hepatology 6 - 15
9 Endocrinology including Diabetes Mellitus & Metabolism 10 - 20
10 AETCOM (*Compulsory) 5
Special note: Demarcation of topics is tentative only; as some amount of
overlapping is unavoidable between these topics. Deviation up to 25% is
acceptable
PAPER - II
S. No Topic Marks up to

1 Infectious Diseases – including HIV infection and sexually transmitted 20 - 30

diseases
2 Cardiology - Alterations in circulatory function & Disorders of Cardio 15 - 20
Vascular System
3 Neurology & Stroke Medicine - Nervous system dysfunction & Neurologic 15 - 20
Disorders
4 Medical Psychiatry 2-6
5 Dermatology - Alterations in skin and Dermatological Disorders 2-6
6 Respiratory Medicine - Alterations in Respiratory function & Disorders of 5 - 16
Respiratory System
7 Rheumatology and bone diseases 2 - 15
8 Aging and Geriatric Medicine 2-6
9 Nutritional factors in diseases - Vitamins & Nutrition 2-6
10 Disorders associated with environmental exposure 2-6
11 AETCOM (*Compulsory) 5
Special note: Demarcation of topics is tentative only; as some amount of
overlapping is unavoidable between these topics. Deviation up to 25% is
acceptable
 Questions are to be framed on clinical scenarios (if possible) to test the comprehensive and
analytical skills.
 Questions should be framed in a structured manner mentioning specific competency being
asked [(aetiology, clinical features, pathology, investigations, differential diagnosis, specific
aspects of treatment, radiotherapy, chemotherapy, etc.
 Multiple choice questions should be framed in an analytical manner and avoiding options
like – All of the above; None of the above; Multiple answers / correct responses.
 At least one question in each paper of the clinical specialties should test knowledge –
competency acquired during the professional development programme (AETCOM
module).
 MODEL QUESTION PAPERS – GENERAL MEDICINE
PAPER – I
Answer all the questions:
Max marks: 100 Time: 3 hrs.
I. Long / Essay Answer Question (2 X 15 = 30 marks)
1. Describe and discuss the pathophysiology, clinical evolution and complications of
cirrhosis and portal hypertension including ascites, spontaneous bacterial peritonitis,
hepatorenal syndrome and hepatic encephalopathy. (5+5+5=15)

2. 80 year old male is bitten by a stray dog in his right leg .The bite was an unprovoked
bite
1.What are the immediate do’s and don’ts for such a wound
2. As per the national guidelines and rabbits profile access what are the categories of dog
bite in humans and what are the recommended post exposure prophylaxis in each
explain
3. What are the clinical manifestations of rabies in humans
4.What are the intramuscular and intradermal regimens of anti rabies vaccines as per
national guidelines(2+5+5+3)
II. Short Answer Questions (10×5=50)
1. Describe the systemic manifestations of rheumatologic disease.
2.Descrbe the etiology of acute and chronic diarrhoea.Write a note on bacillary dysentery?

3. Describe and discuss the relationship between CDC count and the risk of opportunistic
infections.

4. Describe the various tests for iron deficiency.

5.Classify migraine and describe the distinguishing features between classical and non classical
forms of migraine.

6.Enumerate and describe ethical issues in the care of the elderly.

7.Discuss medico legal, socio economic and ethical issues as it pertains to organ donation.
 8.Enumerate the indications and describe the pharmacology, dose, adverse reactions,
hypersensitivity reactions of anti snake venom.

9. Discuss and describe the pharmacology, side effects and interactions of various drugs used in
the therapy of Parkinson’s syndrome.

10. Distinguish between upper and lower gastrointestinal bleeding based on the clinical features.

III. Multiple-choice Questions (1 X 20= 20marks)

1) Progressive multifocal leucoencephalopathy seen in

A.coronavirus infection. B.prion virus infection

C. cytomegalovirus infection D.HIV infection

2) Lipodystrophy is a side-effect of

A. zidovudine. B. Lopinavir

C. Lamivudine. D. Dolutegravir

3) ‘A 36-year-old man has had stable ulcerative colitis for 5 years. He is being treated with
sulfasalazine 1000 mg three times daily. On routine follow-up, he is found to have an ALT of
250 IU/L, an AST of 225 IU/L, an alkaline phosphatase of 450 IU/L, and a bilirubin of 2
μmol/L. Ultrasound of the abdomen reveals no bile duct dilatation or gallstones. Endoscopic
retrograde cholangiopancreatography (ERCP) reveals multifocal strictures and dilatations of
both the intrahepatic and extrahepatic bile ducts. What is the MOST likely diagnosis?

A. sclerosing cholangitis

B. common bile duct stone

C. primary biliary cirrhosis

D.drug-induced hepatitis
 4) A 19-year-old student presents with a fifteen week history of diarrhea. He has lost 2 kg

in weight, and has no. recent travel abroad. A smear of a duodenal biopsy reveals many

trophozoites. What is the best treatment option?

A. Ciprofloxacin B. Gluten free diet C. Metronidazole D. Prednisolone

5) Causes of anaemia in chronic kidney disease includes all of the following , except

A. Increased phosphate levels B .deficiency of Erythropoietin.

C . decreased red cell cell survival. D. toxic effect of uremia on marrow precursors

6. A 6 1-year-old man, with an 8-year history of hepatitis C infection and

well-documented cirrhosis and portal hypertension, presents with a large hematoma

on his thigh. On preoperative screening, his prothrombin time is noted to be 1 7.4

seconds. Transfusion of which of the following is the most appropriate next step

in management of this patient prior to his procedure?

A. Cryoprecipitate B. Fresh frozen plasma C. Packed red blood cells D. Platelets

7) R0ME 3 criteria is used for diagnosis of

A. Blind loop syndrome. B. irritable bowel syndrome

C. inflammatory bowel disease D. peutz jeghers syndrome

8). A 25 year-old man presents with 24 hours blurred vision in left eye and mild frontal

headache. He has a 10 year history of Diabetes Mellitus. Examination reveals a central

scotoma. What is your diagnosis?

A. Central retinal artery occlusion. B. Diabetic retinopathy.

C. Migraine. D. Optic neuritis.

9.R0ME 3 criteria is used for diagnosis of

A. Blind loop syndrome. B. irritable bowel syndrome

C. inflammatory bowel disease D. peutz jeghers syndrome

10. CURB-65 Criteria includes all of the following,except

A. Convulsions B. Age greater than 65

C. respiratory rate greater than 30 D. blood urea more than 20mg/dl.

11. Which of the following findings is diagnostic of iron deficiency anemia?

a) Increased TIBC, decreased serum ferritin b) Decreased TIBC, decreased serum ferritin

c) Increased TIBC, increased serum ferritin d) Decreased TIBC, increased serum ferritin

12. Mannitol infusion causes increase in

a) Blood viscosity b) Osmolarity
c) Intra-ocular tension d) intra cranial tension

13. Which of the following drugs is useful in the prophylaxis of migraine?

a) Propranolol b) Sumatriptan c) Domperidone d) Ergotamine

14. Antibodies most commonly seen in drug induced lupus are:

a) Anti ds DNA Antibodies b) Anti Sm Antibodies

c) Anti-Ro Antibodies d) Anti histone Antibodies

15. Chronic bronchitis is said to be present when patient has chronic cough
a) 3 consecutive months in at least two consecutive years

b) 2 consecutive months for 3 consecutive years

c) 3 consecutive months in one year

d) 1 month in a year for 2 consecutive years
16. Hyperthermia
a) Temperature > 41.5 b) > 40 with autonomic dysfunction
c) No change in hypothalamic thermostat d) Failure of thermoregulation

17. A patient brought in unconscious state with external injuries. CT is normal with no midline
shift and ventricles are normal. Multiple small hemorhages are seen at the base of the brain.
Diagnosis is
a) Subarachnoid hemorrhage b) Diffuse axonal injuries c) Concussion d) Contusion

18. Subacute combined degeneration of cord is caused due to deficiency of

a) Vitamin B1 b) Vitamin B5 c) Vitamin B6 d) Vitamin B12

19. Which of the following should not be done while dealing with a patient of snake bite

a) Tight band applied b) Reassurance

c) Local incision d) Clean with soap and water

20. A 25-year-old man is brought to the emergency department by his wife after vomiting at a
party. The patient admits to drinking 4 glasses of wine and some vodka and says he feels better
now. Temperature is 37.8 C (100 F), blood pressure is 100/50 mm Hg, pulse is 106/min, and
respirations are 14/min. Physical examination is remarkable for blood-tinged vomitus on the
patient's shirt and shoes. Abdominal examination reveals epigastric tenderness on palpation. On
mental status examination, the patient is alert, cooperative, and fully oriented. Blood alcohol
level is 70 mg/dL (0.07% blood alcohol content). The physician recommends laboratory
evaluation, including complete blood count, comprehensive metabolic panel, amylase, and
lipase. The patient insists that he is fine and wants to go home. Which of the following is the
most appropriate course of action?

A. Ask the patient's wife for consent to proceed with laboratory evaluation

B. Discharge the patient with instructions to return to the hospital as needed

C. Do not allow the patient to leave the hospital due to elevated blood alcohol content

D. Explain the potential risks of leaving the hospital without further evaluation
 PAPER – 2
Answer all the questions:
Max marks: 100 Time: 3 hrs.
I. Long / Essay Answer Question (2 X 15 = 30 marks)
1. A 60 year old diabetic male presented to the emergency department with acute onset
central squeezing type of chest pain which is severe in intensity and not relieving even
after taking rest.
1. What is the most probable diagnosis
2. how will you investigate the case to reach the diagnosis.
3. Outline the steps in the management of case and write a note on complications of
such cases.
2. Describe the epidemiology and pathogenesis of hypothyroidism and hyperthyroidism
including the influence of iodine deficiency and autoimmunity in the pathogenesis of
thyroid disease
II. Short Answer Questions (10×5=50)
1. Identify the ECG findings in hyperkalemia.

2. Distinguish between hypertensive urgency and emergency and Enumerate various drugs used
in hypertensive emergencies?

3. Enumerate and describe the pharmacologic basis and side effects of drugs used in
schizophrenia.

4. Describe the treatment of anxiety disorders including behavioural and pharmacologic therapy.

5.Describe and discuss the basic legal and ethical issues in psychiatry.

6.Describe and discuss the various aetiologies of secondary causes of hypertension.

7.Describe microvascular and macrovascular complications of diabetes mellitus.

8.Describe the pharmacology, administration and adverse reaction of pharmacotherapies for

scabies.

9. Describe and identify lepra reactions and supportive measures and therapy of lepra reactions.

10. Describe the various skin changes in Vitamin B complex deficiency.

III. Multiple-choice Questions (1 X 20 = 20 marks)
I. A patient is found to have a holosystolic murmur on physical examination. With deep
inspiration, the intensity of the murmur increases. This is consistent with which of the
following?
A. Atrial-septal defect B. Austin Flint murmur

C. Carvallo’s sign D. Chronic mitral regurgitation

2. In Somogyi phenomenon commonly associated with type 2 diabetes mellitus, the dose of
insulin should be

A. Increased B.decreased C.stopped D.no change needed

3. A patient develops quadriparesis after rapid correction of hyponatremia, this is due to

A.Guillain Barre syndrome B. osmotic demyelination syndrome

C. periodic paralysis D.transverse myelitis

4. 85 year old woman has been fasting all day as part of a new diet which of the following is
a gut peptide that will be increased in this woman
A. peptide YY B.adiponectin C.leptin D. Ghrelin

5. Which of the following is a newer biomarker to assess the prognosis in a patient with
heart failure
A. Soluble ST-2. B. Lipocalin C. Endothelin 1 D. Cystatin
6. Boot shape of heart in TOF is due to:

a) Left atrial enlargement b) Right atrial enlargement

c) Right ventricular hypertrophy d) Biventricular hypertrophy.

7.Which of the following is false with respect to lifestyle modifications for management
hypertension as recommended by AHA 2019 guidelines?

A.low potassium B.low sodium C.DASH diet D. limit alcohol consumption

8. Which of the following is true about schizophrenia

A. Insight is present B.substance abuse is seen C. personality is a normal. . D. speech maybe

disorganized.

9.A 45-year-old white man presents to your office complaining of daytime somnolence,
increased fatigability, and morning headaches. He says that his wife complains that he snores
loudly. He is not taking any medications and does not smoke or consume alcohol His blood
pressure is 145/90 mmHg and heart rate is 90/min. Physical examination reveals a well-
nourished man with BMI = 31 kg/m2 What is the next best step in the management of this
patient?

A.Advised to sleep in supine position B. weight reduction

C.tracheostomy D.drugs for hypertension

10.Shagreen patches are seen in

A. Neurofibromatosis B. Tuberous sclerosis C. syphilis D. TB

11 A thirty five year old man presents in a clinic with history of chronic productive cough that is
worse in the morning and brought on by changes in posture. Sputum is copious and yellow. The
most likely diagnosis in this patient is:
a) Bronchial asthma. b) Bronchiectasis. c) Bronchogenic carcinoma. d) Chronic
bronchitis.

12. Which of the following is approved for the long-term treatment of obesity?

A.Liraglutide B.Fenfluramine C.Sibutramine D.Metformin

13. A 50-year-old female has come with backache, confusion& constipation. Her hemoglobin is
7.3gm/dL, TLC & platelet count are normal. Serum creatinine is 2.6 mg/dL, serum calcium is 13
mg/dL, serum albumin is 2.4 g/dL & total protein is9.1 g/dL. There are lytic lesions in the
vertebrae. Which of the following is the most likely diagnosis?

A. Multiple myeloma B.Milk alkali syndrome

C.Primary hyperparathyroidism D. Metastatic breast cancer

14. A 35-year-old multiparous woman presents with marked dyspnea and orthopnea in the ninth
month of what is known to be a twin pregnancy. She is in atrial fibrillation, and her blood
pressure is 130/95 mm Hg. She has elevated jugular venous pressure, cardiomegaly, and a third
heart sound. There is a grade 2/6 pan systolic murmur at the apex. Chest examination reveals
bibasilar inspiratory crackles. In addition to digoxin and furosemide, which of the following
medications would be MOST appropriate?

a. hydralazine b. captopril b. prednisone d. warfarin

15. Which of the following is not a management for acute Hyperkalemia?

A. calcium gluconate. B . Salbutamol nebulization. C . Insulin. D . Sodium bicarbonate

16. Which of the following class of anti diabetic drugs cause weight gain?

A. biguanides B. Sulfonylureas C .SGLT2 inhibitors. D. DPP 4 inhibitors

17. A young lady presents with repeated episodes of excessive eating followed by purging by use
of laxatives. What is the diagnosis?
a) Binge eating b) Bulimia nervosa c) Schizophrenia d) Anorexia nervosa

18. 3 yr old girl has delayed developmental milestone, delayed speech, difficulty in concentrating
on studies, plays with herself & does not make friends. Diagnosis is

a) Autism b) ADHD. c) Specific learning disorder d) Mental retardation

19. A pt presents with acute rheumatic carditis with fever. True statement is

a) Increased troponin T b) Reduced myocardial contractility

c) Signs of inflammation and necrosis d) Valve replacement will ameliorate CCF

20. A 40 year old male reported with recurrent episodes of oral ulcers, large areas of denuded
skin and flaccid vesiculo-bullous eruptions. Which is the most important bed-side investigation
helpful in establishing the diagnosis a) Gram staining of the blister fluid
b) Culture and sensitivity
c) Skin biopsy and immunofluorescence d) Tzanck smear from the floor of bulla
 UNIVERSITY PRACTICAL/CLINICAL EXAMINATION

Practical / clinical examination will be conducted in the laboratories and/or hospital wards. The
objective will be to assess proficiency and skills to conduct experiments, interpret data and form
logical conclusions. Clinical cases kept in the examination must be common conditions that the
learner may encounter as a physician of first contact in the community. Selection of rare
syndromes and disorders as examination cases is to be discouraged. Emphasis should be on
candidate’s capability to elicit history, demonstrate physical signs, write a case record, analyse
the case and develop a management plan.
The aim is to provide Long case, short case and Objective Structured Clinical Examination
(OSCE).

Skills and competencies acquired during the Professional Development Programme (Including
AETCOM module) to be tested during clinical, practical, orals and viva voce.

Total Practical Marks for General medicine 200 marks

General Medicine Practical/Clinical Examination:

Item Max. Time Nos. Max. Marks Total Marks

allotted
LONG CASE 30 Minutes 1 50 50 Marks
SHORT CASES 10 Minutes 2 (2 x 25) = 50 50 Marks
OSCE stations 5 Minutes each 4 10 Marks 40 Marks
station each
VIVA/ORALS: (Afternoon) will be conducted in 4 stations with a max. 60 Marks
time of 5 minutes at each station. It includes
i) Viva voce Instruments, ECG & X-rays – 60 marks
TOTAL 200 Marks
To be declared as pass, it is mandatory that a candidate should get 50% marks separately
in theory (Not less than 40% in each paper) and practical.

(Practical = Practical /Clinicals + Viva/Orals).

 B. SCHEME OF INTERNAL ASSESSMENT EXAMINATIONS
Theory examinations
A total of 4 (four) Internal Assessment examinations shall be conducted in complete course in
both theory and practical/clinical. One assessment examination in Second professional year, one
assessment examination in Third professional year part-1 and two assessment examinations in
third professional year part-2.

 For 1st, 2nd and 3rd internal assessments question paper and marks pattern may be done
as per the choice and convenience of the college with LAQ/SEQ, SAQ and MCQs.
MCQs shall be accorded a weightage of not more than 20% of the total theory marks in
internal assessment examinations.

 First internal assessment has to be conducted at the end of 2nd MBBS/as per university
academic calendar.
 Second internal assessment has to be conducted at the end of third MBBS Part – I/as per
university academic calendar.
 Third internal assessment has to be conducted five months after commencement of third
MBBS Part – II classes/as per university academic calendar.
 Last (fourth) internal assessment during third professional year part -2 is to be conducted
in the lines of the Final University Examination.
 Fourth internal assessment has to be conducted in co-ordination with other subjects
(General Surgery, OBG and Paediatrics) at the end of third professional year part-II in the
lines of the Final University Examination as per schedule given in academic calendar.

Practical examinations
 1st, 2nd and 3rd internal assessment will be in similar pattern and may be done as per the
choice of the college.
 First internal assessment has to be conducted at the end of 2nd MBBS clinical postings
 Second internal assessment has to be conducted at the end of third MBBS Part – I clinical
postings.
 Third internal assessment has to be conducted at the end of clinical postings as per the
convenience of college.
 Last (fourth) internal assessment during third professional year part -2 is to be conducted
in the lines of the Final University Examination.
 Fourth internal assessment has to be conducted in co-ordination with other subjects
(General Surgery, OBG and Paediatrics) at the end of third professional year part-II in the
lines of university examination pattern as per schedule given in academic calendar.
 *INTERNAL ASSESSMENT FINAL MARKS TO SENT TO UNIVERSITY
Average of all 4 Internal assessments is to be calculated and marks to be sent to the
University after reducing marks in the below mentioned division format for 60 marks.

Internal assessments Average Marks of all internal assessments to be sent to

university
Theory 25
Practical Practical - 25
(Including Logbook Log Book - 5 35
& Record)
Record - 5
Total 60

NOTE :

1. 50% marks combined in theory and practical (not less than 40% in each) to
be scored for eligibility for appearing in University Examinations.
2. 75% Attendance in electives is mandatory for appearing in Final MBBS
examinations.

*********