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🏆 DNB MEDICINE — 1-MONTH TOPPER'S TIMETABLE

For DNB Medicine Theory & Practical | NBEMS Pattern | Last 10 Years High-Yield

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BEFORE YOU START — KNOW THE EXAM

• 3 papers × 3 hours | Long Essays (10 marks), Short Notes (5 marks), Problem-Based Questions (10 marks)
• Practical: Long Case + Short Cases + Viva (OSCEs increasingly)
• Hot trend (2015–2024): Clinical problem-solving > rote recall. Investigations + management algorithms are now the core.

1. Clinical reasoning (not just diagnosis — what next, what investigation, what treatment)
2. Guidelines-based management (JNC, ADA, GOLD, ESC, ISHLT latest)
3. Pathophysiology (especially why a treatment works/fails)
4. Differentials with distinguishing features
5. Recent advances (last 2–3 years are frequently asked)

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THE WEIGHTAGE MAP (Last 10 Years DNB Medicine PYQs)

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📅 WEEK-BY-WEEK TIMETABLE

Daily Schedule: 8 AM–10 PM with breaks Morning (3h): New topic reading Afternoon (2h): PYQs + notes writing Evening (2h): Revision + clinical cases Night (1h): Flashcard review / mnemonics

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🔴 WEEK 1 — CARDIOLOGY + NEPHROLOGY

Day 1–2: CARDIOLOGY — Heart Failure

• HFrEF vs HFpEF definitions and management
• NYHA classification + staging (ACC/AHA A–D)
• Neurohormonal axis (RAAS, SNS, BNP/NT-proBNP)
• Drug therapy: ACEi/ARB/ARNI (sacubitril-valsartan), beta-blockers, MRAs, SGLT2i (empagliflozin — most asked recent advance 2022–24)
• Acute decompensation management
• CRT indications (EF <35%, QRS >150ms, LBBB)
• ICD indications

• "Management of HFrEF" (asked 4× in different forms)
• "Role of SGLT2 inhibitors in heart failure" (2022, 2023)
• "Cardiac resynchronization therapy — indications and mechanism" (2019, 2021)
• "Differentiate HFpEF from HFrEF — management differences"
• "BNP vs NT-proBNP — clinical utility"

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Day 3: CARDIOLOGY — Arrhythmias & ECG

• AF management: rate vs rhythm control, CHA₂DS₂-VASc score, anticoagulation choice
• NOAC vs warfarin (dabigatran, rivaroxaban, apixaban — dosing, reversal agents)
• WPW syndrome — delta waves, management, avoid digoxin/verapamil
• Long QT syndrome — drugs that prolong QT (common exam trap)
• Complete heart block — Stokes-Adams, indications for pacing
• LBBB vs RBBB — clinical significance

• "Management of atrial fibrillation — acute and chronic" (asked 5× last 10 years)
• "CHA₂DS₂-VASc score — calculate and apply" (2020, 2022)
• "Drugs causing QT prolongation" (2019)
• "WPW — ECG + management" (2018, 2021)

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Day 4: CARDIOLOGY — ACS, Valvular Disease

• STEMI: Killip classification, thrombolysis vs PPCI (time windows), door-to-balloon
• NSTEMI/UA: GRACE score, TIMI score, antiplatelet therapy (aspirin + ticagrelor/prasugrel)
• Post-MI complications: VSD, papillary muscle rupture, free wall rupture, Dressler's
• Aortic stenosis: gradient cutoffs, TAVI vs SAVR
• Mitral regurgitation: acute (pulmonary edema) vs chronic management
• Rheumatic heart disease — still asked in Indian context

• "Killip classification and its prognostic significance" (2017, 2020)
• "TAVI — indications, comparison with surgical AVR" (2021, 2023)
• "Post-MI mechanical complications" (2018)
• "Management of NSTEMI" (2016, 2019, 2022)

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Day 5–6: NEPHROLOGY — AKI, CKD, GN

• AKI: KDIGO staging (creatinine + urine output criteria), prerenal vs intrinsic vs postrenal
• FENa formula, urine microscopy interpretation
• Contrast nephropathy prevention
• CKD staging (G1–G5, A1–A3), KDIGO 2022 updates
• Indications for dialysis (AEIOU mnemonic)
• Glomerulonephritis: nephritic vs nephrotic syndrome — distinguishing features
• Nephrotic causes: MCD, FSGS, membranous, MPGN, amyloid — each with characteristic findings
• Nephritic causes: IgA nephropathy (most common GN worldwide), post-strep GN, RPGN
• RPGN: linear (Goodpasture), granular (post-strep), pauci-immune (ANCA) — treat with pulse methylprednisolone + cyclophosphamide
• Renal tubular acidosis Types 1, 2, 4 — differences (very frequently asked)
• Hyponatremia: SIADH diagnosis criteria, management (fluid restrict, tolvaptan, 3% saline — correction rate ≤8–10 mEq/L/24h to avoid osmotic demyelination)
• Hyperkalemia: ECG changes, treatment cascade

• "KDIGO staging of AKI" (2016, 2018, 2020, 2022)
• "Renal tubular acidosis — types and differentiation" (asked 4× last 10 years)
• "RPGN — classification and management" (2017, 2019, 2021)
• "Hyponatremia — SIADH vs other causes, management" (2018, 2020, 2023)
• "IgA nephropathy — Oxford classification" (2021, 2023)
• "Nephrotic syndrome — causes and management" (2016, 2019)

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Day 7: NEPHROLOGY — Electrolytes, Acid-Base, Dialysis

• Metabolic acidosis: anion gap vs non-anion gap, Delta-delta ratio
• Metabolic alkalosis: saline-responsive vs saline-resistant
• Respiratory alkalosis/acidosis with compensation formulas
• Hemodialysis vs peritoneal dialysis — indications, complications
• Transplant immunosuppression basics

• "Acid-base disturbance interpretation with ABG" (virtually every exam)
• "Delta ratio in metabolic acidosis" (2019, 2022)
• "Complications of hemodialysis" (2018, 2021)

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🟠 WEEK 2 — GASTROENTEROLOGY + HEPATOLOGY + PULMONOLOGY

Day 8–9: GASTROENTEROLOGY — Liver Disease

• Cirrhosis complications: ascites management (spironolactone + furosemide ratio 100:40mg), SBP (neutrophil count >250, treat cefotaxime, norfloxacin prophylaxis), hepatorenal syndrome (Types 1 & 2), varices (Baveno VII criteria, TIPS, propranolol)
• Hepatic encephalopathy: West Haven grading, ammonia, lactulose, rifaximin
• Acute liver failure: criteria, N-acetylcysteine, King's College criteria for transplant
• Viral hepatitis: Hep B markers interpretation (sAg, eAg, anti-HBc IgM, DNA levels), treatment (tenofovir, entecavir)
• Hep C: DAA therapy (sofosbuvir-based), SVR definition
• NAFLD/NASH: scoring (NAS score, FIB-4), management (weight loss, pioglitazone, semaglutide — 2023 update)
• Autoimmune hepatitis: ANA, ASMA, anti-LKM, IgG levels, Rose Bengal classification
• Primary biliary cholangitis: anti-mitochondrial antibody M2, UDCA treatment
• PSC: p-ANCA, IBD association, MRCP findings

• "Management of ascites and SBP" (asked 5× — very high yield)
• "Hepatorenal syndrome — types and management" (2018, 2020, 2022)
• "King's College Criteria for liver transplant in ALF" (2017, 2019, 2021)
• "Hepatitis B markers interpretation" (every alternate year)
• "NAFLD — management updates" (2022, 2023)
• "Primary biliary cholangitis vs PSC" (2020)

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Day 10: GASTROENTEROLOGY — IBD, Upper GI

• Crohn's vs UC: differences (table format — location, skip lesions, granulomas, extraintestinal)
• IBD management: 5-ASA, steroids, azathioprine, biologics (infliximab, adalimumab, vedolizumab, ustekinumab)
• Upper GI bleed: Rockford/Forest classification, endoscopic management, Blatchford score
• PUD: H. pylori eradication regimens (triple therapy, bismuth quadruple, levofloxacin-based)
• GERD: stepwise management, Barrett's surveillance
• Celiac disease: anti-tTG IgA, anti-endomysial, HLA-DQ2/DQ8, Marsh classification

• "Differentiate Crohn's disease from UC" (2016, 2018, 2020, 2022)
• "Biologics in IBD — indications" (2021, 2023)
• "H. pylori eradication therapy" (2017, 2019)
• "Celiac disease — diagnosis and management" (2018, 2021)

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Day 11–12: PULMONOLOGY — COPD, Asthma, ILD, Pulmonary Hypertension

• COPD: GOLD 2023 staging (spirometry + symptoms + exacerbations), ABCD groups → ABE groups (2023 GOLD update)
• Bronchodilators: SAMA, LAMA, SABA, LABA — when to combine
• ICS: when to add (eosinophils >300, FEV1 <50%, frequent exacerbations)
• AECOPD management: controlled O₂ (target SpO₂ 88–92%), NIV indications
• Asthma: GINA 2023 track 1 vs track 2, severe asthma — biologics (mepolizumab anti-IL5, dupilumab anti-IL4/13)
• ILD: UIP vs NSIP patterns on HRCT (honeycombing vs ground-glass), causes of each
• IPF: anti-fibrotics (pirfenidone, nintedanib), prognosis
• Sarcoidosis: Lofgren syndrome, Scadding stages, ACE levels, HRCT, steroid indications
• Pulmonary hypertension: WHO groups (Group 1–5), Group 1 PAH management (PDE5i, ERA, prostacyclins)
• PE: Wells score, PERC rule, CTPA, thrombolysis vs anticoagulation
• Pleural effusion: Light's criteria (exudate vs transudate)

• "GOLD 2023 COPD management — new ABCD to ABE change" (2023 — very recent, expected heavily)
• "IPF — diagnosis criteria, management" (2019, 2021, 2023)
• "Pulmonary hypertension — classification and treatment" (2018, 2020, 2022)
• "Sarcoidosis — clinical features, investigations, treatment" (2017, 2020, 2023)
• "Light's criteria for pleural effusion" (asked almost every year)
• "Biologics in severe asthma — mechanism and indications" (2021, 2023)

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Day 13–14: PULMONOLOGY — Respiratory Failure, Pneumonia, TB

• Respiratory failure: Type 1 vs Type 2, A-a gradient calculation
• ARDS: Berlin definition (PaO₂/FiO₂ ratios), lung-protective ventilation (6 mL/kg, plateau <30), prone positioning, neuromuscular blockade
• CAP: CURB-65 / PSI scoring, empirical antibiotics
• HAP/VAP: causative organisms, management (anti-pseudomonal cover)
• TB: 2HRZE/4HR regimen, drug resistance, MDR-TB (bedaquiline, linezolid), XDR-TB
• DOTS classification, new WHO 2022 TB guidelines
• Atypical pneumonia: Legionella (urine antigen, pontiac fever), Mycoplasma (cold agglutinins), Chlamydia

• "Berlin definition and management of ARDS" (2018, 2020, 2022)
• "MDR-TB — diagnosis and management" (2017, 2019, 2021, 2023)
• "CURB-65 score — utility in CAP" (2019, 2021)
• "Prone ventilation in ARDS — evidence" (2021, 2023 post-COVID)

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🟡 WEEK 3 — NEUROLOGY + ENDOCRINOLOGY + HEMATOLOGY

Day 15–16: NEUROLOGY — Stroke, Epilepsy, Movement Disorders

• Ischemic stroke: NIHSS, CT vs MRI timing, IV rtPA (time window 4.5h, absolute contraindications), mechanical thrombectomy (up to 24h with DAWN/DEFUSE criteria)
• Hemorrhagic stroke: ICH vs SAH management
• TIA: ABCD² score, 90-day stroke risk
• Epilepsy: classification (focal vs generalized), first-line drugs (valproate, lamotrigine, levetiracetam, carbamazepine — which for which)
• Status epilepticus: treatment ladder (lorazepam → phenytoin → levetiracetam → anesthesia)
• Parkinson's disease: pathophysiology, Lewy bodies, treatment (L-dopa/carbidopa, dopamine agonists, MAO-B inhibitors, COMT inhibitors), complications (on-off phenomenon, dyskinesias)
• Myasthenia gravis: acetylcholine receptor antibody, edrophonium test, thymoma, pyridostigmine, plasmapheresis, IVIG, thymectomy
• GBS: ascending paralysis, albuminocytologic dissociation, nerve conduction studies, IVIG vs plasmapheresis
• MS: McDonald 2017 criteria, disease-modifying therapy (interferons, natalizumab, ocrelizumab)

• "Thrombolysis in ischemic stroke — eligibility and contraindications" (asked 6× last 10 years)
• "Myasthenia gravis — diagnosis and management" (2017, 2019, 2021, 2023)
• "Status epilepticus — treatment protocol" (2018, 2020, 2022)
• "Parkinson's disease — management and complications" (2016, 2019, 2022)
• "GBS — clinical features and management" (2018, 2020)

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Day 17: NEUROLOGY — Meningitis, Encephalitis, Headache

• Bacterial meningitis: CSF findings (protein, glucose, cells), empirical treatment (ceftriaxone + dexamethasone), H. influenzae, pneumococcal, meningococcal
• Viral encephalitis: HSV (temporal lobe, IV acyclovir), anti-NMDAR encephalitis
• TB meningitis: CSF findings, treat 12 months (HRZE 2 months + HR 10 months)
• Cryptococcal meningitis: India ink, opening pressure, fluconazole
• Headache: ICHD-3 criteria for migraine, cluster headache, sumatriptan, CGRP antagonists (new class — frequently asked 2022–24)

• "CSF analysis in different types of meningitis" (every exam)
• "HSV encephalitis — features and treatment" (2018, 2021)
• "Anti-NMDAR encephalitis" (2020, 2022, 2023 — rising frequency)
• "CGRP antagonists in migraine" (2022, 2023 — new topic)

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Day 18–19: ENDOCRINOLOGY — Diabetes, Thyroid, Adrenal

• T2DM: ADA 2024 algorithm — Metformin + early combination (SGLT2i if ASCVD/CKD/HF, GLP-1 RA if obesity)
• GLP-1 RA: semaglutide, liraglutide — CV benefits, weight loss, renal protection
• DKA: criteria, management (insulin infusion, potassium replacement before insulin if K<3.5)
• HHS: key differences from DKA (no significant ketosis, more severe hyperglycemia, hyperosmolarity)
• Hypothyroidism: TSH targets, levothyroxine dosing, myxedema coma
• Hyperthyroidism: Graves' disease (TSH receptor Ab), toxic nodule, thyroid storm — Burch-Wartofsky score
• Thyroid storm management: PTU, beta-blocker, iodine (give PTU FIRST, then iodine)
• Cushing's syndrome: screening (24h UFC, midnight salivary cortisol, 1mg DST), localizing (high-dose DST, IPSS), causes
• Addison's disease: Short synacthen test, crisis management (hydrocortisone 100mg IV)
• Pheochromocytoma: 24h urinary metanephrines, alpha-block FIRST then beta-block
• Diabetes insipidus: central vs nephrogenic, water deprivation test, desmopressin
• MEN syndromes (1, 2A, 2B): components, genetic mutations (MEN1 gene, RET proto-oncogene)

• "DKA management — step by step" (asked 6× last 10 years)
• "ADA 2023/2024 diabetes management algorithm" (2022, 2023)
• "Cushing's syndrome — investigation approach" (2017, 2019, 2021, 2023)
• "Thyroid storm — diagnosis and management" (2018, 2020)
• "Pheochromocytoma — why alpha-block before beta-block" (2019, 2022)
• "MEN syndromes — components and genetics" (2017, 2020)

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Day 20–21: HEMATOLOGY — Anemia, Bleeding Disorders, Leukemia

• Anemia classification: morphological approach + MCV-based
• Iron deficiency vs ACD vs sideroblastic — differentiating indices (ferritin, TIBC, serum iron, transferrin saturation)
• B12/folate deficiency: megaloblastic changes, subacute combined degeneration, Schilling test
• Hemolytic anemias: warm AIHA (IgG, DAT positive), cold AIHA (IgM, Mycoplasma), PNH (CD55/CD59, eculizumab), G6PD
• Thalassemia: alpha vs beta, HbH, HbBart's, transfusion threshold
• Sickle cell disease: vaso-occlusive crisis, acute chest syndrome, hydroxyurea, exchange transfusion
• DIC: causes, diagnostic criteria (fibrinogen low, D-dimer high, PT/aPTT prolonged, schistocytes)
• TTP: pentad, ADAMTS13, plasma exchange (NOT FFP alone)
• ITP: management (steroids, IVIG, rituximab, thrombopoietin receptor agonists — eltrombopag, romiplostim)
• Leukemias: AML (Auer rods, FAB classification, M3 = APL — ATRA + arsenic), CML (BCR-ABL, imatinib), CLL (smear lymphocytes, Rai staging), ALL (CALLA/CD10)
• Lymphomas: Hodgkin (Reed-Sternberg cells, ABVD), NHL classification, DLBCL (RCHOP)
• Multiple myeloma: CRAB criteria, MGUS vs myeloma, serum protein electrophoresis, bortezomib-based therapy

• "TTP vs HUS — differentiation and management" (asked 5× last 10 years)
• "APL (M3 AML) — pathophysiology and ATRA role" (2017, 2019, 2021)
• "Multiple myeloma — CRAB criteria, diagnosis, management" (2018, 2020, 2022)
• "DIC — diagnosis and treatment" (2016, 2018, 2020)
• "Approach to anemia with peripheral smear findings" (every exam)
• "PNH — clinical features, eculizumab" (2020, 2022)

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🟢 WEEK 4 — RHEUMATOLOGY + INFECTIOUS DISEASE + RAPID REVISION

Day 22–23: RHEUMATOLOGY — SLE, RA, Vasculitis, Crystal Arthropathies

• SLE: SLICC 2012 / ACR-EULAR 2019 criteria, organ damage, anti-dsDNA (disease activity), anti-Sm (specific), complement levels
• Lupus nephritis: ISN/RPS classification (Class III/IV most common), treat with MMF or cyclophosphamide
• Drug-induced lupus: antihistone antibody, causative drugs (hydralazine, procainamide, isoniazid, minocycline)
• RA: ACR/EULAR 2010 criteria, anti-CCP (most specific), RF, DAS28, treatment (MTX first, then biologics — anti-TNF)
• Antiphospholipid syndrome: criteria, recurrent thrombosis/pregnancy loss, warfarin for life
• Vasculitis: GCA (temporal artery biopsy, treat before biopsy), Takayasu, GPA (c-ANCA/PR3), MPA (p-ANCA/MPO), Kawasaki
• Gout: urate crystals (negatively birefringent, needle-shaped), allopurinol timing (not during acute attack), target uric acid <6mg/dL
• Pseudogout: calcium pyrophosphate, positively birefringent, rhomboid crystals, chondrocalcinosis
• Ankylosing spondylitis: HLA-B27, bamboo spine, sacroiliitis, anti-TNF if refractory
• Sjögren's syndrome: anti-Ro/SSA, anti-La/SSB, Schirmer's test, lip biopsy

• "SLE — criteria, lupus nephritis classification and management" (every exam)
• "Antiphospholipid syndrome — criteria and treatment" (2018, 2020, 2022)
• "RA — management algorithm, biologics" (2017, 2019, 2021, 2023)
• "Vasculitis — ANCA pattern and disease association" (2019, 2021, 2023)
• "Gout — acute attack vs chronic management" (2016, 2018, 2020)

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Day 24: INFECTIOUS DISEASE — HIV, Tropical Diseases, Sepsis

• HIV: CD4 count milestones (OI risk thresholds), when to start ART (now: all CD4 counts), preferred first-line (TDF/FTC + DTG — dolutegravir-based)
• OIs by CD4 count: >200 (TB, HSV), 100–200 (PCP, Toxoplasmosis), <100 (CMV, MAC, Cryptosporidiosis)
• PCP: CD4 <200, silver stain, TMP-SMX (treatment + prophylaxis), adjuvant steroids if PaO₂ <70
• Toxoplasmosis: ring-enhancing lesions, pyrimethamine + sulfadiazine
• Cryptococcal meningitis: induction (amphotericin B + flucytosine 2 weeks), consolidation (fluconazole)
• Sepsis: Sepsis-3 definition (SOFA score ≥2), 1-hour bundle (blood cultures before antibiotics, lactate, IV fluid, vasopressors), norepinephrine first choice
• Malaria: P. falciparum severe criteria (WHO), artesunate IV for severe malaria, ACT for uncomplicated
• Dengue: NS1 antigen, dengue IgM/IgG, warning signs (platelet <100,000 + any leak sign), fluid management
• Typhoid: Widal (limitations), blood culture gold standard, azithromycin/ceftriaxone for treatment
• Leptospirosis: Weil's disease, penicillin/doxycycline

• "HIV — OI prophylaxis based on CD4 count" (asked every exam)
• "Sepsis-3 definition and 1-hour bundle" (2018, 2020, 2022, 2023)
• "Severe malaria — WHO criteria and management" (2017, 2019, 2021)
• "PCP pneumonia — diagnosis and management" (2018, 2021)

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Day 25: DERMATOLOGY IN MEDICINE + POISONING

• Erythema multiforme vs SJS vs TEN: causes (drugs, HSV), BSA involvement criteria, management
• Pemphigus vulgaris vs bullous pemphigoid: antibody targets (desmoglein 3 vs BP180/BP230), histology, immunofluorescence patterns
• Necrotizing fasciitis: surgical emergency, type 1 vs type 2
• Organophosphate poisoning: SLUDGE/DUMBELS, atropine + pralidoxime
• Paracetamol overdose: acetylcysteine protocol, King's College criteria
• Methanol/ethylene glycol: anion-gap + osmolar gap, fomepizole treatment
• Opioid overdose: naloxone
• Salicylate toxicity: mixed acid-base picture

• "SJS vs TEN — differentiation and management" (2017, 2019, 2022)
• "Organophosphate poisoning — mechanism and management" (2018, 2020)
• "Paracetamol overdose — management and liver transplant criteria" (2019, 2021)

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Day 26–27: RAPID FIRE TOPICS (Frequently Repeated in MCQs & Viva)

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Day 28: FULL-LENGTH MOCK EXAM DAY

• Attempt 3 previous DNB theory papers (2021, 2022, 2023 sets)
• Time yourself strictly: 10 min/long essay, 5 min/short note
• Mark every question you couldn't answer — those are your Day 29 targets

Day 29: TARGETED REVISION

• All marked questions from Day 28
• Re-read any topic where you scored <50% in mock

Day 30: FINAL RAPID REVISION

• All mnemonics, classifications, scoring systems, and drug doses
• All "recent advances" topics (2022–2024)
• Practical case revision: 5 long cases, 10 short cases verbally

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⚡ HIGH-YIELD MNEMONICS & CLASSIFICATIONS (Know Cold)

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📚 MASTER REFERENCE GUIDE — WHAT TO READ WHERE

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🚨 COMMON MISTAKES DNB RESIDENTS MAKE

1. Writing a diagnosis without a management plan — DNB always awards marks for structured management. Always write Investigation → Short-term management → Long-term management → Complications to watch.
2. Ignoring units and normal values — If you write "creatinine was elevated" without saying what the normal is, you lose marks. Know: Cr normal 0.6–1.2 mg/dL, K normal 3.5–5 mEq/L, etc.
3. Not mentioning contraindications — When asked about a drug, always mention 2–3 key contraindications. This differentiates average from excellent answers.
4. Outdated guidelines — DNB increasingly tests 2022–2024 guideline updates. Using 2015 guidelines for COPD or diabetes will cost marks.
5. Missing the pathophysiology question within the clinical question — They often ask clinical scenarios BUT want the mechanism. "Why does cirrhosis cause SBP?" needs a mechanistic answer.
6. Not writing in points/tables — Examiners are humans reading 200 papers. A well-tabulated comparison (Crohn's vs UC) gets more marks than 3 dense paragraphs.
7. Neglecting electrolytes and ABG interpretation — These are asked in EVERY exam and yet residents routinely lose marks on them. Practice 20 ABG questions.
8. Not knowing drug doses — "Cefotaxime 2g IV q8h for SBP" shows expertise. Vague doses show a student who memorized a diagnosis but never treated a patient.

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⚠️ RARE BUT FREQUENTLY ASKED DNB TOPICS (Traps)

• Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu) — AVMs, epistaxis, telangiectasias, iron deficiency, SMAD4/ENG mutation
• Antiphospholipid syndrome catastrophique — multi-organ thrombosis, treat with anticoagulation + steroids + PLEX
• Hemophagocytic lymphohistiocytosis (HLH) — HScore, ferritin >10,000, treat with dexamethasone + etoposide
• DRESS syndrome — Drug Reaction with Eosinophilia and Systemic Symptoms, RegiSCAR criteria, steroids
• Addisonian crisis vs hypothyroid crisis vs pheochromocytoma crisis — distinguish clinically
• Acute intermittent porphyria — AIP precipitants (drugs, fasting, hormones), triad (abdominal pain + neuropsychiatric + autonomic), diagnose with urinary ALA/PBG
• Cryoglobulinemia — Type I (myeloma), Type II/III (HCV-associated), palpable purpura, glomerulonephritis
• Anti-GBM disease (Goodpasture's) — hemoptysis + nephritis, linear IgG on IF, PLEX is definitive
• Relapsing polychondritis — saddle-nose deformity, auricular chondritis, tracheal involvement

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🔮 WHAT NBEMS IS LIKELY TO ASK IN 2024–2025 (Pattern Prediction)

1. SGLT2 inhibitors — now indicated in HF (all EF types), CKD (KDIGO 2022), T2DM. Mechanism + benefits in each indication.
2. GLP-1 receptor agonists — CV outcomes (LEADER, SUSTAIN-6, REWIND trials), weight loss (SURMOUNT), renal protection, semaglutide for NASH (2023 data).
3. Dolutegravir-based ART — now universal first-line for HIV.
4. CAR-T cell therapy — indications in DLBCL, ALL, multiple myeloma.
5. Dupilumab — severe asthma, atopic dermatitis, mechanism (anti-IL-4/IL-13).
6. Terlipressin in hepatorenal syndrome — FDA approved 2022, mechanism.
7. COVID-19 related complications — long COVID, myocarditis, VITT (vaccine-induced thrombotic thrombocytopenia).
8. CGRP antagonists for migraine — fremanezumab, erenumab — new class, mechanism.
9. Bimekizumab — IL-17A/F inhibitor for psoriatic arthritis/AS (2023).
10. AI in medicine — likely to appear as short note: "Role of AI in early diagnosis/radiology."

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📊 DAILY TIME ALLOCATION SUMMARY

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🎯 TOPPER'S CHECKLIST — Before Every Exam

• Can I name the diagnostic criteria for every major disease? (SLE, RA, DM, MS, Sepsis-3)
• Can I write a structured management plan for every major emergency? (DKA, AKI, Status epilepticus, ARDS, SBP, TTP)
• Do I know which investigation is GOLD STANDARD for each disease?
• Do I know the FIRST-LINE drug, SECOND-LINE drug, and conditions for biological therapy for each major disease?
• Can I interpret any ABG, peripheral smear description, CSF report, and renal indices set?
• Do I know all GUIDELINE YEARS currently in force? (GOLD 2023, ADA 2024, ACC/AHA 2022 HF, KDIGO 2022)
• Have I written at least 15 full essay answers under exam conditions?

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