MRCPUK Part 1 Syllabus

MRCPUK Compiled and edited by the MRCP(UK) Part 1 Examining Board

Part 1 Syllabus

and published for the Federation of Royal Colleges of Physicians of the UK by the MRCP(UK) Central Office

Royal College of Physicians of Edinburgh

Royal College of Physicians & Surgeons of Glasgow

Royal College of Physicians of London

1

MRCPUK Part 1 Syllabus

MRCPUK

Part 1 Syllabus

Compiled and edited by the MRCP (UK) Part 1 Examining Board

MRCP (UK) Central Office Royal Colleges of Physicians

 1999

ROYAL COLLEGES OF PHYSICIANS

Royal College of Physicians of Edinburgh 9

Queen Street

Edinburgh EH2 1JQ Royal College of Physicians & Surgeons of Glasgow 234/242

St Vincen Vincentt Street Street

Glasgow G2 5RJ Royal College of Physicians of London 11

St Andrews Andrews Place

Regents Park London NW1 4LE All rights rights reserved. reserved. No part part of this this publica publication tion may be reproduce reproduced, d, stored stored in a retrieval retrieval system, or transmitte transmitted, d, in any form form or or by any any means means,, electr electroni onic, c, mechan mechanica ical, l, photocopy photocopying, ing, recordi recording ng or or otherwis otherwisee without without the prior permission of the copyright owners. First First Published Published 1999

F OREWORD The MRCP (UK) Part 1 Examination for the Membership of the Royal Colleges of Physicians of the United Kingdom was introduced in October

1968.

Since

then there have been major developments in the study of medical education and the certification of competence competence worldwide. worldwide. These developme developments nts have have had an impact impact both on on generic generic and and specialis specialistt trainin training. g. The Roy Royal al Colleg Colleges es of Physicians Physicians are committe committed d to the academic academic develo development pment of medical medical educ educat atio ion n and and as part part of that that commi ommitm tmen entt are are pub publi lish shin ing g a raft aft of publications publications coverin covering g various various aspects of the MRCP (UK) Examination. Examination. The Syllabus for the MRCP (UK) Part 1 Examination Examination is a key key element in the Royal Royal Colleges' Colleges' on-going commitment commitment to candidates and and their tutors. This Syllabus covers those areas of knowledge tested in the MRCP (UK) Part

1

Exami Examina natio tion. n. We belie believe ve tha thatt a thor thorou ough gh kno knowle wledg dgee of commo common n and and important important disorder disorderss is essentia essentiall and that candidat candidates es should should also also have have an understanding understanding of basic sciences sciences relevant relevant to medical medical practice practice so so that not only can physicians in training develop their full clinical and academic potential but also achieve achieve success in the the Examination. Examination. A major aim of the MRCP (UK) Part 1 Examination is to encourage candidates to read widely thereby providing a sound basis for continuing medical educ educat atio ion. n. It has has been been show shown n tha thatt over over-r -rel elia ianc ncee on test testss of clin clinic ical al performance performance and clinical skills alone causes causes candidates to limit their study to those those condition conditionss that they see see routinely routinely on ward ward rounds rounds and and the result result is that physicia physicians ns in in traini training ng do do not not read read broadl broadlyy about about other other commo common n and and important clinical problems and relevant relevant clinical science.

I

The current current Examination Examination employs multiple true/false true/false MCQs to test a large large body of core core knowledge which which is at a level appropriate appropriate for this stage stage in a young physician's professional development. Our hope hope is that that this Syllabus Syllabus will assist assist candidat candidates es and and their their tutors tutors in knowing the extent of knowledge knowledge required required to pass the Examination. Examination. Althou Although gh each each diet diet will will not test test every every are area a of knowle knowledge dge deta detaile iled d in the Syllabus, Syllabus, the Examination Examination should be viewed viewed as a representative representative sample of the items items of of knowled knowledge ge set set out in the the follow following ing pages pages.. The Syllab Syllabus us should should be used in conjunction with the MRCP (UK) (U K) Part 1 Examination papers which are being published simultaneously. This Syllabus Syllabus could could not have been produced produced without without the considerable considerable input of the the follo followin wing g past past and prese present nt member memberss of the the MRCP MRCP (UK) (UK) Part Part

1

Examining Board, Board, though the Medical Secretary Secretary and Chairman of the Board Board bear prime responsibility for the edited script:

II

David Barnett

Frank Dunn

Nicholas Bateman

Christopher Ellis

Michael Besser

Paul Emery

Michael Buckley

Gordon Erskine

Desmond Canavan

Michael Ford

Nigel Cooke

Ray Fox

Jane Dacre

Roderick Hay

John Dagg

Parveen Kumar

Kar Neng Lai

John Scadding

Kok-Onn Lee

John Thomson

Ken Lim

Allister Vale

Gary Love

John Walls

Christopher McManus

Alexander Wong

Christine Rodger

Andrew Zealley

In addition, the comments comments of of Kate Kate Horne and Jim Benson, both of Central Central Offi Office ce,, are are ackn acknow owle ledg dged ed gra grate tefu fully lly..

Barb Barbar ara a Ree Reeve vess prep prepar ared ed the the

manuscript for press press notwithstanding notwithstanding multiple revisions. revisions. John Reid Reid of Metro Press was was a constant source of assistance assistance as this series of books on the MRCP (UK) was produced. Kenneth Cochran Cochran and John Thomson generously assisted with proof reading. It is int inten ende ded d that that the the 2000/2001 Syllabus will be published in late

2000

to

reflect the further changes changes to the Examination Examination which have have been agreed agreed in principle by the MRCP (UK) Policy Committee. Jane Dacre

Allister Vale

Medical Secretary

Chairman

MRCP (UK) Central Office 11

St Andre Andrews ws Place Place

London NW1 4LE November 1999

III

CONTENTS Introduction Entry requirements Purpose and academic aims Content Content of the Examination Examination Assessment Assessment of a candidate's performance performance Quality of the Examination Syllabus Genetics Cell, molecular and and membrane membrane biology Anatomy Physiology, Physiology, biochemistry and metabolism metabolism Immunology Immunology and immunological tests Clinical conditions Management Infectious diseases and tropical medicine Microbiology Immunology of infectious diseases Pathophysiology Epidemiology Treatment Specific infections Statistics, Statistics, epidemiology and evidence-based evidence-based medicine medicine Descriptive statistics Graphical techniques Inferential techniques Evidence-based medicine Clinical trials Clinical haematology Iron metabolism Megaloblastic anaemias Haemolytic anaemias Other anaemias Polycythaemia and myeloproliferative disorders White cell disorders Disorders Disorders of haemostasis Clinical pharmacology pharmacology,, therapeutics therapeutics and clinical toxicology toxicology Pharmacology Clinical pharmacokinetics pharmacokinetics

1 1 2 3 4 4

4 5 5 6 6 7 7 7 9 10 10 10 10 10 11 11 13 13 13 14 14 14 15 15 15 15 16 16 16 16 17 17 17

V

Monitoring drug therapy Adverse drug reactions Drug interactions Pharmacogenetics Therapeutics Therapeutics for specific patient patient groups Clinical toxicology Criteria for selecting drugs in a therapeutic class Drug formulations and routes of administration Rheumatology Clinical science Clinical conditions Investigations Management Cardiology Anatomy and physiology Pathophysiology and pathology Cell biology Clinical pharmacology pharmacology Clinical cardiology Respiratory medicine Anatomy and physiology Pathophysiology and pathology Cell biology and genetics Clinical pharmacology pharmacology Clinical conditions Neurology Neuroanatomy Neurophysiology Neurogenetics Cell biology Neuropharmacology Neuropathology Clinical neurology Psychiatry Mental state Aetiological factors in psychiatric illness Investigations Syndromes of psychiatric disorder and their treatment VI

17 18 18 18 18 19 19 20 21 21 22 23 23 24 24 24 25 25 25 27 27 27 28 28 28 30 30 30 30 31 31 31 31 33

33 33 33 33

Psychiatric aspects of physical disease Mental retardation Gastroenterology Clinical science Clinical nutrition Disorders Disorders of the mouth, tongue and salivary salivary glands Disorders of the oesophagus and stomach Functional disorders Disorders of the small intestine Disorders Disorders of the liver, liver, biliary tree and pancreas The acute abdomen Inflammatory bowel diseases Colorectal disorders Endocrinology Thyroid Hypothalamus/Pituitary Adrenal Ovary Testis Growth Parathyroid/bone Diabetes mellitus Disorders Disorders of lipid metabolism Nephrology Physiology Molecular biology and genetics Glomerular and tubular disorders Infections of the kidney Calculus formation within the urinary tract Acute and chronic renal failure Hypertension and renal problems in pregnancy Drugs and the kidney Renal replacement replacement therapy Dermatology Basic science Clinical dermatology Investigation Drugs and therapy

34 34 35 35 35 36 36 36 37 37 38 38 38 40 40 40 41 41 42 42 42 43 43 44 44 44

44 45 45 46 46 46 46 47

47 47 48 48

VII

I NTRODUCTION There are three Royal Colleges Colleges of Physicians in the United Kingdom: the Royal College of of Physicians of Edinburgh, Edinburgh, the Royal Royal College of of Physicians and and Surgeons of Glasgow and the Royal College of Physicians Physicians of London. All three Colleges share share a common Membership Membership Examination; Part 1 was introduced in October 1968. Since Since Janua January ry 1971, the Royal Royal College of Physicians Physicians of Ireland has used the MRCP(UK) Part 1 Exami xamina nati tion on as the the fir first st part part of its its examination leading to Membership of the Royal College of Physicians of Ireland. In addition, the School of Postgradu Postgraduate ate Medical Studies in Singapore Singapore uses the MRCP(UK) Part 1 Examination paper as Part 1 of its Master of Medicine (Singapore) degree. Although divided into two parts the MRCP(UK) is a single examination. MRCP(UK) Part 1 is not not in itse itself lf a diplom diploma, a, nor does does it carry carry Memb Members ership hip status.

ENTRY REQUIREMENTS To meet the entry requiremen requirements ts for the Part Part 1 Exami Examina natio tion, n, you you must must hold hold an accep acceptable table medical medical qualifica qualification tion.. You will not be admitt admitted ed to the Examination before the expiry of 18 months from the date of your graduation. graduation. Further details are are given given in the Regulations. Regulations.

1

PURPOSE

AND ACADEMIC AIMS

The Part 1 Examina Examination tion is is set at a level level which which is is appropri appropriate ate for for medica medicall graduates graduates of some two years standing. The MRCP(UK) MRCP(UK) Part 1 Examination is designed to identify those physicians in training who have a broad knowledge and understanding understanding of basic sciences sciences relevant relevant to medical practice as well as of common common or important important disorders. disorders. The MRCP (UK) has three main academic aims: range of up-to-date up-to-date medical medical knowledge so that physicians • To test a wide range in training are encouraged to develop their full clinical and academic potential;

• To maintain and improve the practice of clinical medicine; • To provide a sound basis for continuing medical education. The practice of high quality medicine medicine necessitates that you have have knowledge of important important new advance advancess in disease disease mechanis mechanisms, ms, an understan understanding ding of evidence-base evidence-based d medicine, medicine, and an ability ability to apply this this knowledge knowledge and and unders understan tandin ding g in the the manage managemen mentt of patien patients. ts. Prepa Prepara ratio tion n for for the Examinati Examination on will encoura encourage ge you to acquire acquire relevant relevant knowledge knowledge and understanding. It is important important that you devel develop op skills skills and acquir acquiree professio professional nal habits habits which which will enable enable you to to keep keep abreas abreastt of curre current nt medical medical knowled knowledge ge and and new developments. developments. Preparation Preparation for the Examination will help you to develop such skills skills and profes profession sional al habits. habits. Hence, Hence, reading reading the medical medical litera literatur turee and attending attending relev relevant ant medical medical meetings meetings should should be a normal normal part part of your your professional life.

2

CONTENT

OF THE EXAMINATION

The Examination currently consists of 60 multiple choice questions (MCQs) which are are designed to test test your knowledge knowledge of a wide range range of topics in general medicine including the scientific basis of clinical practice.

As a general general guide guide you will will wish to know that there are are some 14 clinical science MCQs in the Part 1 Examination and these are made up as follows: Genetics Cell, molecular and and membrane membrane biology Anatomy Physiology, Physiology, biochemistry and metabolism metabolism Immunology Statistics, Statistics, epidemiology and evidence-based evidence-based medicine

1-2 2-3 2 5-6 2-3 1

In addition, addition, question questionss are set on common common or important important clinical clinical disorder disorderss as follows: Infectious diseases and tropical medicine Clinical haematology Clinical pharmacology pharmacology,, therapeutics therapeutics and toxicology toxicology Rheumatology Cardiology Respiratory medicine Neurology Psychiatry Gastroenterology Endocrinology Nephrology Dermatology Sexually transmitted diseases

4 4 6 2 4 4 4 4 4 4 4 1 0-1

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ASSESSMENT

OF A CANDIDATE ’ S PERFORMANCE PERFORMANCE

Your answe answerr sheet sheet is machine machine read and it is therefo therefore re imper imperativ ativee that you adhere strictly to the Examination instructions in completing your answer sheet. The MRCP(UK) Part 1 Examination currently assesses your performance in relation relation to that that of other other candidat candidates es and and not not by means means of an an extern external al standard standard of performa performance nce set by the examiner examiners. s. As a resul resultt the pass mark (but not the pass rate which is currently currently approxima approximately tely 35 per cent) does vary at each Exami Examinati nation. on.

QUALITY

OF THE EXAMINATION

The MRCP(UK) Part 1 Examining Board considers each question prior to its appearance in the paper and subsequently reviews each question’s performance. In addition to the final scores scores obtained by the candidates, candidates, the MRCP(UK) Part 1 Examining Board will also note the mean score for the Examination Examination and the mean scores scores for for, and the discriminatory discriminatory power power of, of, the question questionss that compris comprise e the paper paper.. A detailed detailed analysi analysiss of the respo responses nses to to each item (including a separate separate index of discrimination discrimination for every item), and a coefficient coefficient indicating the internal internal reliability of the Examination Examination as a whole whole are also considered by the Board to ensure the quality of the Examination is maintained.

SYLLABUS No syllabus can be comprehensive. comprehensive. Hence, this Syllabus Syllabus is indicative indicative of those areas of knowledge with which which you you are expected to be familiar familiar,, but is not intended to be exhaustive or to exclude other items of knowledge which are of similar similar relevan relevance. ce. You can expect, expect, howeve howeverr, that the majority majority of questio questions ns will test knowledge in the broad broad areas specified.

4

GENETICS You should have an understanding of the structure and function of chromosomes and genes and a knowledge of the principles of inheritance of chromosomal and genetic disorders. Examples Examples of question question topics might include: include:

• Inherited diseases • Chromosome structure • Common chromosome abnormalities CELL EL L ,

MOLECULAR AND MEMBRANE BIOLOGY

The cell is the the fundamen fundamental tal unit of the the structur structuree of of organ organs. s. It is import important ant that you understand understand the structure structure and function function of the components components of of the cell and its membrane. membrane. You should understand how how cells communicate communicate internally and with each other by means of chemical substances and membrane receptors. Examples Examples of question question topics might include: include:

• Function of intracellular organelles • Cellular communication

5

ANATOMY Clinically relevan relevantt anatomy will will be tested, including neuroana neuroanatomy tomy.. Examples Examples of question question topics might include: include:

• Peripheral nerve lesions • Cranial nerve abnormalities Dermatomes, myotomes myotomes and reflexes • Dermatomes, PHYSIOLOGY,

BIOCHEMISTRY AND METABOLISM

It is essential essential that you understand understand the structure structure and and function of the different different organs which which make up up the body and how how these organs organs interact, interact, such as through through hormonal hormonal and neural neural influences. influences. You should should know the broad principles of metabolism such as the production of energy and the pathways of carbohy carbohydra drate, te, protein protein and lipid lipid metaboli metabolism, sm, but a detailed detailed knowledg knowledgee of the chemical processes in the steps of the metabolic pathways is not necessary. necessary. You should have an understanding understanding of the principles of nutrition, water water,, electrol electrolyte yte and acid-base acid-base balance. balance. Knowled Knowledge ge of the physiology physiology and biochemistry of each organ organ system is examined under that specialty. specialty. Examples Examples of question question topics might include: include:

• The mechanism of blood pressure control • Acid-base balance

6

I MMUNOLOGY Although a detailed knowledge of basic immunology and immunological diseases is not required, required, you should should have a sound sound working working knowledge of the principles of immunomechanisms. immunomechanisms. Examples Examples of question question topics might include: include:

• Humoral and cell-mediated immunity • Immunodeficiency syndromes • Phagocytic dysfunction diseases Complement nt deficien deficiencies cies • Compleme Hypersensitivities including allergies and autoimmune diseases • Hypersensitivities Immunology and immunological tests You should have a basic knowledge of the immune system in health and disease. Examples Examples of question question topics might include: include:

• Common immunological laboratory tests • Evaluation of patients with immune disease • Intercellular communication and signal transduction • Lymphocyte and phagocytic cell biology • Antigen presentation Humoral, cellular cellular and mucosal mucosal immunity immunity including including • Humoral, • • •

TH1 TH1 and TH2 TH2

responses Inflammation Complement Complement system and cytokines Hypersensitivity Hypersensitivity and autoimmunity

Clinical conditions You should be able to answer questions on the various immunodeficiency syndromes.

7

Examples Examples of questio question n topics topics might might include: include:

immunodeficiency • Mechanisms of immunodeficiency • Antibody immunodeficiency disorders • T-cell immunodeficiency disorders • Combined antibody and cellular immunodeficiency disorders • Phagocytic dysfunction diseases Complement ment deficienc deficiencies ies • Comple You should know the main clinical characteristics and immediate management of acute allergic emergencies. emergencies. Examples Examples of questio question n topics topics might might include: include:

• Anaphylaxis • Angio-oedema • Urticaria You should be familiar with immunology as applied to other medical diseases. Examples of question topics might include immunomechanisms immunomechanisms in:

• Rheumatic diseases (connective tissue diseases) diseases, diabetes mellitus, mellitus, • Endocrine diseases (thyroid autoimmune diseases, • • • • •

8

Addison's disease) Haematological Haematological diseases (pernicious (pernicious anaemia, anaemia, autoimmune haemolytic haemolytic anaemia, idiopathic thrombocytopenic thrombocytopenic purpura) purpura) Gastrointestinal Gastrointestinal diseases (Coeliac (Coeliac disease, inflammatory bowel bowel disease, hepatobiliary diseases) Renal Re nal diseas diseases es (Goodp (Goodpastu asture' re'ss syndr syndrome ome,, immune immune-co -compl mplex ex glomerulonephritis) Dermatological Dermatological diseases diseases (discoid (discoid lupus, lupus, pemphigus, pemphigus, pemphigoid) Neurological Neurological diseases (demyelinating (demyelinating diseases, myasthenic myasthenic syndromes)

Management You should be able to answer questions on the principles of immunosuppressive therapy including major indications and side-effects. Examples Examples of question question topics might include: include:

Immunosuppressive drug therapy therapy (corticosteroids (corticosteroids,, cytotoxic agents, and • Immunosuppressive

• • • •

cyclosporin) Intravenous immunoglobulin Monoclonal antibodies Cytokine therapy Bone marrow transplantation

You should know about about the principles of immunisation immunisation and be familiar with vaccines currently in use.

9

INFECTIOUS

DISEASES AND TROPICAL MEDICINE

Microbiology You should understand the major taxonomy of bacteria in terms of Gram-staining and aerobic/anaer aerobic/anaerobic obic metabolism. metabolism. Virus classification classification is not important important except except for membe members rs and char character acteristic isticss of the herpes herpes group group.. Virus replication replication with reference to retroviruses retroviruses should be understood. understood. Major pathogenic protozoa and helminths should be known. Examples Examples of question question topics might include: include:

• Aerobic or anaerobic bacteria Gram-staining characteristics of bacteria • Gram-staining Immunology of infectious diseases You should understand immune deficiency states linked with types of opportunistic opportunistic infections infections.. Principles Principles of immunisatio immunisation n and knowledge knowledge of vaccines currently used should also be known. Examples Examples of question question topics might include: include:

• Opportunistic infections • Immunisation policy Pathophysiology You should have a basic understanding of:

• Septic shock • ARDS • Role of cytokines in infection Epidemiology You should have have knowledge knowledge of the principles of of epidemiology relevant relevant to infectious diseases.

10

Examples Examples of question question topics might include: include:

• Mechanisms of transmission of pathogens • How epidemics happen states, reservoirs, reservoirs, vectors and and zoonoses zoonoses • Knowledge of carrier states, • Elementary concepts of the control of communicable diseases (including •

immu immuni nisa sati tion on,, isol isolat atio ion, n, conta ontact ct trac tracin ing, g, chem chemop opro roph phyl ylax axis is of clos closee contacts) Broad awareness awareness of geographical geographical variation in disease including TB, HIV, HIV, Hepatitis Hepatitis B, malaria malaria

Treatment You should know the broad indications for, for, and major adverse effects effects of, commonly employed antimicrobial agents. Examples Examples of question question topics might include: include:

• B-lactams • Tetracyclines • Macrolides • Aminoglycosides • Quinolines • Trimethoprim • Metronidazole • Antituberculous drugs • Antimalarial drugs • Antiviral agents Specific infections Knowledg Knowledge e of the chara characteri cteristic stics, s, recogn recognition ition,, preven prevention tion,, eradica eradication tion and and pathological pathological effects of all commonly encountered encountered bacteria, viruses, viruses, rickettsia, fungi, fungi, protoz protozoa, oa, parasite parasitess and toxins toxins,, includin including g an underst understandin anding g of of the the princi principle pless of of inf infecti ection on contr control, ol, will will be requi require red. d. Specia Speciall atte attenti ntion on to to differential differential diagnosis, diagnosis, appropriate appropriate investigations investigations and awareness awareness of when presumptive therapy is indicated is essential.

11


• Septicaemia • Meningitis and encephalitis • Endocarditis Pneumonia nia (commu (communit nity-a y-acqu cquire ired, d, hospit hospital-a al-acqu cquire ired, d, lung lung • Pneumo • • • • • • • • • • • •

12

absces abscess, s,

empyema) Tuberculosis PUO (approp (appropriat riatee inves investiga tigation tions, s, when when empiric empirical al therap therapyy might might be indicated) Soft-tissue infection and osteomyelitis Streptococcal Streptococcal infection, infection, rheumatic fever fever,, nephritis Intra-abdominal Intra-abdominal sepsis Food-poisoning Food-poisoning (especially salmonellosis, salmonellosis, campylo-bacter, campylo-bacter, verocytotoxin verocytotoxin producing E coli) Tropical ropical infectio infections ns (especial (especially ly malaria, malaria, bilharzia, bilharzia, amoebiasis amoebiasis,, filariasi filariasis, s, leishmaniasis, leishmaniasis, hookworm and viral haemorrhagic fevers) fevers) Viral hepatitis HIV/ HIV/AIDS (course (course of typical typical infectio infection; n; CD4 count count and HIV viral viral load as markers markers of progre progression; ssion; main opportunis opportunistic tic infections infections includ including ing Pneumocystis Pneumocystis pneumonia, CNS toxoplasmosis toxoplasmosis,, cryptococcal cryptococcal meningitis, meningitis, tuberculosis) Glandular fever syndrome and its differentiation from HIV seroconversion illness Spirochaetosis Spirochaetosis - syphilis, syphilis, leptospirosis, leptospirosis, borrelia Toxic shock syndrome and staphylococcal infections

STATISTICS , EPIDEMIOLOGY EVIDENCE - BASED MEDICINE

AND

You should have a basic understanding of the usage and limitations of the common statistical tests used in reporting the results of research in clinical journals. The following following lists of terms should give some idea idea of the range of terms and techniques techniques which you you should understand, understand, all of which can be found regularly regularly in journals such as The Lancet, British Medical Journal and New England Journal of Medicine. You are not not expected to have have any knowledge knowledge of computer computer packages packages for carrying out statistical calculations. calculations. You may may be expected to to carry out simple calculat calculations ions that that do not require require the the use of a calculato calculatorr. You are not not expected expected to memoris memorisee formul formulae ae for for statisti statistical cal tests, tests, but should should under understan stand d their conceptual basis. The following following lists are not intended to be inclusive inclusive but as illustrative illustrative of of the type of knowledge knowledge that you need need to possess. possess.

Descriptive statistics Examples Examples of question question topics might include: include:

Mean, median median,, mode mode • Mean, deviation, standard error error • Standard deviation, • Confidence interval • Variance Range, quartile, quartile, interinter-quarti quartile le range range • Range, • Percentile • Skewness • Contingency table • Population • Missing values • Outliers

Graphical techniques Examples Examples of question question topics might include: include:

• Histogram • Box-plot • Scattergram 13

Inferential techniques Examples Examples of question question topics might include: include:

• Null hypothesis • Alternative hypothesis • Parametric and non-parametric tests • Normal distribution • Type 1 and Type 2 errors • False positive and false negative • Statistical power • One and two-tailed tests value • Statistical significance, P value • T-test • Mann-Whitney and Wilcoxon test Chi-square test for 2 x 2 contingen contingency cy table • Chi-square • Correlation (Pearson's and Spearman's) • Linear regression • Study design Evidence-based medicine You are expected to have an understanding of evidence-based medicine and an ability to apply this understanding understanding in the management management of patients. patients.

Clinical trials Examples Examples of question question topics might include: include:

Interpretation of simple clinical trial data • Interpretation • Randomisation • Placebo-controlled trial • Open trial • Single-blind trial • Double-blind trial • Intention-to-treat • Bias

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CLINICAL HAEMATOLOGY You will be expected to have knowledge of the following: Physiology, control control and function of formed blood elements • Physiology, • Bone marrow structure and function Applicati ations ons of bioch biochemi emistr stryy, geneti genetics cs,, immun immunolo ology gy,, and vir virolo ology gy to • Applic

• • • • • •

blood disorders Effects of age and pregnancy on blood disease Splenomegaly, Splenomegaly, lymphadenopathy lymphadenopathy,, and their causes Principles and hazards hazards of of blood and blood product replacement replacement therapy Principle Principles, s, but not detail, detail, of anti-tumo anti-tumour ur chemothe chemotherap rapyy Principles of marrow transplantation Adverse effects of drugs on the blood

Iron metabolism You should have an understanding of: iron, including its absorption absorption • Physiology of iron, • Iron overload deficiency states states including including diagnosis, diagnosis, causes and treatment treatment • Iron deficiency metabolism, including including anaemias anaemias of chronic chronic disord disorders ers • Iron metabolism,

and and

sideroblastic sideroblastic anaemias

Megaloblastic anaemias You should understand the physiology of vitamin B12 and folic acid and the mechanisms and investigation of deficiencies and their management. Examples Examples of question question topics might include: include:

• B deficiency • Folate deficiency 12

Haemolytic anaemias You should understand:

• Mechanisms of shortened red cell survival Features and management of congenital and acquired acquired haemolytic states • Features 15

• Molecular

pathology haemoglobinopathies

of

thalassaemia

and

common


• Causes of haemolysis • Diagnosis of haemolytic anaemia Other anaemias Examples Examples of question question topics might include: include:

• Anaemias complicating systemic disease • Aplastic anaemia • Myelodysplastic syndromes Polycythaemia and myeloprolifera myeloproliferative tive disorders You sho shoul uld d know know the the caus causes es,, inve invest stig igat atio ion n and and mana manage geme ment nt of polycythaemia and myeloproliferative disorders.

White cell disorders You should understand the: Physiology of leucocytes • Physiology • Leucocytosis and leucopenia Acute and chro chronic nic leuka leukaemi emias as,, includ including ing diagn diagnosi osis, s, manage managemen mentt and • Acute

•

prognosis Lymphoproliferative diseases including Hodgkin's disease, non-Hodgkin’s lymphomas, lymphomas, and plasma cell dyscrasia dyscrasiass

Disorders of haemostasis You should possess knowledge of: coagulation • Platelet function and coagulation Thrombocytopenia and impaired platelet function • Thrombocytopenia • Thrombocytosis • Common congenital and acquired disorders of coagulation (especially anticoagulant anticoagulant therapy and disseminated intravascular intravascular coagulation) coagulation)

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CLINICAL

PHARMACOLOGY, THERAPEUTICS AND CLINICAL TOXICOLOGY You are expected to have a good knowledge and understanding of the principles of clinical pharmacology pharmacology,, therapeutics therapeutics and clinical toxicology. toxicology.

Pharmacology You should understand the:

• Mechanisms by which drugs produce their pharmacological effects principles of agonism agonism and antagonism antagonism • Basic principles Clinical implicati implication on of of drugs drugs that act at differ different ent recepto receptorr sites sites • Clinical between the pharmacologic pharmacological al effects effects of drugs drugs at the molecular molecular • Links between •

level, level, the cellul cellular ar level level,, and the the tissue/ tissue/org organ an level level,, and how how these these are are affected by disease processes and other drugs Principles by which both therapeutic and adverse effects occur

Clinical pharmacokinetics You should understand understand the principles principles that underlie:

• Processes of drug absorption and distribution • Biotransformation and excretion • Concepts of drug half-life and clearance and zero order kinetics • First order and Application of of this knowledge to clinical clinical situations is necessary necessary but detailed kinetic calculations calculations will will not be required. required.

Monitoring drug therapy You should understand understand the principles that that underlie the monitoring monitoring of drug therapy including: Direct measure measuremen mentt of therapeutic therapeutic respon response se • Direct Measurement of plasma drug concentrations concentrations • Measurement Knowledge of of the scientifi scientificc basis for the the • Knowledge

measureme measurement nt of drug concentration and its link to the principles of pharmacokinetics

17

Emphasis will be given to the areas of clinical practice and therapeutics where the narrow therapeutic range of particular pharmacokinetic properties of the drug make this approach important.

Adverse drug reactions You should have an understanding of the epidemiology of adverse drug reaction reactionss and know how to to recog recognise nise and avoi avoid d them. them. You must must also be aware of important important adverse effects effects of commonly commonly used drugs and have have an understanding of the importance of adverse drug reaction reporting schemes.

Drug interactions You should have an understanding of the epidemiology of adverse drug interactions, interactions, and of the mechanisms mechanisms by which which interactions interactions may occur. occur. You should also have a knowledge of common drug interactions and their clinical consequences.

Pharmacogenetics You should understand the principles of pharmacogenetics and its importance in determining determining variations variations in response response to drugs in man, both in terms of efficacy and toxicity toxicity.. You should should have have knowledge knowledge of the clinical consequences consequences of the common common pharmacoge pharmacogenetic netic variations variations relevant relevant to clinical practice.

Therapeut Therapeutics ics for specific patient patient groups groups You should understand the principles of therapeutics as they apply in the following circumstances:

• The elderly Pregnancy and and breast breast feeding • Pregnancy • Patients with renal disease • Patients with hepatic disease You should should understand understand that that the altered altered physiology physiology in these patient patient groups may aff affect ect the pharm pharmaco acokinet kinetics ics and and pharmac pharmacodyn odynamics amics of drugs drugs.. You

18

should know the principles underlying underlying drug choice, in pregnancy and breast breast feeding, and have an understanding understanding of the teratogenic effects effects of drugs that may be used used in pregna pregnancy ncy.. In the case case of renal renal and hepatic hepatic diseas diseasee it is also necessary for you to have have an understandin understanding g of drugs drugs that that may produce toxicity of these organs and whose use is particularly affected by disease of these organs.

Clinical toxicology You should understand understand the principles of management of patients who have been poison poisoned ed with drugs drugs or other toxic toxic substanc substances. es. This should should include include assessme assessment, nt, recogni recognition tion of commo common n symptom symptom patterns patterns,, principle principless of removal removal of toxic substances, substances, and their antidotes where where these approaches approaches may be appropriate. Examples Examples of question question topics might include: include:

• Paracetamol poisoning • Salicylate poisoning antidepressantt poisoning • Tricyclic antidepressan • Lithium poisoning • Iron poisoning • Digoxin poisoning • Intoxication due to drugs of abuse Criteria for selecting drugs in a therapeutic class You should should understand understand the criteria that that may be used to select a drug from among drugs drugs in a popular therapeutic therapeutic class. class. This would would include:

• Differences in pharmacokinetics and pharmacodynamics • The approved indications of the drug • Possible adverse effects or drug interactions Cost effectiv effectivenes enesss • Cost You should also be aware of the nomenclature used in describing studies that may be used used to underpin underpin drug drug selection.

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Drug formulations and routes of administration You should be aware of the various various formulations of medicines available available,, and of the routes routes by which which medicin medicines es may be admini administer stered. ed. You should should also understand the advantages and disadvantages of various routes and prepara preparation tions. s. From From this this knowled knowledge, ge, you would would be expect expected ed to be be able to select the most appropriate appropriate formulation formulation and route of drug administration administration in common clinical scenarios.

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RHEUMATOLOGY Detailed knowledge of all the rheumatic rheumatic conditions is not required. required. However However,, you should have a sound working knowledge of the basic principles of the common musculoskeletal conditions. Examples Examples of question question topics might include: include:

• Inflammatory arthritis • Back pain • Periarticular disorders • Osteoarthritis • Connective tissue diseases • Bone diseases Clinical science Basic Basic physi physiolo ology gy,, bioche biochemis mistry try,, anatom anatomyy and path patholo ology gy relat relating ing to musculoskeletal disease should be known. Examples Examples of questions questions topics might include: include:

• Physiology of pain • Physiology of inflammation • Urate metabolism • Bone metabolism anatomy,, particularly of cervical cervical and lumbar lumbar nerve roots, roots, and of • Applied anatomy peripheral nerves commonly involved in disease

The pathology of the common rheumatic conditions should be known. Examples of question topics might include pathological findings in:

• Rheumatoid arthritis • Osteoarthritis • Connective tissue diseases • Bone diseases 21

Clinical conditions You should know the relative prevalence and major associations of the common rheumatological conditions. Examples of question topics might include the relationship relationship to:

• Age • Gender • Genetic influences • Constitutional influences • Environmental influences • Occupational influences You should be able to answer questions on the symptoms and signs of the rheumatic diseases. Examples Examples of question question topics topics might might include: include:

syndromes • Rheumatoid arthritis and associated syndromes Seronegative spondyloarthritis (ankylosing spondylitis, psoriatic arthritis, • Seronegative

• • • • • •

reactive arthritis, arthritis, enteropathic enteropathic arthritis) Osteoarthritis Crystal arthritis (gout, (gout, pyrophosphate pyrophosphate arthritis) arthritis) Connective Connective tissue tissue diseases diseases (systemic lupus erythematosus, erythematosus, Sjogren's syndrome, syndrome, scleroderma, scleroderma, polymyositis/ polymyositis/dermatom dermatomyositis yositis)) Polymyalgia rheumatica and giant-cell arteritis Systemic vasculitic syndromes Bone disorders disorders (osteoporosis (osteoporosis,, osteomalacia, Paget’s Paget’s disease)

You should be familiar with arthritis associated with other medical conditions. Examples Examples of question question topics might include: include:

• Sarcoidosis • Erythema nodosum Parvovirus B • Infections and arthritis (e.g. Parvovirus

22

19)

Investigations You should have have knowledge of the investigations investigations relevant relevant to the diagnosis and assessment assessment of rheumatic rheumatic diseases. diseases. Examples Examples of question question topics might include: include:

• Acute phase proteins • Immunological tests relating to the connective tissue diseases (ANA, •

anti-dsDN anti-dsDNA, A, ANCA, ANCA, anti-Jo anti-Jo1, 1, anti-Ro anti-Ro)) Contemporary Contemporary imaging techniques in rheumatology rheumatology (x-ray (x-ray, ultrasound, ultrasound, CAT CAT scanning, scanning, MRI scanning)

Management You should should be able to answer questions on the management management of acute rheumatological emergencies. Examples Examples of question question topics might include: include:

• Septic arthritis • Osteomyelitis • Temporal arteritis • Acute spinal cord compression You should be able to answer questions questions on the management of rheumatic diseases. Examples Examples of question question topics might include: include:

therapies (education, physiotherapy) physiotherapy) • Non-drug related therapies contra-indications, adverse • Drug related therapies (indications and contra-indications,

• • • • • •

effects, effects, drug interactions) interactions) Simple analgesics Non-steroidal Non-steroidal anti-inflammatory anti-inflammatory drugs Corticosteroids Allopurinol Disease modifying anti-rheumatic anti-rheumatic drugs Immunosuppressive drugs

23

CARDIOLOGY Anatomy and physiology You should have knowledge of the basic anatomy and physiology of the heart in health health and diseas disease: e: Examples Examples of question question topics might include: include:

Clinicallyy relevan relevantt normal normal anatomy anatomy of the heart, heart, coronar coronaryy arteries arteries and • Clinicall

• • • • • • • •

great great vessels vessels Determinants Determinants of heart heart rate and rhythm rhythm Cardiac function Cardiac conduction Cardiac output Vascular tone Blood pressure Coronary blood flow Genesis Genesis of heart sounds sounds

Pathophysiology Pathophysiology and pathology You should know the mechanisms underlying the main pathological processes. Examples Examples of question question topics might include: include:

• Thrombosis • Infarction • Atherogenesis • Hypertrophy Heart failu failure re • Heart • Cardiomyopathies • Dysrhythmias • Hypertension

24

Cell biology You do not need detailed specialised specialised knowledge of cell biology as only topics of proven clinical relevance will be tested. Examples Examples of question question topics might include: include:

• Excitation-contraction process • Molecular and cellular aspects of hypertrophy of the myocardium and of vascular smooth muscle

Clinical pharmacology You should know the indications for drug therapy in cardiac disease and understand the actions, actions, interactions interactions and side effects effects of the drugs used. The emphasis will often be on new drugs or on novel applications or newly observed side effects effects of established drugs. drugs. Details of drug dosage are asked asked only rarely.

Clinical cardiology You must must know know the clin clinical ical featur features es and and manage managemen mentt of the the cardiac cardiac disorders encounter encountered ed in hospital practice by the general physician, physician, though detailed detailed speci specialist alist knowledg knowledgee is not expected expected.. You shou should ld have have know knowledg ledgee of risk factors. Examples Examples of question question topics might include: include:

Clinical • Clinical

• • • •

features features of of constrictiv constrictive e pericarditis pericarditis,, cardiac cardiac tamponade, tamponade, endocar endocarditis ditis,, valvula valvularr heart disease disease Management of acute coronary coronary syndromes syndromes Management of cardiac failure Management issues in atrial atrial fibrillation fibrillation Indicatio Indications ns for, for, and types of, of, permanen permanentt pacemake pacemakerr

Knowle Knowledge dge of of importa important nt change changess in clini clinical cal pra practic ctice, e, follow following ing the the publication of of major clinical trials, is likely to be tested.

25


• Use of ACE inhibitors after myocardial infarction • Use of HMG CoA reductase inhibitors in primary •

and secondary

prevention of coronary morbidity and mortality Use of beta-adrenoceptor beta-adrenoceptor blocking drugs in left left ventricular ventricular dysfunction

You should know the:

• Indications for invasive and non-invasive cardiac investigation Principles of these investiga investigative tive methods methods,, their limitation limitationss and the • Principles clinical relevance of the results

Knowledge of the practical aspects of the investigative techniques is not required. Examples Examples of question question topics might include: include:

• Common ECG abnormalities • Basic echocardiographic abnormalities such as hypertrophic obstructive •

26

cardiomyopathy or pericardial effusion Indications for coronary angiography

R ESPIRATORY MEDICINE Anatomy and physiology You should understand understand clinically relevan relevantt anatomy of the upper and lower respiratory respiratory tract and thorax including radiological radiological anatomy. anatomy. You should have knowledge of the principles of respiratory physiology including:

• How respiration is controlled • Principles of gas exchange and oxygen transport • Ventilation-perfusion relationships • Lung volumes and transfer factor • Respiratory aspects of sleep and exercise physiology You should understand the: humoral and cellular aspects of respiratory defence mechanisms mechanisms • Physical, humoral inhibitors and pulmonary surfactant • Physiology of the proteinase inhibitors

Pathophysiology Pathophysiology and pathology You should understand the effects of disease on pulmonary physiology and anatomy including:

• The pulmonary and bronchial circulations and gas exchange • Adaptations to chronic hypoxaemia • Pleural fluid production and reabsorption You should understand the application of the basic immunological processes to pulmonary pathology including:

• Asthma • Alveolitis • Tuberculosis You should possess knowledge of humoral and cellular immunodeficiency states and sequelae.

27

The microbiology of acute and chronic respiratory infections should be known.

Cell biology and genetics You should have knowledge of:

• Lung inflammation and repair • Vasculitis • Cystic fibrosis • Anti-protease deficiency You should understand the genetics of:

• Asthma • Cystic fibrosis • Alpha antitrypsin deficiency 1

The role and value of gene therapy should be understood.

Clinical pharmacology The indications indications for, for, and mechanisms mechanisms of action of, of, drugs used in in respiratory respiratory disease together with their interactions and side effects should be known. Important Important respir respirator atoryy complic complicatio ations ns of of other other drugs drugs,, e.g., NSAIDs NSAIDs and beta blockers should also be understood.

Clinical conditions The clinical clinical features features,, investigation investigation and management management of respirator respiratoryy disease likely to be encountered encountered by a general general physician must must be known. Examples Examples of question question topics might include: include:

• Pleural effusion Chestt pain pain • Ches • Haemoptysis • Breathlessness 28

The impact of systemic disease on on the respiratory respiratory system should should be known. Examples Examples of question question topics might include: include:

• Vasculitis • Neuromuscular diseases • HIV infection Knowle Knowledge dge of of occupa occupatio tional nal lung lung dise disease ase,, particu particular larly ly pneumoconiosis, pneumoconiosis, and asbestos related disease is required. required.

asthm asthma, a,

You should should know how to assess assess respiratory respiratory malignan malignantt conditions conditions and understand the general general principles of oncological oncological management management including the indications for surgery. The indications indications for specialised investigations investigations,, including bronchoscopy bronchoscopy,, CT scanning, lung biopsy, biopsy, lung volumes volumes and exercise exercise testing should be known. known. You should have knowledge of the investigation of sleep related disorders and of the radiological aspects of respiratory disease. You should know the indications for, for, and problems of, of, lung transplantation. transplantation. You should have knowledge regarding the control of Mycobacterium tuberculosis infection.

Exclusions Knowledge of of detailed pulmonary mechanics mechanics,, oncology oncology drug regimens, regimens, drug therapy of environmental environmental mycobacterial mycobacterial infection, infection, inhalation drug kinetics kinetics and detailed histological histological descriptions descriptions is not not required. required.

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NEUROLOGY Neuroanatomy You are not expected expected to have detailed detailed knowledge knowledge of neuroanatomy neuroanatomy.. Questions with an anatomical bias will be confined to circumstances where an understanding of anatomical structure is of critical importance in appreciating the localisation of a particular neurological problem. Examples Examples of questio question n topics topics might include: include:

• The clinical features of a lesion within the cavernous sinus manifestations of a particular nerve root or peripheral nerve disorder disorder • The manifestations • The organisation of pathways within the spinal cord Neurophysiology Detaile Detailed d knowled knowledge ge of neur neuroph ophysi ysiolo ology gy is not not expec expected ted but, but, as with with neuroanatomy neuroanatomy,, certain aspects of the subject are particularly relevant relevant to the understanding of neurological disease and may be tested. Examples Examples of question question topics might include: include:

formation tion,, circula circulation, tion, absorptio absorption n and conte content nt of the cerebro cerebrospin spinal al • The forma

• •

fluid Aspects of cerebral blood flow The principles of nerve conduction and its modification by disease processes

Neurogenetics You are expected expected to have have knowledge knowledge of recent recent advances advances in in the understanding of the genetic basis for various neurological disorders. Examples Examples of question question topics might include: include:

• The role of dystrophin in muscle disease • Genetic aspects of myotonic dystrophy • Genetic aspects of Alzheimer's disease

30

Cell biology Questions in this area will relate to advances in the cellular mechanisms of certain neurological disease processes which have provided better understanding understanding of disease disease mechanisms mechanisms and and which might, in the future, future, lead to more rational therapy. Examples Examples of question question topics might include: include:

• The genesis of tissue damage in stroke and the role of certain excitatory • •

neurotransmitters The role of the dopaminergic system in various extrapyramidal disorders The role role of other other neurotransm neurotransmitters itters in certain diseases, diseases, for example, example, in Alzheimer's disease

Neuropharmacology You are expected to have some knowledge of new drug developments in neurology, neurology, as well as the established drug therapies. Examples Examples of question question topics might include: include:

• The role of some recently introduced anticonvulsants present status of immunosuppres immunosuppressant sant therapy in multiple sclerosis • The present Neuropathology You are not expected to have a detailed knowledge knowledge of of neuropathology neuropathology.. You will be expected to have an outline knowledge of the pathological pathological aspects of some common diseases, diseases, for example, multiple sclerosis, sclerosis, Parkinson's Parkinson's disease and Alzheimer's disease.

Clinical neurology Questions in the field field of clinical clinical neurology neurology will test test your knowledge of the more common common disorders. disorders. There will will be emphasis on clinical features features which have been shown shown to be be of diagnostic diagnostic value. value. The choice choice of subject subject matter will will be influen influenced ced by areas areas of recen recentt advance advance,, particularl particularlyy those which which have have

31

either led to better definition of disease disease entities, entities, or have have led to their improved management. In the field of of cerebrovascular cerebrovascular medicine, examples of question topics might include:

Epidemiological aspects, in particular the risk factors for stroke stroke • Epidemiological evidence e for the role of anti-pla anti-platelet telet agents agents in transien transientt ischaemi ischaemicc • The evidenc

•

32

attacks The role of carotid endarterectomy endarterectomy in the management of stroke patients patients

PSYCHIATRY Mental state You should should understa understand nd the conduct conduct and scope scope of a mental state examination. You are expected to be familiar with the features of abnormal mental states and particularly those that that present present commonly commonly to physicians physicians and and to Accident Accident and Emergency Departments.

Aetiological factors in psychiatric illness You should understand the primary aetiological factors in psychiatric areas including:

• Genetic factors • Environmental factors • Life events Investigations You should be familiar familiar with the potential value value of, of, and indications indications for, for, common investigations used in psychiatric illness including:

• Psychometric testing • EEG • Brain imaging Syndromes of psychiatric disorder and their treatment You should have knowledge of: Organic brain brain syndrom syndromes es (deliriu (delirium, m, dementia dementia,, focal focal brain brain syndromes syndromes,, • Organic

• • • •

head injury) Schizophrenia and related syndromes Paranoid disorders and related syndromes Affec Affective tive disord disorders ers (anxiety (anxiety states states,, phobic phobic disorders disorders,, bipolar bipolar affectiv affectivee disorders) Grief and bereavement

33

Self-harm,, attempte attempted d suicide, suicide, suicide suicide • Self-harm • Substance misuse (including alcohol dependence) • Eating disorders • Obsessive compulsive disorder • Abnormal illness behaviour • Syndromes associated with medically explained physical symptoms (including somatization and somatoform syndrome)

Psychiatric Psychiatric aspects of physical disease You should be aware of the psychiatric presentations of physical disease including:

• Endocrine and metabolic disorders • Toxic states • AIDS Neurological disease • Neurological • Epilepsy • Pain Mental retardation You should know the features of the commoner syndromes.

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G ASTROENTEROLOGY Clinical science You should understand the: gastrointestinal and hepatobilary tract • Structure and function of the gastrointestinal Neurohormonal control control of gut motility • Neurohormonal • Secretory and absorptive functions of the gastro-intestinal tract

• • •

and liver Symptoms and signs of gastrointestinal, gastrointestinal, hepatobiliary and pancreatic pancreatic diseases Genetics of the more common gastrointestinal and liver disorders Clinical pharmacology of drugs used in gastrointestinal disorders including their actions, interactions interactions and adverse effects


• Control of gastric acid secretion control of gut function • Autonomic control • Genetics of familial adenomatous polyposis • Haemochromatosis Effects of cholinergic, cholinergic, adrenergic adrenergic and serotonergic serotonergic agents on gut gut function • Effects Clinical nutrition You should be familiar with:

• Nutritional requirements in health Assessment of nutritional status • Assessment • Nutritional deficiency states • Primary nutritional disorders Examples Examples of question question topics might include: include:

• Calorific requirements • Body water distribution • Derivation of the body mass index • Protein calorie malnutrition 35

constituents • Essential dietary constituents • Vitamin requirements Pathogenesis and management management of obesity • Pathogenesis

Disorders of the mouth, tongue and salivary salivary glands You should have an understanding of: ulcers, periodontal periodontal and salivary disorders disorders • Mouth ulcers, • Oral manifestations of systemic and dermatological disorders Examples Examples of question question topics might include: include:

• Causes of mouth ulcers and their management • Skin disorders commonly involving the buccal mucosa Disorders of the oesophagus and stomach You should be familiar with the following disorders:

• Achalasia • Carcinomas • Peptic ulceration • Gastritis • Gastrointestinal haemorrhage Examples Examples of question question topics might include: include:

Presentation, investigation investigation and and management management of oesophageal oesophageal strictures strictures • Presentation, • Role of Helicobacter-associated gastritis in peptic ulcer disease Management of hypovo hypovolaemic laemic shock shock • Management

Functional disorders You should have a knowledge of: functional dyspepsia dyspepsia • Functional chest pain and functional • Irritable bowel syndrome and functional abdominal pain • Functional constipation and diarrhoea

36


control of visceral visceral nociception nociception and gut motility • Neural control • Role of emotional and psychosocial factors in illness and the use of pain-modifying drug therapy therapy • Management of chronic pain and

Disorders of the small intestine You should have knowledge of:

• Malabsorption syndromes and gluten enteropathy • Hormone-secreting tumours of the gut Examples Examples of question question topics might include: include:

Aetiology, clinical and histopathological features features of gluten enteropathy enteropathy • Aetiology, Investigations tions commonly commonly used in the assessment assessment of suspected suspected • Investiga malabsorption

Disorders of the liver, liver, biliary tree and pancreas pancreas You should have knowledge of:

• Bilirubin metabolism and the enterohepatic circulation of bile acids • Causes of jaundice and cholestasis • Common pancreatic disorders including carcinoma Fulminantt liver liver failur failuree • Fulminan • Acute and chronic hepatitis Drugs, toxins toxins,, alcohol alcohol and the liver • Drugs, Examples Examples of question question topics might include: include:

Aetiology, clinical and histopathological histopathological features features of acute and chronic chronic • Aetiology,

• •

hepatitic disorders Hepatorenal syndromes and their management Aetiolo Aetiology gy,, presen presentat tation ion and manage managemen mentt of acute acute and chroni chronicc pancreatitis

37

The acute abdomen You should have knowledge of:

• Perforated viscus and peritonitis • Intestinal obstruction • Ischaemic disease of the small and large bowel Examples Examples of question question topics might include: include:

• Common causes of acute abdominal pain and their investigation and •

management Management Management of septic shock associated associated with intra-abdomin intra-abdominal al sepsis

Inflammatory bowel diseases You should be familiar with:

• Crohn's disease • Ulcerative colitis • Infective gastroenteritis Parasitic and protozoal protozoal gut gut infections • Parasitic Examples Examples of question question topics might include: include:

Causes,, investig investigatio ation n and manag managemen ementt of acute acute and chronic chronic enteric enteric • Causes

•

disorders Manifestations of inflammatory bowel disease and its complications

Colorectal disorders You should have knowledge of:

• Polyps • Carcinomas • Diverticular disease • Anorectal disorders

38


• Pathology and clinical genetics of disorders presenting with colonic •

polyps Causes Causes and and treatm treatment ent of haemor haemorrho rhoids ids,, anal fissure fissuress and ano-rect ano-rectal al fistulae

39

ENDOCRINOLOGY Although Although you you are are not expected expected to have have a detailed detailed knowledge knowledge of of bioc bioche hemi mist stry ry,, it is anti antici cipa pate ted d that that you you wil willl hav havee an an ins insig ight ht into into the the mechanisms of hormone action and the importance of receptors and substances involved involved in control control of intracellular intracellular metabolism. You should have have a knowledge of the clinically relevant relevant anatomical aspects of this specialty. specialty. Examples Examples of question question topics might include: include:

• Factors involved in cell signalling relationships of the pituitary gland • Anatomical relationships • The cell types in the pancreatic islets pathways of carbohydrate, carbohydrate, protein and fat • A broad understanding of the pathways • • •

metabolism Endocrine tests in routine clinical use Genetic aspects of endocrine disease Disorders affecting multiple endocrine systems

Thyroid Since thyroid disease is common you are expected to have a broad knowledge of the mechanisms mechanisms of thyroid disease, disease, its clinical presentation presentation and treatment. Examples Examples of question question topics might include: include:

• Thyroid hormone biosynthesis and its control interfering with with thyroid thyroid function • Important drugs interfering • Indications for use of various types of thyroid function test • Autoimmunity and the thyroid • Clinical features of thyrotoxicosis and hypothyroidism • Goitre and its management • Thyroid neoplasia Hypothalamus/Pituitary Detailed knowledge of the structure of the pituitary and hypothalamic hormones is unnecessary.Y unnecessary. You will require a knowledge of the physiology physiolog y and testing of the control mechanisms of the endocrine system.

40


• The physiology and pathophysiology of control of pituitary hormone • • • • •

secretion The mechanisms of maintaining plasma osmolality Tests of pituitary hormone secretion Pituitary diseases diseases such such as acromegaly acromegaly,, prolactinoma prolactinoma and Cushing’ Cushing’ss syndrome Drugs used used in the treatment treatment of pituitary disease Pituitary replacement replacement therapy

Adrenal A detailed knowledge of mechanisms mechanisms of steroid biosynthesis biosynthesis is not required, required, but you are expected to have have some knowledge knowledge of those those parts which are are clinically important. Examples Examples of question question topics might include: include:

• An understanding of the build-up of precursor compounds when there is • • • •

defective cortisol biosynthesis in adrenocortical hyperplasia Tests for adrenocortical function Endocrine causes of hypertension and their differential diagnosis Clinical features features and management management of adrenal hyperhyper- and hypofunction Complications of steroid therapy

Ovary You are expected to be conversan conversantt with the physiology of ovarian ovarian function and with the conditions presenting to a physician. Examples Examples of question question topics might include: include:

• Hormonal changes across the menstrual cycle • Physiological changes in pregnancy • The differential diagnosis of hirsutism and virilism • Causes of amenorrhoea and anovulation • Endocrine causes of infertility 41

Testis You are not expected to have a detailed knowledge knowledge of the urological urological investigation investigation of of infertility infertility but some concept concept of relevan relevantt investigations investigations and of the endocrine aspects of testicular function is required. Examples Examples of question question topics might include: include:

hypogonadism both primary and secondary secondary • The aetiology of hypogonadism • Causes of male infertility related to general medical disease and its

• •

treatment Causes of erectile dysfunction and its investigation Androgen Androgen replacement replacement therapy

Growth Growth is a very very important topic in relation relation to general general medicine medicine as well as endocrinology. You are expected expected to be conversant conversant with:

• Factors controlling growth hormone secretion • Normal growth patterns medical and endocrine endocrine causes of short stature • General medical • Control of excessive growth • Growth hormone therapy and its complications Parathyroid/bone Detailed knowledge of the anatomy and physiology of bone metabolism is not required. required. You are are expected however however to have have some broad broad concept concept of the control control of bone turnover and the disorders disorders which can result in its failure. Examples Examples of question question topics might include: include:

• Control of calcium metabolism • Laboratory tests of parathyroid function • The causes of hypercalcaemia • The mechanisms of osteomalacia 42

Hyperparathyroidism, m, both primary and secondary secondary • Hyperparathyroidis primary, secondary and pseudo-hypoparathyroidism pseudo-hypoparathyroidism • The differentiation of primary, prophylaxis and treatment treatment of osteoporosis osteoporosis • The prophylaxis • Calcitonin and its role in metabolism

Diabetes mellitus You are expected to have detailed knowledge of this very common condition. Examples Examples of question question topics might include: include:

• Control of carbohydrate metabolism • Genetics of diabetes • Aetiology of type diabetes and type diabetes • Long-term complications of diabetes • Insulin resistance emergencies • Management of diabetic emergencies Differential diagnosis and treatment treatment of hypoglycae hypoglycaemia mia • Differential 1

2

Disorders of lipid metabolism Although a detailed knowledge knowledge of of lipid metabolism metabolism is not not required, required, you are are expected to have an understanding of the importance of this group of disorders. Examples Examples of question question topics might include: include:

• Control of cholesterol metabolism Aetiology of diff differen erentt types of • Aetiology • •

hyperlip hyperlipidaemia idaemia including including both both

cholesterol and triglyceride disorders Indications for lipid lowering agents and their complications Types of secondary hyperlipidaemia

43

NEPHROLOGY Physiology You should have knowledge of:

• Discrete functions of glomerular ultrafiltration and tubular function Proximal and distal distal parts of the nephron, nephron, with particular particular reference reference to • Proximal • • •

control of water and electrolyte balance Renal tubular acidosis Cystinuria Fluid, electrolyte, and acid-balance disturbances disturbances

Molecular biology and genetics You are expected to possess a basic knowledge of genetic defects of common kidney disorders including:

• Polycystic kidney • Alport’s syndrome • Hypophosphataemic rickets You should have an understanding of inflammatory injury of the kidney mediated by various cytokines and growth factors.

Glomerular and tubular disorders You are expected to have some knowledge of glomerular ultrastructure based based upon upon techniqu techniques es of light light microsc microscopy opy,, electro electron n microsc microscopy opy and and immunofluorescence immunofluorescence as applied applied to renal biopsy biopsy.. These techniques techniques form the basis of current current understanding understanding of primary glomerular disorders as in idiopathic glomerulonephritis glomerulonephritis,, and nephropathies nephropathies of systemic diseases. Examples Examples of question question topics might include: include:

• Diabetes mellitus • SLE • Hypertensive nephrosclerosis • Vasculitis • Amyloidosis 44

Knowledge of interstitial nephritis (especially those cases with reversible aetiology such as drugs drugs , heavy metals and analgesics) analgesics) is expected. expected. You should be acquainted with the metabolic sequelae of acute nephritic and nephrotic syndromes. You should be aware of the investigation investigation and assessment of glomerular and tubular disorders, disorders, including ultrasonic ultrasonic studies and nuclear medicine. You should have an understanding of disturbed renal and metabolic functions in nephrotic syndrome from a variety of causes.

Infections of the kidney You should should be be familiar familiar with with the manag managemen ementt of urinary urinary tract tract infectio infections ns includin including g their detection, detection, predisp predisposin osing g factors, factors, preven prevention tion and treatme treatment. nt. A knowledge of anatomical abnormalities leading to repeated urinary tract infection is expected. Examples Examples of question question topics might include: include:

• Reflux nephropathy • Prostatic hypertrophy You should be aware aware of other infections infections that could affect affect the kidney by direct invasion or by immune-complex deposition. Examples Examples of question question topics topics might include infecti infection on of the urinary tract tract with:

• Mycobacteria • HIV • CMV • HBV • HCV Calculus formation within the urinary tract You should possess a knowledge of metabolic disorders predisposing to

45

stone formation, formation, their investigation, investigation, prevention prevention and treatment. treatment. Examples Examples of question question topics might include: include:

• Idiopathic hypercalciuria • Primary hyperparathyroidism • Cystinuria • Hyperoxaluria Acute and chronic renal failure A knowledge knowledge of the the management of acute and chronic chronic renal renal failure failure and of the disturbed physiology involv involved ed is expected. expected. You should be familiar with pathophysiological pathophysiological changes changes and non-dialytic tre treatment atment in different different stages of progressive renal failure. Principles of nutritional requirements and dietary intervention for patients with chronic renal failure is required. Other therapeutic means to slow down the progression of renal failure should be understood.

Hypertension and renal problems in pregnancy You are expected to be familiar familiar with renal adaptation adaptation to pregnancy pregnancy, the management management and prophyl prophylaxis axis of renal renal disease disease and and hypertensio hypertension n in pregnancy.

Drugs and the kidney A knowledge of the role of the kidney in the normal elimination of drugs is expected and you should understand the mechanisms by which drugs cause neph nephro roto toxi xicc damag damage. e. The The princ principl iples es of dos dosee adjus adjustm tmen entt acco accord rdin ing g to residual renal function should be known.

Renal Renal replace replacement ment therapy therapy A knowledge knowledge of differen differentt dialysis modalities modalities and their their complications complications is expected. You should know the complications related related to immunosuppressive immunosuppressive therapy following renal transplantation.

46

DERMATOLOGY Basic science You will be expected to have a working knowledge of the structure and function of the epidermis and dermis.

Clinical dermatology Many diseases diseases affecting affecting internal internal organs organs will present present with skin signs signs or symptoms. You are expected expected to be able to recogn recognise ise the cutaneous cutaneous symptoms and signs of systemic diseases. Examples Examples of question question topics might include: include:

vascular disease such as SLE, systemic sclerosis sclerosis • Collagen vascular • Metabolic and endocrine disorders • Infectious diseases • Cancers • Leukaemias • Respiratory and cardiovascular diseases • Common inherited diseases such as neurofibromatosis You should have knowledge of the main dermatological complications of therapeutic therapeutic immunosuppr immunosuppression ession (for (for example, example, systemic corticoster corticosteroid oid therapy therapy,, cyclospor cyclosporin in etc.) or of of diseases diseases such as HIV which which cause immunosuppression. In addition you should know the differential diagnosis and plan of investigation investigation of patients who present present with the following following cutaneous signs or symptoms which may indicate internal disease:

• Itch • Hyperpigmentation Generalised erythema • Generalised • Loss of hair • Increased hair growth • Common patterns of nail dystrophy such as clubbing • Erythema nodosum 47

• Erythema multiforme • Purpura • Ulceration • Vasculitis A knowledge of the clinical features of the following skin diseases is required:

• Psoriasis • Eczema • Urticaria fungal infections infections (dermatoph (dermatophytosis, ytosis, pityriasis versicolo versicolor) r) • Superficial fungal • Common skin cancers such as melanoma • Vitiligo and alopecia areata • Pemphigus and pemphigold herpes virus infections (herpes simplex, varicella varicella zoster) • Cutaneous herpes • Cutaneous staphylococcal and streptococcal infections • Leprosy Investigation You shou should ld know know the princi principles ples but not details details of derm dermato atolog logica icall investigation such as patch testing.

Drugs and therapy You will will not be expecte expected d to have have a detailed detailed knowled knowledge ge of the treatm treatment ent of skin diseases diseases or or dermatose dermatoses. s. Howeve Howeverr you should should know know the drugs drugs which which cause life-threatening skin conditions such as erythroderma or StevensJohnson syndrome, syndrome, angio-oedema and toxic epidermal necrolysis. necrolysis.

48

The publication of this Syllabus for the MRCP (UK) Part 1 Examination is a key element in the Royal Colleges of Physicians commitment to candidates and their tutors. The Syllabus is indicative of those areas of knowledge required to pass the Examination. Although each diet will not test every area of knowledge detailed in the Syllabus, the Examination should be viewed as a representative sample of the items of knowledge knowledge set out in the Syllabus.

This Syllabus should be used in conjunction with the MRCP (UK) Part 1 Questions 2003.

Royal Royal College of Physicians of Edinburgh Royal College of Physicians & Surgeons of Glasgow Royal College of Physicians of London

h g r u b n i d E , s s e r P o r t e M y b n o i t c u d o r P t n i r P & n g i s e D

MRCPUK Part 1 Syllabus

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