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MRCP 1 BASIC GUIDE

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INCLUDES EXAM PATTERN AND BASIC SYLLABUS MATERIAL. PLEASE NOTE THIS IS THE BASIC OUTLINE PROVIDED.ITS VALIDITY CANNOT BE FULLY GUARANTEED OR RELIED ON.
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-EXAM FORMATThe MRCP(UK) Part 1 Examination is designed to assess a candidate's knowledge and understanding of the clinical sciences relevant to medical practice and of common or important disorders to a level appropriate for entry to specialist training. The MRCP(UK) Part 1 Examination has a two-paper format. Each paper is 3 hours in duration and contains 100 multiple choice questions in one from five (best of five) format, where a candidate chooses the best answer from five possible answers. Candidates will be tested on a wide range of common and important disorders in General Medicine as set out in the published syllabus. The composition of the Papers is as follows: Specialty Cardiology Clinical pharmacology, therapeutics and toxicology Clinical sciences** Dermatology Endocrinology Gastroenterology Haemotology and oncology Neurology Ophthalmology Psychiatry Renal medicine Respiratory medicine Rheumatology Tropical medicine, infectious and sexually transmitted diseases Number of questions* 15 20 25 8
15
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15 15 15 4 8 15 15 15 15
200

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* This should be taken as an indication of the likely number of questions - the actual number may vary slightly. ** Clinical sciences comprise: Cell, molecular and membrane biology Clinical anatomy Clinical biochemistry and metabolism Clinical physiology Genetics Immunology Statistics, epidemiology and evidencebased medicine
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Cardiology
Anatomy and physiology - Basic anatomy and physiology of the heart in health and disease including: --- Clinical relevant normal anatomy of the heart, coronary arteries and great vessels --- Determinants of the heart rate and rhythm --- Cardiac conduction --- Cardiac output ---Vascular tone --- Blood pressure --- Coronary blood flow --- Genesis of heart sound Pathophysiology and pathology - Mechanism underlying the main pathological processes Ex: --- Thrombosis --- Infarction --- Atherogenesis --- Hypertrophy ---Heart failure --- Cardiomyopathies --- Dysrhythmias --- Hypertension Cell biology - Topics of proven clinical relevance such as: --- Excitation-contraction process --- Molecular and cellular aspects of hypertrophy of the myocardium of vascular smooth muscle Clinical pharmacology - Indications of drug therapy in cardiac disease - Actions, interactions, and side effects of the drugs used, with emphasis on new drugs and newly observed side effects. Clinical cardiology - Clinical features and management of the cardiac disorders encountered in hospital practice by the general physician - Risk factors Ex: --- Clinical features of constrictive pericarditis, cardiac tamponade, endocarditis, valvular disease --- Management of acute coronary syndromes --- Management of cardiac failure ---Management issues in atrial fibrillation --- Indications for, and types of, permanent pacemaker - Important changes in clinical practice, following the publication of major clinical trials Ex:

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--- 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 blocking drugs in left ventricular dysfunction - Indications for invasive and non-invasive cardiac investigation - Principle of these investigative methods, their limitations and the clinical relevance Ex: --- Common ECG abnormalities ---Basic echocardiographic abnormalities such as hypertrophic obstructive cardiomyopathy or pericardial effusion --- Indication for coronary angiography
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Clinical pharmacology, therapeutics and clinical toxicology


Pharmacology - Mechanisms by which drugs produce their pharmacological effects - Basic principles of agonism and antagonism - Clinical implication of drugs that act at different receptor sites - Links between the pharmacological effects of drugs at the molecular level, the cellular level, and the tissue / organ level, and how these are affected by disease processes and other drugs - Principles by which both therapeutic and adverse effects occur Clinical pharmacokinetics - Processes of drug absorption and distribution - Bio-transformation and excretion - Concepts of drug half-life and clearance - First order and zero order kinetics Monitoring drug therapy - Direct measurement of therapeutic response - Measurement of plasma drug concentrations - Scientific basis for the measurement of drug concentration and its link to the principles of pharmacokinetics Adverse drug reactions - Epidemiology of adverse drug reactions: recognition and avoidance - Important adverse effects of commonly used drugs - Importance of adverse drug reaction reporting schemes Drug interactions - Adverse drug interactions and mechanisms by which interaction may occur - Common drug interactions and their clinical consequences Pharmacogenetics - Principles of pharmacogenetics and its importance in determining variations in response to drugs in man, both in term of efficacy and toxicity - Clinical consequences of the common pharmacogenetic variations relevant to clinical practice Therapeutics for specific patient groups - Principles of therapeutics as they apply in the following circumstances: --- The elderly --- Pregnancy and breast feeding --- Patients with renal disease --- Patients with hepatic disease ----- Effects of these altered physiology on the pharmacokinetics and pharmacodynamics of drugs ----- Principle underlying drug choice, in pregnancy and breast feeding ----- Teratogenic effects of drugs that may be used in pregnancy -

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Drugs that may produce toxicity in the case of renal and hepatic disease Clinical toxicology - Principle of management of patients poisoned by drugs or other toxic substances - Assessment, recognition of common symptom patterns - Principles of removal of toxic substances - Antidotes where these approaches may be appropriate Criteria for selecting drugs in a therapeutic class - Criteria used to select a drug from among drugs in a popular therapeutic class including: --- Differences in pharmacokinetics and pharmacodynamics --- The approved indications of the drug --- Possible adverse effects or drug inteactions --- Cost effectiveness ----- Nomenclature ----- Used to describing studies that may be used to underpin drug selection Drug formulations and routes of administration - Various formulations of medicines available - Routes by which medicines may be administered - Advantages and disadvantages of various routes and preparation - Most appropriate formulation selection and drug administration in common clinical scenarios
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Cell, molecular and membrane biology


Structure and function of the components of the cell and its membrane How cells communicate internally and with each other by means of chemical substances and membrane receptors. Ex: - Function of intracellular organelles - Cellular communication

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Anatomy
Clinical relevant anatomy including neuroanatomy Ex: - Peripheral nerve lesions - Cranial nerve abnormalities - Dermatomes, myotomes and reflexes

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Physiology, biochemistry and metabolism


Structure and function of the different organs and their interaction (such as hormonal and neural influences) Broad principle of metabolism such as the production of energy and pathways of carbohydrate, protein, and lipid metabolism Principle of nutrition, water, electrolyte and acid base balance. Physiology and biochemistry of each organ system Ex: - The mechanism of blood pressure control - Acid-base balance

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Gastroenterology
Clinical science - Structure and function of the gastrointestinal and hepatobilary tract - Neurohormonal control of gut motility - Secretory and absorptive functions of the gastro-intestinal tract and liver - Symptoms and signs of gastrointestinal, hepatobiliary and pancreatic diseases - Genetics of the more common gastrointestinal and liver disorders - Clinical pharmacology of drugs used in gastrointestinal disorders including their actions, interactions and adverse effects Clinical nutrition - Nutritional requirements in health - Assessment of nutritional status - Nutritional deficiency states - Primary nutritional disorders Disorders of the mouth, tongue and salivary glands - Mouth ulcers, periodontal and salivary disorders - Oral manifestations of systemic and dermatological disorders Disorders of the oesophagus and stomach - Alchalasia - Carcinomas - Peptic ulceration - Gastritis - Gastrointestinal haemorrhage Functional disorders - Functional chest pain and functional dyspepsia - Irritable bowel syndrome and functional abdominal pain - Functional constipation and diarrhoea Disorders of the small intestine - Malabsoption syndromes and gluten enteropathy - Hormone-secreting tumours of the gut Disorders of the liver, biliary tree and pancreas - Bilirubin metabolism and the enterohepatic circulation of bile acids - Causes of jaundice and cholestasis - Common pancreatic disorders including carcinoma - Fulminant liver failure - Acute and chronic hepatitis - Drugs, toxins, alcohol and the liver The acute abdomen - Perforated viscus and peritonitis - Intestinal obstruction - Ischaemic disease of the small and large bowel Inflammatory bowel diseases

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Crohn's disease Ulcerative colitis Infective gastroenteritis Parasitic and protozoal gut infections
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Colorectal disorders - Polyps - Carcinomas - Diverticular disease - Anorectal disorders

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Clinical haematology
Physiology, control and function of formed blood elements Bone marrow structure and function Applications of biochemistry, genetics, immunology and virology to blood disorders Effects of age and pregnancy on blood diseases Splenomegaly, lymphadenopathy and their causes Principles and hazards of blood and blood product replacement therapy Principles, but not detail, of anti-tumour chemotherapy Principles of marrow transplantation Adverse effects of drugs on the blood Iron metabolism - Physiology of iron, including its absorption - Iron overload - Iron deficiency states including diagnostic, causes and treatment - Iron metabolism, including anaemias of chronic disorders and sideroblastic anaemias Megaloblastic anaemias - Physiology of vitamin B12 and folic acid - Mechanisms and investigation of deficiencies and their management Haemolytic anaemias - Mechanisms of shortened red cell survival - Feature and management of congenital and acquired haemolytic states - Molecular pathology of thalassaemia and common haemoglobinopathies Ex: - Causes of haemolysis - Diagnostic of haemolytic anaemia Other anaemias - Anaemias complicating systemic disease - Aplastic anaemia - Myelodysplastic syndromes Polycythaemia and myeloproliferative disorders - Causes, investigation and management of polycythaemia - Causes, investigation and management of myeloproliferative disorders White cells disorders - Physiology of leucocytes - Leucocytosis and leucopenia

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- Acute and chronic leukaemias, including diagnosis, management and prognosis - Lymphoproliferative diseases including Hodgkin's disease, nonHodgkin's lymphomas and plasma cell dyscrasias. Disorders of haemostasis - Platelet function and coagulation - Thrombocytopenia and impaired platelet function - Thrombocytosis - Common congenital and acquired disorders of coagulation (especially anticoagulant therapy and disseminated intravascular coagulation)
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Neurology
Neuroanatomy - Detailed Neuroanatomy to appreciate the localisation of a particular neurological problem Ex: --- Clinical features of a lesion within the cavernous sinus --- Manifestations o a particular nerve root or peripheral nerve disorder --- Organisation of pathways within the spinal cord Neurophysiology - Aspects of Neurophysiology relevant to the understanding of neurological disease Ex: - Formation, circulation, absorption and content of the cerebrospinal fluid - Aspect of cerebral blood flow - Principles of nerve conduction and its modification by disease processes Neurogenetics - Recent advances in the understanding of the genetic basis for various neurological disorders Cell biology - Advances in the cellular mechanisms of certain neurological disease processes which have provided better understanding of disease mechanisms and which might, in the future, lead to more rational therapy Neuropharmacology - New drug developments in neurology - Established drug therapies Ex: --- Role of some recently introduced anticonvulsants --- Present status of immunosuppressant therapy in multiple sclerosis Neuropathology - Pathological aspects of some common diseases such as multiple

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sclerosis, Parkinson's disease and Alzheimer's disease Clinical neurology - Common disorders - Clinical features which have been shown to be of diagnostic value - Areas of recent advance, particularly those which have either led to better definition of disease entities, or have led to their improved management Ex: --- Epidemiological aspects, in particular the risk factors for stroke --- The evidence for the role of anti-platelet agents in transient ischaemic attacks - The role of carotid endarterectomy in the management of stroke patients
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Psychiatry
Mental state - Conduct and scope of a mental state examination - Features of abnormal mental states and particularly those present commonly to physicians and to Accident and Emergency Departments Aetiological factors in psychiatric illness - Primary aetiological factors in psychiatric areas including: ---Genetic factors ---Environmental factors ---Life events Investigations - Potential value of, and indications for, common investigations used in psychiatric illness including: ---Psychometric testing ---EEG ---Brain imaging Syndromes of psychiatric disorder and their treatment - Organic brain syndromes (delirium, dementia, focal brain syndromes, head injury) - Schizophrenia and related syndromes - Paranoid disorders and related syndromes - Affective disorders (anxiety states, phobic disorders, bipolar affective disorders) - Grief and bereavement - Self-harm, attempted suicide, suicide - Substance misuse (including alcohol dependence) - Eating disorders - Obsessive compulsive disorder - Abnormal illness behaviour - Syndromes associated with medically explained physical

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symptoms (including somatization and somatoform syndrome) Psychiatric aspects of physical disease - Psychiatric presentation of physical disease including: ---Endocrine and metabolic disorders ---Toxic states ---AIDS ---Neurological disease ---Epilepsy ---Pain Mental retardation - Features of the commoner syndromes
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Respiratory medicine
Anatomy and physiology - Clinical relevant anatomy of the upper and lower respiratory tract and thorax including radiological anatomy - 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 - Physical, humoral and cellular aspects of respiratory defence mechanisms - Physiology of the proteinase inhibitors and pulmonary surfactant Pathophysiology and pathology - Effects of disease on pulmonary physiology and anatomy including: --- The pulmonary and bronchial circulations as gas exchange --- Adaptations to chronic hypoxaemia --- Pleural fluid production and reabsorption - Application of the basic immunological processes to pulmonary pathology including: --- Asthma ---Alveolitis --- Tuberculosis - Humoral and cellular immunodeficiency states and sequelae - Microbiology of acute and chronic respiratory infections Cell biology and genetics - Lung inflammation and repair - Vasculitis - Cystic fibrosis - Anti-protease deficiency Clinical pharmacology - Indications for, and mechanisms of action of, drugs used in

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respiratory disease together with their interactions and side effects. - Important respiratory complications of other drugs (NSAIDs and beta blockers) Clinical conditions - Clinical features, investigation and management of respiratory disease likely to be encountered by a general physician Ex: --- Pleural effusion --- Chest pain ---Haemoptysis --- Breathlessness - Impact of systemic disease on the respiratory system Ex: --- Vasculitis --- Neuromuscular disease ---HIV infection - Occupational lung disease, particularly asthma, pneumoconiosis and asbestos related disease - Assessment of respiratory malignant condition - General principles of oncological management including indication of surgery Indications for specialised investigations including bronchoscopy, CT scanning, lung biopsy, lung volumes and exercise testing - Investigation of sleep related disorders and of the radiological aspects of respiratory diseases - Indications for, and problems of, lung transplantation - Control of Mycobacterium tuberculosis infection ---Exclusion - Knowledge of detailed pulmonary mechanics, oncology drug regimens, drug therapy of environmental mycobacterial infection, inhalation drug kinetics, and detailed histological descriptions is not required.
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Rheumatology
Basic principles of the common musculoskeletal conditions Clinical science - Basic physiology, biochemistry, anatomy and pathology relating to musculoskeletal diseases - Pathology of the common rheumatic conditions Clinical conditions - Relative prevalence and major associations of the common rheumatological conditions - Symptoms and signs of the rheumatic diseases - Arthritis associated with other medical conditions Investigations - Investigations relevant to the diagnosis and assessment of rheumatic diseases including - Acute phase proteins - Immunological tests relating to the connective tissue diseases - Contemporary imaging techniques Management - Management of acute rheumatological emergencies including Septic arthritis, Osteomyelitis, temporal arteritis and acute spinal cord compression - Management of rheumatic diseases

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Statistics, Epidemiology and Evidence-based medicine


Descriptive statistics - Mean, median, mode, standard deviation, standard error, confidence interval, variance - Range, quartile, inter-quartile range, percentile - Skewness - Contingency table, population - Missing values - Outliers Graphical techniques - Histogram - Box-plot - Scattergram Inferential techniques - 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 - Statistical significance, P value - T-test - Mann-Whitney and Wilcoxon test - Chi-square test for 2 x 2 contingency table - Correlation (Pearson's and Spearman's) - Linear regression - Study design Evidence based medicine - General understanding of evidence-based management and applications to management of patients Clinical trials - Interpretation of simple clinical trial data - Randomisation - Placebo-controlled trial - Open trial - Single-blind trial - Double-blind trial - Intention-to-treat - Bias

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Infectious diseases and tropical medicine


Microbiology - Taxonomy of bacteria in terms of Gram-straining and aerobic /anaerobic metabolism - Virus classification for members of the herpes group - Virus replication with reference to the retroviruses - Major pathogenic protozoa and helminths Ex: -Aerobic or anaerobic bacteria -Gram-staining characteristics of bacteria Immunology of infectious diseases - Immune deficiency states linked with types of opportunistic infections - Principle of immunisation and vaccines currently used Ex: - Opportunistic infections - Immunisation policy Pathophysiology - Septic shock - ARDS - Role of cytokines in infection Epidemiology - Principles relevant to infectious diseases Ex: - Mechanisms of transmission of pathogens - How epidemics happen - Knowledge of carrier states, reservoirs, vectors and zoonoses - Elementary concepts of the control of communicable diseases (including immunisation, isolation, contact tracing, chemoprophylaxis of close contacts) - Geographical variation in diseases including TB, HIV, Hepatitis B, malaria Treatment - Broad indications for commonly employed antimicrobial agents - Major adverse effects for commonly employed antimicrobial agents Ex: - B-lactams - Tetracyclines - Macrolides - Aminoglycosides - Quinolines - Trimethoprim

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Metronidazole Antituberculous drugs Antimalarial drugs Antiviral agents
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Specific infections - Characteristics, recognition, prevention, eradication, and pathological effects of all commonly encountered bacteria, viruses, rickettsia, fungi, protozoa, parasites and toxins. - Principle of infection control - Differential diagnostic and appropriate investigations - Presumptive therapies indications Ex: - Septicaemia - Meningitis and encephalitis - Endocarditis - Pneumonia (community-acquired, hospital-acquired, lung abscess, empyema) - Tuberculosis - PUO (appropriate investigations, when empirical therapy might be indicated) - Soft-tissue infection and Osteomyelitis - Streptococcal infection, rheumatic fever, nephritis - Intra-abdominal sepsis - Food-poisoning - Tropical Infections (especially malaria, bilharzias, amoebiasis, filariasis, leishmaniasis, hookworm and viral haemorrhagic fevers) - Viral hepatitis - HIV/AIDS (course of typical infection, CD4 count and HIV viral load as markers of progression; main opportunistic infections including Pneumocytis pneumonia, CNS toxoplasmosis, cryptococcal meningitis, tuberculosis) - Glandular fever syndrome and its differentiation from HIV seroconversion illness - Spirochaetosis - syphilis, leptospirosis, borrelia - Toxic shock syndrome and staphylococcal infections

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Immunology
Principles of immuno-mechanisms Ex: - Humoral and cell-mediated immunity - Immunodeficiency syndromes - Phagocytic dysfunction diseases - Complement deficiencies - Hypersensitivities including allergies and autoimmune diseases Immunological tests: - Immune system in health and disease Ex: - Common immunological laboratory tests - Evaluation of patients with immune disease - Intercellular communication and signal transduction - Lymphocyte and phagocytic cell biology - Antigen presentation - Humoral, cellular and mucosal immunity including Th2 and TH2 responses - Inflammation - Complement system and cytokines - Hypersensitivity and autoimmunity Clinical condition - Various immunodeficiency syndromes Ex: - Mechanisms of immunodeficiency - Antibody immunodeficiency disorders - T-cell immunodeficiency disorders - Combined antibody and cellular immunodeficiency disorders - Phagocytic dysfunction diseases - Complement deficiencies - Clinical characteristics and immediate management of acute allergic emergencies Ex: - Anaphylaxis - Angio-oedema - Urticaria - Immunology as applied with other medical diseases (ex: Rheumatic diseases - connective tissue diseases) Ex: - Rheumatic diseases (connective tissue disease) - Endocrine diseases (thyroid autoimmune diseases, diabetes mellitus, Addison's disease) - Haematological diseases (pernicious anaemia, autoimmune haemolytic anaemia, idiopathic thrombocytopenic purpura) - Gastrointestinal diseases (Coleiac disease, inflammatory bowel

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20 | P a g e - M R C P 1 P R E P B A S I C S f o r M R C P 1
disease, hepatobiliary diseases) - Renal diseases (Goodpasture's syndrome, immune-complex glomerulonephritis) - Dermatological diseases (demyelinating diseases, myasthenic syndromes) Management - Principles of immunosuppressive therapy including major indications and side-effects Ex: - Immunosupressive drug therapy - Intravenous immunoglobulin - Monoclonal antibodies - Cytokine therapy - Bone marrow transplantation - Principle of immunisation - Vaccines currently in use
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Genetics
Structure and function of chromosomes and genes Principle of inheritance of chromosomal and genetic disorders Ex: - Inherited diseases - Chromosome structure - Common chromosome abnormalities

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Endocrinology
Mechanisms of hormone action and importance of Receptors and substances involved in control of intracellular metabolism Clinically relevant anatomical aspects of the speciality Thyroid - Mechanisms of thyroid disease - Clinical presentation and treatment Ex: ---Thyroid hormone biosynthesis and its control ---Important drugs interfering with thyroid function ---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 - Physiology and testing of the control mechanisms of the endocrine system Ex: ---The physiology and Pathophysiology of control of pituitary hormone secretion ---The mechanisms of maintaining plasma osmolality ---Tests of pituitary diseases such as acromegaly, prolactinoma and Cushing's syndrome ---Drugs used in the treatment of pituitary disease ---Pituitary replacement therapy Adrenal - Clinically relevant mechanisms of steroid biosynthesis Ex: ---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 and management of adrenal hyper- and hypofunction ---Complications of steroid therapy Ovary - Physiology of ovarian functions - Conditions presenting to a physician Ex: ---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

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22 | P a g e - M R C P 1 P R E P B A S I C S f o r M R C P 1
Testis - Relevant investigations of urological infertility - Endocrine aspects of testicular functions Growth - Factors controlling growth hormone secretion - Normal growth patterns - General medical and endocrine causes of short stature - Control of excessive growth - Growth hormone therapy and its complications Parathyroid/bone - Control of bone turnover and disorders which can result of its failure Ex: ---Control of calcium metabolism ---Laboratory tests of parathyroid function ---The causes of hypercalcaemia ---Mechanisms of oesteomalacia ---Hyperparathyroidism, both primary and secondary ---The differentiation of primary, secondary and pseudohypoparathyroidism ---The differentiation of primary, secondary and pseudohypoparathyroidism ---The prophylaxis and treatment of osteoporosis ---Calcitonin and its role in metabolism Diabetes mellitus - Detailed knowledge is required. Ex: ---Control of carbohydrate metabolism ---Genetics of diabetes ---Aetiology of type I diabetes and type 2 diabetes ---Long-term complications of diabetes ---Management of diabetic emergencies ---Differential diagnosis and treatment of hypoglycaemia Disorders of lipid metabolism - Importance of this group disorder Ex: ---Control of cholesterol metabolism ---Aetiology of different types of hyperlipidaemia including both cholesterol and triglyceride disorders ---Indications for lipid lowering agents and their complications ---Types of secondary hyperlipidaemia
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Nephrology
Physiology - Discrete functions of Glomerular ultrafiltration and tubular function - Proximal and distal parts of the nephron, with particular reference to control of water and electrolyte balance - Renal tubular acidosis - Cystinuria - Fluid, electrolyte, and acid-balance disturbances Molecular biology and genetics - Genetic defects of common disorders including: ---Polycystic kidney ---Alport's syndrome ---Hypophosphataemic rickets - Inflammatory injury of the kidney mediated by various cytokines factors Glomerular and tubular disorders - Glomerular ultra structure based upon techniques of light microscopy, electron microscopy and immunofluorescence as applied to renal biopsy - Primary Glomerular disorders as in idiopathic glomerulonephritis, and nephropathies of systemic diseases Ex: ---Diabetes mellitus ---SLE ---Hypertensive nephrosclerosis ---Vasculitis ---Amyloidosis - Interstitial nephritis, in particular vase s with reversible aetiology such as drug, heavy metals and analgesics - Metabolic sequelae of acute nephrotic and nephritic syndromes - Investigation and assessment of Glomerular and tubular disorders, including ultrasonic studies and nuclear medicine - Disturbed renal and metabolic functions in nephritic syndrome from a variety of causes Infections of the kidney - Management of urinary tract infections including their detention, predisposing factors, prevention, and treatment - Anatomical abnormalities leading to repeated urinary tract infection Ex: ---Reflux nephropathy ---Prostatic hypertrophy - Other infections that might affect the kidney by direct invasion or by immune-complex deposition Calculus formation within the urinary tract - Metabolic disorders predisposing to stone formation, their

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24 | P a g e - M R C P 1 P R E P B A S I C S f o r M R C P 1
investigation, prevention and treatment Ex: ---Idiopathic hypercalciuria ---Primary Hyperparathyroidism ---Cystinuria ---Hyperoxaluria Acute and chronic renal failure - Management of acute and chronic renal failure and of disturbed physiology involved - Pathophysiological changes and non-dialytic treatment in different stages of progressive renal failure - Principle of nutritional requirements and diatery intervention for patients with chronic renal failure - Other therapeutic means to slow down the progression of renal failure Hypertension and renal problems in pregnancy - Renal adaptation to pregnancy - Management and profylaxis of renal disease and hypertension in pregnancy Drug and the kidney - Role of the kidney in the normal elimination of drugs - Mechanisms by which drugs cause nephrotoxic damage - Principle of dose adjustment according to residual renal function Renal replacement therapy - Different dialysis modalities and their complications - Complications related to immunosuppressive therapy following renal transplantation
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Dermatology
Basic science - Structure and function of the epidermis and dermis Clinical dermatology - Recognition of cutaneous symptoms and signs of systemic diseases (diseases affecting internal organs and presenting skin signs or symptoms) Ex: ---Collagen vascular disease such as SLE, systemic sclerosis ---Metabolic and endocrine disorders ---Infectious diseases ---Cancers ---Leukaemias ---Respiratory and cardiovascular diseases ---Common inherited diseases such as neurofibromatosis - Main dermatological complications of therapeutic immunosuppression (ex: systemic corticosteroid therapy, cyclosporin) or of diseases such as HIV which cause immunosuppression - Differential diagnosis and plan of investigation of patients whom, present with the following cutaneous signs or symptoms which

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25 | P a g e - M R C P 1 P R E P B A S I C S f o r M R C P 1
may indicate internal diseases: ---Itch ---Hyperpigmentation ---Generalised erythema ---Loss of hair ---Increased hair growth ---Common patterns of nail dystrophy such as clubbing ---Erythema nodosum ---Erythema multiform ---Purpura ---Ulceration ---Vasculitis - Clinical features of the following skin diseases: ---Psoriasis ---Eczema ---Urticaria ---Superficial fungal infections (dermatophytosis, pityriasis versicolor) ---Common skin cancers such as melanoma ---Vitiligo and alopecia areata ---Pemphigus and pemphigold ---Cutaneous herpes virus infections (herpes simplex, varicella zoster) ---Cutaneous staphylococcal and streptococcal infections ---Leprosy Investigation - Principles of dermatological investigation such as patch testing Drugs and therapy - Drugs which cause life-threatening skin conditions such as ---Erythroderma ---Stevens-Johnson syndrome, ---Angio-oedema ---Toxic epidermal necrolysis
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