MRCP UK syllabus Genetics

-The structure and function of chromosomes and genes and a knowledge of the principles of inheritance of chromosomal and genetic disorders. Examples of question topics might include: -Inherited diseases -Chromosome structure -Common chromosome abnormalities -The cell is the fundamental unit of the structure of organs. It is important that you understand the structure and function of the components of the cell and its membrane. ou should understand how cells communicate internally and with each other by means of chemical substances and membrane receptors. Examples of question topics might include: -!unction of intracellular organelles -Cellular communication ---------------------------------------------------------------------------------------------------------------------------CELL, MOLECULAR AND MEMBRANE BIOLOGY -Clinically rele"ant anatomy will be tested# including neuroanatomy. Examples of question topics might include: -$eripheral ner"e lesions -Cranial ner"e abnormalities -%ermatomes#myotomes and reflexes It is essential that you understand the structure and function of the different organs which make up the body and how these organs interact# such as through hormonal and neural influences. - ou should know the broad principles of metabolism such as the production of energy and the pathways of carbohydrate# protein and lipid metabolism# but a detailed knowledge of the chemical processes in the steps of the metabolic pathways is not necessary. - ou should ha"e an understanding of the principles of nutrition#water# electrolyte and acidbase balance. -&nowledge of the physiology and biochemistry of each organ system is examined under that specialty. Examples of question topics might include: The mechanism of blood pressure control 'cid-base balance

Examples of question topics might include immunomechanisms in: ( /heumatic diseases 0connecti"e tissue diseases1 ( Endocrine diseases 0thyroid autoimmune diseases# diabetes mellitus# 'ddison2s disease1 ( )aematological diseases 0pernicious anaemia# autoimmune haemolytic anaemia# idiopathic thrombocytopenic purpura1 ( 3astrointestinal diseases 0Coeliac disease# inflammatory bowel disease# hepatobiliary diseases1 ( /enal diseases 03oodpasture2s syndrome# immune-complex glomerulonephritis1 ( %ermatological diseases 0discoid lupus# pemphigus# pemphigoid1 ( 4eurological diseases 0demyelinating diseases#myasthenic syndromes1 -anagement ou should be able to answer questions on the principles of immunosuppressi"e therapy including ma5or indications and side-effects. Examples of question topics might include: ( )umoral and cell-mediated immunity ( Immunodeficiency syndromes ( $hagocytic dysfunction diseases ( Complement deficiencies ( )ypersensiti"ities including allergies and autoimmune diseases Immunology and immunological tests ou should ha"e a basic knowledge of the immune system in health and disease. IMMUNOLOGY Examples of question topics might include: ( -echanisms of immunodeficiency ( 'ntibody immunodeficiency disorders ( T-cell immunodeficiency disorders ( Combined antibody and cellular immunodeficiency disorders ( $hagocytic dysfunction diseases ( Complement deficiencies ou should know the main clinical characteristics and immediate management of acute allergic emergencies.ANATOMY PHYSIOLOGY. Examples of question topics might include: ( Common immunological laboratory tests ( E"aluation of patients with immune disease ( Intercellular communication and signal transduction ( *ymphocyte and phagocytic cell biology ( 'ntigen presentation ( )umoral# cellular and mucosal immunity including T)+ and T). Examples of question topics might include: ( Immunosuppressi"e drug therapy 0corticosteroids# cytotoxic agents# and cyclosporin1 ( Intra"enous immunoglobulin ( -onoclonal antibodies ( Cytokine therapy ( 6one . Examples of question topics might include: ( 'naphylaxis ( 'ngio-oedema ( . BIOCHEMISTRY AND METABOLISM 'lthough a detailed knowledge of basic immunology and immunological diseases is not required# you should ha"e a sound working knowledge of the principles of immunomechanisms.rticaria ou should be familiar with immunology as applied to other medical diseases. responses ( Inflammation ( Complement system and cytokines ( )ypersensiti"ity and autoimmunity Clinical conditions ou should be able to answer questions on the "arious immunodeficiency syndromes.

. -a5or pathogenic proto9oa and helminths should be known. 8irus classification is not important except for members and characteristics of the herpes group.pecific infections &nowledge of the characteristics# recognition# pre"ention# eradication and pathological effects of all commonly encountered bacteria# "iruses# rickettsia# fungi# proto9oa# parasites and toxins# including an understanding of the principles of infection control# will be required. $rinciples of immunisation and knowledge of "accines currently used should also be known. IN!ECTIOUS DISEASES AND TROPICAL MEDICINE Examples of question topics might include: ( -echanisms of transmission of pathogens ( )ow epidemics happen ( &nowledge of carrier states# reser"oirs# "ectors and 9oonoses ( Elementary concepts of the control of communicable diseases 0including immunisation# isolation# contact tracing# chemoprophylaxis of close contacts1 ( 6road awareness of geographical "ariation in disease including T6# )I8# )epatitis 6# malaria Treatment ou should know the broad indications for# and ma5or ad"erse effects of# commonly employed antimicrobial agents. Examples of question topics might include: ( :pportunistic infections ( Immunisation policy $athophysiology ou should ha"e a basic understanding of: ( . 8irus replication with reference to retro"iruses should be understood.pecial attention to differential diagnosis# appropriate in"estigations and awareness of when presumpti"e therapy is indicated is essential.epticaemia ( -eningitis and encephalitis ( Endocarditis ( $neumonia 0community-acquired# . Examples of question topics might include: ( 6-lactams ( Tetracyclines ( -acrolides ( 'minoglycosides ( <uinolines ( Trimethoprim ( -etronida9ole ( 'ntituberculous drugs ( 'ntimalarial drugs ( 'nti"iral agents . ( /ole of cytokines in infection Epidemiology ou should ha"e knowledge of the principles of epidemiology rele"ant to infectious diseases. Examples of question topics might include: ( .eptic shock ( '/%. Microbiolog ou should understand the ma5or taxonomy of bacteria in terms of 3ram-staining and aerobic7anaerobic metabolism. Examples of question topics might include: ( 'erobic or anaerobic bacteria ( 3ram-staining characteristics of bacteria Immunology of infectious diseases ou should understand immune deficiency states linked with types of opportunistic infections.marrow transplantation ou should know about the principles of immunisation and be familiar with "accines currently in use.

ou are not expected to ha"e any knowledge of computer packages for carrying out statistical calculations.kewness ( Contingency table ( $opulation ( -issing "alues ( :utliers 3raphical techniques Examples of question topics might include: ( )istogram ( 6ox-plot ( .pearman2s1 ( *inear regression ( . toxoplasmosis# cryptococcal meningitis# tuberculosis1 ( 3landular fe"er syndrome and its differentiation from )I8 serocon"ersion illness ( .tudy design E"idence-based medicine ou are expected to ha"e an understanding of e"idence-based medicine and an ability to apply this understanding in the management of patients.pirochaetosis . contingency table ( Correlation 0$earson2s and .syphilis# leptospirosis# borrelia ( Toxic shock syndrome and staphylococcal infections ou should ha"e a basic understanding of the usage and limitations of the common statistical tests used in reporting the results of research in clinical 5ournals.tandard de"iation# standard error ( Confidence inter"al ( 8ariance ( /ange# quartile# inter-quartile range ( $ercentile ( . %escripti"e statistics Examples of question topics might include: ( -ean# median# mode ( .hospital-acquired# lung abscess# empyema1 ( Tuberculosis ( $. x .oft-tissue infection and osteomyelitis ( . ou may be expected to carry out simple calculations that do not require the use of a calculator.tatistical power ( :ne and two-tailed tests ( .: 0appropriate in"estigations# when empirical therapy might be indicated1 ( . The following lists are not intended to be inclusi"e but as illustrati"e of the type of knowledge that you need to possess. The following lists of terms should gi"e some idea of the range of terms and techniques which you should understand# all of which can be found regularly in 5ournals such as The *ancet# 6ritish -edical ?ournal and 4ew England ?ournal of -edicine. 0course of typical infection= C%> count and )I8 "iral load as markers of progression= main opportunistic infections including $neumocystis pneumonia# C4. errors ( !alse positi"e and false negati"e ( .cattergram STATISTICS. EPIDEMIOLOGY AND E"IDENCE#BASED MEDICINE Inferential techniques Examples of question topics might include: ( 4ull hypothesis ( 'lternati"e hypothesis ( $arametric and non-parametric tests ( 4ormal distribution ( Type + and Type . ou are not expected to memorise formulae for statistical tests# but should understand their conceptual basis.tatistical significance# $ "alue ( T-test ( -ann-@hitney and @ilcoxon test ( Chi-square test for .treptococcal infection# rheumatic fe"er# nephritis ( Intra-abdominal sepsis ( !ood-poisoning 0especially salmonellosis# campylo-bacter# "erocytotoxin producing E coli1 ( Tropical infections 0especially malaria# bilhar9ia# amoebiasis# filariasis# leishmaniasis# hookworm and "iral haemorrhagic fe"ers1 ( 8iral hepatitis ( )I87'I%. Clinical trials .

ingle-blind trial ( %ouble-blind trial ( Intention-to-treat ( 6ias ou will be expected to ha"e knowledge of the following: ( $hysiology# control and function of formed blood elements ( 6one marrow structure and function ( 'pplications of biochemistry# genetics# immunology# and "irology to blood disorders ( Effects of age and pregnancy on blood disease ( . @hite cell disorders ou should understand the: ( $hysiology of leucocytes ( *eucocytosis and leucopenia ( 'cute and chronic leukaemias# including diagnosis# management and prognosis ( *ymphoproliferati"e diseases including )odgkin2s disease# non-)odgkinAs lymphomas# and plasma cell dyscrasias %isorders of haemostasis ou should possess knowledge of: ( $latelet function and coagulation ( Thrombocytopenia and impaired platelet function ( Thrombocytosis ( Common congenital and acquired disorders of coagulation 0especially anticoagulant therapy and disseminated intra"ascular coagulation1 . deficiency (!olate deficiency )aemolytic anaemias ou should understand: ( -echanisms of shortened red cell sur"i"al ( !eatures and management of congenital and acquired haemolytic states CLINICAL HAEMATOLOGY ( -olecular pathology of thalassaemia and common haemoglobinopathies Examples of question topics might include: ( Causes of haemolysis ( %iagnosis of haemolytic anaemia :ther anaemias Examples of question topics might include: ( 'naemias complicating systemic disease ( 'plastic anaemia ( -yelodysplastic syndromes $olycythaemia and myeloproliferati"e disorders ou should know the causes# in"estigation and management of polycythaemia and myeloproliferati"e disorders. Examples of question topics might include: (6+.Examples of question topics might include: ( Interpretation of simple clinical trial data ( /andomisation ( $lacebo-controlled trial ( :pen trial ( .plenomegaly# lymphadenopathy# and their causes ( $rinciples and ha9ards of blood and blood product replacement therapy ( $rinciples# but not detail# of anti-tumour chemotherapy ( $rinciples of marrow transplantation ( 'd"erse effects of drugs on the blood Iron metabolism ou should ha"e an understanding of: ( $hysiology of iron# including its absorption ( Iron o"erload ( Iron deficiency states including diagnosis# causes and treatment ( Iron metabolism# including anaemias of chronic disorders and sideroblastic anaemias -egaloblastic anaemias ou should understand the physiology of "itamin 6+. and folic acid and the mechanisms and in"estigation of deficiencies and their management.

Therapeutics for specific patient groups ou should understand the principles of therapeutics as they apply in the . $harmacogenetics ou should understand the principles of pharmacogenetics and its importance in determining "ariations in response to drugs in man# both in terms of efficacy and toxicity. $harmacology ou should understand the: ( -echanisms by which drugs produce their pharmacological effects ( 6asic principles of agonism and antagonism ( Clinical implication of drugs that act at different receptor sites ( *inks between the pharmacological effects of drugs at the molecular le"el# the cellular le"el# and the tissue7organ le"el# and how these are affected by disease processes and other drugs ( $rinciples by which both therapeutic and ad"erse effects occur Clinical pharmacokinetics ou should understand the principles that underlie: ( $rocesses of drug absorption and distribution ( 6iotransformation and excretion ( Concepts of drug half-life and clearance ( !irst order and 9ero order kinetics 'pplication of this knowledge to clinical situations is necessary but detailed kinetic calculations will not be required. ou should ha"e knowledge of the clinical consequences of the common pharmacogenetic "ariations rele"ant to clinical practice. %rug interactions ou should ha"e an understanding of the epidemiology of ad"erse drug interactions# and of the mechanisms by which interactions may occur. 'd"erse drug reactions ou should ha"e an understanding of the epidemiology of ad"erse drug reactions and know how to recognise and a"oid them. ou must also be aware of important ad"erse effects of commonly used drugs and ha"e an understanding of the importance of ad"erse drug reaction reporting schemes. ou should also ha"e a knowledge of common drug interactions and their clinical consequences. THERAPEUTICS AND CLINICAL TO$ICOLOGY Emphasis will be gi"en to the areas of clinical practice and therapeutics where the narrow therapeutic range of particular pharmacokinetic properties of the drug make this approach important.ou are expected to ha"e a good knowledge and understanding of the principles of clinical pharmacology# therapeutics and clinical toxicology. -onitoring drug therapy ou should understand the principles that underlie the monitoring of drug therapy including: ( %irect measurement of therapeutic response ( -easurement of plasma drug concentrations ( &nowledge of the scientific basis for the measurement of drug concentration and its link to the principles of pharmacokinetics CLINICAL PHARMACOLOGY.

alicylate poisoning ( Tricyclic antidepressant poisoning ( *ithium poisoning ( Iron poisoning ( %igoxin poisoning ( Intoxication due to drugs of abuse Criteria for selecting drugs in a therapeutic class ou should understand the criteria that may be used to select a drug from among drugs in a popular therapeutic class.following circumstances: ( The elderly ( $regnancy and breast feeding ( $atients with renal disease ( $atients with hepatic disease ou should understand that the altered physiology in these patient groups may affect the pharmacokinetics and pharmacodynamics of drugs. In the case of renal and hepatic disease it is also necessary for you to ha"e an understanding of drugs that may produce toxicity of these organs and whose use is particularly affected by disease of these organs. ou should also understand the ad"antages and disad"antages of "arious routes and preparations.rate metabolism ( 6one metabolism ( 'pplied anatomy# particularly of cer"ical and lumbar ner"e roots# and of .)owe"er# you should ha"e a sound working knowledge of the basic principles of the common musculoskeletal conditions. This should include assessment# recognition of common symptom patterns# principles of remo"al of toxic substances# and their antidotes where these approaches may be appropriate. ou +B should know the principles underlying drug choice# in pregnancy and breast feeding# and ha"e an understanding of the teratogenic effects of drugs that may be used in pregnancy. !rom this knowledge# you would be expected to be able to select the most appropriate formulation and route of drug administration in common clinical scenarios. Examples of question topics might include: ( Inflammatory arthritis ( 6ack pain ( $eriarticular disorders ( :steoarthritis ( Connecti"e tissue diseases ( 6one diseases Clinical science 6asic physiology# biochemistry# anatomy and pathology relating to musculoskeletal disease should be known. Clinical toxicology ou should understand the principles of management of patients who ha"e been poisoned with drugs or other toxic substances. %etailed knowledge of all the rheumatic conditions is not required. This would include: ( %ifferences in pharmacokinetics and pharmacodynamics ( The appro"ed indications of the drug ( $ossible ad"erse effects or drug interactions ( Cost effecti"eness ou should also be aware of the nomenclature used in describing studies that may be used to underpin drug selection. Examples of question topics might include: ( $aracetamol poisoning ( . Examples of questions topics might include: ( $hysiology of pain ( $hysiology of inflammation ( . %rug formulations and routes of administration ou should be aware of the "arious formulations of medicines a"ailable# and of the routes by which medicines may be administered.

Examples of question topics might include: • %arcoidosis • Er#thema nodosum • /nfections and arthritis &e.ds32A' A2CA' anti. Examples of question topics might include: • %eptic arthritis • !steom#elitis • 5emporal arteritis • Acute spinal cord compression You should "e a"le to answer questions on the management of rheumatic diseases.s disease( You should "e familiar with arthritis associated with other medical conditions.4o0' anti. +arvovirus .drug related therapies &education' ph#siotherap#( • 3rug related therapies &indications and contra. Examples of question topics might include: • Acute phase proteins • /mmunological tests relating to the connective tissue diseases &A2A' anti. Examples of question topics might include the relationship to: • Age • ender • enetic influences • Constitutional influences • Environmental influences • !ccupational influences You should "e a"le to answer questions on the s#mptoms and signs of the rheumatic diseases. Examples of question topics might include pathological findings in: ( /heumatoid arthritis ( :steoarthritis ( Connecti"e tissue diseases ( 6one diseases RHEUMATOLOGY Clinical conditions You should know the relative prevalence and major associations of the common rheumatological conditions.g.$o( • Contemporar# imaging techniques in rheumatolog# &x.ra#' ultrasound' CA5 scanning'6$/ scanning( 6anagement You should "e a"le to answer questions on the management of acute rheumatological emergencies. Examples of question topics might include: • 2on.indications' adverse .cell arteritis • %#stemic vasculitic s#ndromes • -one disorders &osteoporosis' osteomalacia' +aget.peripheral ner"es commonly in"ol"ed in disease The pathology of the common rheumatic conditions should be known. Examples of question topics might include: • $heumatoid arthritis and associated s#ndromes • %eronegative spond#loarthritis &ank#losing spond#litis' psoriatic arthritis' reactive arthritis' enteropathic arthritis( • !steoarthritis • Cr#stal arthritis &gout' p#rophosphate arthritis( • Connective tissue diseases &s#stemic lupus er#thematosus' %jogren)s s#ndrome' scleroderma' pol#m#ositis*dermatom#ositis( • +ol#m#algia rheumatica and giant.01( /nvestigations You should have knowledge of the investigations relevant to the diagnosis and assessment of rheumatic diseases.

5he emphasis will often "e on new drugs or on novel applications or newl# o"served side effects of esta"lished drugs.inflammator# drugs • Corticosteroids • Allopurinol • 3isease modif#ing anti.effects' drug interactions( • %imple analgesics • 2on.contraction process • 6olecular and cellular aspects of h#pertroph# of the m#ocardium and of vascular smooth muscle Clinical pharmacolog# You should know the indications for drug therap# in cardiac disease and understand the actions' interactions and side effects of the drugs used.rheumatic drugs • /mmunosuppressive drugs Anatom# and ph#siolog# You should have knowledge of the "asic anatom# and ph#siolog# of the heart in health and disease: Examples of question topics might include: • Clinicall# relevant normal anatom# of the heart' coronar# arteries and great vessels • 3eterminants of heart rate and rh#thm • Cardiac function • Cardiac conduction • Cardiac output • 7ascular tone • -lood pressure • Coronar# "lood flow • enesis of heart sounds +athoph#siolog# and patholog# You should know the mechanisms underl#ing the main pathological processes. You should have knowledge of risk factors. Examples of question topics might include: • Clinical features of constrictive pericarditis' cardiac tamponade' endocarditis' valvular heart disease • 6anagement of acute coronar# s#ndromes • 6anagement of cardiac failure • 6anagement issues in atrial fi"rillation • /ndications for' and t#pes of' permanent pacemaker 9nowledge of important changes in clinical practice' following the pu"lication of major clinical trials' is likel# to "e tested. 3etails of drug dosage are asked onl# rarel#. Examples of question topics might include: • Excitation.adrenoceptor "locking drugs in left ventricular d#sfunction . Clinical cardiolog# You must know the clinical features and management of the cardiac disorders encountered in hospital practice "# the general ph#sician' though detailed specialist knowledge is not expected.steroidal anti. Examples of question topics might include: • 5hrom"osis • /nfarction • Atherogenesis • 8#pertroph# • 8eart failure • Cardiom#opathies • 3#srh#thmias • 8#pertension CARDIOLOGY Cell "iolog# You do not need detailed specialised knowledge of cell "iolog# as onl# topics of proven clinical relevance will "e tested. Examples of question topics might include: • :se of ACE inhi"itors after m#ocardial infarction • :se of 86 CoA reductase inhi"itors in primar# and secondar# prevention of coronar# mor"idit# and mortalit# • :se of "eta.

g. Cell "iolog# and genetics You should have knowledge of: • . Clinical conditions . RE!PIRATORY MEDICI"E 5he micro"iolog# of acute and chronic respirator# infections should "e known.ung volumes and transfer factor • $espirator# aspects of sleep and exercise ph#siolog# You should understand the: • +h#sical'humoral and cellular aspects of respirator# defence mechanisms • +h#siolog# of the proteinase inhi"itors and pulmonar# surfactant +athoph#siolog# and patholog# You should understand the effects of disease on pulmonar# ph#siolog# and anatom# including: • 5he pulmonar# and "ronchial circulations and gas exchange • Adaptations to chronic h#poxaemia • +leural fluid production and rea"sorption You should understand the application of the "asic immunological processes to pulmonar# patholog# including: • Asthma • Alveolitis • 5u"erculosis You should possess knowledge of humoral and cellular immunodeficienc# states and sequelae. Examples of question topics might include: • Common EC a"normalities • -asic echocardiographic a"normalities such as h#pertrophic o"structive cardiom#opath# or pericardial effusion • /ndications for coronar# angiograph# Anatomy and physiolo y You should understand clinicall# relevant anatom# of the upper and lower respirator# tract and thorax including radiological anatom#. Clinical pharmacolog# 5he indications for' and mechanisms of action of' drugs used in respirator# disease together with their interactions and side effects should "e known. perfusion relationships • . /mportant respirator# complications of other drugs' e. You should have knowledge of the principles of respirator# ph#siolog# including: • 8ow respiration is controlled • +rinciples of gas exchange and ox#gen transport • 7entilation.' 2%A/3s and "eta "lockers should also "e understood.You should know the: • /ndications for invasive and non.invasive cardiac investigation • +rinciples of these investigative methods' their limitations and the clinical relevance of the results 9nowledge of the practical aspects of the investigative techniques is not required.protease deficienc# You should understand the genetics of: • Asthma • C#stic fi"rosis • Alpha 0 antitr#psin deficienc# 5he role and value of gene therap# should "e understood.ung inflammation and repair • 7asculitis • C#stic fi"rosis • Anti.

You should have knowledge of the investigation of sleep related disorders and of the radiological aspects of respirator# disease. You should know the indications for' and pro"lems of' lung transplantation. Examples of question topics might include: • 5he role of d#strophin in muscle disease • enetic aspects of m#otonic d#stroph# • enetic aspects of Al=heimer)s disease "EUROLOGY . Examples of question topics might include: • 5he clinical features of a lesion within the cavernous sinus • 5he manifestations of a particular nerve root or peripheral nerve disorder • 5he organisation of pathwa#s within the spinal cord 2europh#siolog# 3etailed knowledge of neuroph#siolog# is not expected "ut' as with neuroanatom#' certain aspects of the su"ject are particularl# relevant to the understanding of neurological disease and ma# "e tested. Examples of question topics might include: • 7asculitis • 2euromuscular diseases • 8/7 infection 9nowledge of occupational lung disease' particularl# asthma' pneumoconiosis' and as"estos related disease is required. Examples of question topics might include: • +leural effusion • Chest pain • 8aemopt#sis • -reathlessness 5he impact of s#stemic disease on the respirator# s#stem should "e known. Examples of question topics might include: • 5he formation' circulation' a"sorption and content of the cere"rospinal fluid • Aspects of cere"ral "lood flow • 5he principles of nerve conduction and its modification "# disease processes 2eurogenetics You are expected to have knowledge of recent advances in the understanding of the genetic "asis for various neurological disorders. 5he indications for specialised investigations' including "ronchoscop#' C5 scanning' lung "iops#' lung volumes and exercise testing should "e known. You should have knowledge regarding the control of 6#co"acterium tu"erculosis infection. Exclusions 9nowledge of detailed pulmonar# mechanics' oncolog# drug regimens' drug therap# of environmental m#co"acterial infection' inhalation drug kinetics and detailed histological descriptions is not required.5he clinical features' investigation and management of respirator# disease likel# to "e encountered "# a general ph#sician must "e known. "#u$oanatomy You are not expected to have detailed knowledge of neuroanatom#. You should know how to assess respirator# malignant conditions and understand the general principles of oncological management including the indications for surger#. <uestions with an anatomical "ias will "e confined to circumstances where an understanding of anatomical structure is of critical importance in appreciating the localisation of a particular neurological pro"lem.

Clini%al n#u$olo y <uestions in the field of clinical neurolog# will test #our knowledge of the more common disorders. Examples of question topics might include: • 5he role of some recentl# introduced anticonvulsants • 5he present status of immunosuppressant therap# in multiple sclerosis 2europatholog# You are not expected to have a detailed knowledge of neuropatholog#. You are expected to "e familiar with the features of a"normal mental states and particularl# those that present commonl# to ph#sicians and to Accident and Emergenc# 3epartments. 5here will "e emphasis on clinical features which have "een shown to "e of diagnostic value. platelet agents in transient ischaemic attacks • 5he role of carotid endarterectom# in the management of stroke patients M#ntal stat# You should understand the conduct and scope of a mental state examination. Aetiological factors in ps#chiatric illness You should understand the primar# aetiological factors in ps#chiatric areas including: • enetic factors • Environmental factors • .ife events /nvestigations You should "e familiar with the potential value of' and indications for' .Cell "iolog# <uestions in this area will relate to advances in the cellular mechanisms of certain neurological disease processes which have provided "etter understanding of disease mechanisms and which might' in the future' lead to more rational therap#. /n the field of cere"rovascular medicine' examples of question topics might include: • Epidemiological aspects' in particular the risk factors for stroke • 5he evidence for the role of anti. Examples of question topics might include: • 5he genesis of tissue damage in stroke and the role of certain excitator# neurotransmitters • 5he role of the dopaminergic s#stem in various extrap#ramidal disorders • 5he role of other neurotransmitters in certain diseases' for example' in Al=heimer)s disease 2europharmacolog# You are expected to have some knowledge of new drug developments in neurolog#' as well as the esta"lished drug therapies. You will "e expected to have an outline knowledge of the pathological aspects of some common diseases' for example' multiple sclerosis' +arkinson)s disease and Al=heimer)s disease. 5he choice of su"ject matter will "e influenced "# areas of recent advance' particularl# those which have either led to "etter definition of disease entities' or have led to their improved management.

harm' attempted suicide' suicide • %u"stance misuse &including alcohol dependence( • Eating disorders • !"sessive compulsive disorder • A"normal illness "ehaviour • %#ndromes associated with medicall# explained ph#sical s#mptoms &including somati=ation and somatoform s#ndrome( +s#chiatric aspects of ph#sical disease You should "e aware of the ps#chiatric presentations of ph#sical disease including: • Endocrine and meta"olic disorders • 5oxic states • A/3% • 2eurological disease • Epileps# • +ain 6ental retardation You should know the features of the commoner s#ndromes.intestinal tract and liver • %#mptoms and signs of gastrointestinal' hepato"iliar# and pancreatic diseases • enetics of the more common gastrointestinal and liver disorders • Clinical pharmacolog# of drugs used in gastrointestinal disorders including their actions' interactions and adverse effects Examples of question topics might include: • Control of gastric acid secretion • Autonomic control of gut function • enetics of familial adenomatous pol#posis • 8aemochromatosis • Effects of cholinergic' adrenergic and serotonergic agents on gut function Clinical nutrition You should "e familiar with: • 2utritional requirements in health • Assessment of nutritional status • 2utritional deficienc# states • +rimar# nutritional disorders Examples of question topics might include: • Calorific requirements • -od# water distri"ution • 3erivation of the "od# mass index • +rotein calorie malnutrition A%5$!E25E$!.common investigations used in ps#chiatric illness including: • +s#chometric testing • EE • -rain imaging %#ndromes of ps#chiatric disorder and their treatment You should have knowledge of: • !rganic "rain s#ndromes &delirium' dementia' focal "rain s#ndromes' head injur#( • %chi=ophrenia and related s#ndromes • +aranoid disorders and related s#ndromes • Affective disorders &anxiet# states' pho"ic disorders' "ipolar affective disorders( • rief and "ereavement P!YCHIATRY • %elf. Clini%al s%i#n%# You should understand the: • %tructure and function of the gastrointestinal and hepato"ilar# tract • 2eurohormonal control of gut motilit# • %ecretor# and a"sorptive functions of the gastro.! Y • Essential dietar# constituents • 7itamin requirements • +athogenesis and management of o"esit# 3isorders of the mouth' tongue and salivar# glands You should have an understanding of: • 6outh ulcers' periodontal and salivar# disorders • !ral manifestations of s#stemic and dermatological disorders Examples of question topics might include: .

modif#ing drug therap# 3isorders of the small intestine You should have knowledge of: • 6ala"sorption s#ndromes and gluten enteropath# • 8ormone.a"dominal sepsis /nflammator# "owel diseases You should "e familiar with: • Crohn)s disease • :lcerative colitis • /nfective gastroenteritis • +arasitic and proto=oal gut infections Examples of question topics might include: • Causes' investigation and management of acute and chronic enteric disorders • 6anifestations of inflammator# "owel disease and its complications Colorectal disorders You should have knowledge of: .secreting tumours of the gut Examples of question topics might include: • Aetiolog#' clinical and histopathological features of gluten enteropath# • /nvestigations commonl# used in the assessment of suspected mala"sorption 3isorders of the liver' "iliar# tree and pancreas You should have knowledge of: • -iliru"in meta"olism and the enterohepatic circulation of "ile acids • Causes of jaundice and cholestasis • Common pancreatic disorders including carcinoma • >ulminant liver failure • Acute and chronic hepatitis • 3rugs' toxins' alcohol and the liver Examples of question topics might include: • Aetiolog#' clinical and histopathological features of acute and chronic hepatitic disorders • 8epatorenal s#ndromes and their management • Aetiolog#' presentation and management of acute and chronic pancreatitis Th# a%ut# abdom#n You should have knowledge of: • +erforated viscus and peritonitis • /ntestinal o"struction • /schaemic disease of the small and large "owel Examples of question topics might include: • Common causes of acute a"dominal pain and their investigation and management • 6anagement of septic shock associated with intra.• Causes of mouth ulcers and their management • %kin disorders commonl# involving the "uccal mucosa Diso$d#$s o& th# o#sopha us and stoma%h You should "e familiar with the following disorders: • Achalasia • Carcinomas • +eptic ulceration • astritis • astrointestinal haemorrhage Examples of question topics might include: • +resentation' investigation and management of oesophageal strictures • $ole of 8elico"acter. associated gastritis in peptic ulcer disease • 6anagement of h#povolaemic shock >unctional disorders You should have a knowledge of: • >unctional chest pain and functional d#spepsia • /rrita"le "owel s#ndrome and functional a"dominal pain • >unctional constipation and diarrhoea Examples of question topics might include: • 2eural control of visceral nociception and gut motilit# • $ole of emotional and ps#chosocial factors in illness • 6anagement of chronic pain and the use of pain.

Examples of question topics might include: • 5h#roid hormone "ios#nthesis and its control • /mportant drugs interfering with th#roid function • /ndications for use of various t#pes of th#roid function test • Autoimmunit# and the th#roid • Clinical features of th#rotoxicosis and h#poth#roidism • oitre and its management • 5h#roid neoplasia 8#pothalamus*+ituitar# 3etailed knowledge of the structure of the pituitar# and h#pothalamic hormones is unnecessar#.up of precursor compounds when there is defective cortisol "ios#nthesis in adrenocortical h#perplasia • 5ests for adrenocortical function • Endocrine causes of h#pertension and their differential diagnosis • Clinical features and management of adrenal h#per. Examples of question topics might include: • An understanding of the "uild.• +ol#ps • Carcinomas • 3iverticular disease • Anorectal disorders Examples of question topics might include: • +atholog# and clinical genetics of disorders presenting with colonic pol#ps • Causes and treatment of haemorrhoids' anal fissures and ano. and h#pofunction • Complications of steroid therap# !var# You are expected to "e conversant with the ph#siolog# of ovarian function and with the conditions presenting to a ph#sician.You will require a knowledge of the ph#siolog# and testing of the control mechanisms of the endocrine s#stem.rectal fistulae Although #ou are not expected to have a detailed knowledge of "iochemistr#' it is anticipated that #ou will have an insight into the mechanisms of hormone action and the importance of receptors and su"stances involved in control of intracellular meta"olism.s s#ndrome • 3rugs used in the treatment of pituitar# disease • +ituitar# replacement therap# Adrenal A detailed knowledge of mechanisms of steroid "ios#nthesis is not required' "ut #ou are expected to have some knowledge of those parts which are clinicall# important. You should have a knowledge of the clinicall# relevant anatomical aspects of this specialt#. E"DOCRI"OLOGY Examples of question topics might include: • 5he ph#siolog# and pathoph#siolog# of control of pituitar# hormone secretion • 5he mechanisms of maintaining plasma osmolalit# • 5ests of pituitar# hormone secretion • +ituitar# diseases such as acromegal#' prolactinoma and Cushing. Examples of question topics might include: • >actors involved in cell signalling • Anatomical relationships of the pituitar# gland • 5he cell t#pes in the pancreatic islets • A "road understanding of the pathwa#s of car"oh#drate' protein and fat meta"olism • Endocrine tests in routine clinical use • enetic aspects of endocrine disease • 3isorders affecting multiple endocrine s#stems 5h#roid %ince th#roid disease is common #ou are expected to have a "road knowledge of the mechanisms of th#roid disease' its clinical presentation and treatment. .

h#poparath#roidism • 5he proph#laxis and treatment of osteoporosis • Calcitonin and its role in meta"olism 3ia"etes mellitus You are expected to have detailed knowledge of this ver# common condition. Examples of question topics might include: • Control of cholesterol meta"olism • Aetiolog# of different t#pes of h#perlipidaemia including "oth cholesterol and trigl#ceride disorders • /ndications for lipid lowering agents and their complications • 5#pes of secondar# h#perlipidaemia +h#siolog# You should have knowledge of: . You are expected to "e conversant with: • >actors controlling growth hormone secretion • 2ormal growth patterns • eneral medical and endocrine causes of short stature • Control of excessive growth • rowth hormone therap# and its complications +arath#roid*"one 3etailed knowledge of the anatom# and ph#siolog# of "one meta"olism is not required. Examples of question topics might include: • Control of car"oh#drate meta"olism • enetics of dia"etes • Aetiolog# of t#pe 0 dia"etes and t#pe ? dia"etes • .Examples of question topics might include: • 8ormonal changes across the menstrual c#cle • +h#siological changes in pregnanc# • 5he differential diagnosis of hirsutism and virilism • Causes of amenorrhoea and anovulation • Endocrine causes of infertilit# 5estis You are not expected to have a detailed knowledge of the urological investigation of infertilit# "ut some concept of relevant investigations and of the endocrine aspects of testicular function is required.a"orator# tests of parath#roid function • 5he causes of h#percalcaemia • 5he mechanisms of osteomalacia • 8#perparath#roidism' "oth primar# and secondar# • 5he differentiation of primar#' secondar# and pseudo. You are expected however to have some "road concept of the control of "one turnover and the disorders which can result in its failure.ong. Examples of question topics might include: • 5he aetiolog# of h#pogonadism "oth primar# and secondar# • Causes of male infertilit# related to general medical disease and its treatment • Causes of erectile d#sfunction and its investigation • Androgen replacement therap# rowth rowth is a ver# important topic in relation to general medicine as well as endocrinolog#. Examples of question topics might include: • Control of calcium meta"olism • .term complications of dia"etes • /nsulin resistance • 6anagement of dia"etic emergencies • 3ifferential diagnosis and treatment of h#pogl#caemia 3isorders of lipid meta"olism Although a detailed knowledge of lipid meta"olism is not required' #ou are expected to have an understanding of the importance of this group of disorders.

You should have an understanding of distur"ed renal and meta"olic functions in nephrotic s#ndrome from a variet# of causes. You should "e aware of the investigation and assessment of glomerular and tu"ular disorders' including ultrasonic studies and nuclear medicine."alance distur"ances 6olecular "iolog# and genetics You are expected to possess a "asic knowledge of genetic defects of common kidne# disorders including: • +ol#c#stic kidne# • Alport.complex deposition. Examples of question topics might include: • $eflux nephropath# • +rostatic h#pertroph# You should "e aware of other infections that could affect the kidne# "# direct invasion or "# immune. Examples of question topics might include infection of the urinar# tract with: • 6#co"acteria • 8/7 • C67 • 8-7 • 8C7 Calculus formation within the urinar# tract You should possess a knowledge of meta"olic disorders predisposing to @ stone formation' their investigation' prevention and treatment.s s#ndrome • 8#pophosphataemic rickets You should have an understanding of inflammator# injur# of the kidne# mediated "# various c#tokines and growth factors. lomerular and tu"ular disorders You are expected to have some knowledge of glomerular ultrastructure "ased upon techniques of light microscop#' electron microscop# and immunofluorescence as applied to renal "iops#.• 3iscrete functions of glomerular ultrafiltration and tu"ular function • +roximal and distal parts of the nephron' with particular reference to control of water and electrol#te "alance • $enal tu"ular acidosis • C#stinuria • >luid' electrol#te' and acid. 5hese techniques form the "asis of current understanding of primar# glomerular disorders as in idiopathic glomerulonephritis' and nephropathies of s#stemic diseases. /nfections of the kidne# You should "e familiar with the management of urinar# tract infections including their detection' predisposing factors' prevention and treatment. Examples of question topics might include: • /diopathic h#percalciuria • +rimar# h#perparath#roidism • C#stinuria • 8#peroxaluria Acute and chronic renal failure . Examples of question topics might include: • 3ia"etes mellitus • %.E • 8#pertensive nephrosclerosis • 7asculitis • Am#loidosis 2E+8$!. A knowledge of anatomical a"normalities leading to repeated urinar# tract infection is expected. You should "e acquainted with the meta"olic sequelae of acute nephritic and nephrotic s#ndromes.! Y 9nowledge of interstitial nephritis &especiall# those cases with reversi"le aetiolog# such as drugs ' heav# metals and analgesics( is expected.

oss of hair • /ncreased hair growth • Common patterns of nail d#stroph# such as clu""ing • Er#thema nodosum DERMATOLOGY • Er#thema multiforme • +urpura • :lceration • 7asculitis A knowledge of the clinical features of the following skin diseases is required: • +soriasis • Ec=ema • :rticaria • %uperficial fungal infections &dermatoph#tosis' pit#riasis versicolor( • .eukaemias • $espirator# and cardiovascular diseases • Common inherited diseases such as neurofi"romatosis You should have knowledge of the main dermatological complications of therapeutic immunosuppression &for example' s#stemic corticosteroid therap#' c#closporin etc.( or of diseases such as 8/7 which cause immunosuppression.E' s#stemic sclerosis • 6eta"olic and endocrine disorders • /nfectious diseases • Cancers • . You should "e familiar with pathoph#siological changes and non. Clinical dermatolog# 6an# diseases affecting internal organs will present with skin signs or s#mptoms. Examples of question topics might include: • Collagen vascular disease such as %.A knowledge of the management of acute and chronic renal failure and of the distur"ed ph#siolog# involved is expected. 3rugs and the kidne# A knowledge of the role of the kidne# in the normal elimination of drugs is expected and #ou should understand the mechanisms "# which drugs cause nephrotoxic damage. 8#pertension and renal pro"lems in pregnanc# You are expected to "e familiar with renal adaptation to pregnanc#' the management and proph#laxis of renal disease and h#pertension in pregnanc#. /n addition #ou should know the differential diagnosis and plan of investigation of patients who present with the following cutaneous signs or s#mptoms which ma# indicate internal disease: • /tch • 8#perpigmentation • eneralised er#thema • . +rinciples of nutritional requirements and dietar# intervention for patients with chronic renal failure is required. -asic science You will "e expected to have a working knowledge of the structure and function of the epidermis and dermis. $enal replacement therap# A knowledge of different dial#sis modalities and their complications is expected.dial#tic treatment in different stages of progressive renal failure. 5he principles of dose adjustment according to residual renal function should "e known. You are expected to "e a"le to recognise the cutaneous s#mptoms and signs of s#stemic diseases. You should know the complications related to immunosuppressive therap# following renal transplantation. !ther therapeutic means to slow down the progression of renal failure should "e understood.

Common skin cancers such as melanoma • 7itiligo and alopecia areata • +emphigus and pemphigold • Cutaneous herpes virus infections &herpes simplex' varicella =oster( • Cutaneous staph#lococcal and streptococcal infections • .oedema and toxic epidermal necrol#sis.threatening skin conditions such as er#throderma or %tevens. . 4ohnson s#ndrome' angio. 8owever #ou should know the drugs which cause life.epros# /nvestigation You should know the principles "ut not details of dermatological investigation such as patch testing. 3rugs and therap# You will not "e expected to have a detailed knowledge of the treatment of skin diseases or dermatoses.