CARDIOVASCULAR 1.

Hypertension A common disorder defined as sustained elevation of systolic blood pressure (BP) > 160 mmHg and/or diastolic BP > 90 mmHg. Three successive readings are typically required for diagnosis. What to revise Risk factors and causes of primary and secondary hypertension Long-term risks of uncontrolled hypertension Drug treatment of hypertension 2.Ischaemic heart disease (IHD) A condition caused by reduction or cessation of the blood supply to the myocardium. It gives rise to four main syndromes: stable angina, unstable angina, myocardial infarction and sudden cardiac death. The most important cause of IHD is atherosclerosis. What to revise The pathophysiology and causes of atherosclerosis Cardiac risk factors Diagnosis and management of myocardial infarction Interventions and drugs in the long-term management of IHD 3.Heart failure This can be defined as the inability of the heart to maintain sufficient cardiac output to adequately perfuse the tissues for normal metabolism. It can be caused by conditions that damage heart muscle (e.g. IHD or cardiomyopathies) or that demand increased work of the heart (e.g. systemic hypertension or valvular heart disease). What to revise Causes of heart failure Symptoms and signs of right- and left-sided heart failure Compensatory mechanisms in heart failure Medical management of heart failure 4.Arrhythmia Any deviation from the normal sinus rhythm of the heart is known as an arrhythmia. They are classified clinically by site of origin (supraventricular or ventricular) and heart rate (bradycardia or tachycardia). What to revise How to spell 'arrhythmia' Causes of and risk factors for arrhythmia Recognition of the big four: atrial fibrillation (AF), heart block, ventricular tachycardia (VT) and VF (ventricular fibrillation) Treatment protocols - drugs, cardioversion, ablation and defibrillation 5.Thromboembolic disease The pathological formation of thrombus and its acute complication of embolus, especially to the pulmonary vasculature; pulmonary embolus accounts for 1% of all hospital deaths. Ninety per cent of deep vein thromboses (DVTs) occur in the deep veins of the lower limb. What to revise Understand Virchow's triad and learn the specific risk factors for thrombosis: immobility, cardiac failure, pregnancy, the combined oral contraceptive pill (COCP) and varicose veins Symptoms and signs of DVT and pulmonary embolism (PE) Classification of PE from major to minor and the emergency management of PE Anticoagulation and its role in thromboembolic disease

6.Heart valve disorders Disease of the heart valves produces two types of disorder - stenosis and regurgitation - which can coexist in the same valve. Valvular disease can be caused by damage to the valve leaflets or to the valve ring, or can be secondary to damage to the papillary muscles or chordae. Important mechanisms include degenerative calcification, rheumatic heart disease (the incidence of which is declining) and infective endocarditis. What to revise Concentrate on the big four: mitral stenosis, mitral regurgitation, aortic stenosis and aortic regurgitation Learn the symptoms and signs of aortic and mitral valve disease Learn the causes, in particular calcification, endocarditis and rheumatic heart disease Know the types of valve replacement and the precautions necessary in patients who have these 7.Peripheral vascular disease A common degenerative disease of the blood vessels, in particular of the arteries. It results in a number of specific problems, including acute and chronic ischaemia of the legs, ischaemia of the organs (e.g. kidneys, brain, bowel) and aortic aneurysm. It can be due to a number of pathological processes, including arteriosclerosis and atheroma formation. What to revise Risk factors for peripheral vascular disease: smoking, hypertension, lipids, etc. Mechanisms of arteriosclerosis and atherosclerosis and the changes that occur in the artery walls Ischaemia of the legs: symptoms, signs and management Aortic aneurysm: definitions, diagnosis and treatment RESPIRATORY DISEASE 1.Chronic obstructive pulmonary disease (COPD) A common condition occurring in 17% of men and 8% of women aged 45-64 years. It could perhaps more correctly be called 'chronic bronchitis and emphysema' because both conditions coexist in all patients to varying degrees. Virtually confined to smokers, mortality from COPD is related to the number of cigarettes smoked per day. What to revise Diagnostic definitions - clinical history for bronchitis and pathological for emphysema Symptoms and signs, and the two subtypes of patient: pink puffers and blue bloaters Management of acute exacerbations and long-term prophylaxis Interpretation of arterial blood gas results 2.Asthma A common chronic inflammatory condition of the airways that causes reversible obstruction. The airways are characteristically hyper-responsive to a wide range of stimuli. Oedema, smooth muscle hypertrophy and mucus plugging cause obstruction. What to revise Classification into extrinsic and intrinsic asthma, and the triggering, exacerbating and relieving factors Structural changes that occur in the airway, and their clinical features Emergency management of acute asthma Medical management of chronic asthma and inhaler technique 3.Lung cancer Bronchogenic carcinoma is the most common cause of death from cancer in the UK, affecting 30 000 people per year. Males are affected more than females but there is an increasing incidence in women. Peak incidence is between 40 and 70 years. The UK has the highest incidence of this disease in the world. What to revise The four main histological types: squamous cell (50%), small cell (20%), adenocarcinoma (20%) and large cell anaplastic (10%) Risk factors, clinical features and prognosis for each type Symptoms and signs of pulmonary involvement, local spread, metastatic spread and also endocrine and neurological syndromes Management and palliation

4.Pneumonia Pneumonia is defined as the consolidation of lung tissue caused by formation of intra-alveolar inflammatory exudates as a result of a lung infection. This must be visible on X-ray to be properly called pneumonia, as opposed to 'chest infection'. Pneumonia is the fifth most common cause of death, according to US data. What to revise Predisposing factors to chest infection and pneumonia Common causative organisms and the distinction between community-acquired and hospital-acquired pneumonia Diagnostic and pathological features of bronchopneumonia, lobar pneumonia and atypical pneumonia The special features of pneumonia in immunocompromised patients Appropriate antibiotic use for the various types of pneumonia 5.Pulmonary tuberculosis (TB) This is a chronic granulomatous infection of the lung caused by Mycobacterium tuberculosis. It is uncommon in the UK (incidence 7 per 100 000 per year) but extremely common worldwide. It is a very common exam topic because of the increasing incidence in elderly, immunocompromised and homeless people, and the emergence of drug-resistant strains. What to revise Risk factors for infection and routes by which the organism can be spread Pathogenesis: primary and secondary TB; the histopathological sequence of events that leads to granuloma formation Symptom, signs and diagnosis of TB Non-pulmonary TB Drug treatments for TB, public health measures to prevent spread and the problems of ensuring compliance with treatment 6.Cystic fibrosis A hereditary disease characterized by the production of abnormally thick mucus due to the presence of an abnormal transmembrane chloride ion transporter. It primarily affects lung and pancreas. It is the most common autosomal recessive disorder, affecting 1 in 2000 newborns. A common exam topic. What to revise Pathogenesis: learn the genetic and molecular mechanisms and the physiological effects that produce the clinical features of the disease Symptoms, signs and methods of diagnosis Prognosis and management of the pulmonary and pancreatic effects of the disease 7.Diffuse interstitial diseases (alveolitis) A group of non-infectious, non-malignant disorders in which there is inflammation of the alveolar walls with a thickening of the interstitium between the alveoli, usually with fibrosis. It is worth learning about the features of the general disease process and one or two of the conditions in more detail. What to revise Histopathological changes for this general group of diseases, and management, which is similar for all of them Symptoms, signs and diagnostic features of interstitial diseases The three main causes of chronic pulmonary fibrosis: (i) idiopathic (sarcoidosis and cryptogenic fibrosing alveolitis); (ii) dust inhalation, which might be inorganic (coal workers' pneumoconiosis) or organic (farmers' lung); and (iii) iatrogenic (radiation pneumonitis or drug-induced by amiodarone or anticancer drugs) 8.Pneumothorax The presence of air in the pleural cavity. It is common and can be spontaneous or caused by trauma. The severity can vary from mild to life threatening. What to revise Causes of pneumothorax: spontaneous (idiopathic or secondary to underlying disease) and traumatic (accidental or iatrogenic) Diagnosis and assessment of severity Management and risks of recurrence

GASTROINTESTINAL DISEASE 1.Gastritis, gastro-oesophageal reflux disease (GORD) and peptic ulceration A spectrum of disease comprising inflammation and ulceration of the oesophagus, stomach or duodenum caused by mucosal damage due to particularly acid gastric secretions. In the West, 10% of the population experience this at some time in their lives. GORD and ulcers normally develop in adulthood and follow a history of repeated healing and relapse over many years. What to revise Risk factors, causative agents and protective mechanisms, in particular the role of Helicobacter pylori Symptoms and signs of gastritis, gastro-oesophageal reflux and peptic ulcers Diagnostic tests in peptic ulcer disease Medical and surgical management 2.Inflammatory bowel disease (IBD) A group of common disorders characterized by idiopathic inflammation of the intestinal wall. Crohn's disease and ulcerative colitis (UC) are the two most important conditions. Prevalence in the UK is 30-50 per 100 000 for Crohn's disease and 80 per 100 000 for UC. Neither aetiology is fully understood. What to revise The clinical and pathological features of UC and Crohn's disease - a common theme for questions is to compare and contrast the two The complications and sequelae of IBD The systemic manifestations of IBD Medical and surgical management 3.Viral hepatitis This is a common condition caused by a group of unrelated hepatotrophic viruses, all of which cause a primary hepatitis or inflammation of the liver. Clinical features are similar regardless of aetiology. Hepatitis viruses A to G are now recognized and other, non-hepatotrophic viruses such as Epstein-Barr and cytomegalovirus have also been known to cause hepatitis. What to revise The characteristics and route of infection of hepatitis viruses A to E, with emphasis on B and C Symptoms and signs of hepatitis, and diagnostic tests The presence of serum antibody and antigen for hepatitis B and C through the course of the infection Methods of treatment and immunization 4.Colorectal carcinoma An adenocarcinoma derived from glandular epithelium in the mucosa of the large bowel. This is the second most common cause of death from neoplasia in the UK, with a peak incidence between 60 and 70 years. What to revise Aetiology and risk factors for colorectal cancer. Understand the progression from previous adenomas and the genetic model of successive mutations that cause neoplasia Symptoms, signs and diagnosis Classification, staging and grading Methods of treatment and prognosis 5.Oesophageal cancer Oesophageal cancer has an incidence of 5-10 per 100 000 per year in the UK. Squamous cell and adenocarcinoma are the most common types. Prognosis is usually poor because the disease is advanced by the time symptoms arise. What to revise Aetiology and risk factors for oesophageal cancer. Understand the concept of metaplasia in Barrett's oesophagus and how this can progress Symptoms and signs, diagnosis by gastroscopy Management options and prognosis

6.Gastric adenocarcinoma A common cancer arising from the mucus-secreting epithelial cells in the stomach. Incidence is 20-40 per 100 000 per year in the UK. It is typically seen after the age of 30, with an increased incidence over 50 years of age. The male:female ratio is 3:2. What to revise Aetiology and risk factors for gastric cancer The geographical distribution The sequence of genetic changes leading to neoplasia Classification of gastric cancers Symptoms, signs and methods of diagnosis Surgical and medical management 7.Malabsorption syndromes A spectrum of disorders that produce the syndrome of weight loss, abdominal distension, diarrhoea with loose bulky stool, steatorrhoea and anaemia. Mechanisms include disorders of intraluminal digestion by pancreatic enzymes, solubilization by bile acids, terminal digestion by mucosal enzymes and transepithelial transport. What to revise The physiological mechanisms involved in digestion and how they can fail in the various types of malabsorption syndrome Clinical and pathological features of coeliac disease and its treatment Know an example for the each of the types of malabsorption mentioned above ENDOCRINE AND METABOLIC DISEASE 1.Diabetes mellitus A group of metabolic disorders characterized by chronic hyperglycaemia due to relative insulin deficiency. It is common and affects around 40 million people worldwide. It is a large and important topic in medicine because of its numerous complications, which affect almost all parts of the body. What to revise Have a reasonable overview of normal glucose metabolism Classification of diabetes mellitus - types 1 and 2 Symptoms, signs and diagnostic criteria Complications of diabetes: cardiovascular, eyes, kidneys, neuropathy, feet, infections, skin and joints Long-term management with diet, oral hypoglycaemics and insulin Diabetic emergencies: ketoacidosis and hyperosmolar non-ketotic coma Monitoring treatment 2.Obesity A common and increasing problem in the West, obesity is defined as a body mass index (BMI) above 29 and is a risk factor for a number of chronic illnesses, including hypertension, ischaemic heart disease and diabetes. What to revise BMI and classification of obesity Socioeconomic risk factors for obesity Long-term problems associated with obesity Management of obesity: diet, exercise, medication and surgery 3.Protein energy malnutrition Starvation is a major cause of morbidity and mortality worldwide. Although not common in developed countries, poverty, inappropriate diet and coexisting medical conditions (such as surgery, sepsis, cancer, anorexia nervosa and malabsorption syndromes) can produce degrees of starvation. What to revise Pathophysiology of starvation: understand carbohydrate, fat and protein metabolism in the fed and starved states Classification and clinical features of protein-energy malnutrition Assessing the degree of malnutrition Treatment: resuscitation, refeeding and rehabilitation

4.Thyroid dysfunction The metabolic activity of many tissues is regulated by the thyroid gland; over- and underactivity of the thyroid are the most common of all endocrine problems. Hypothyroidism can be caused primary thyroid disease or be secondary to hypothalamic or pituitary disease. Hyperthyroidism is nearly always caused by intrinsic thyroid disease and affects 25% of females at some time, with a female:male ratio of 5:1. What to revise Causes and clinical features of hypothyroidism Investigation and treatment of hypothyroidism Causes and clinical features of hyperthyroidism Graves' disease and thyroid eye disease Acute and long-term management of hyperthyroidism 5.Adrenal dysfunction The adrenal cortex secretes three main groups of steroid hormones: glucocorticoids, mineralocorticoids and adrenal androgens. These have wide-ranging effects throughout the body and therefore the clinical features of adrenal dysfunction are complex. Cushing's syndrome is common but the main cause is iatrogenic through use of steroid therapy. Addison's disease is rare but is a common topic for exam questions. What to revise Normal function of the adrenal axis - glucocorticoids and mineralocorticoids Investigation and diagnostic tests in adrenal disease Causes, clinical features and management of Cushing's syndromes Causes, clinical features and management of Addison's disease Hyperaldosteronism and Conn's syndrome Problems associated with corticosteroid therapy 6.Parathyroid dysfunction Parathyroid hormone (PTH) is a polypeptide secreted by the chief cells of the parathyroid glands. It acts on the bones and kidneys to increase levels of serum calcium and decrease levels of serum phosphate. Primary hyperparathyroidism is the most common of the thyroid disorders and has a prevalence of 1 per 800 in the UK. Over 90% of patients are over 50 and the female:male ratio is 2:1. What to revise Understand the basics of normal calcium metabolism and the mechanisms by which PTH acts to regulate calcium and phosphate Causes, clinical features and management of primary hyperparathyroidism Definitions of secondary and tertiary hyperparathyroidism, and of renal osteodystrophy Hypoparathyroidism and clinical features of hypocalcaemia 7.Pituitary tumours These are the most common cause of pituitary disease. Clinical features are the result of excess hormone secretion, local effects of the tumour or inadequate hormone production by the remainder of the gland. What to revise Understand the normal function of the hypothalamus and pituitary The common tumour types and clinical syndromes that they cause: prolactinoma, acromegaly, Cushing's disease, nonfunctioning tumours Diagnostic tests used in pituitary disease RENAL 1.Urinary tract infection (UTI) UTIs are common infection in women but rare in men because of the longer urethra. Recurrent or untreated infection can cause considerable morbidity, including renal disease and end-stage renal failure. It is of particular significance in children because of the need for early diagnosis of abnormal urinary tracts. What to revise Common causative organisms and risk factors for infection Symptoms, signs and diagnosis Complications of UTIs , Management and further investigation (especially in children)

2.Benign prostatic hypertrophy (BPH) This commonly occurs in men over the age of 60 years. The aetiology is not known but BPH is characterized by hyperplasia of the glandular and connective tissue in the prostate, resulting in compression of the urethra and bladder outflow obstruction. What to revise Symptoms and signs of bladder outflow obstruction or 'prostatism' Diagnostic procedures Medical and surgical management 3.Prostate cancer Carcinoma of the prostate is the fourth most common cause of death from malignancy in men in the UK - accounting for 7% of cancers in men. By the age of 80 years, 80% of men have malignant cells within the prostate, although most remain dormant. What to revise Clinical features and diagnosis Treatment with hormone analogues, radiotherapy and surgery Prognosis 4.Renal and vesical calculi About 2% of the UK population have a urinary tract stone at any given time. Most are composed of calcium oxalate and phosphate but mixed infective stones are also common. It is commonly a recurrent problem - 50% of patients will have formed a further stone within 10 years. What to revise Aetiology and risk factors for the various types of stone Symptoms, signs and diagnostic tests Conservative and surgical management of renal and vesical calculi 5.Renal failure The term refers to the failure of renal excretory function due to depression of the glomerular filtration rate. It is often associated with failure of other renal functions: acid-base balance; regulation of salt, water and blood pressure; secretion of erythropoietin and activation of vitamin D. What to revise Definitions of renal failure: prerenal, renal and postrenal; acute versus chronic renal failure Causes of renal failure, which can be grouped into failure of renal perfusion, disease of the renal vasculature, glomerulonephritis and tubulointerstitial disease Symptoms, signs and diagnostic tests Management of end-stage renal failure: CAPD (Continuous Ambulatory Peritoneal Dialysis), haemodialysis, transplant and ancillary treatment (e.g. erythropoietin, calcium supplementation) HAEMATOLOGY 1.Anaemia A state in which the level of haemoglobin in the blood is below the normal range for the patient's age and sex: 13.5-18.0 g/dL in males and 11.5-16.0 g/dL in females. Causes are numerous and can be divided roughly into three categories: (i) reduced production of haemoglobin or red blood cells; (ii) increased red cell destruction; or (iii) blood loss (acute or chronic). What to revise The causes of anaemia as outlined above Symptoms and signs of anaemia Investigations to find the cause of anaemia 2.Sickle-cell disease A common inherited disease caused by a point mutation in the beta-globin gene, which results in the substitution of valine for glutamate. The resultant haemoglobin variant, HbS, polymerizes at low oxygen saturations, causing the characteristic sickle deformity of the red cells, which 'sludge' in the small vessels and undergo haemolysis.

What to revise Epidemiology and pathophysiology of sickle-cell disease: association with malaria-endemic regions Classification of sickle-cell disease: heterozygous and homozygous forms Clinical features of sickle-cell disease Management of sickle-cell crises 3.Leukaemia A spectrum of diseases caused by malignant proliferation of haemopoietic precursor cells in the bone marrow. They are not common - the incidence is 5 per 100 000 per year for all types - but they are important because of their responsiveness to treatment. What to revise Classification of the four main types: acute lymphoblastic, acute myeloblastic, chronic lymphocytic and chronic myeloid. Be aware of the subclassification within these main types (FAB, RAI, etc.) Aetiological factors: especially genetic mutations such as the Philadelphia chromosome and the BCR-ABL fusion product Symptoms and signs of leukaemia Diagnostic tests (blood film, bone marrow biopsy and cytogenetics) Management of leukaemia: chemotherapy - especially STI571, GM-CSF (Granulocyte, Monocyte - Colony Stimulating Factor) and ATRA (All-Trans Retinoic Acid) and supportive treatment (i.e. blood transfusions) 4.Lymphoma The lymphomas are caused by neoplastic proliferation of cells in the lymphoid system. Classification is based on histological appearance of the abnormal cells and is divided into Hodgkin's and non-Hodgkin's lymphoma (NHL). What to revise Classification of the lymphomas and how the disease is staged and graded Symptoms, signs and methods of diagnosis A differential diagnosis of causes of lymph node enlargement Prognosis and management of lymphoma 5.Myeloma A disease caused by malignant proliferation of plasma cells in the bone marrow. It is part of a spectrum of diseases characterized by the presence of a serum paraprotein that can be demonstrated as a monoclonal band on electrophoresis. It occurs mainly in people over 50 years of age. The clinical features are caused by bone destruction, bone marrow infiltration and failure, and renal failure due to deposition of the light chain paraprotein. What to revise Pathophysiology of the disease and mechanisms by which the clinical features are produced Symptoms, signs and diagnostic tests: blood film, protein electrophoresis, Bence-Jones proteins in urine and bone marrow biopsy in particular Prognosis and management 6.Haemophilia A An X-linked recessive inherited disease characterized by a deficiency of clotting factor VIII. The incidence is 1 in 7500 of the male population per year. Clinical features depend on the level of factor VIII - if it is less than 1% of normal the patient will experience frequent spontaneous bleeds from early life. Bleeds commonly occur into the large joints (haemarthroses) and lead to crippling deformity if the condition is untreated. What to revise Understand the clotting pathway and how factor VIII plays a central role. Make sure you are learning the up-to-date version and not the old intrinsic/extrinsic model Classification of the severity of haemophilia, and clinical features Management of haemophilia: factor VIII, activated factor VII, ddAVP (1-deamino-8-D-arginine vasopressin, also known as desmopressin) and potential for gene therapy Risks of treatment with blood products and the effects of human immunodeficiency virus (HIV) and hepatitis C infection on people with haemophilia

SURGICAL DISEASE 1.Acute abdomen The most common surgical presentation, rather than a disease in itself. It is important to have a clear approach to the assessment and management of this condition. What to revise The differential diagnosis of an acute abdomen Symptoms and signs of peritonitis The diagnostic approach and investigations required Initial management 2.Appendicitis A common surgical problem that can present at any age but with a peak incidence in the teens and early adulthood. Diagnosis can be problematic because classic symptoms occur in only 55% of cases. What to revise Aetiology of appendicitis, and vulnerable groups Symptoms, signs and differential diagnosis of appendicitis Clinical course of the disease Management of acute appendicitis 3.Diverticular disease This is a very common condition in the West and is caused by lack of dietary fibre. It affects two-thirds of the population by the age of 70 years and is more common in women than men (3:2). Many cases are asymptomatic and the most common presentation is with abdominal pain. What to revise Aetiology and risk factors for diverticular disease Definitions of diverticular disease: diverticulosis, diverticulitis Symptoms, signs and differential diagnosis Clinical features and complications Conservative and surgical management 4.Pancreatitis This occurs in 10-20 per 100 000 people per year in the UK. Most cases of acute pancreatitis are caused by gallstones or alcohol. It is a potentially life-threatening condition with an overall mortality of 8-10%. What to revise Aetiology and risk factors for pancreatitis Symptoms, signs and diagnostic tests Ranson's criteria for assessment of severity, and clinical course of the disease Management of acute pancreatitis 5.Large bowel obstruction This is a common cause of an acute abdomen and is characterized by the symptoms and signs of abdominal pain, distension, vomiting and inability to pass stool or flatus. Common causes include simple constipation, cancer of the colon, diverticular stricture and sigmoid volvulus. What to revise Symptoms, signs and differential diagnosis of large bowel obstruction Diagnostic investigations Conservative and surgical management 6.Cholecystitis Gallstones are very common but only a small minority of adults with gallstones develop acute cholecystitis, which in 95% of cases is due to the impaction of a gallstone in Hartmann's pouch.

What to revise Aetiology and risk factors for gallstones - the F's (Fat, Fertile Females) Symptoms and signs of acute cholecystitis Clinical course and diagnosis of acute and chronic cholecystitis Conservative, endoscopic and surgical management 7.Hernia The abnormal protrusion of a viscus, or of part of a viscus, through the coverings that contain it. Incisional hernias are the most common type, followed by inguinal, femoral and finally umbilical hernias. Inguinal hernia occurs in 1-2% of children, mostly boys (9:1) and in 112 per 100 000 adults per year in the UK. The ratio of inguinal to femoral hernias is 40:1 in men and 3:1 in women. What to revise The anatomy of the inguinal and femoral canals, and aetiology of hernias Classification of hernias by location, type and severity Symptoms, signs and differential diagnosis for the above types of hernia Conservative and surgical management Refresh your knowledge of the regional anatomy Risk factors for testicular torsion Symptoms, signs and differential diagnosis Surgical management 8.Testicular torsion An acute and painful condition caused by rotation of a testis on its mesentery, so that blood supply is impaired resulting in ischaemic pain and oedema. It is a surgical emergency and the torsion must be corrected within hours to save the testis. It occurs at any age but most often in adolescents. What to revise Aetiology and risk factors for haemorrhoids Symptoms, signs and classification of haemorrhoids Conservative and surgical management, and prognosis 9.Haemorrhoids This is a common problem caused by hypertrophy of vascular cushions of tissue at the anal margin. It is a condition of mid- to late adulthood - half of all patients are over the age of 50. Symptoms are rectal bleeding, prolapse, pain, mucus discharge and prutitus ani.