PA Curriculum Matrix

National Practitioner Programme
Matrix specification of Core Clinical Conditions for the Physician

Associate by category of level of competence
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Matrix specification of Core Clinical Conditions for the Physician Assistant by category of level of competence
Matrix specification of Core Clinical

Conditions for the Physician Associate
by category of level of competence
(WORKING DOCUMENT TO BE READ IN CONJUNCTION WITH THE

COMPETENCE AND CURRICULUM FRAMEWORK FOR THE PHYSICIAN
ASSOCIATE)
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Contents
Specification of core clinical conditions
Model for categorising clinical conditions on the basis of required competence
Examples of core conditions matrices

Matrix showing indicative conditions across the full range of system categories
Example of a complete single system matrix: the cardiovascular system
Example of core conditions related to a particular disease process: infection
Example of a condition matrix for a clinical presentation: chest pain
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Core Clinical Conditions
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Conditions in category 1A
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Conditions in category 1B
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Conditions in category 2A
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Conditions in category 2B
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Symptom Based Competencies

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‘The Top 20’ – Common Medical Presentations

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Core clinical and procedural skills
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ACKNOWLEGEMENTS
Dr Prakash Abraham Consultant Endocrinologist

Mr George Ashcroft Consultant Orthopaedic Surgeon
Ms Ria Agarwal Physician Associate
Dr Steven Baguley Consultant Sexual Health
Dr Gillian Bain Consultant Gastroenterologists
Ms Kate Bascombe Physician Associate
Dr Alexandra Bonsall Dermatology Registrar
Professor Graham Devereux Consultant Respiratory Physician
Dr Karen Duncan Consultant Haematologist
Mr Fraser Gill Consultant in Emergency Medicine
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Dr James McLay Consultant Physician
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Dr Manjul Medhi Infectious Diseases Registrar
Dr Colin Millar Consultant Nephrologist
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Dr John Olson Consultant medical Ophthalmologist
Dr Ashaltha Shetty Consultant Obstetrician
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Dr Christopher Skinner Consultant Acute Physician

Dr Angela Sun Consultant Paediatrician
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Specification of core clinical conditions
The model on the following page describes a two-dimensional categorisation

– the X axis referring to competence in undertaking the diagnostic process
and the Y axis referring to competence in managing the condition. This
model of conditions is then used in the systems-based lists on subsequent
pages.
The categorisation of conditions relates to the expected competence on

qualification. Depending on local arrangements and arrangement with the
supervising practitioner, experience post-qualification within a particular
field may draw conditions from a lower to a higher category (e.g. 2B to 1A)
However, it is key to the Physician Associate role that, whatever their
current field of practice, they maintain competence across the breadth of
clinical conditions outlined in this section: i.e. conditions may not be
allowed to ‘slip’ from category 1A to 2B.
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Following the explanation of the core condition matrix, this section gives
four examples of matrices as follows:
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• examples of indicative conditions across the full range of systems;
• a complete example of the specification for one system;
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• an example of specification on the basis of a disease process; and

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• an example of specification of conditions on the basis of a clinical

presentation.
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Model for categorising clinical conditions on the basis of required
competence
X axis: Is the Physician Associate competent to take a significant role in the diagnostic
process?
YES: Category 1 The Physician Associate is able to identify a condition as a
possibility within differential diagnoses and to take measures to
confirm or refute the diagnosis.
NO: Category 2 The Physician Associate is aware of the condition, but does not
necessarily have the knowledge or resources to make the diagnosis.
Y axis: Is the Physician Associate competent to take responsibility for management of

the condition?
YES: Category A The Physician Associate is able to manage the
uncomplicated condition without routine referral to others.
NO: Category B The Physician Associate participates in the management of
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the condition, but does not take a lead role in determining the
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management strategy.
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X axis: Taking a significant role in the diagnostic process?
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YES – Category 1 NO – Category 2

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1A 2A
Y axis: Taking responsibility for management of the condition?
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The Physician Associate is Once the condition has been

YES – Category A
able to diagnose the diagnosed, either by their

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condition in a patient who is supervising doctor or a

presenting with the problem clinical specialist, the
for the first time and will Physician Associate is able
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normally be able to manage to manage the condition

it without regular or routine without routine referral.
referral.
The Physician Associate is able The Physician Associate is

to identify the condition as a able to undertake the day to
possible diagnosis: may not day management of the
NO – Category B
have the knowledge/resources patient and condition once

to confirm the diagnosis or to the diagnosis and strategic
manage the condition safely, management decisions have
but can take measures to avoid been made by another.
immediate deterioration and
refer appropriately.
1B 2B
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As with most models, this is something of an oversimplification of reality. Relatively simple

conditions may be complicated by the personal circumstances of the patient, their reaction to
the disease process or some other underlying health problem. Equally, a Physician Associate
may already be familiar with a non-core condition because of prior experience. However, whilst
the following diagram may be closer to the truth, we believe that the simplified model is a
more appropriate basis for the development of curricula.
X axis: Taking a significant role in the diagnostic process?
Definitely Definitely not

Definitely
1A Needs confirmation 2A
Able to of diagnosis by Diagnosis requires
diagnose supervising doctor knowledge beyond
and treat that of Physician
Y axis: Taking responsibility for management?
Associate but
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Physician Associate Physician Associate
differential diagnosis responsible for
includes conditions that may management
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need investigation in a
specialist facility
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Physician Associate may

Physician Associate need advice on
differential diagnosis suggests management if condition
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referral is necessary becomes exacerbated

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Physician Associate Condition may be

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diagnoses but recognises diagnosed/managed by a

condition requires referral Physician Associate with
experience
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Physician Associate
identifies that referral is Peripheral to role, but
Definitely not
necessary despite not may be part of patient

having a differential history
diagnosis
1B
2B
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Examples of core conditions matrices

Matrix showing indicative conditions across the full range of system
categories
Taking a significant role in the diagnostic process?
Yes No
1A 2A
Mental health: depression Mental health: dysthymic disorder
Cardiovascular: essential hypertension Cardiovascular: giant cell arteritis
Respiratory: acute bronchitis
Gastro-intestinal: gastroenteritis
Musculoskeletal: gout Musculoskeletal: rheumatoid arthritis
Eye: corneal abrasions
Ear, nose and throat: acute otitis media
Yes
Female reproductive: dysmenorrhoea

Neurological: migraine Neurological: partial/partial complex seizures
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Metabolic and endocrine: hyperkalaemia Metabolic and endocrine: hypertriglyceridaemia
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Taking responsibility for management?
Renal and GU: cystitis

Dermatological: atopic eczema
Haematological: folate deficiency
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Sexual health: contraceptive advice
Systemic infection: measles
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Mental health: phobias Mental health: autistic disorder

Cardiovascular: acute myocardial infarction Cardiovascular: dilated cardiomyopathy
Respiratory: acute epiglottitis Respiratory: tuberculosis
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Gastro-intestinal: acute pancreatitis Gastro-intestinal: pancreatic neoplasms

Musculoskeletal: fracture of the hip Musculoskeletal: juvenile rheumatoid arthritis
Eye: cataract Eye: hyphaema
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Ear, nose and throat: mastoiditis Ear, nose and throat: acoustic neuromas
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Female reproductive:placenta Female reproductive: carcinoma cervix

No
praevia Neurological: Guillain-Barré syndrome

Neurological: nerve entrapment, eg carpal tunnel Metabolic and endocrine: acromegaly
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Metabolic and endocrine: thyroiditis Renal and GU: renal vasculitis

Renal and GU: testicular carcinoma Dermatological: lichen simplex chronicus
Dermatological: basal cell carcinoma Haematological: G6PD deficiency
Haematological: aplastic anaemia
Sexual health: gonococcal infections Systemic infection: toxoplasmosis
Systemic infection: malaria
1B 2B
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Matrix specification of Core Clinical Conditions for the Physician Associate by category
Assistant by category ofof level
level ofof competence
competence
Example of a complete single system matrix:

The Cardiovascular System
Yes No
1A 2A
Hypertension Vascular diseases
Essential Giant cell arteritis
Isolated systolic Ischaemic heart disease
Iatrogenic Angina pectoris
Yes
Hypotension • ab e
Orthostatic/postural
Hypovolaemic shock
Vascular diseases
Phlebitis/thrombophlebitis
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Hypertension Cardiomyopathy
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Secondary Dilated
Malignant/accelerated Hypertrophic
Hypotension Restrictive
Cardiogenic shock
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Conduction disorders Atrial septal defect
Bundle branch block Ventricular septal defect
Premature beats Coarctation of aorta
Atrioventricular block Patent ductus arteriosus
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Paroxysmal supraventricular tachycardia Tetralogy of Fallot

Ventricular tachycardia Valvular disease

Ventricular fibrillation/flutter Mitral valve prolapse
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Atrial fibrillation/flutter
Vascular diseases
Chronic/acute arterial occlusion
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Varicose veins
Venous thrombosis
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Peripheral vascular disease

Acute rheumatic fever
No
Aortic aneurysm/dissection
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Arterial embolism/thrombosis
Valvular disease
Aortic stenosis/regurgitation
Mitral stenosis/regurgitation
Tricuspid stenosis/insufficiency
Pulmonary stenosis/insufficiency
Cardiac failure
Ischaemic
Valvular
Hypertensive
Ischaemic heart disease
Acute myocardial infarction
Angina pectoris
• Unstable angina
• Prinzmetals angina
Other forms of heart disease
Acute and subacute bacterial endocarditis
Acute pericarditis
Cardiac tamponade
Pericardial effusion
1B 10
2B
Example of core conditions related to a particular disease process:

Infection
Yes No
1A 2A
Respiratory system
Bacterial pneumonia
Neurological system
Herpes zoster/shingles
Eyes
Yes
Acute bacterial conjunctivitis

Renal and GU systems
Orchitis
Skin Skin
Cellulitis Lyme disease
Cardiovascular system
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Acute bacterial endocarditis
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Respiratory system Respiratory system HIV-
Acute epiglotitis related pneumonia
Bronchiectasis Digestive
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Digestive system system
Appendicitis Intra-abdominal abscess
Neurological system
Prion disease
No
Musculoskeletal system
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Septic arthritis
Ear, nose and throat
Mastoiditis
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Peritonsillar abscess
Systemic infection disease
Botulism
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Example of a condition matrix for a clinical presentation: Chest Pain

Yes No
1A 2A
Cardiovascular
Angina pectoris: stable
Respiratory
Bacterial pneumonia
Viral pneumonia
Gastro-intestinal
Yes
Oesophagitis
Gastro-oesophageal reflux disease
Dyspepsia
Neurological
Herpes zoster (of chest wall)
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Mental health
Panic disorder
Cardiovascular
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Acute myocardial infarction
Angina pectoris: unstable
Angina pectoris: Prinzmetal’s variant
No
Respiratory Respiratory
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Pulmonary embolism Fungal pneumonia

Pleurisy HIV-related pneumonia
Gastro-intestinal
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Acute cholecystitis
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1B 2B
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Core Clinical Conditions

Matrix of Core Clinical Conditions by system theme
The conditions are broadly divided by the degree to which the PA plays a role
in diagnosis and the level of responsibility the PA has in management of the
process. Hence each condition falls into one of four categories:
1A-The PA plays a significant role in the diagnosis and takes significant

responsibility in management
1B-The PA plays a significant role in the diagnosis but does not take significant
responsibility in management
2A-The PA does not play a significant role in the diagnosis but does take a
significant responsibility in management
2B-The PA does not play a significant role in the diagnosis and does not take a
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By the end of the programme the student is expected to be able to
demonstrate evidence of clinical experience in all conditions in category 1A,
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1B and 2A and at a minimum a familiarity and a theoretical understanding of
all conditions in category 2B.
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CARDIOVASCULAR
Hypertension
Primary 1A
Isolated systolic 1A
Iatrogenic 1A
Secondary 1B
Accelerated 1B
Hypotension
Orthostatic/ postural 1B
Hypovolaemic shock 1B
Cardiogenic shock 1B
Vascular Diseases
Phlebitis/ thrombophlebitis 1A
Deep venous thrombosis 1A
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Pulmonary embolus 1A
Peripheral vascular disease 1B
Varicose veins 1B
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Acute rheumatic fever 2B
Venous thrombosis 1B
Ruptured aortic aneurysm 1B
Aortic aneurysm dissection 1B
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Arterial embolism/ thrombosis 1B

Acute cerebrovascular accident (stroke) 1A
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Acute limb ischaemia 1A

Giant cell arteritis 2A
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Conduction Disorders
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Bundle branch block (left & right) 1A

Trifasicular block 1B
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Premature beats 1B
Atrial fibrillation/ flutter 1A
Atrioventricular block 1B
Paroxysmal supraventricular tachycardia 1B
Ventricular tachycardia (emergency list) 1A
Ventricular fibrillation/ flutter (emergency list) 1A
Complete heart block (emergency list) 1A
Cardiomyopathy
Dilated 1B
Hypertrophic 2B
Restrictive 2B
Congenital Heart Disease
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Atrial septal defect 2B
Ventricular septal defect 2B
Coarctation of the aorta 1B
Patent ductus arteriosus 2B
Tetralogy of Fallot 2B
Ischaemic Heart Disease

Acute coronary syndrome myocardial infarction 1A
Acute Coronary Syndrome 1A
e.g. myocardial infarction–unstable angina
Angina pectoris: Prinzmetal’s / variant 1B
Angina pectoris: Stable 1A
Valvular Disease
Aortic stenosis/ regurgitation 1B
Mitral stenosis/ regurgitation 1B
Tricuspid stenosis/ insufficiency 1B
Pulmonary stenosis/ insufficiency 1B
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Mitral valve prolapse 2B
Cardiac Failure
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Acute Left Ventricular Systolic dysfunction 1A
Chronic Left Ventricular Systolic Dysfunction 1A
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Valvular 1B
Hypertensive 1A
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Other Cardiovascular Problems

Acute bacterial endocarditis 1A
Subacute bacterial endocarditis 1B
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Acute pericarditis 1B
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Cardiac tamponade 1B
Pericardial effusion 1B
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RESPIRATORY
Infectious Respiratory Disorders

Acute Bronchitis 1A
Influenza 1A
Croup 1A
Respiratory syncytial virus infection 1A
Bacterial pneumonia 1A
Viral pneumonia 2B
Acute bronchiolitis 1B
Acute epiglottitis 1B
Pertussis 1A
Empyema 1B
Fungal pneumonias 2B
HIV-related pneumonias 2B
Tuberculosis 1B
Obstructive Pulmonary Disease
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Chronic Obstructive Pulmonary Disease 1A
Asthma 1A
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Sleep apnoea 1B
Bronchiectasis 2B
Cystic fibrosis 2B
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Neoplastic Pulmonary Disease

Bronchogenic carcinoma 1B
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Mesothelioma 2B
Metastatic tumours 1B
Carcinoid tumours 2B
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Pulmonary nodules 2B
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Restrictive Pulmonary Disease

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Idiopathic pulmonary fibrosis 2B

Extrinsic Allergic Alveolitis 2B
Asbestosis 2B
Pneumoconiosis 2B
Sarcoidosis 2B
Pulmonary Circulation
Pulmonary embolism (emergency list) 1A
Cor pulmonale 1B
Pulmonary hypertension – primary 2B
Pulmonary hypertension – secondary 1B
Pleural Diseases
Pleural effusion 1B
Pleural Plaque 1B
Pneumothorax: Primary 1B
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Pneumothorax: Traumatic 1B
Pneumothorax: Tension (emergency list) 1A
Pneumothorax: Secondary 1B
Pleurisy 1B
Personal Notes
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RENAL AND GENITO-URINARY
Benign Conditions of the GU Tract

Benign prostatic hyperplasia 2A
GU Infectious/ Inflammatory Conditions

Cystitis 1A
Balanitis 1A
Prostatitis 2A
Epididymitis 2A
Orchitis 2A
Urethritis 2A
Pyelonephritis 1B
Renal Diseases
Acute kidney injury 1B
Glomerulonephritis 2B
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Nephrotic syndrome 1B
Polycystic kidney disease 1B
Vasculitis 2B
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Acute renal colic 1A
Renal/ GU Neoplastic Diseases

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Bladder carcinoma 1B
Prostate carcinoma 1B
Renal cell carcinoma 1B
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Testicular carcinoma 1B
Wilms tumour 2B
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Other GU Tract Problems

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Incontinence 1B
Cryptorchidism 1B
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Hydrocoele/ variocoele 1B
Nephro/ urolithiasis 1B
Paraphimosis/ phimosis 1B
Testicular torsion (emergency list) 1B
Other Renal/ GU Problems

Frank Haematuria 1B
Ureteric trauma 2B
Hyperkalaemia 1A
Acute urinary retention (emergency list) 1A
Chronic urinary retention 1B
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Personal Notes
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GASTRO-INTESTINAL
Oesophagus
Barrett's oesophagus 2A
Mallory-Weiss tear 1B
Neoplasms 1B
Strictures 1B
Varices 1B
Food bolus obstruction 1B
Motor Disorders 2B
Stomach
Gastro-oesophageal reflux disease 1A
Varices 1B
Gastritis and duodenitis (inc H.pylori) 1A
Peptic ulcer disease 1A
Gastric Neoplasms 1B
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Pyloric stenosis 1B
Small Intestine
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Coeliac disease 1B
Small bowel bacterial overgrowth 2A
Bile acid malabsorption 2B
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Short bowel syndrome 2B
Colon
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Constipation/ faecal impaction 1A

Irritable bowel syndrome 1A
Infectious diarrhoea 1A
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Diverticular disease 1A
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Diverticulitis 1B
Appendicitis 1B
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Intussusception 1B
Ischaemic bowel disease 1B
Obstruction 1B
Toxic megacolon 1B
Polyps 1B
Colonic neoplasm 1B
Inflammatory bowel disease 2B
Rectum
Haemorrhoids 1A
Anal fissure 1A
Anorectal abscess/ fistula 1B
Pilonidal disease 1B
Polyps 1B
Rectal neoplasms 1B
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Gallbladder and Biliary Tree
Acute cholecystitis 1A
Cholelithiasis 1B
Chronic cholecystitis 1B
Cholangiocarcinoma 1B
Sphinctor of Oddi dysfunction 2B
Liver
Viral hepatitis 1B
Cholestatic liver diseases (PBC, PSC) 2B
Metabolic liver disease (Haemochromatosis/Wilson's) 2B
Non alcoholic fatty liver disease 1B
Alcohol related liver disease 1B
Jaundice 1B
Ascites including SBP 1B
Hepatorenal syndrome 2B
Hepatic encephalopathy 1B
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Acute liver failure including paracetamol overdose 2B
Liver transplantation 2B
Benign hepatic lesions 1B
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Hepatic neoplasms (primary and secondary) 1B
Pancreas
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Acute pancreatitis (emergency list) 1A

Chronic pancreatitis 1B
Pancreatic neoplasms 1B
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Hernia
Hiatus 1A
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Incisional 1B
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Inguinal 1B
Umbilical 1B
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Ventral 1B
Nutrition
Nutritional assessment 1A
Refeeding syndrome 1A
Other Gastro-Intestinal Conditions

Peritonitis-Acute 1B
Gastro-intestinal perforation (emergency list) 1A
Gastro-intestinal haemorrhage (emergency list) 1A
Iron deficiency anaemia 1A
Intra-abdominal abscess 1B
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Personal Notes
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ENDOCRINE AND METABOLIC
Diseases of the Thyroid and Parathyroid

Hypothyroidism including Hashimoto’s Thyroiditis 1A
Hyperthyroidism: Graves’ disease 1B
Hyperthyroidism: Thyroid storm 1B

Thyroiditis 1B
Hyperparathyroidism 1B
Hypoparathyroidism 1B
Thyroid neoplastic disease 1B
Diabetes Mellitus
Type 2 diabetes mellitus 1A
Hypoglycaemia 1A
Type 1 diabetes mellitus 1B
Lipid Disorders
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Hypercholesterolaemia 1A
Hypertriglyceriadaemia 1A
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Diseases of the Adrenal glands
Corticoadrenal insufficiency. Addisons (emergency list) 1A
Cushing’s syndrome 1B
Cushings disease 2B
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Electrolyte and Acid-Base Disorders

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Hypo/ Hypernatraemia 1B
Hypo/ Hyperkalaemia (emergency list) 1A
Hypo/ Hypercalcaemia 1B
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Volume depletion (emeregency list) 1A

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Hypomagnesaemia 1B
Metabolic alkalosis/ acidosis 1B
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Respiratory alkalosis/ acidosis 1B

Volume excess 1B
Other Metabolic and Endocrine

Gynaecomastia 1B
Galactorrhoea 1B
Lactose intolerance 2B
Phaeochromocytoma 2B
Diseases of the Pituitary Gland

Acromegaly 1B
Diabetes insipidus 2B
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Personal Notes
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MENTAL HEALTH
Mood Disorders
Depression: Mild/Moderate 1A
Depression Severe 1B
Bipolar/Affective Disorder 2B
Organic Disorders
Dementia 2A
Disorders of Adult Personality

Emotionally Unstable Personality Disorder 2B
Dissocial Personality Disorder 2B
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Disorders Due to Pyschoactive Substance Use
Tobacco use 1A
Alcohol/Drug –Harmful Use 1A
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Alcohol/Drug Dependence 1B
Neurotic, Stress and Somatiform Disorders

Acute Reaction to Stress 1A
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Adjustment Disorder 1A
Post-Traumatic Stress Disorder 1B
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Generalised Anxiety Disorder 1A

Phobias 1B
Panic Disorder 1B
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Obsessive Compulsive Disorder 2B

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Psychosis
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Schizophrenia 2B
Delusional disorder 2B
Schizoaffective disorder 2B
Behavioural Syndromes Associated with Physiological

Disturbance
Overeating Associated with Psychological Disturbance 1B
Anorexia nervosa 1B
Bulimia Nervosa 1B
Disorders of Psychological Development

Autism 2B
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Behavioural and Emotional Disorders with Onset Occurring in
Childhood
Hyperkinetic Disorder 2B
Attention Deficit Hyperactivity Disorder 2B
Personal Notes
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FEMALE REPRODUCTIVE
Uterus
Dysfunctional uterine bleeding 2A
Endometritis 2B
Prolapse 1B
Leimyoma 2B
Uterine Abnormality (Bicornuate uterus/uterus didelphys) 2B
Endometrial cancer 1B
Cervix
Cervicitis 2A
Cervical dysplasia 2B
Benign Cervical Polyps 2A
Incompetent Cervix 2B
Carcinoma cervix 1B
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Vagina/ Vulva
Vaginal Discharge 2A
Neoplasm 1B
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Rectocoele 1B
Bartholin’s cyst 1B
Vaginal Septae 1B
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Menstrual Disorders
Dysmenorrhoea 1B
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Premenstrual syndrome 1A
Amenorrhoea 1B
Polycystic ovarian syndrome 1B
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Menopausal Symptoms 2B
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Uncomplicated Pregnancy
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Prenatal diagnosis/ care 1A
Uncomplicated Pregnancy
Normal labour/ delivery 1B
Emergency Labour Complications 1B
Complicated Pregnancy
Ectopic pregnancy (emergency list) 2A
Pre-eclampsia 2A
Complications of Pre-eclampsia 1B
Gestational diabetes 2A
Miscarriage 2A
Manual Vacuum Aspiration 2B
Fetal Abnormality 2B
Assessment of Fetal Wellbeing 2B
Abruptio placenta (emergency list) 1B
Placenta previa 1B
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Postpartum haemorrhage 1B
Premature rupture of membranes 2B
Rh incompatibility 1B
Multiple gestation 1B
Fetal distress 1B
Gestational trophoblastic disease 2B
Cholestasis 2B
Epilepsy and Pregnancy 2B
Infections and Pregnancy (HIV,Hep B&C) 2B
Maternal Drug Abuse 1B
Perinatal Mental Health 2B
Postnatal Care (Perineal Care, Bladder care, pelvic Floor 1A
Exercises, Post C Section Care
Puerperal Sepsis 1B
Thrombosis (DVT, PE) 1B
Dystocia 2B
Ovarian Neoplasms 1B
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Breast
Abscess 1A
Fibroadenoma 1B
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Cystic change 2B
Milk mastitis 1A
Viral mastitis 2B
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Breast cancer 1B
Personal Notes
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SEXUAL HEALTH
Contraception
Contraceptive advice 1A
Contraceptive Methods 1A
Safe Sex Advice 1A
Sexual Dysfunction
Male sexual dysfunction 1B

Female sexual dysfunction 1B
Infertility
Infertility advice and Overview Options 1A

Basic Infertility Workup 2A
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Sexual Assault Bacterial Disease
Chlamydia 1A
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Gonococcal infections 1A
Syphilis 1B
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Viral Disease
Herpes Simplex 1A
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Human papillomavirus infections 1A

HIV infection 1B
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Personal Notes
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INFECTIONS (Not Covered Elsewhere)
Fungal Disease
Candidiasis 1A
Cryptococcosis 2B
Histoplasmosis 2B
Pneumocystis J 2B
Viral Disease
Epstein-Barr virus infections 1A
Herpes simplex-shingles 1A
Herpes simplex-oral 1A
Herpes simplex-labial 2A
Influenza 1A
Mumps 1A
Roseola (Sixth disease) 1A
Rubella 1A
Measles 1A
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Varicella-zoster virus infections 1A
Erythema infectiosum 1A
Rabies 2B
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Cytomegalovirus infections 2B
Bacterial/ Mycobacterial Disease

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E.coli 0157 1A
Salmonellosis 1A
Shigellosis 1A
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Tetanus 2B
Cholera 2B
Diphtheria 2B
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Botulism 2B
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Atypical mycobacterial disease 2B

Cellulitis 1A
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Osteomyelitis 1A
Acute bacterial endocarditis 1A
Sub-acute bacterial endocarditis 1A
Pneumonia bacterial 1A
Parasitic Disease
Threadworms 1A
Hookworms 1A
Amoebiasis 2B
Malaria 1B
Toxoplasmosis 2B
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Personal Notes
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HAEMATOLOGICAL
Anaemias
Vitamin B12 deficiency 1A
Folate deficiency 1A
Iron deficiency 1A
Sickle cell anaemia 1B
Haemolytic anaemia 1B
Haematological Malignancies
Acute/ chronic lymphocytic leukaemia 1B
Acute/ chronic myelogenous leukaemia 1B
Lymphoma 1B
Multiple myeloma 1B
Polycythaemia 1B
Coagulation Disorders
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Idiopathic thrombocytopenic purpura 1B
Thrombotic thrombocytopenic purpura 1B
Factor VIII disorders 2B
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Factor IX disorders 2B
Thrombocytopenia 2B
Other Haematological Disorders

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Aplastic anaemia 1B
Primary Polycythaemia 1B
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Leucopenia 1B
Myelodysplastic Syndrome 1B
Thalassaemia 2B
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Personal Notes
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NEUROLOGICAL
Diseases of Peripheral Nerves

Bell’s Palsy 1A
Diabetic peripheral neuropathy 1B
Guillain-Barre syndrome (acute IDP) 2B
Chronic IDP 2B
Movement Disorders
Essential tremor 1A
Parkinson’s disease 1B
Huntington’s disease 2B
Multi-system atrophy) 2B
Young onset movement disorders ?define 2B
Headaches
Classic migraine 1A
Atypical migraine 2B
Tension headache 2A
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Cluster headache 2A
Other Neurological Conditions

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Post-herpetic neuralgia 1A
Neurological – seizures (emergency list) 1A

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Syncope-Cardiac – arrhythmias and valvular 1A

Syncope Carotid sinus 1A
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Syncope - Vaso-vagal 1A
Spinal cord lesions 1B
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Transient ischaemic Attack (emergency list) 1A

ra
Multiple sclerosis 2B
Venous sinus thrombosis 2B
D
Cavernous sinus thrombosis 2B

Neoplasm – primary and secondary 2B
Metabolic Encephalopathy – acute and chronic 2B
Wernicke’s Encephalopathy 1A
Korsakoff’s Syndrome 2A
Peripheral nerve lesions – wrist or foot drop 1B
Nerve entrapment: e.g. carpal tunnel 1A
Myasthenia gravis 2B
Cerebral palsy 2B
Sarcoid 2B
Seizure Disorders
Status epilepticus (emergency list) 1A
Primary general 2B
Partial or partial complex seizures 2B
34
Vascular Diseases
Cerebrovascular Accident 1A
Subarachnoid Haemorrhage 1A
Transient ischaemic attack 1A

Raised intracranial pressure 1B
Internal carotid dissection 2B
Temporal arteritis 2A
Cerebral Vasculitis ?define further 2B
Infectious/ Inflammatory Disorders

Viral Ecephalitis 2B
Acute bacterial meningitis (emergency list) 1A
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HIV ?clarification 2B
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Tuberculosis meningitis 2B
Neuro-Syphilis 2B
Lymes disease: Standard presentation 1A
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Lymes disease: Non-standard presentation 2B
Prion Disease 2B
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Dementias
Alzheimer’s disease 1B
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Personal Notes
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Personal Notes
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MUSCULOSKELETAL AND ORTHOPAEDICs
Disorders of the Shoulder

Sprains/ strains 1A 1A
Fractures/ (clavicle, humerus ,) 1B

Dislocations acromioclavicular joint, humerus 1B
Adhesive capsulitis/Frozen Shoulder 1B
Rotator cuff disorders 1B
Shoulder instability 2B
Osteoarthritis Shoulder 1B
Disorders of the Elbow/Forearm/Wrist/Hand

Sprains/ strains 1A
Trigger finger 1B
Dupytrens disease 1B
Fractures/ dislocations: Boxers’, Scaphoid, Colles 1A
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Carpal tunnel syndrome 1B
de Quervain’s tenosynovitis 1B
Epicondylitis 1A
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Fractures/Dislocations Elbow 1B
Disorders of the Back/ Spine

Back/ neck pain 1A
oc
Injury (differential diagnosis – musc./neuro.) 1A

Kyphosis/ scoliosis 1B
D
Herniated disk pulposis 1B

Back/ neck fractures 1B
Spinal stenosis 2B
ft
Ankylosing spondylitis 1B
ra
Disorders of the hip

D
Fractures/ dislocations 1B
Osteoarthritis 1B
Avascular necrosis 1B
Disorders of the Knee

Sprains/ strains 1A
Bursitis 1B
Meniscal injuries 1B
Patello-femoral pain syndrome 1A
Osteoarthritis 1B
Musculoskeletal Neoplastic Disease

Bone cysts/ tumours 2B
Osteosarcoma 2B
Disorders of the Ankle/ Foot

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Sprains/ strains 1A
Hallux Valgus/ Rigidus 1B
Morton’s Neuroma 1B
Paediatric
Flat foot 1A
Knock knees/bow legs 1A
Osgood-Schlatter disease 1A
Irritable/septic hip 1B
Developmental Dysplasia hip 1B
Pulled elbow 1A
Slipped upper femoral epiphysis 1B
Non-accidental injury 1B
Rheumatological Conditions
Fibromyalgia 2B
Gout 1A
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Polymyalgia rhuematica 1B
Pseudogout 1B
Rheumatoid arthritis 1B
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Reiter’s syndrome 1B
Polyarteritis nodosa 2B
Polymyositis 2B
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Scleroderma 2B
Sjogren’s syndrome 2B
Juvenile rheumatoid arthritis 2B
D
Systemic lupus erythematosus 2B

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Other Musculoskeletal Problems

Osteoporosis /Osteomalacia 1B
ra
Paget’s disease 1B
Renal osteodystrophy 1B
D
Vascular sickle cell 1B
Musculoskeletal Infection
Cellulitis 1A
Septic arthritis 1A
Acute osteomyelitis 1A
Chronic osteomyelitis 1B
Infected joint arthroplasty 1B
Orthopaedic Emergencies
Compartment Syndrome 1B
Cauda equina syndrome 2B
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Personal Notes
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SKIN
Eczematous Eruptions
Atopic 1A
Contact 1B
Nappy 1B
Peri-oral 1B
Seborrhoeic 1B
Nummular 1B
Venous stasis 1B
Actinic keratosis 1B
Papulosquamous Diseases
Tinea versicolor 1A
Tinea corporis/ pedis 1A
Drug eruptions 1A
Pityriasis rosea 1A
Psoriasis 1B
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Dermatophyte infections 1B
Lichen planus 1B
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Acneiform Lesions
Acne vulgaris 1A
Rosacea 1B
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Folliculitis 1A
Hair and Nails

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Androgenic alopecia male 1A
Female baldness 1B
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Onycomycosis 1A
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Paronychia 1A
D
Viral Diseases
Exanthems 2A
Herpes simplex: Oral 1A
Herpes simplex: labial 2A
Molluscum contagiosum 1A
Verrucae 1A
Varicella-zoster virus infectious 1A
Condyloma acuminatum 1B
Bacterial Infections
Cellulitis 1A
Impetigo 1A
Erysipelas 1B
Insects/ Parasites
40
Lice 1A
Scabies 1A
Bites
Insect 1A
Animal 1A
Human 1A
Skin Trauma
Simple laceration 1A
Complex laceration 1B
Superficial burns 1A
Partial or full thickness burns 1B
Needlestick injuries 1A
Other Dermatological Conditions

Urticaria 1B
Vitiligo 1B
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Hydradenitis suppurativa 1B
Melasma 1B
Lipomas 1A
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Epithelia inclusion cysts 2B
Venous leg ulcers 1B
Bed sores 1B
Arterial leg ulcers 1B
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Bullous conditions 1B
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Desquamation
Stevens-Johnson syndrome 1B
Erythema multiforme 1B
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Toxic epidermal necrolysis 1B

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Dermal Neoplasia
D
Basal cell carcinoma 1B
Other Dermatological Conditions

Dyshidrosis 2B
Lichen simplex chronicus 2B
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Personal Notes
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OPHTHALMOLOGY
Eye Disorders
Blepharitis 1A
Conjunctivitis 1A
Corneal abrasion 1A
Keratitis 1B
Foreign body 1B
Pterygium 1A
Chalazion 1A
Orbital cellulitis 1A
Dacrocytitis 1A
Strabismus 1B
Cataract 1B
Congenital cataract 2B
Macular degeneration 2B
Ectropion 1B
Entropion 1B
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Chronic glaucoma 2B
Acute glaucoma (emergency list) 1B
Diabetic retinopathy 2B
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Hypertensive retinopathy 1B
Retinal detachment 1B
Retinal vascular occlusion (emergency list) 1B
oc
Retinoblastoma 2B
Raised intracranial pressure (signs of) 1B
Optic neuritis 1B
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Optic atrophy 1B
Blow out fracture 1B
ft
Acute visual loss 1B

Acute painful eye 1B
ra
Thyroid eye disease 1B

Horner’s 1B
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Hyphaema 2B
Neuromuscular – myasthenia gravis: LEMS 2B
Cranial nerve palsy (III, IV, VI) 1B
Personal Notes
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EAR, NOSE AND THROAT
Ear Disorders
Acute otitis media 1A
Earwax impaction 1A
Acute labyrinthitis 2B
Otitis externa 1A
Vertigo 2B
Chronic otitis media 1B
Mastoiditis 1B
Meniere’s disease 1B
Barotrauma 1B
Hearing impairment 1B
Tympanic membrane perforation 1A
Nose/ Sinus Disorders

Acute sinusitis 1A
Allergic rhinitis 1A
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Epistaxis 1B
Chronic sinusitis 1B
Nasal polyps 1B
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Mouth/ Throat Disorders
Acute pharyngitis 1A
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Acute tonsillitis 1A
Aphthous ulcers 1A
Laryngitis 1A
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Oral candidiasis 1A
Oral herpes simplex 1A
Parotitis 1B
ft
Quinsy (peritonsillar abcess) 1B

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Epiglottits 1B
Acute epiglottitis (emergency list) 1A
D
Oral leukoplakia 1B
Sialadenitis 2B
Dental abscess 1B
ENT Neoplasm
Acoustic neuromas 1B
Nasopharyngeal and oral cancers 1B
45
Personal Notes
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Accident and Emergency Medicine
CARDIOVASCULAR
Accelerated Hypertension 1B
Orthostatic/ postural hypotension 1B
Cardiogenic shock 1B
Pulmonary embolus 1A
Deep venous thrombosis 1A
Ruptured Aortic aneurysm 1B
Dissecting Aortic aneurysm 1B
Arterial embolism/ thrombosis 1B
Acute cerebrovascular accident (stroke) 1A
Acute limb ischaemia 1A
Bundle branch block (left & right) 1A
Trifasicular block 1B
Atrial fibrillation/ flutter 1A
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Atrioventricular block 1B
Paroxysmal supraventricular tachycardia 1B
Ventricular tachycardia (emergency list) 1A
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Ventricular fibrillation/ flutter (emergency list) 1A
Complete heart block (emergency list) 1A
Acute coronary syndrome myocardial infarction 1A
oc
Acute coronary syndrome –unstable angina 1A

Angina pectoris: Prinzmetal’s/ variant 1B
Angina pectoris: Stable 1A
D
Acute Left Ventricular systolic dysfunction 1A

Acute and subacute bacterial endocarditis 1B
ft
Acute pericarditis 1B
Cardiac tamponade 1B
ra
Pericardial effusion 1B
D
RESPIRATORY
Croup 1A
Acute bronchiolitis 1B
Acute exacerbation of COPD 1A
Acute Asthma 1A
Pulmonary embolism 1A
Pneumothorax: Primary 1B
Pneumothorax: Traumatic 1B
Pneumothorax: Tension 1A
Pneumothorax: Secondary 1B
RENAL AND GENITOURINARY

Acute kidney injury 1B
Paraphimosis/ phimosis 1B
Testicular torsion (emergency list) 1B
47
Frank Haematuria 1B
Ureteric trauma 2B
Hyperkalaemia 1A
Acute urinary retention (emergency list) 1A
Acute priaprism 1B
GASTRO-INTESTINAL
Diverticulitis 1B
Acute Appendicitis 1B
Ischaemic bowel disease 1B
Intestinal Obstruction 1B
Acute cholecystitis 1A
Acute pancreatitis 1A
Acute peritonitis 1B
Gastro-intestinal perforation 1B
Gastro-intestinal haemorrhage 1B
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ENDOCRINE AND METABOLIC
Hyperthyroidism: Thyroid storm 1B
Hypoglycaemia 1A
um
Corticoadrenal insufficiency. Addisons Syndrome 1A
Hypo/ Hypernatraemia 1B
Hypo/ Hyperkalaemia (emergency list) 1A
oc
Metabolic alkalosis/ acidosis 1B

Respiratory alkalosis/ acidosis 1B
Volume excess 1B
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FEMALE REPRODUCTIVE
ft
Ectopic pregnancy 1B
Abruptio placenta 1B
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SEXUAL HEALTH
D
Contraceptive advice 1A
HAEMATOLOGICAL
Sickle cell crisis 1B
NEUROLOGICAL
Syncope - Cardiac – arrhythmias 1A
Syncope Vaso-vagal 1A
Cavernous sinus thrombosis 2B
Peripheral nerve lesions – wrist or foot drop 1B
Nerve entrapment: e.g. carpal tunnel 1A
Status epilepticus 1A
Primary general 2B
Cerebrovascular accident 1A
Subarachnoid haemorrhage 1A
48
Transient ischaemic attack 1A
Internal carotid dissection 2B
Acute bacterial meningitis 1A
MUSCULOSKELETAL AND ORTHOPAEDICS

Sprains/ strains of the shoulder 1A
Fractures/ (clavicle, humerus) 1B
Dislocations acromioclavicular joint, humerus 1B
Sprains/ strains of the Elbow/Forearm/ Wrist/Hand 1A
Fractures/ dislocations: Boxers’, Scaphoid, Colles 1A
Fractures/Dislocations Elbow 1B
Back/ neck pain 1A
Spinal Injury (differential diagnosis – musc./neuro.) 1A
Back/ neck fractures 1B
Fractures/ dislocations of the hips 1B
Sprains/ strains of the knee 1A
Bursitis affecting the knee 1B
Fractures/ dislocations of the knee 1B
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Meniscal injuries 1B
Sprains/ strains of the ankle and foot 1A
Fractures/ dislocations of the ankle and foot 1B
um
Pulled elbow 1A
oc

Cellulitis 1A
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Septic arthritis 1A
Acute osteomyelitis 1A
ft
Infected joint arthroplasty 1B

Compartment Syndrome 1B
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Cauda equina syndrome 2B

D
DERMATOLOGY
Cellulitis 1A
Erysipelas 1B
Insect 1A
Animal 1A
Human 1A
Simple laceration 1A
Complex laceration 1B
Superficial burns 1A
Partial or full thickness burns 1B
Needlestick injuries 1A
Urticaria 1B
Stevens-Johnson syndrome 1B
Toxic epidermal necrolysis 1B
49
EYE
Conjunctivitis 1A
Corneal abrasion 1A
Keratitis 1A
Foreign body 1A
Orbital cellulitis 1A
Acute glaucoma (emergency list) 1A
Retinal detachment 1B
Retinal vascular occlusion (emergency list) 1A
Blow out fracture of the orbit 1B
Hyphaema 2B
Acute visual loss 1B
EAR NOSE AND THROAT
Epistaxis 1B
Quinsy (peritonsillar abcess) 1A
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Epiglottits 1B
Acute epiglottitis (emergency list) 1A
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PAEDIATRICS
Cardiovascular
Measurement and Interpretation of blood pressure 1A
Secondary Hypertension 2B
Classification of heart murmur 1A
Innocent heart murmur 1A
Atrial Septal Defect 1B
Ventricular Septal Defect 1B
Coarctation of aorta 2B
Tetralogy of fallot 2B
Patent Ductus Arteriosus 1B
Heart failure 2B
Rheumatic Fever 2B
Bacterial endocarditis 2B
Supraventricular tachycardia 1B
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Respiratory
Asthma 1A
Viral induced wheeze 1A
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Bronchiolitis 1A
Viral Upper Respiratory Tract Infection 1A
Croup 1A
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Viral pneumonia 1B
Bacterial pneumonia 1B
Pleural effusion 1B
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Bacterial tracheitis 2B
ft
Pertussis 1B
Cystic fibrosis 2B
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Pneumothorax 1B
Laryngomalacia 2B
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Anaphylatic reaction 1B
Acute pharyngitis 1A
Acute tonsillitis 1A
Acute otitis media 1A
Otitis externa 1A
Acute sinusitis 1A
Allergic rhinitis 1A
Epistaxis 1B
Renal and Genito-Urinary

Urinary tract infection 1A
Pyelonephritis 1B
Acute renal colic 1B
Nephrotic syndrome 1B
Acute nephritis 1B
Frank haematuria 1B
52
Acute renal failure 2B
Balanitis 1B
Testicular torsion 1B
Hydrocoele 1B
Hypospadius 1B
Nocturnal eneuresis 1B
Haemolytic-uraemic syndrome 1B
Dermatology
Eczema 1A
Cradle cap 1A
Nappy rash 1A
Urticaria 1A
Erythema toxicum 1A
Steven Johnson Syndrome 1B
Toxic shock syndrome 1B
Kawasaki syndrome 1B
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Haemangiomas 1A
Staph scalded skin 1B
Cellulitis 1A
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Impetigo 1A
Lice 1A
Scabies 1A
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Endocrinology
Plotting growth chart 1A
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Type 1 diabetes mellitus 1B

Diabetic ketoacidosis 1B
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Hypoglycaemia 1A
Congenital hypothyroidism 1B
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Autoimmune hypothyroidism 1B
Hyperthyroidism 1B
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Corticosteroid insufficiency 2B
Electrolyte and Acid-based Disorders

Hypo/Hypernatraemia 1B
Hypo/Hyperkalaemia 1B
Hypomagnesaemia 1B
Metabolic acidosis/alkalosis 1B
Respiratory acidosis/alkalosis 1B
Volume excess 1B
Syndrome of inappropriate anti-diuretic hormone secretion 1B
Gastrointestinal
Infectious diarrhoea +/- vomiting 1A
Appendicitis 1B
Intussusception 1B
53
Obstruction 1B
Constipation/ faecal impaction 1A
Inflammatory bowel disease 2B
Gastro-oesophageal reflux 1A
Cow’s milk protein intolerance 1A
Lactose intolerance secondary to infectious diarrhoea 1A
Coeliac disease 1A
Oesophagitis 1A
Mallory-Weiss tear 1B
Pyloric stenosis 1B
Neonatal jaundice 1B
Childhood jaundice 1B
Fluid requirement of neonate and children 1A
Dehydration 1A
Haematology and Oncology

Iron deficiency anaemia 1B
Vitamin B12 deficiency 2B
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Folate deficiency 2B
Haemolytic anaemia 2B
Sickle cell anaemia 2B
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Brain tumour 2B
Acute/ chronic lymphocytic leukaemia 2B
Acute/ chronic myelogenous leukaemia 2B
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Lymphoma 2B
Bleeding disorders 2B
Febrile neutropenia 1B
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Neutropenia 1B
Idiopathic thrombocytopenic purpura 2B
ft
Infection
ra
Septic shock 1B
Meningitis and encephalitis 1B
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Fever of unknown origin 2B

Hand, foot and mouth 1A
Varicella-zoster virus infections 1A
Eczema herpeticum 1B
Molluscum contagiosum 1A
Epstein-Barr virus infections 1A
Mumps 1B
Roseola 1A
Rubella 1B
Measles 1B
Peri-orbital cellulitis 1B
Musculoskeletal
Reactive arthritis 1B
Septic arthritis 1B
Osteomyelitis 1B
54
Flat foot 1A
Knock knees/bow legs 1A
Hypermobile joints 1A
Developmental Dysplasia hip 1B
Pulled elbow 1B
Perthes 1B
Juvenile idiopathic arthritis 1B
Systemic lupus erythematosus 2B
Neurology
Developmental assessment 1A
Classic migraine 1B
Atypical migraine 2B
Tension headache 2B
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Cluster headache 2B
Syncope Vaso-vagal 1A
Cerebral palsy 2B
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Status epilepticus (emergency list) 1B
Primary general seizures 1B
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Febrile convulsion 1B
Raised intracranial pressure 2B
Bell’s Palsy 2B
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Lymes disease 1B
Drug overdose 1B
ft
Alcohol intoxication 1B
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Emergency
Febrile convulsion 1B
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Status Epilepticus 1B
Suspected Non Accidental Injury 1B
Aystole/ PEA 1B
SVT 1B
Apnoea/ respiratory depression 1B
Meningitis and encephalitis 1B
Personal Notes
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EMERGENCY CONDITIONS
The following table contains a list of acute presentations and
conditions which a Physician Associate should be able to recognise,
assess and initiate appropriate treatment and support prior to senior
help arriving.
Cardiovascular DVT
Ruptured aortic aneurysm
Dissecting aortic aneurysm
Acute limb ischaemia
Accelerated hypertension with end organ
damage
Complete heart block
VT
VF
SVT/AF (Haemodynamically Unstable)
Acute pulmonary oedema
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ACS MI
ACS unstable angina
Syncope
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Bleeding Oesophageal Varices
Acute pancreatitis
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Gastrointestinal perforation
Gastrointestinal Gastrointestinal haemorrhage
Peritonitis
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Acute bowel ischaemia

Intestinal obstruction
ft
Oesophageal food bolus obstruction

ra
Status epilepticus
Subarachnoid haemorrhage
D
GCA with visual symptoms

Neurological
Acute thromboembolic stroke
Spinal Cord Compression
Transient Ischaemic Attack
Acute septicaemia
Septic shock
Acute meningitis
Infectious Disease
Neutropenic sepsis
Necrotising fasciitis
Central Venous Line Sepsis
Hypercalcaemia
Acute hypoglycaemia
Endocrine & Hypovolaemic shock
Electrolytes Diabetic Keto-Acidosis
Hyperglycaemic Hyperosmolar-State
Alcoholic ketoacidosis
57
Hyper/hypokaleamia
Blood gas and acid base disruption
Acute adrenal failure (Addisons/Iatrogenic)
Myxoedema Coma
Acute renal colic

Testicular torsion
Renal & GU
Acute urinary retention
Acute kidney injury
Acute Epistaxis
ENT Acute peri-tonsillar abscess
Acute epiglottitis adult and paediatric
Near drowning Sea/Fresh water
Pulmonary Embolus
Tension pneumothorax
Aspiration of Foreign Body
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Respiratory
Type 1 and 2 Respiratory failure
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Acute Severe Asthma
Massive Haemoptysis
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Controlled Oxygen Therapy
Foreign body/trauma
Eye Acute painful eye

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Acute visual loss

Pre-eclampsia
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Female Health Placental abruption

Ectopic pregnancy
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Open fracture/dislocations
Orthopaedics Fracture dislocations with associated
ra
neurovascular compromise
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Alcohol Withdrawal/ Delirium Tremens
Miscellaneous Hypothermia/Hyperthermia
Febrile convulsion
Paediatrics Suspected Non Accidental Injury
Opiate Toxicity
Paracetamol Overdose
Salicylate Toxicity
Poisoning
Bezodiazepine Toxicity
SSRI/SNRI and Tricyclic Antidepressant Toxicity
Amphetamine /Cocaine/MDMA Toxicity
58
Toxic Alcohol (ethanol, methanol, ethylene
glycol) Ingestion
Iron toxicity
Beta blocker and calcium channel blocker
toxicity
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The Content of Learning

This section lists the specific knowledge, skills, attitudes and behaviours
which should be attained following completion of a Physician Associate training
programme.
The competencies are presented in four parts:
Part 1 - Symptom Competencies - define the knowledge, skills and

attitudes required for each level of learning for different problems with
which a patient may present. These symptoms are further broken down in
to emergency presentations; top 20 presentations and other presentations.
The top 20 presentations are listed together to emphasise the frequency
with which these problems are encountered in clinical practice, and are
based on medical admission unit audit data.
Part 2 - System specific competencies - define competencies to be

attained by the end of training for each body system, and also lists the
conditions and basic science of which the physician associate must acquire
t
knowledge.
en
Part 3 - Investigation competencies - lists investigations that a
physician associate must be able to describe, order, and interpret by the end
um
of training.
Part 4 – Procedural competencies - lists procedures that a physician

oc
associate should be competent in by the end of training.

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Symptom Based Competencies
Emergency Presentations
Cardio-Respiratory Arrest
The physician associate will have full competence in the assessment and
resuscitation of the patient who has suffered a cardio-respiratory arrest,
as defined by the UK Resuscitation Council
Knowledge Skills Attitudes and Behaviour
Causes of cardio- Rapidly assess the Recognise and intervene in

respiratory arrest collapsed patient in terms critical illness promptly to
of ABC, airway, breathing prevent cardiac arrest such
and circulation as peri-arrest arrhythmias,
Recall the ALS hypoxia
t
algorithm for adult
en
cardiac arrest Perform Basic Life
Support competently as Maintain safety of
defined by Resuscitation environment for patient and
um
Outline indication and Council (UK): effective health workers
safe delivery of drugs chest compressions,
used in cardiac arrest airway manoeuvres, bag
scenarios: and mask ventilation Participate in UK
adrenaline, atropine, Resuscitation Council
oc
amiodarone, buffers approved ILS and ALS course

Competently perform (MANDATORY
further steps in advanced REQUIREMENT)
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life support: IV drugs;

safe DC shocks when
indicated; identification Succinctly present clinical
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and rectification of details of situation to senior

reversible causes of doctor
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cardiac arrest
Consult senior and seek

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anaesthetic team support
61
Shocked Patient
The physician associate will be able to identify a shocked patient, assess

their clinical state, produce a list of appropriate differential diagnoses
and initiate immediate management
Knowledge Skills Attitudes and

Behaviour
Identify physiological Recognise significance of Exhibit calm and

perturbations that major physiological methodical approach to
define shock perturbations assessing critically ill
patient
Identify principle Perform immediate (physical)
categories of shock assessment (A,B,C) Adopt leadership role
(i.e. cardiogenic, where appropriate
circulatory)
t
Institute immediate, simple
en
resuscitation (oxygen, iv Involve senior and
Elucidate main causes access, fluid resuscitation) specialist (e.g. critical
of shock in each care outreach) services
category (e.g. MI, promptly
um
Arrange simple monitoring of
heart failure, PE,
blood loss, sepsis) relevant indices (oximetry,
arterial gas analysis) and vital
signs (BP, pulse & respiratory
oc
Define sepsis rate, temp, urine output)

syndromes
Order, interpret and act on
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initial investigations
appropriately: ECG, blood
cultures, blood count,
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electrolytes
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Unconscious Patient
The physician associate will be able to promptly assess the unconscious

patient to produce a differential diagnosis, establish safe monitoring,
investigate appropriately and formulate an initial management plan,
including recognising situations in which emergency specialist
investigation or referral is required
Make a rapid and

Identify the principal Recognise need for
immediate assessment
causes of immediate assessment
including examination of
unconsciousness and resuscitation
coverings of nervous
t
(metabolic, neurological)
system (head, neck,
en
spine) and Glasgow
Coma Scale
Assume leadership role
Recognise the principal where appropriate
um
sub causes (drugs, Initiate appropriate
hypoglycaemia, hypoxia;
immediate management
trauma, infection,
(A,B,C, cervical collar,
vascular, epilepsy, raised Involve senior staff
administer glucose)
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intra-cranial pressure, promptly

reduced cerebral blood
flow, endocrine)
Take simple history from
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witnesses when patient

has stabilised Involve appropriate
specialists to facilitate
List appropriate immediate assessment
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investigations for each and management (e.g.

Prioritise, order, interpret
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and act on simple imaging, intensive care,

investigations neurosurgeons)
appropriately
D
Outline immediate
management options
Initiate early (critical)
management (e.g. control
fits, manage poisoning)
including requesting safe
monitoring
63
Anaphylaxis
The physician associate will be able to identify patients with anaphylactic

shock, assess their clinical state, produce a list of appropriate differential
diagnoses, initiate immediate resuscitation and management and organise
further investigations

Behaviour
Identify physiological Recognise clinical Exhibit a calm and

perturbations causing consequences of acute methodical approach
anaphylactic shock anaphylaxis
Adopt leadership role

Elucidate causes of Perform immediate physical where appropriate
anaphylactic shock assessment (laryngeal
t
oedema, bronchospasm,
en
hypotension) Involve senior and
Define follow-up specialist allergy
pathways after acute services promptly
resuscitation Institute resuscitation
um
(adrenaline, oxygen, IV
access, fluids)
oc
Arrange monitoring of
relevant indices
D

ft
(tryptase, C1 esterase
inhibitor etc.)
ra
D
64
‘The Top 20’ – Common Medical Presentations
Abdominal Pain
The physician associate will be able to assess a patient presenting with

abdominal pain to produce a valid differential diagnosis, investigate
appropriately, formulate and implement a management plan
Outline the different Elicit signs of tenderness, Exhibit timely intervention

classes of abdominal guarding, and rebound when abdominal pain is
pain and how the history tenderness and interpret the manifestation of
and clinical findings differ appropriately critical illness or is life-
between them threatening, in
conjunction with senior
and appropriate
t
specialists
en
Order, interpret and act
Identify the possible on initial investigations
causes of abdominal appropriately: blood tests;
pain, depending on site, radiographs; ECG;
um
details of history, acute microbiology Recognise the importance
or chronic investigations of a multi-disciplinary
approach including early
surgical assessment
oc
when appropriate
Define the situations in Initiate first line
which urgent surgical, management: the diligent
urological or use of suitable analgesia;
D
gynaecological opinion ‘nil by mouth’; IV fluids; Display sympathy to

should be sought resuscitation physical and mental
responses to pain
ft
ra
Determine which first line

investigations are Involve other specialties
D
required, depending on promptly when required

the likely diagnoses
following evaluation
65
Acute Back Pain
The physician associate will be able to assess a patient presenting with back
pain to produce a valid differential diagnosis, investigate appropriately,
formulate and implement a management plan
Recall the causes of acute Perform examination Involve neurosurgical unit

back pain and elicit signs of spinal promptly in event of
cord / cauda equina neurological symptoms or
compromise signs
Specify abdominal
pathology that may
present with back pain Practise safe Ask for senior help when
prescribing of critical abdominal
t
analgesics / anxiolytics pathology is suspected
en
to provide symptomatic
Outline the features that relief
raise concerns as to a
um
sinister cause (‘the red Recognise the socio-
flags’) and lead to economic impact of
consideration of a chronic Order, interpret and act chronic lower back pain
cause (‘the yellow flags’) on initial investigations
oc
appropriately: blood
tests, myeloma screen,
radiographs Participate in multi-
Recall the indications of disciplinary approach:
D
an urgent MRI of spine physio, OT

ft
ra
Outline indications for

hospital admission
D
66
Blackout / Collapse
The physician associate will be able to assess a patient presenting with a

collapse to produce a valid differential diagnosis, investigate appropriately,
formulate and implement a management plan (see also ‘Syncope’ and ‘Falls’)

Behaviour
Recall the causes for Elucidate history to establish Recognise impact

sudden loss of whether event was LOC, fall episodes can have on
consciousness (LOC) without LOC, vertigo (with lifestyle particularly in
eye witness account if the elderly
possible)
Differentiate the causes
depending on the Recognise
situation of collapse, Assess patient in terms of recommendations
t
associated symptoms ABC and degree of regarding fitness to
en
and signs, and eye consciousness and manage drive in relation to
witness reports appropriately undiagnosed
blackouts
um
Outline the indications Perform examination to elicit
for temporary and signs of cardiovascular or
permanent pacing neurological disease and to
systems distinguish epileptic disorder
oc
from other causes

D

appropriately: ECG, blood
ft
tests inc. glucose

ra
Manage arrhythmias
appropriately as per ALS
D
guidelines
Institute external pacing

systems when appropriate
67
Breathlessness

breathlessness to produce a valid differential diagnosis, investigate

Behaviour
Interpret history and clinical signs

Specify the common to list appropriate differential Exhibit timely assessment
cardio-respiratory diagnoses: esp. pneumonia, and treatment in the
conditions that asthma, COPD, PE, pulmonary acute phase
present with oedema, pneumothorax
breathlessness
Differentiate between stridor and Recognise the distress
wheeze caused by
Explain orthopnoea breathlessness and
and paroxysmal Order, interpret and act on initial discuss with patient and
nocturnal dyspnoea investigations appropriately: carers
routine blood tests, oxygen
saturation, arterial blood gases,
t
Identify non cardio- chest radiograph, ECG, PEFR, Recognise the impact of
en
respiratory factors spirometry long term illness
that can contribute to
or present with Initiate treatment in relation to
diagnosis, including safe oxygen Consult senior when
um
breathlessness
therapy, early antibiotics for respiratory distress is
pneumonia evident
Define basic
pathophysiology of Perform chest aspiration and
chest drain insertion Involve Critical Care team
oc
breathlessness
promptly when indicated
Recognise disproportionate
List the common and dyspnoea and hyperventilation
serious causes of
D
Exhibit non-judgemental
wheeze and stridor Recognise other causes of
attitudes to patients with
dyspnoea in patients with wheeze
a smoking history
(e.g. pneumothorax) and manage
ft
appropriately
ra
Evaluate and advise on good

inhaler technique
D
68
D
ra
ft
D
oc
um
en
t
69
-
20
-
Chest Pain
Skills Attitudes and

Behaviour
Characterise the different Interpret history and clinical

Perform timely
types of chest pain, and signs to list appropriate
assessment and
outline other symptoms differential diagnoses: esp.
treatment of patients
that may be present for cardiac pain & pleuritic
presenting with chest
pain
pain
List the common causes
for each category of Order, interpret and act on
chest pain and initial investigations in the Involve senior when
associated features: context of chest pain chest pain heralds
cardiac, pleuritic, appropriately: such as critical illness or when
musculoskeletal, upper ECG, blood gas analysis, cause of chest pain is
GI blood tests, chest unclear
radiograph, cardiac
List respiratory causes of enzymes
t
Recognise the
chest pain
en
contribution and
Commence initial
expertise of specialist
Define the emergency treatment
cardiology nurses
pathophysiology of acute including coronary
and technicians
um
coronary syndrome and syndromes, pulmonary
pulmonary embolus embolus and aortic
dissection
Identify the indications
and limitations of cardiac Elect appropriate arena of
oc
enzymes and d dimer care and degree of

analysis monitoring
D
Outline emergency Formulate initial discharge

treatments for PTE plan
ft
ra
D
70
-
21
Confusion, Acute -
The physician associate will be able to assess an acutely confused patient

to formulate a valid differential diagnosis, investigate appropriately,
List the common and Examine to elicit cause of Recognise that the cause
serious causes for acute acute confusion of acute confusion is often
confusion multi-factorial
Perform mental state

Outline important initial examinations Contribute to multi-
investigations, including (abbreviated mental test disciplinary team
electrolytes, cultures, and mini-mental test) to management
full blood count, ECG, assess severity and
t
blood gases, thyroid progress of cognitive
en
impairment
Recognise effects of
acutely confused patient
um
Recognise the factors on other patients and staff
that can exacerbate Recognise pre-disposing in the ward environment
acute confusion e.g. factors: cognitive
change in environment, impairment, psychiatric
infection disease
oc
D
List the pre-existing

factors that pre-dispose
to acute confusion
ft
ra
D
71
-
22
-
Cough

cough to produce a valid differential diagnosis, investigate appropriately,
List the common and Order, interpret and act Contribute to patients
serious causes of cough on initial investigations understanding of their
appropriately: blood tests, illness
chest radiograph and
PFT
Identify risk factors
relevant to each Exhibit non-judgmental
aetiology including attitudes to patients with a
precipitating drugs history of smoking
t
en
Outline the different Consult seniors promptly
um
classes of cough and when indicated
how the history and
clinical findings differ
between them
oc
Recognise the importance

of a multi-disciplinary
approach
State which first line
D
investigations are
required, depending on
the likely diagnoses
ft
following evaluation
ra
D
72
-
23
-
Diarrhoea

diarrhoea to produce a valid differential diagnosis, investigate
Specify the causes of

Evaluate nutritional and Seek a surgical and
diarrhoea (secretory,
hydration status of the senior opinion when
infective, etc)
patient required
Correlate presentation
with other symptoms:
such as abdominal pain, Assess whether patient Exhibit sympathy and
rectal bleeding, weight requires hospital empathy when
admission considering the distress
t
loss
associated with diarrhoea
en
and incontinence
Outline the
pathophysiology of Perform rectal
um
diarrhoea for each examination as part of
aetiology physical examination Demonstrate awareness
of infection control
procedures
oc
Describe the
investigations necessary Initiate investigations:
to arrive at a diagnosis blood tests, stool
examination, endoscopy
D
and radiology as
Identify the indications appropriate
ft
for urgent surgical review

in patients presenting
ra
with diarrhoea
D
73
-
24
Falls -
The physician associate will be able to assess a patient presenting with a fall
and produce a valid differential diagnosis, investigate appropriately, formulate
and implement a management plan (see also ‘Syncope’ and ‘Blackout/Collapse’)
Describe causes of falls Define the Recognise the psychological

and risk factors for falls, significance of a fall impact to an older person and
including drug and depending on their carer after a fall
neurovascular causes circumstances, and
whether recurrent, to
distinguish when
further investigation Contribute to the patients
Outline the assessment of is necessary understanding as to the
a patient with a fall and give
reason for their fall
a differential diagnosis
t
Identify possible
en
secondary
State conditions that may complications of falls Discuss with seniors promptly
present as a fall and appropriately
um
Commence
Outline the relationship appropriate treatment Relate the possible reasons
between falls risk and including pain relief for the fall and the
oc
fractures and bone prophylaxis management plan to patient

and carers
D
Outline secondary risks of

falls, such as loss of
confidence, infection
ft
ra
D
74
-
Fever 25
-
The physician associate will be able assess a patient presenting with fever
to produce a valid differential diagnosis, investigate appropriately,
Recognise the presence

Outline the physiology Adhere to local antibiotic
of septic shock in a
of developing a fever prescribing policies
patient, commence
resuscitation and liaise
with senior colleagues
promptly
Recall the broad Highlight importance of
causes of fever: nosocomial infection and
infection, malignancy, principles for infection
inflammation control
on initial investigations
t
appropriately: blood tests,
en
cultures, CXR
Define Pyrexia of Consult senior in event of
um
Unknown Origin Identify the risk factors in septic syndrome
the history that may
indicate an infectious
disease e.g. travel,
Recall the role of anti- Discuss with senior
oc
sexual history, IV drug

pyretics use, animal contact, drug colleagues and follow local
therapy guidelines in the
management of the
D
immunosuppressed e.g.
Differentiate features of Commence appropriate HIV, neutropenia
viral and bacterial empirical antibiotics when
ft
infection an infective source of

fever is deemed likely in
ra
accordance with local Promote communicable

prescribing policy disease prevention: e.g.
Outline indications for immunisations, anti-
D
LP in context of fever malarials, safe sexual

practices
75
-
26
-
Fits / Seizure
The physician associate will be able to assess a patient presenting with a fit,
stabilise promptly, investigate appropriately, formulate and implement a
management plan

Behaviour
Outline the causes Recognise and manage a Recognise need for

for seizure patient presenting with status urgent referral in case
epilepticus of uncontrolled
recurrent loss of
Recall the common
consciousness or
t
epileptic syndromes Obtain collateral history from
seizures
en
witness
List the essential
Recognise the
initial investigations Promptly recognise and treat principles of safe
um
following a ‘first fit’ precipitating causes: metabolic,
discharge, after
infective, malignancy discussion with senior
Recall the indications colleague
for a CT head
oc
Recognise importance
Describe the of Epilepsy Nurse
indications, Specialist
D
contraindications and
side effects of the Recognise the
commonly used anti- psychological and
ft
convulsants
social consequences of
epilepsy
ra
Differentiate seizure
from other causes of
D
collapse
76
-
27
-
Haematemesis & Melaena
The physician associate will be able to succinctly assess the patient with an
upper GI haemorrhage to determine significance; resuscitate appropriately;
and liaise with endoscopist effectively

Behaviour
Detail the anatomy of the Recognise shock or Seek senior help

upper GI tract impending shock and and endoscopy or
resuscitate rapidly and surgical input in
appropriately event of significant
Specify the causes of upper GI bleed
GI bleeding, with
associated risk factors Distinguish upper and lower
GI bleeding Observe safe
practices in the
t
Outline methods of prescription of
en
assessing the significance Demonstrate ability to site blood products
and prognosis of an upper large bore IV access
GI bleed and how this
impacts on importance of
um
Perform assessment to
urgent endoscopy e.g.
postulate cause of bleeding:
Rockall score
in particular detect the
presence of liver disease
oc
Outline the principles of

choice of IV access, fluid
Safely prescribe drugs
choice and speed of fluid
administration indicated in event of a likely
D
upper GI variceal bleed:

broad spectrum antibiotics,
Broadly outline endoscopic vasoconstrictor agents, acid
ft
methods of haemostasis suppression

ra
D
77
-
28
-
Headache

headache to produce a valid differential diagnosis, investigate appropriately,

Behaviour
Recall the common and Recognise important Recognise the nature of

life-threatening causes diagnostic features in headaches that may have
of acute new headache, history a sinister cause and
and how the nature of assess and treat urgently
the presentation
classically varies Perform a comprehensive
between them neurological examination, Liaise with senior doctor
including eliciting signs of promptly when sinister
t
papilloedema, temporal cause is suspected
en
Understand the arteritis, meningism and
pathophysiology of head trauma
headache Involve neurosurgical
team promptly when
um
Order, interpret and act on appropriate
Define the indications initial investigations
for urgent CT/MRI
scanning in the context
oc
of headache Perform a successful

lumbar puncture when
indicated with minimal
D
Define clinical features discomfort to patient

of raised intra-cranial observing full aseptic
pressure technique
ft
ra
Interpret basic CSF

analysis: cell count,
protein, gram stain and
D
glucose
Initiate prompt treatment

when indicated:
appropriate analgesia;
antibiotics; anti-virals;
steroids
78
-
29
-
Jaundice

jaundice to produce a valid differential diagnosis, investigate appropriately,

Behaviour
Outline the
Take a thorough history Exhibit non-judgmental
pathophysiology of
and examination to arrive attitudes to patients with
jaundice in terms of pre-
at a valid differential a history of alcoholism or
hepatic, hepatic, and
diagnosis substance abuse
post-hepatic
List causes for each Recognise the presence of Consult seniors and
category of jaundice chronic liver disease or gastroenterologists
t
with associated risk fulminant liver failure promptly when indicated
en
factors
Describe the need for Interpret basic Contribute to the patient’s

investigations to establish understanding of their
um
careful prescribing in a
patient with jaundice aetiology: blood tests and illness
abdominal ultrasound
scanning
Outline basic Recognise the
oc
investigations to importance of a multi-

establish aetiology Recognise complications disciplinary approach
of jaundice: sepsis and
D
renal impairment
Describe medical,
surgical and radiological
ft
treatments
ra
D
79
-
30
-
Limb Pain & Swelling

limb pain or swelling to produce a valid differential diagnosis, investigate
Recall the causes of

Perform a full Liaise promptly with
unilateral and bilateral
examination including surgical colleagues in
limb swelling in terms of
assessment of viability event of circulatory
acute and chronic
and perfusion of limb and compromise (eg
presentation
differentiate pitting compartment syndrome)
oedema; cellulitis; venous
thrombosis; compartment
Summarise the different
syndrome
causes of limb pain in
Recognise importance of
t
terms of leg, arm and
thrombo-prophylaxis in
en
hand
high risk groups
Recognise compartment
syndrome and critical
Outline the
um
ischaemia and take
pathophysiology for
appropriate timely action
pitting oedema, non-
pitting oedema and
thrombosis
oc

State the risk factors for
D
the development of
Doppler studies, urine
thrombosis
protein
ft
Outline the indications,

ra
side effects of diuretics Practise safe prescribing
and anti-coagulants of initial treatment as
D
appropriate (anti-
coagulation therapy,
antibiotics etc)
Differentiate the features
of limb pain and/or
swelling pain due to
cellulitis and DVT Prescribe appropriate
analgesia
80
-
31
-
Palpitations

palpitations to produce a valid differential diagnosis, investigate
Recall basic cardiac Elucidate nature of Consult senior colleague

electrophysiology patient’s complaint promptly when required
Define the term Order, interpret and act Advise on lifestyle

palpitations on initial investigations measures to prevent
appropriately: ECG, palpitations/arrhythmias
blood tests when appropriate
t
en
Define common causes
of palpitations e.g.
anxiety, drugs, Recognise and
um
thyrotoxicosis) commence initial
treatment of arrhythmias
being poorly tolerated by
patient (peri-arrest
oc
List the categories of arrhythmias) as per UK

arrhythmia Resuscitation Council
Guidelines
D
State common
arrhythmogenic factors Ensure appropriate
ft
including drugs monitoring of patient on

ward
ra
D
Outline the indications,

side effects of the
commonly used anti-
arrhythmic medications
81
-
32
-
Poisoning
The physician associate will be able to assess promptly a patient presenting with
deliberate or accidental poisoning, initiate urgent treatment, ensure appropriate
monitoring and recognise the importance of psychiatric assessment in episodes
of self harm

Behaviour
Recall indications for gastric Recognise critically ill Contact senior promptly
lavage, activated charcoal overdose patient and in event of critical
and whole bowel irrigation resuscitate as appropriate illness or patient
refusing treatment
Define parameters used to Take a full history of event,
give clues to type of including collateral if Recognise the details
poisoning: pupils, pulse and possible of poisoning event
t
respiration, blood pressure, given by patient may be
en
temperature, glucose, inaccurate
Examine to determine
seizure, coma, renal function,
nature and effects of
osmolar and anion gap
poisoning Show compassion and
um
patience in the
Outline presentation and assessment and
Commence poison-specific management of those
management of poisoning
treatments who have self-harmed
with: paracetamol, aspirin,
oc
opiates, alcohol,
benzodiazepines, beta Order, interpret and act on
blockers, digoxin, carbon initial investigations
D
monoxide, anti-coagulants, appropriately: biochemistry,

tricyclic anti-depressants, arterial blood gas, glucose,
SSRIs, amphetamines and ECG, and drug
cocaine
ft
concentrations
ra
Recognise importance of Ensure appropriate

accessing TOXBASE and monitoring in acute period
National Poisons Information of care
D
Service
82
-
33
-
Rash
The physician associate will be able assess a patient presenting with an

acute-onset skin rash and common skin problems to produce a valid
differential diagnosis, investigate appropriately, formulate and implement a
management plan
Define the characteristic Take a thorough Demonstrate sympathy

lesions found in the focussed history & and understanding of
acute presentation of conduct a detailed patients‘ concerns due to
common skin diseases examination, including the cosmetic impact of skin
the nails, scalp and disease
mucosae to arrive at
appropriate differential
Outline basic diagnoses
investigations to Engage the patient in the
t
establish aetiology management of their
en
condition particularly with
Recognise the regard to topical treatments
importance of a detailed
um
Identify risk factors, drug history
particularly drugs,
infectious agents and Reassure the patient about
allergens the long term prognosis
oc
Recognise that and lack of transmissibility

anaphylaxis may be a of most skin diseases
cause of an acute skin
Describe possible rash
D
medical treatments
ft

ra
appropriately to establish
aetiology
D
83
-
34
-
Vomiting and Nausea
The physician associate will be able to assess a patient with vomiting and
nausea to produce a valid differential diagnosis, investigate appropriately,
Recall the causes and Elicit signs of dehydration Involve surgical team
pathophysiology of and take steps to rectify promptly in event of GI
nausea and vomiting obstruction
Recognise and treat

List commonly used anti- suspected GI obstruction Respect the impact of
emetics and differentiate appropriately: nil by nausea and vomiting in
the indications for each mouth, NG tube, IV fluids the terminally ill and
t
involve palliative care
en
services appropriately
Outline alarm features Practise safe prescribing

um
that make a diagnosis of of anti-emetics
upper GI malignancy
possible
oc

radiographs
D
ft
ra
D
84
-
35
-
Weakness and Paralysis
The physician associate will be able to assess a patient presenting with motor
weakness to produce a valid differential diagnosis, investigate appropriately,
formulate and implement a management plan (see also ‘Speech Disturbance’
and ‘Abnormal Sensation (Paraesthesia and Numbness)’)
Broadly outline the Elucidate speed of onset

physiology and and risk factors for Recognise importance of
neuroanatomy of the neurological dysfunction timely assessment and
components of the motor treatment of patients
system Perform full examination to presenting with acute motor
elicit signs of systemic weakness
Recall the myotomal disease and neurological
distribution of nerve dysfunction and identify
roots, peripheral nerves, associated deficits Consult senior and acute
t
and tendon reflexes stroke service, if available,
en
Describe likely site of as appropriate
Define the clinical lesion in motor system and
features of upper and produce differential
lower motor neurone, diagnosis
Recognise patient and
um
neuromuscular junction
Order, interpret and act on carers distress when
and muscle lesions
initial investigations for presenting with acute motor
Outline the common and acute motor weakness weakness
important causes for appropriately
oc
lesions at the sites

listened above Recognise when Consult senior when rapid
swallowing may be unsafe progressive motor
D
Recall the Bamford and manage appropriately weakness or impaired

classification of stroke, consciousness is present
and its role in prognosis Detect spinal cord
compromise and
ft
Outline investigations for investigate promptly

acute presentation, Involve speech and
ra
including indications for Perform tests on language therapists

urgent head CT respiratory function and appropriately
inform senior appropriate
D
Contribute to multi-
disciplinary approach
85
-
36
Other Important Presentations -
Abdominal Mass / Hepatosplenomegaly

an abdominal mass to produce a valid differential diagnosis, investigate

Behaviour
Define the different Elicit associated Recognise the anxiety

types of abdominal symptoms and risk that the finding of an
mass in terms of factors for the presence abdominal mass may
aetiology, site, and of diseases presenting induce in a patient
clinical characteristics with abdominal mass,
(e.g. mitotic, hepatomegaly and
inflammatory) splenomegaly
t
Participate in multi-
en
disciplinary team
approach
Describe relevant Elicit and interpret
um
investigations related to important clinical findings
clinical findings: of mass to establish its
radiological, surgical, likely nature
endoscopy
oc

Identify the causes of on initial investigations
D
hepatomegaly and appropriately: blood tests,

splenomegaly imaging
ft
ra
D
86
-
37
-
Abdominal Swelling & Constipation
The physician associate will be able to undertake assessment of a patient

presenting with abdominal swelling or distension to produce a valid
differential diagnosis, investigate appropriately, formulate and implement a
management plan
Define the causes of

Examine to identify the Recognise the multi-
abdominal swelling and
nature of the swelling, factorial nature of
their associated clinical
including a rectal constipation, particularly
findings
examination, and elicit in the elderly
co-existing signs that
may accompany ascites
Outline the common
causes of constipation,
Recognise the importance
t
including drugs
of multi-disciplinary
en
Identify risk factors for the approach
development of ascites
Outline the
and constipation,
pathophysiology of portal
um
including initial blood
hypertension and bowel
tests
obstruction
oc
Outline important steps

in the diagnosis of the
cause of ascites,
D
including imaging and

the diagnosis of
spontaneous bacterial
Perform a safe diagnostic
ft
peritonitis and
malignancy and therapeutic ascitic
tap with aseptic
ra
technique with minimal

Define alarm features discomfort to the patient
D
that raise suspicion of

colorectal malignancy
Interpret results of
Identify mode of action diagnostic ascitic tap
and side effects of the
commonly used laxatives
Institute initial
management as
appropriate to the type of
swelling
87
-
38
-
Abnormal Sensation (Paraesthesia and Numbness)
The physician associate will be able to assess a patient with abnormal

sensory symptoms to arrive at a valid differential diagnosis, investigate
Broadly outline the Take a full history, Recognise the distress

physiology and including drugs, lifestyle, chronic paraesthesia can
neuroanatomy of the trauma cause
sensory components of
the nervous system
Perform full examination Consult senior and acute

including all modalities of stroke service, if
Recall the dermatomal sensation to elicit signs of available, as appropriate
t
distribution of nerve roots nervous system
en
and peripheral nerves dysfunction
Contribute to multi-
um
disciplinary approach
List common and Describe likely site of
important causes of lesion: central, root,
abnormal sensation and mononeuropathy, or
oc
likely site of lesion in polyneuropathy

nervous system (e.g.
trauma, vascular)
D
Outline the symptomatic

ft
treatments for
neuropathic pain
ra
D
Outline indications for an

urgent head CT
88
-
39
-
Aggressive / Disturbed Behaviour
The physician associate will be competent in predicting and preventing

aggressive and disturbed behaviour; using safe physical intervention and
tranquillisation; investigating appropriately and liasing with the mental
health team
Elucidate the factors that Ensure appropriate arena Involve senior colleague
allow prediction of for nursing patient with and mental health care
aggressive behaviour: disturbed behaviour team promptly
personal history, alcohol
and substance misuse,
delirium
Ensure sufficient support
is available
t
Define acute psychosis
en
and list its predominant Advocate practice
features and causes Assess patient fully outlined in national
including mental state guidelines (e.g. NICE) on
um
examination to produce a managing violence
valid differential diagnosis
Recall indications,
oc
side effects of
tranquillisers Order, interpret and act
appropriately when
D
possible
Outline the legal
framework authorising
ft
interventions in the
management of the
ra
Practise safe rapid

disturbed or violent tranquillisation if indicated
patient as defined in national
D
guidelines e.g. NICE
Recognise warning signs

of incipient violent
behaviour
Ensure close monitoring

following tranquillisation
89
-
40
-
Alcohol and Substance Dependence
The physician associate will be able to assess a patient seeking help

for substance abuse, and formulate an appropriate management plan
Outline the Take a detailed medical Recognise the aggressive

pathophysiology of and psychiatric history to patient and manage
withdrawal syndromes identify physical or appropriately
psychological
dependence
Describe the medical, Seek specialist advice

psychiatric and socio- when appropriate e.g.
economic consequences Examine patient to elicit gastroenterology,
of alcohol and drug complications of alcohol intensive care, psychiatry
t
misuse and substance misuse
en
um
Outline the measures Obtain collateral history if
taken to correct features possible
of malnutrition, including
vitamin and mineral
oc
supplementation
Investigate as
appropriate
D
Recall effects of alcohol

and recreational drugs
on cerebral function Practise safe prescribing
ft
of sedatives for
ra
withdrawal symptoms
D
Detect and address other

health issues: liver
disease, malnutrition,
Wernicke’s
encephalopathy
90
-
41
-
Anxiety / Panic disorder

features of an anxiety disorder and reach a differential diagnosis to guide
investigation and management
Recall the main features Assess a patient to detect

of anxiety disorder organic illness
Recognise the chronicity

Be familiar with national Evaluate patient’s mental of anxiety syndromes and
guidelines (e.g. NICE) on state to categorise cause the distress and disability
management of anxiety of symptoms as per they cause
national guidelines (e.g.
t
NICE) on Anxiety
en
Elucidate the main
categories of anxiety
um
disorder: panic,
generalised anxiety,
phobias
oc
Recognise the role of

depression in anxiety
D
symptoms
ft
ra
Recall organic disorders

and medications than
can mimic some features
D
of anxiety disorder
Outline broad treatment

strategies for anxiety
disorders
91
-
42
Bruising -

easy bruising to produce a valid differential diagnosis, investigate
Outline the different Order, interpret and act Recognise the importance
types of easy bruising on initial investigations of a multidisciplinary
appropriately including approach
blood tests, radiographs,
microbiology
Identify the possible investigations
causes of easy bruising, Acknowledge anxiety
depending on the site, caused by possible
age of the patient and diagnosis of a serious
details of the history, Initiate first line blood condition
t
particularly in relation to management in
en
prescribed medication consultation with senior
clinicians
Consult senior if there is
um
concern bruising is
State which first line manifestation of critical
investigations are illness
required, depending on
the likely diagnosis
oc
Recognise that trauma is

an important cause of
D
State the common bruising and that bruising

clinical presentations of is a common problem in
coagulation disorders the elderly
ft
ra
D
92
-
43
-
Chance Findings
The physician associate will be able to construct a management plan for

patients referred by colleagues due to asymptomatic abnormal findings
Recall asymptomatic Elucidate finding and Refer non-urgent cases to

abnormal findings that place it in context of either GP or appropriate
may precipitate particular patient specialist for out-patient
discussion with medical review or investigation
team: abnormal
radiograph; accelerated
hypertension; deranged Decide whether
blood tests (anaemia, immediate assessment of Recognise the non-
calcium, urea and patient is required, after specific modes by which
electrolytes, full blood discussion with senior serious illness may
t
count, clotting); colleague if uncertain present
en
proteinuria; microscopic
haematuria; abnormal
ECG; drug interactions
um
and reactions Formulate an appropriate Seek specialist advice
management plan for when appropriate
each scenario
State asymptomatic
oc
findings that warrant

immediate assessment, Order, interpret and act
admission and on further initial
D
management investigations
appropriately
ft
ra
Manage common
metabolic presentations
D
appropriately
(hyper/hypokalaemia,
hyper/hyponatraemia)
93
-
44
Dialysis -
The physician associate will be aware of the principles, indications, and

complications of Renal Replacement Therapy (RRT)
Outline the methods of Demonstrate ability to Recognise importance of

RRT assess a patient on long prompt senior and Renal
term dialysis presenting Unit input in the
to hospital to arrive at a management of patients
valid differential diagnosis on RRT
Elucidate the common
complications of long
term haemodialysis
Order, interpret and act Recognise the valuable
on initial investigations insight patients on long
appropriately, recognising term RRT have into the
t
Recall the importance of importance of full septic nature of their symptoms
en
sepsis in patients on screen
RRT
um
Commence initial
management of patient if
appropriate
oc
D
ft
ra
D
94
-
45
Dyspepsia -

heartburn to produce a valid differential diagnosis, investigate
Define dyspepsia and Identify alarm symptoms Respect findings of

recall principle causes indicating urgent previous endoscopy when
endoscopy referral patients have
exacerbation of
symptoms
Recall the lifestyle
factors that contribute to Investigate as
dyspepsia appropriate: H pylori
testing, endoscopy
t
en
State the indications for
endoscopy as stated in
national guidelines (e.g.
um
NICE)
oc
Recall indications,
side effects of acid
suppression and
D
mucosal protective
medications
ft
ra
Recall the role of H

Pylori and its detection
D
and treatment
Define alarm symptoms

of upper GI malignancy
95
-
46
-
Dysuria

dysuria to produce a valid differential diagnosis, investigate appropriately,
Recall anatomy of the Take a full history, Recognise the need for
genito-urinary tract including features specialist genito-urinary
pertaining to sexual heath input when appropriate
Elucidate the causes of

dysuria in males and Initiate appropriate Participate in sexual
females treatment if appropriate health promotion
t
en
Outline the Order, interpret and act Use microbiology
pathophysiology of on initial investigations resources in the
um
infective causes of management of patients
urethritis with dysuria when
appropriate
oc
Outline the principles of

management
D
ft
ra
D
96
-
47
-
Genital Discharge and Ulceration

genital discharge or ulceration to produce a valid differential diagnosis,
investigate appropriately, formulate and implement a management plan
List the disorders that Take a full history that Recognise the re-
can present with genital includes associated emergence of sexually
discharge symptoms, sexual, transmitted diseases
menstrual and (STDs)
contraceptive history and
details of previous STDs
t
List the disorders that
en
can present with genital Recognise the importance
ulceration of contact tracing
Perform full examination
including inguinal lymph
um
nodes, scrotum, male
Outline the investigations urethra, rectal Promote safe sexual
necessary: urinalysis; examination, speculum practices
urethral smear and
oc
culture in men; high

vaginal and endo-
cervical swab in women, Be able to pass a Advocate the presence of
genital skin biopsy speculum competently
D
a chaperone during
and sensitively without assessment
discomfort to the patient
ft
ra
D
97
-
48
-
Haematuria
The physician associate will be able to assess a patient with haematuria to

produce a valid differential diagnosis, investigate appropriately, formulate
and implement a management plan
Recall the anatomy of Perform a focussed Involve renal unit when

the urinary tract examination, including a rapidly progressive
rectal examination glomerulonephritis is
suspected
Outline the causes of

microscopic and Demonstrate when a
macroscopic haematuria patient needs urological
assessment and
t
investigation
en
Determine whether a
glomerular cause is
um
likely, and indications for Order, interpret and act
a nephrology opinion on initial investigations
such as: urine culture,
cytology and microscopy;
oc
blood tests
D
ft
ra
D
98
-
49
Haemoptysis -

haemoptysis to produce valid differential diagnosis, investigate
Identify the common and Perform a detailed

life threatening causes of history and physical
haemoptysis: bronchitis, examination to
pneumonia, PE and determine an appropriate
carcinoma differential diagnosis Involve seniors and
respiratory physicians as
appropriate
Describe initial treatment Order, interpret and act
t
including fluids and on initial investigations
en
oxygen management appropriately: routine
bloods, clotting screen,
chest radiograph and
ECG, sputum tests
um
Initiate treatment
oc
including indications for

starting or withholding
anticoagulants and
D
antibiotics
ft
ra
D
99
-
50
-
Head Injury
The physician associate will able to assess a patient with traumatic head
injury, stabilise, admit to hospital as necessary and liaise with appropriate
colleagues, recognising local and national guidelines (e.g. NICE)
Recall the Instigate initial Recognise advice

pathophysiology of management: ABC, provided by national
concussion cervical spine protection guidelines on head injury
(e.g. NICE)
Outline symptoms that Assess and classify

may be present patient in terms of GCS Ask for senior and
and its derivative anaesthetic support
t
components (E,V,M) promptly in event of
en
decreased consciousness
Outline the indications
for hospital admission
um
following head injury Take a focused history
and a full examination to Involve neurosurgical
elicit signs of head injury team promptly in event of
and focal neurological CT scan showing
oc
Outline the indications deficit structural lesion

for urgent head CT scan
as per national
guidelines (e.g. NICE)
D
Manage short term Recommend indications

complications, with senior for repeat medical
assistance if required: assessment in event of
ft
Recall short term seizures, airway discharge of patient from

compromise hospital
ra
complications of head
injury
D
Advise nurses on Participate in safe transfer

appropriate frequency procedures if referred too
and nature of tertiary care
observations
100
-
51
Hoarseness and Stridor -

symptoms of upper airway pathology to produce a valid differential
diagnosis, investigate appropriately, formulate and implement a
management plan (see also ‘wheeze’)
Explain the mechanisms Differentiate hoarseness, Involve senior and

of hoarseness and stridor and wheeze anaesthetic team
stridor promptly in event of
significant airway
compromise
Assess severity:
List the common and cyanosis, respiratory rate
serious causes for and effort
hoarseness and stridor Involve specialist team as
t
appropriate: respiratory
en
team, ENT or neurological
Perform full examination, team
eliciting signs that may
um
co-exist with stridor or
hoarseness e.g. bovine
cough, Horner’s
syndrome, other
neurological signs, fever
oc
D

ft
blood gas analysis, chest

radiograph, flow volume
ra
loops, FEV1/peak flow

ratio
D
101
-
52
-
Hypothermia

hypothermia to establish the cause, investigate appropriately, formulate
Define hypothermia and Employ the emergency Recognise the often multi-
its diagnosis management of factorial nature of
hypothermia as per ALS hypothermia in the elderly
guidelines and outline preventative
approaches
Outline perturbations
caused by hypothermia,
including ECG and blood Correct any predisposing
test interpretation factors leading to Recognise seriousness of
t
hypothermia hypothermia and act
en
promptly to re-warm
List the causes of

um
hypothermia Request appropriate
monitoring of the patient Recognise that death can
only usually be certified
after re-warming
oc
List complications of
hypothermia
D
ft
ra
D
102
-
53
-
Immobility
The physician associate will be able to assess a patient with immobility to

produce a valid differential diagnosis, investigate appropriately, and produce
a management plan
Take appropriate and

Describe the risk factors focussed collateral Recognise the importance
and causes of immobility history from of a multidisciplinary
carers/family/GP approach and specialist
referral as appropriate
Construct problem list
Explain the role of following assessment
multidisciplinary team
Discuss the role of the Display ability to discuss
multidisciplinary team in plans with patients and or
t
management of these carers
en
Define the basic patients
principles of
rehabilitation Formulate appropriate
um
management plan Recognise the anxiety and
including medication, distress caused to patient
rehabilitation and goal and carers by underlying
Describe the conditions setting. condition and admission to
oc
causing immobility which hospital

may be improved by Identify conditions
treatment and or leading to acute
rehabilitation presentation to hospital
D

on relevant initial
ft
investigations
appropriately to elucidate
ra
a differential diagnosis
D
103
-
54
Involuntary Movements -
The physician associate will be able to assess a patient presenting

with involuntary movements to produce a valid differential diagnosis,
investigate appropriately, formulate and implement a management
plan
Differentiate and outline Assess including a full Exhibit empathy when

the differential diagnoses neurological examination considering the impact on
of Parkinsonism and to produce a valid quality of life of patient
tremor: be aware of differential diagnosis and carers that
myoclonus, and other movement disorders can
less common movement have
disorders
Recognise importance of
t
Outline the main drug multi-disciplinary
en
groups used in the approach to management
management of
movement disorders
um
Recognise the
importance of specialist
referral
oc
D
ft
ra
D
104
-
55
-
Joint Swelling

joint pain or swelling to produce a valid differential diagnosis, investigate

Behaviour
Outline the generic Recognise the importance of Recognise that

anatomy of the different history for clues as to monoarthritis calls for
types of joint diagnosis timely joint aspiration
to rule out septic
cause
Differentiate mono-, Perform a competent

oligo-, and polyarthritis physical examination of the
t
and list principle causes musculo-skeletal system Recognise and
en
for each using both the GALS facilitate the need for
screening examination and surgical intervention in
the regional examination septic arthritis
um
technique (REMS)
Elucidate the importance
of co-morbidities in the
diagnosis of joint Recognise importance
oc
swelling Elicit and interpret extra- of multi-disciplinary

articular signs of joint approach to joint
disease disease: physio, OT,
social services
D
Outline treatment options

for chronic arthritides:
disease modifying drugs, Order, interpret and act on
ft
analgesia, physiotherapy initial investigations

ra
radiographs, joint aspiration,

cultures
D
Perform knee aspiration

using aseptic technique
causing minimal distress to
patient
Interpret plain radiographs of

swollen joints
Practise safe prescribing of

analgesics for joint disease
105
-
56
-
Lymphadenopathy

lymphadenopathy to produce a valid differential diagnosis, investigate
Outline the anatomy and Elicit associated Recognise patient

physiology of the symptoms and risk concerns regarding
lymphatic system factors for the presence possible cause for
of diseases presenting lymphadenopathy
with lymphadenopathy

generalised and local Recognise the need for
lymphadenopathy in Examine to elicit the senior and specialist input
t
terms of infective, signs of
en
malignant, reactive and lymphadenopathy and
infiltrative associated diseases
Recognise the
um
association of inguinal
lymphadenopathy with
Outline the investigations Order, interpret and act STDs, assess and refer
indicated when on initial investigations appropriately
oc
tuberculosis is appropriately
considered
D
Initiate treatment if
appropriate
ft
ra
D
106
-
57
-
Loin Pain
The physician associate will be able to assess a patient presenting with loin
pain to produce a valid differential diagnosis, investigate appropriately,

Behaviour
List the common and Elucidate risk factors for Involve senior and renal
serious causes of loin causes of loin pain team if there is
pain and renal colic associated renal
impairment
Perform full examination to

Outline other symptoms elicit signs of renal
that may classically pathology Involve urology team as
t
accompany loin pain and appropriate
en
renal colic

um
initial investigations Recognise local
Outline indications and appropriately: blood tests, guidelines in prescribing
contraindications for an urinalysis, urine culture antibiotics
urgent IVU and microscopy,
oc
radiographs, ultrasound
D
Prescribe appropriate
analgesia safely
ft
ra
Commence appropriate
antibiotics when infective
D
cause is likely
Recognise co-existing
renal impairment promptly
107
-
58
-
Medical Complications During Acute Illness and Following Surgical
Procedure
The physician associate will be able to assess, investigate and treat medical
problems arising post-operatively and during acute illness and recognise
importance of preventative measures
List common medical Recognise critically ill Recognise importance of

complications occurring patient and instigate thrombo-embolic
in post-operative and resuscitative measures complications and
unwell patients and how prophylaxis during acute
they present illness and in post-
operative period
Assess patient with
t
history and examination
en
Explain reasons for to form differential
medical problems diagnosis Recognise the importance
frequently presenting of measures to prevent
atypically post- complications: DVT
um
operatively prophylaxis, effective
Initiate treatment when analgesia, nutrition,
appropriate in physiotherapy, gastric
consultation with the protection
oc
Recall investigations surgical team

indicated in different
scenarios: short of
breath, chest pain, Call for senior help when
D
respiratory failure, Institute measures for appropriate

drowsiness, febrile, thrombosis prophylaxis
collapse, GI bleed when appropriate, as per
ft
national or local
ra
guidelines Respect opinion of

referring surgical team
D
108
-
59
-
Medical Problems in Pregnancy
The physician associate will be competent in the assessment,

investigation and management of the common and serious medical
complications of pregnancy
Outline the normal Recognise the critically ill Recognise the importance
physiological changes pregnant patient, initiate of thrombo-embolic
occurring during resuscitation measures complication of pregnancy
pregnancy and liaise promptly with
senior and obstetrician
Communicate with
List the common medical obstetric team throughout
problems occurring in Take a valid history from the diagnostic and
t
pregnancy a pregnant patient management process
en
um
Identify the unique Examine a pregnant Discuss case with senior
challenges of diagnosing patient competently promptly
medical problems in
pregnancy
oc
Produce a valid list of Seek timely

differential diagnoses gastroenterology opinion
Recall safe prescribing in cases of significant
D
practices in pregnancy jaundice
Initiate treatment if
ft
appropriate
ra
D
109
-
60
-
Memory Loss (Progressive)
The physician associate will be able to assess a patient with progressive

memory loss to determine severity, differential diagnosis, investigate
appropriately, and formulate management plan
Define the clinical Take an accurate Demonstrate a patient

features of dementia that collateral history sensitive approach to
differentiate from focal wherever possible interacting with a
brain disease, reversible confused patient and their
encephalopathies, and carers
pseudo-dementia
Perform a full
examination looking for
reversible causes of Recognise that a change
t
List the principle causes cognitive impairment and of environment in hospital
en
of dementia neurological disease can exacerbate
symptoms and cause
distress
um
Demonstrate ability to
use tools measuring
cognitive impairment at Recommend support
oc
the bedside networks to carers

Recall factors that may
exacerbate symptoms:
drugs, infection, change
D
of environment, Order, interpret and act Participate in multi-

biochemical on initial investigations disciplinary approach to
abnormalities, appropriately to care: therapists, elderly
ft
constipation determine reversible care team, old age

cause such as: blood psychiatrists, social
ra
tests, cranial imaging, services

EEG
D
Recognise need for

Detect and rectify specialist involvement
exacerbating factors and opportunities for
treatment
110
-
61
-
Micturition (Difficult)
The physician associate will be able to assess a patient presenting

with difficulty in micturition to produce a valid differential diagnosis,
investigate appropriately, formulate and implement a management
plan
Outline causes of Examine to elicit signs of Recognise the importance

difficulty in micturating in renal disease, bladder of recognising and
terms of oliguria and outflow obstruction and preventing renal
urinary tract obstruction deduce volaemic status impairment in the context
of patient of bladder outflow
obstruction
Recall techniques that

Differentiate oliguric pre-
allow oliguria and
t
renal failure; acute renal
bladder outflow Liaise with senior in event
en
failure and post renal
obstruction to be of oliguria heralding
failure
differentiated incipient shock
um
Recall the investigation on initial investigations Liaise promptly with
and management of appropriately: urinalysis, appropriate team when
oc
prostatic cancer abdominal ultrasound, oliguria from bladder

bladder scanning, urine outflow obstruction is
culture and microscopy suspected (urology,
gynaecology)
D
Initiate treatment when

ft
indicated
ra
Perform catheterisation
D
using aseptic technique

with minimal discomfort
to patient
Recognise incipient
shock and commence
initial treatment
111
-
62
-
Neck Pain

neck pain to produce a valid differential diagnosis, investigate
Outline the common and Take a full history, Consult senior colleague
serious causes of neck including recent trauma promptly in the event of
pain in terms of focal neurological signs or
meningism; tender mass; critical illness
musculoskeletal;
vascular Perform a full
examination to elicit signs
that may accompany
neck pain
t
en
um
plain radiographs, thyroid
function
oc
Recognise meningitis and

D
promptly initiate
appropriate investigations
and treatment with
ft
consultation with senior

ra
D
Practise appropriate
prescribing of analgesia
112
-
63
-
Physical Symptoms in Absence of Organic Disease
The physician associate will be able to assess and appropriately investigate

a patient to conclude that organic disease is unlikely, counsel sensitively,
and formulate an appropriate management plan
List symptoms that Take a full history, Adopt attitude that

commonly have a including associated presentation has organic
non-organic symptoms of anxiety or cause until otherwise proven,
component depression and past and assess and investigate
medical assessments as appropriate
Perform full examination Consult senior promptly
t
including mental state when appropriate
en
um
Recognise the Strive to establish underlying
hyperventilation precipitants to non-organic
syndrome presentations: life stresses,
hypochondriacal states
oc
Appreciate the implications of

D
unnecessary tests in terms of

cost and iatrogenic
complications
ft
ra
D
113
-
64
-
Polydipsia

polydipsia to produce a valid differential diagnosis, investigate
Understand mechanisms Identify other pertinent Sympathetically explain

of thirst symptoms e.g. nocturia likely causes of polydipsia
to patient
Identify common causes Order, interpret and act

of polydipsia on initial investigations Use appropriate aseptic
appropriately techniques for invasive
procedures and to minimise
t
healthcare acquired
en
infection.
Initiate adequate initial
therapy
um
oc
D
ft
ra
D
114
-
65
-
Polyuria

polyuria to produce a valid differential diagnosis, investigate appropriately,
Define true polyuria Identify other pertinent Consult senior colleague

symptoms as appropriate
Outline the causes of

polyuria (in terms of Perform full examination
osmotic, diabetes to assess volaemic
insipidus etc) status, and elicit
associated signs
t
en
Outline the
pathophysiology of Order, interpret and act
um
diabetes insipidus on initial investigations
appropriately
oc
Elucidate the principles

of treating new onset Calculate and interpret
diabetes mellitus, serum and urine
hypercalcaemia osmolarity
D
ft
Commence treatment as
ra
appropriate
D
115
-
66
Pruritus -
The physician associate will be able to assess a patient presenting with itch
to produce a valid differential diagnosis, investigate appropriately, formulate
Recall principle causes Examine to elicit signs of Recognise the need for
in terms of infestations, a cause for pruritus specialist dermatological
primary skin diseases, input
systemic diseases (e.g.
lymphoma), liver
disease, pregnancy Describe accurately any
associated rash Recognise the need for
other specialists in
pruritus heralding
Outline the principles of systemic disease
t
treating skin conditions Formulate a list of
en
differential diagnoses um
Outline the indications of
and side effects of Order, interpret and act
topical steroids and on initial investigations
differentiate their appropriately
different potencies
oc
Recognise the
D
presentation of skin
cancer
ft
ra
D
116
-
67
-
Rectal Bleeding
The physician associate will be able to assess a patient with rectal bleeding
to identify significance differential diagnosis, investigate appropriately,
Recall the causes of Perform examination Liaise with senior and

bleeding per rectum including rectal surgical team when
examination appropriate
Outline indications for

surgical review Recognise and Recognise role of IBD
appropriately treat the nurse when patient with
shocked patient including known IBD presents
t
consultation with surgical
en
Outline the treatments colleagues
indicated in acute colitis
um
appropriately
oc
Distinguish upper and

D
lower GI bleeding
ft
ra
D
117
-
68
-
Skin and Mouth Ulcers

skin or mouth ulceration to produce a valid differential diagnosis,
(see also Dermatology in Section 2 for Skin Tumour competencies)

Behaviour
List the common and Recognise likely skin Recognise the

serious causes of skin and oral malignancy importance of
(especially leg) or mouth prevention of pressure
ulceration ulcers and diabetic
ulcers
Recognise life
threatening skin rashes
t
Outline the classification of presenting with ulcers,
en
skin ulcers by cause commence treatment Participate in multi-
and involve senior disciplinary team: nurse
specialists, podiatrist
um
Outline the pathophysiology,
investigation and Assess and formulate
management principles of immediate management
oc
diabetic ulcers plan for diabetic foot

ulceration
D
Recognise association
between mouth ulceration Order, interpret and act
and immunobullous disease on initial investigations
ft
appropriately
ra
D
118
-
69
Speech Disturbance -
The physician associate will be able to assess a patient with speech

disturbance to produce a valid differential diagnosis, investigate
Define dysphonia, Take a history from a Recognise the role of

dysarthria and dysphasia patient with speech speech and language
disturbance therapy input
Recall the neuro-

anatomy relevant to Examine patient to define Recognise the
speech and language nature of speech relationship between
disturbance and elicit dysarthria and swallowing
other focal signs difficulties and advise
t
en
patients and carers
Differentiate receptive accordingly
and expressive
dysphasia List differential diagnoses
um
following assessment
Involve stroke team or
neurology promptly as
List causes for appropriate
oc
dysphonia, dysarthria Order, interpret and act

and dysphasia on initial investigations
appropriately
D
ft
ra
D
119
-
70
-
Suicidal Ideation
The physician associate will be able to take a valid psychiatric history to

elicit from a patient suicidal ideation and underlying psychiatric pathology;
assess risk; and formulate appropriate management plan
Outline the risk factors Take a competent Liaise promptly with

for a suicidal attempt psychiatric history psychiatric services if in
doubt or when high risk of
repeat self harm is
suspected
Outline the common co- Be familiar with scoring
existing psychiatric tools to assess risk of
pathologies that may further self harm (eg
precipitate suicidal Beck’s score) Recognise the role of the
t
ideation Self Harm Team prior to
en
discharge
Elicit symptoms of major

um
Outline the indications, psychiatric disturbance
contraindications and Ensure prompt
side effects of the major communication is
groups of psychomotor maintained with
oc
medications Obtain collateral history community care on

when possible discharge (GP, CPN)
D
Outline the powers that

enable assessment and Recognise and manage
treatment of patients appropriately anxiety and
ft
following self harm or aggression

self harm ideation as
ra
defined in the Mental

Health Act
D
120
-
71
-
Swallowing Difficulties
The physician associate will be able to assess a patient with swallowing

difficulties to produce a valid differential diagnosis, investigate appropriately,
Outline the physiology of Elicit valid history, Recognise importance of

swallowing detecting associations multi-disciplinary approach
that indicate a cause: to management
weight loss, aspiration,
heartburn
swallowing problems
Examine a patient to
t
elicit signs of
en
Differentiate between neurological disease,
neurological and GI causes malignancy and
connective tissue
um
disease
Outline investigative options:

contrast studies, endoscopy,
oc
manometry, CT Be able to evaluate

whether patient is safe
to eat or drink by mouth
D
Outline the pathophysiology,

staging, and therapeutic
options of oesophageal
ft
malignancy
ra
D
Define odynophagia and list

causes
121
-
72
-
Syncope & Pre-syncope

syncope to produce a valid differential diagnosis, investigate appropriately,
formulate and implement a management plan (see also ‘
blackouts/collapse’)
Define syncope Take thorough history Recognise impact

from patient and witness episodes can have on
to elucidate episode lifestyle particularly in the
elderly
Outline the
pathophysiology of
syncope depending on Differentiate pre-syncope
situation (vaso-vagal, from other causes of Recognise
cough, effort, micturition, ‘dizziness’ recommendations
t
carotid sinus regarding fitness to drive
en
hypersensitivity) in relation to syncope
Assess patient in terms of

um
ABC and degree of
Differentiate from other consciousness and Recognise and act upon
causes of collapse in manage appropriately criteria for referral for
terms of associated carotid sinus
oc
symptoms and signs, hypersensitivity studies.

and eye witness reports
Perform examination to
elicit signs of
D
cardiovascular disease
Outline the indications
for cardiac monitoring
ft
ra

appropriately: blood tests
D
ECG
122
-
73
Unsteadiness / Balance Disturbance -

unsteadiness or a disturbance of balance to produce a valid list of
differential diagnoses, investigate appropriately, formulate and implement a
management plan
Outline the neuro- Take history from patient Recognise the importance
anatomy and physiology and attempt to define of multi-disciplinary
relevant to balance, complaint as either pre- approach: physio, OT
coordination and syncope, vertigo or
movement unsteadiness
Define and differentiate Perform full physical

types of vertigo and list examination to elicit signs
t
en
causes of neurological, inner ear
or cardiovascular disease
including orthostatic
hypotension
um
Define and differentiate
sensory and cerebellar
ataxia and list causes
Describe an abnormal
oc
gait accurately
D
Recognise intoxication
ft
ra
Initiate basic
investigations and urgent
treatment with vitamins
D
when appropriate
123
-
74
-
Visual Disturbance (diplopia, visual field deficit, reduced acuity)
The Physician Associate should be able to assess the patient presenting

with a visual disturbance to produce a valid differential diagnosis,
Broadly outline the basic Perform full examination In case of acute visual
anatomy and physiology including acuity, eye loss recognise early
of the eye and the visual movements, visual fields, requirement for review by
pathways fundoscopy, related Ophthalmology team
cranial nerves and
structures of head & neck
Define the different types Recognise rapidly

of visual field defect and progressive symptoms
t
list common causes Formulate differential and consult senior
en
diagnosis um promptly
Define diplopia and list

common causes Order, interpret and act Recognise anxiety acute
on initial investigations visual symptoms invoke in
appropriately patients
oc
List common causes for

reduced visual acuity
D
ft
ra
D
124
-
75
Weight Loss -

unintentional weight loss to produce a valid differential diagnosis,
List the common causes Take a valid history Recognise multi-factorial

for weight loss (in terms highlighting any risk aspect of weight loss,
of psychosocial, factors for specific especially in the elderly
neoplasia, disorders presenting with
gastroenterological etc) weight loss, and a
thorough social history
Recognise prominence of
psychosocial factors, with
Outline the indications collateral history where
and complications for Examine fully to elucidate possible
t
nutritional supplements, signs of disorders
en
and enteral feeding presenting with weight
including PEG/NG loss, and also assess
feeding degree of malnutrition Liaise with nutritional
um
services appropriately

oc
on initial screening
investigations
D
Initiate nutritional
measures including
ft
enteral preparations
when appropriate
ra
D
Pass a fine bore NG

feeding tube and ensure
correct positioning
125
D
ra
ft
D
oc
um
en
t
126
Core Clinical and Procedural Skills which the Newly Qualified Physician
Associate should be able to undertake safely and competently.
1: Intermediate Life Support (ILS)

2: Measure Blood Pressure- Adult
3: Measure Blood Pressure-Child
4: Venepuncture
5: IV cannulation
6: Arterial Blood Gas Sampling
7: Urethral Catheterisation-Male
8: Urethral Catheterisation-Female
9: Perform and Interpret and Electrocardiogram (ECG)
10: Perform and Interpret Peak Flow
11: Complete a Paediatric Growth Chart
12: Perform and Interpret Urine Dip-stick Analysis
13: Principles of Manual Handling
t
14: Blood cultures
en
Although Unable to Undertake the Following Procedures Within the NHS at the
Present Time the Newly Qualified PA should also know how to perform the
um
following:
Injection –IV
oc
Injection- IM
Injection –SC (Insulin, LMW Heparin)
Prepare and administer IV medications and fluids
D
Safely administer blood and blood products

Oxygen Administration
ft
Airways Care including simple adjuncts (Guedal airway)

ra
D
127
29

PA Curriculum Matrix

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National Practitioner Programme

Matrix specification of Core Clinical Conditions for the Physician

Matrix specification of Core Clinical

(WORKING DOCUMENT TO BE READ IN CONJUNCTION WITH THE

Specification of core clinical conditions

Model for categorising clinical conditions on the basis of required competence

Examples of core conditions matrices

Symptom Based Competencies

‘The Top 20’ – Common Medical Presentations

Core clinical and procedural skills

Dr Prakash Abraham Consultant Endocrinologist

Dr Christopher Skinner Consultant Acute Physician

Specification of core clinical conditions

The model on the following page describes a two-dimensional categorisation

The categorisation of conditions relates to the expected competence on

• an example of specification on the basis of a disease process; and

• an example of specification of conditions on the basis of a clinical

Y axis: Is the Physician Associate competent to take responsibility for management of

YES – Category 1 NO – Category 2

The Physician Associate is Once the condition has been

able to diagnose the diagnosed, either by their

condition in a patient who is supervising doctor or a

normally be able to manage to manage the condition

The Physician Associate is able The Physician Associate is

have the knowledge/resources patient and condition once

As with most models, this is something of an oversimplification of reality. Relatively simple

X axis: Taking a significant role in the diagnostic process?

Definitely Definitely not

Physician Associate may

referral is necessary becomes exacerbated

Physician Associate Condition may be

diagnoses but recognises diagnosed/managed by a

necessary despite not may be part of patient

Examples of core conditions matrices

Female reproductive: dysmenorrhoea

Renal and GU: cystitis

Mental health: phobias Mental health: autistic disorder

Gastro-intestinal: acute pancreatitis Gastro-intestinal: pancreatic neoplasms

Female reproductive:placenta Female reproductive: carcinoma cervix

praevia Neurological: Guillain-Barré syndrome

Metabolic and endocrine: thyroiditis Renal and GU: renal vasculitis

Example of a complete single system matrix:

Paroxysmal supraventricular tachycardia Tetralogy of Fallot

Ventricular tachycardia Valvular disease

Peripheral vascular disease

Example of core conditions related to a particular disease process:

Acute bacterial conjunctivitis

Example of a condition matrix for a clinical presentation: Chest Pain

Taking a significant role in the diagnostic process?

Pulmonary embolism Fungal pneumonia

Core Clinical Conditions

1A-The PA plays a significant role in the diagnosis and takes significant

Arterial embolism/ thrombosis 1B

Acute limb ischaemia 1A

Bundle branch block (left & right) 1A

Congenital Heart Disease

Ischaemic Heart Disease

Other Cardiovascular Problems

Infectious Respiratory Disorders

Obstructive Pulmonary Disease

Neoplastic Pulmonary Disease

Restrictive Pulmonary Disease

Idiopathic pulmonary fibrosis 2B