MRCPUK

Part 1
Compiled and

edited by the

MRCP(UK)

Syllabus
Part 1

Examining Board

and

published for the

Federation of

Royal Colleges of

Physicians of the UK

by the MRCP(UK)

Central Office

Royal College of Physicians of Edinburgh

Royal College of Physicians & Surgeons of Glasgow

Royal College of Physicians of London

1
MRCPUK Part 1 Syllabus
MRCPUK
Part 1
Syllabus

Compiled and edited by the

MRCP (UK) Part 1 Examining Board

MRCP (UK) Central Office

Royal Colleges of Physicians

 1999 ROYAL COLLEGES OF PHYSICIANS

Royal College of Physicians of Edinburgh

9 Queen Street
Edinburgh EH2 1JQ

Royal College of Physicians & Surgeons of Glasgow

234/242 St Vincent Street
Glasgow G2 5RJ

Royal College of Physicians of London

11 St Andrews Place
Regents Park
London NW1 4LE

All rights reserved. No part of this publication may be

reproduced, stored in a retrieval system, or transmitted, in
any form or by any means, electronic, mechanical,
photocopying, recording or otherwise without the prior
permission of the copyright owners.

First Published 1999

F OREWORD

The MRCP (UK) Part 1 Examination for the Membership of the Royal Colleges
of Physicians of the United Kingdom was introduced in October 1968. Since
then there have been major developments in the study of medical education
and the certification of competence worldwide. These developments have
had an impact both on generic and specialist training. The Royal Colleges of
Physicians are committed to the academic development of medical
education and as part of that commitment are publishing a raft of
publications covering various aspects of the MRCP (UK) Examination. The
Syllabus for the MRCP (UK) Part 1 Examination is a key element in the Royal
Colleges' on-going commitment to candidates and their tutors.

This Syllabus covers those areas of knowledge tested in the MRCP (UK) Part 1
Examination. We believe that a thorough knowledge of common and
important disorders is essential and that candidates should also have an
understanding of basic sciences relevant to medical practice so that not only
can physicians in training develop their full clinical and academic potential
but also achieve success in the Examination.

A major aim of the MRCP (UK) Part 1 Examination is to encourage candidates

to read widely thereby providing a sound basis for continuing medical
education. It has been shown that over-reliance on tests of clinical
performance and clinical skills alone causes candidates to limit their study to
those conditions that they see routinely on ward rounds and the result is
that physicians in training do not read broadly about other common and
important clinical problems and relevant clinical science.

I
 The current Examination employs multiple true/false MCQs to test a large
body of core knowledge which is at a level appropriate for this stage in a
young physician's professional development.

Our hope is that this Syllabus will assist candidates and their tutors in
knowing the extent of knowledge required to pass the Examination.
Although each diet will not test every area of knowledge detailed in the
Syllabus, the Examination should be viewed as a representative sample of
the items of knowledge set out in the following pages. The Syllabus should
be used in conjunction with the MRCP (UK) Part 1 Examination papers which
are being published simultaneously.

This Syllabus could not have been produced without the considerable input
of the following past and present members of the MRCP (UK) Part 1
Examining Board, though the Medical Secretary and Chairman of the Board
bear prime responsibility for the edited script:

David Barnett Frank Dunn

Nicholas Bateman Christopher Ellis
Michael Besser Paul Emery
Michael Buckley Gordon Erskine
Desmond Canavan Michael Ford
Nigel Cooke Ray Fox
Jane Dacre Roderick Hay
John Dagg Parveen Kumar
Kar Neng Lai John Scadding
Kok-Onn Lee John Thomson
Ken Lim Allister Vale
Gary Love John Walls
Christopher McManus Alexander Wong
Christine Rodger Andrew Zealley

II
In addition, the comments of Kate Horne and Jim Benson, both of Central
Office, are acknowledged gratefully. Barbara Reeves prepared the
manuscript for press notwithstanding multiple revisions. John Reid of Metro
Press was a constant source of assistance as this series of books on the MRCP
(UK) was produced. Kenneth Cochran and John Thomson generously assisted
with proof reading.

It is intended that the 2000/2001 Syllabus will be published in late 2000 to

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

Jane Dacre Allister Vale

Medical Secretary Chairman

MRCP (UK) Central Office

11 St Andrews Place
London NW1 4LE

November 1999

III
C ONTENTS
Introduction 1
Entry requirements 1
Purpose and academic aims 2
Content of the Examination 3
Assessment of a candidate's performance 4
Quality of the Examination 4
Syllabus 4
Genetics 5
Cell, molecular and membrane biology 5
Anatomy 6
Physiology, biochemistry and metabolism 6
Immunology 7
Immunology and immunological tests 7
Clinical conditions 7
Management 9
Infectious diseases and tropical medicine 10
Microbiology 10
Immunology of infectious diseases 10
Pathophysiology 10
Epidemiology 10
Treatment 11
Specific infections 11
Statistics, epidemiology and evidence-based medicine 13
Descriptive statistics 13
Graphical techniques 13
Inferential techniques 14
Evidence-based medicine 14
Clinical trials 14
Clinical haematology 15
Iron metabolism 15
Megaloblastic anaemias 15
Haemolytic anaemias 15
Other anaemias 16
Polycythaemia and myeloproliferative disorders 16
White cell disorders 16
Disorders of haemostasis 16
Clinical pharmacology, therapeutics and clinical toxicology 17
Pharmacology 17
Clinical pharmacokinetics 17

V
 Monitoring drug therapy 17
Adverse drug reactions 18
Drug interactions 18
Pharmacogenetics 18
Therapeutics for specific patient groups 18
Clinical toxicology 19
Criteria for selecting drugs in a therapeutic class 19
Drug formulations and routes of administration 20
Rheumatology 21
Clinical science 21
Clinical conditions 22
Investigations 23
Management 23
Cardiology 24
Anatomy and physiology 24
Pathophysiology and pathology 24
Cell biology 25
Clinical pharmacology 25
Clinical cardiology 25
Respiratory medicine 27
Anatomy and physiology 27
Pathophysiology and pathology 27
Cell biology and genetics 28
Clinical pharmacology 28
Clinical conditions 28
Neurology 30
Neuroanatomy 30
Neurophysiology 30
Neurogenetics 30
Cell biology 31
Neuropharmacology 31
Neuropathology 31
Clinical neurology 31
Psychiatry 33
Mental state 33
Aetiological factors in psychiatric illness 33
Investigations 33
Syndromes of psychiatric disorder and their treatment 33

VI
 Psychiatric aspects of physical disease 34
Mental retardation 34
Gastroenterology 35
Clinical science 35
Clinical nutrition 35
Disorders of the mouth, tongue and salivary glands 36
Disorders of the oesophagus and stomach 36
Functional disorders 36
Disorders of the small intestine 37
Disorders of the liver, biliary tree and pancreas 37
The acute abdomen 38
Inflammatory bowel diseases 38
Colorectal disorders 38
Endocrinology 40
Thyroid 40
Hypothalamus/Pituitary 40
Adrenal 41
Ovary 41
Testis 42
Growth 42
Parathyroid/bone 42
Diabetes mellitus 43
Disorders of lipid metabolism 43
Nephrology 44
Physiology 44
Molecular biology and genetics 44
Glomerular and tubular disorders 44
Infections of the kidney 45
Calculus formation within the urinary tract 45
Acute and chronic renal failure 46
Hypertension and renal problems in pregnancy 46
Drugs and the kidney 46
Renal replacement therapy 46
Dermatology 47
Basic science 47
Clinical dermatology 47
Investigation 48
Drugs and therapy 48

VII
I NTRODUCTION
There are three Royal Colleges of Physicians in the United Kingdom: the Royal
College of Physicians of Edinburgh, the Royal College of Physicians and
Surgeons of Glasgow and the Royal College of Physicians of London. All three
Colleges share a common Membership Examination; Part 1 was introduced in
October 1968. Since January 1971, the Royal College of Physicians of Ireland
has used the MRCP(UK) Part 1 Examination as the first part of its
examination leading to Membership of the Royal College of Physicians of
Ireland. In addition, the School of Postgraduate Medical Studies in Singapore
uses the MRCP(UK) Part 1 Examination paper as Part 1 of its Master of
Medicine (Singapore) degree.

Although divided into two parts the MRCP(UK) is a single examination.

MRCP(UK) Part 1 is not in itself a diploma, nor does it carry Membership
status.

E NTRY REQUIREMENTS

To meet the entry requirements for the Part 1 Examination, you must hold
an acceptable medical qualification. You will not be admitted to the
Examination before the expiry of 18 months from the date of your
graduation. Further details are given in the Regulations.

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 P URPOSE AND ACADEMIC AIMS

The Part 1 Examination is set at a level which is appropriate for medical

graduates of some two years standing. The MRCP(UK) Part 1 Examination is
designed to identify those physicians in training who have a broad
knowledge and understanding of basic sciences relevant to medical practice
as well as of common or important disorders.

The MRCP (UK) has three main academic aims:

• To test a wide range of up-to-date medical knowledge so that physicians

in training are encouraged to develop their full clinical and academic
potential;

• To maintain and improve the practice of clinical medicine;

• To provide a sound basis for continuing medical education.
The practice of high quality medicine necessitates that you have knowledge
of important new advances in disease mechanisms, an understanding of
evidence-based medicine, and an ability to apply this knowledge and
understanding in the management of patients. Preparation for the
Examination will encourage you to acquire relevant knowledge and
understanding.

It is important that you develop skills and acquire professional habits which
will enable you to keep abreast of current medical knowledge and new
developments. Preparation for the Examination will help you to develop such
skills and professional habits. Hence, reading the medical literature and
attending relevant medical meetings should be a normal part of your
professional life.

2
C ONTENT OF THE EXAMINATION

The Examination currently consists of 60 multiple choice questions (MCQs)

which are designed to test your knowledge of a wide range of topics in
general medicine including the scientific basis of clinical practice.

As a general guide you will wish to know that there are some 14 clinical
science MCQs in the Part 1 Examination and these are made up as follows:

Genetics 1-2
Cell, molecular and membrane biology 2-3
Anatomy 2
Physiology, biochemistry and metabolism 5-6
Immunology 2-3
Statistics, epidemiology and evidence-based medicine 1

In addition, questions are set on common or important clinical disorders

as follows:

Infectious diseases and tropical medicine 4

Clinical haematology 4
Clinical pharmacology, therapeutics and toxicology 6
Rheumatology 2
Cardiology 4
Respiratory medicine 4
Neurology 4
Psychiatry 4
Gastroenterology 4
Endocrinology 4
Nephrology 4
Dermatology 1
Sexually transmitted diseases 0-1

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 ASSESSMENT OF A CANDIDATE ’ S PERFORMANCE

Your answer sheet is machine read and it is therefore imperative that you
adhere strictly to the Examination instructions in completing your answer
sheet.

The MRCP(UK) Part 1 Examination currently assesses your performance in

relation to that of other candidates and not by means of an external
standard of performance set by the examiners. As a result the pass mark
(but not the pass rate which is currently approximately 35 per cent) does vary
at each Examination.

Q UALITY OF THE EXAMINATION

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

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

4
G ENETICS
You should have an understanding of the structure and function of
chromosomes and genes and a knowledge of the principles of inheritance of
chromosomal and genetic disorders.

Examples of question topics might include:

• Inherited diseases
• Chromosome structure
• Common chromosome abnormalities

C ELL , MOLECULAR AND MEMBRANE BIOLOGY

The cell is the fundamental unit of the structure of organs. It is important

that you understand the structure and function of the components of the
cell and its membrane. You should understand how cells communicate
internally and with each other by means of chemical substances and
membrane receptors.

Examples of question topics might include:

• Function of intracellular organelles

• Cellular communication

5
 A NATOMY
Clinically relevant anatomy will be tested, including neuroanatomy.

Examples of question topics might include:

• Peripheral nerve lesions

• Cranial nerve abnormalities
• Dermatomes, myotomes and reflexes

P HYSIOLOGY, BIOCHEMISTRY AND METABOLISM

It is essential that you understand the structure and function of the different
organs which make up the body and how these organs interact, such as
through hormonal and neural influences. You should know the broad
principles of metabolism such as the production of energy and the pathways
of carbohydrate, protein and lipid metabolism, but a detailed knowledge of
the chemical processes in the steps of the metabolic pathways is not
necessary. You should have an understanding of the principles of nutrition,
water, electrolyte and acid-base balance. Knowledge of the physiology and
biochemistry of each organ system is examined under that specialty.

Examples of question topics might include:

• The mechanism of blood pressure control

• Acid-base balance

6
I MMUNOLOGY
Although a detailed knowledge of basic immunology and immunological
diseases is not required, you should have a sound working knowledge of the
principles of immunomechanisms.

Examples of question topics might include:

• Humoral and cell-mediated immunity

• Immunodeficiency syndromes
• Phagocytic dysfunction diseases
• Complement deficiencies
• Hypersensitivities including allergies and autoimmune diseases
Immunology and immunological tests
You should have a basic knowledge of the immune system in health and
disease.

Examples of question topics might include:

• Common immunological laboratory tests

• Evaluation of patients with immune disease
• Intercellular communication and signal transduction
• Lymphocyte and phagocytic cell biology
• Antigen presentation
• Humoral, cellular and mucosal immunity including TH1 and TH2
responses
• Inflammation
• Complement system and cytokines
• Hypersensitivity and autoimmunity

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

7
 Examples of question topics might include:

• Mechanisms of immunodeficiency
• Antibody immunodeficiency disorders
• T-cell immunodeficiency disorders
• Combined antibody and cellular immunodeficiency disorders
• Phagocytic dysfunction diseases
• Complement deficiencies
You should know the main clinical characteristics and immediate
management of acute allergic emergencies.

Examples of question topics might include:

• Anaphylaxis
• Angio-oedema
• Urticaria
You should be familiar with immunology as applied to other medical
diseases.

Examples of question topics might include immunomechanisms in:

• Rheumatic diseases (connective tissue diseases)

• Endocrine diseases (thyroid autoimmune diseases, diabetes mellitus,
Addison's disease)
• Haematological diseases (pernicious anaemia, autoimmune haemolytic
anaemia, idiopathic thrombocytopenic purpura)
• Gastrointestinal diseases (Coeliac disease, inflammatory bowel disease,
hepatobiliary diseases)
• Renal diseases (Goodpasture's syndrome, immune-complex
glomerulonephritis)
• Dermatological diseases (discoid lupus, pemphigus, pemphigoid)
• Neurological diseases (demyelinating diseases, myasthenic syndromes)

8
Management
You should be able to answer questions on the principles of
immunosuppressive therapy including major indications and side-effects.

Examples of question topics might include:

• Immunosuppressive drug therapy (corticosteroids, cytotoxic agents, and

cyclosporin)
• Intravenous immunoglobulin
• Monoclonal antibodies
• Cytokine therapy
• Bone marrow transplantation

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

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 I NFECTIOUS DISEASES AND TROPICAL MEDICINE

Microbiology
You should understand the major taxonomy of bacteria in terms of
Gram-staining and aerobic/anaerobic metabolism. Virus classification is
not important except for members and characteristics of the herpes group.
Virus replication with reference to retroviruses should be understood. Major
pathogenic protozoa and helminths should be known.

Examples of question topics might include:

• Aerobic or anaerobic bacteria

• Gram-staining characteristics of bacteria
Immunology of infectious diseases
You should understand immune deficiency states linked with types of
opportunistic infections. Principles of immunisation and knowledge of
vaccines currently used should also be known.

Examples of question topics might include:

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

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

10
 Examples of question topics might include:

• Mechanisms of transmission of pathogens

• How epidemics happen
• Knowledge of carrier states, reservoirs, vectors and zoonoses
• Elementary concepts of the control of communicable diseases (including
immunisation, isolation, contact tracing, chemoprophylaxis of close
contacts)
• Broad awareness of geographical variation in disease including TB, HIV,
Hepatitis B, malaria

Treatment
You should know the broad indications for, and major adverse effects of,
commonly employed antimicrobial agents.

Examples of question topics might include:

• B-lactams
• Tetracyclines
• Macrolides
• Aminoglycosides
• Quinolines
• Trimethoprim
• Metronidazole
• Antituberculous drugs
• Antimalarial drugs
• Antiviral agents
Specific infections
Knowledge of the characteristics, recognition, prevention, eradication and
pathological effects of all commonly encountered bacteria, viruses, rickettsia,
fungi, protozoa, parasites and toxins, including an understanding of the
principles of infection control, will be required. Special attention to
differential diagnosis, appropriate investigations and awareness of when
presumptive therapy is indicated is essential.

11
 Examples of question topics might include:

• Septicaemia
• Meningitis and encephalitis
• Endocarditis
• Pneumonia (community-acquired, hospital-acquired, lung abscess,
empyema)
• Tuberculosis
• PUO (appropriate investigations, when empirical therapy might be
indicated)
• Soft-tissue infection and osteomyelitis
• Streptococcal infection, rheumatic fever, nephritis
• Intra-abdominal sepsis
• Food-poisoning (especially salmonellosis, campylo-bacter, verocytotoxin
producing E coli)
• Tropical infections (especially malaria, bilharzia, amoebiasis, filariasis,
leishmaniasis, hookworm and viral haemorrhagic fevers)
• Viral hepatitis
• HIV/AIDS (course of typical infection; CD4 count and HIV viral load as
markers of progression; main opportunistic infections including
Pneumocystis pneumonia, CNS toxoplasmosis, cryptococcal meningitis,
tuberculosis)
• Glandular fever syndrome and its differentiation from HIV
seroconversion illness
• Spirochaetosis - syphilis, leptospirosis, borrelia
• Toxic shock syndrome and staphylococcal infections

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S TATISTICS , EPIDEMIOLOGY AND
EVIDENCE - BASED MEDICINE
You should have a basic understanding of the usage and limitations of the
common statistical tests used in reporting the results of research in clinical
journals. The following lists of terms should give some idea of the range of
terms and techniques which you should understand, all of which can be
found regularly in journals such as The Lancet, British Medical Journal and
New England Journal of Medicine.

You are not expected to have any knowledge of computer packages for
carrying out statistical calculations. You may be expected to carry out simple
calculations that do not require the use of a calculator. You are not expected
to memorise formulae for statistical tests, but should understand their
conceptual basis.

The following lists are not intended to be inclusive but as illustrative of the
type of knowledge that you need to possess.

Descriptive statistics
Examples of question topics might include:

• Mean, median, mode

• Standard deviation, standard error
• Confidence interval
• Variance
• Range, quartile, inter-quartile range
• Percentile
• Skewness
• Contingency table
• Population
• Missing values
• Outliers
Graphical techniques
Examples of question topics might include:

• Histogram
• Box-plot
• Scattergram

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 Inferential techniques
Examples of question topics might include:

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

Clinical trials
Examples of question topics might include:

• Interpretation of simple clinical trial data

• Randomisation
• Placebo-controlled trial
• Open trial
• Single-blind trial
• Double-blind trial
• Intention-to-treat
• Bias

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C LINICAL HAEMATOLOGY

You will be expected to have knowledge of the following:

• Physiology, control and function of formed blood elements

• Bone marrow structure and function
• Applications of biochemistry, genetics, immunology, and virology to
blood disorders
• Effects of age and pregnancy on blood disease
• Splenomegaly, lymphadenopathy, and their causes
• Principles and hazards of blood and blood product replacement therapy
• Principles, but not detail, of anti-tumour chemotherapy
• Principles of marrow transplantation
• Adverse effects of drugs on the blood

Iron metabolism
You should have an understanding of:

• Physiology of iron, including its absorption

• Iron overload
• Iron deficiency states including diagnosis, causes and treatment
• Iron metabolism, including anaemias of chronic disorders and
sideroblastic anaemias

Megaloblastic anaemias
You should understand the physiology of vitamin B12 and folic acid and the
mechanisms and investigation of deficiencies and their management.

Examples of question topics might include:

• B12 deficiency
• Folate deficiency
Haemolytic anaemias
You should understand:

• Mechanisms of shortened red cell survival

• Features and management of congenital and acquired haemolytic states

15
 • Molecular pathology of thalassaemia and common
haemoglobinopathies

Examples of question topics might include:

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

• Anaemias complicating systemic disease

• Aplastic anaemia
• Myelodysplastic syndromes
Polycythaemia and myeloproliferative disorders
You should know the causes, investigation and management of
polycythaemia and myeloproliferative disorders.

White cell disorders

You should understand the:

• Physiology of leucocytes
• Leucocytosis and leucopenia
• Acute and chronic leukaemias, including diagnosis, management and
prognosis
• Lymphoproliferative diseases including Hodgkin's disease, non-Hodgkin’s
lymphomas, and plasma cell dyscrasias

Disorders of haemostasis
You should possess knowledge of:

• Platelet function and coagulation

• Thrombocytopenia and impaired platelet function
• Thrombocytosis
• Common congenital and acquired disorders of coagulation (especially
anticoagulant therapy and disseminated intravascular coagulation)

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

Pharmacology
You should understand the:

• Mechanisms by which drugs produce their pharmacological effects

• Basic principles of agonism and antagonism
• Clinical implication of drugs that act at different receptor sites
• Links between the pharmacological effects of drugs at the molecular
level, the cellular level, and the tissue/organ level, and how these are
affected by disease processes and other drugs
• Principles by which both therapeutic and adverse effects occur

Clinical pharmacokinetics
You should understand the principles that underlie:

• Processes of drug absorption and distribution

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

Monitoring drug therapy

You should understand the principles that underlie the monitoring of drug
therapy including:

• Direct measurement of therapeutic response

• Measurement of plasma drug concentrations
• Knowledge of the scientific basis for the measurement of drug
concentration and its link to the principles of pharmacokinetics

17
 Emphasis will be given to the areas of clinical practice and therapeutics
where the narrow therapeutic range of particular pharmacokinetic
properties of the drug make this approach important.

Adverse drug reactions

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

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

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

Therapeutics for specific patient groups

You should understand the principles of therapeutics as they apply in the
following circumstances:

• The elderly
• Pregnancy and breast feeding
• Patients with renal disease
• Patients with hepatic disease
You should understand that the altered physiology in these patient groups
may affect the pharmacokinetics and pharmacodynamics of drugs. You

18
 should know the principles underlying drug choice, in pregnancy and breast
feeding, and have an understanding of the teratogenic effects of drugs that
may be used in pregnancy. In the case of renal and hepatic disease it is also
necessary for you to have an understanding of drugs that may produce
toxicity of these organs and whose use is particularly affected by disease of
these organs.

Clinical toxicology
You should understand the principles of management of patients who have
been poisoned with drugs or other toxic substances. This should include
assessment, recognition of common symptom patterns, principles of
removal of toxic substances, and their antidotes where these approaches
may be appropriate.

Examples of question topics might include:

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

• Differences in pharmacokinetics and pharmacodynamics

• The approved indications of the drug
• Possible adverse effects or drug interactions
• Cost effectiveness
You should also be aware of the nomenclature used in describing studies
that may be used to underpin drug selection.

19
 Drug formulations and routes of administration
You should be aware of the various formulations of medicines available, and
of the routes by which medicines may be administered. You should also
understand the advantages and disadvantages of various routes and
preparations. From this knowledge, you would be expected to be able to
select the most appropriate formulation and route of drug administration in
common clinical scenarios.

20
R HEUMATOLOGY
Detailed knowledge of all the rheumatic conditions is not required. However,
you should have a sound working knowledge of the basic principles of the
common musculoskeletal conditions.

Examples of question topics might include:

• Inflammatory arthritis
• Back pain
• Periarticular disorders
• Osteoarthritis
• Connective tissue diseases
• Bone diseases
Clinical science
Basic physiology, biochemistry, anatomy and pathology relating to
musculoskeletal disease should be known.

Examples of questions topics might include:

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

The pathology of the common rheumatic conditions should be known.

Examples of question topics might include pathological findings in:

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

21
 Clinical conditions
You should know the relative prevalence and major associations of the
common rheumatological conditions.

Examples of question topics might include the relationship to:

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

Examples of question topics might include:

• Rheumatoid arthritis and associated syndromes

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

You should be familiar with arthritis associated with other medical

conditions.

Examples of question topics might include:

• Sarcoidosis
• Erythema nodosum
• Infections and arthritis (e.g. Parvovirus B 19)

22
Investigations
You should have knowledge of the investigations relevant to the diagnosis
and assessment of rheumatic diseases.

Examples of question topics might include:

• Acute phase proteins

• Immunological tests relating to the connective tissue diseases (ANA,
anti-dsDNA, ANCA, anti-Jo1, anti-Ro)
• Contemporary imaging techniques in rheumatology (x-ray, ultrasound,
CAT scanning, MRI scanning)

Management
You should be able to answer questions on the management of acute
rheumatological emergencies.

Examples of question topics might include:

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

Examples of question topics might include:

• Non-drug related therapies (education, physiotherapy)

• Drug related therapies (indications and contra-indications, adverse
effects, drug interactions)
• Simple analgesics
• Non-steroidal anti-inflammatory drugs
• Corticosteroids
• Allopurinol
• Disease modifying anti-rheumatic drugs
• Immunosuppressive drugs

23
 CARDIOLOGY

Anatomy and physiology

You should have knowledge of the basic anatomy and physiology of the
heart in health and disease:

Examples of question topics might include:

• Clinically relevant normal anatomy of the heart, coronary arteries and

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

Pathophysiology and pathology

You should know the mechanisms underlying the main pathological
processes.

Examples of question topics might include:

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

24
Cell biology
You do not need detailed specialised knowledge of cell biology as only topics
of proven clinical relevance will be tested.

Examples of question topics might include:

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

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

Clinical cardiology
You must know the clinical features and management of the cardiac
disorders encountered in hospital practice by the general physician, though
detailed specialist knowledge is not expected. You should have knowledge
of risk factors.

Examples of question topics might include:

• Clinical features of constrictive pericarditis, cardiac tamponade,

endocarditis, valvular heart disease
• Management of acute coronary syndromes
• Management of cardiac failure
• Management issues in atrial fibrillation
• Indications for, and types of, permanent pacemaker

Knowledge of important changes in clinical practice, following the

publication of major clinical trials, is likely to be tested.

25
 Examples of question topics might include:

• Use of ACE inhibitors after myocardial infarction

• Use of HMG CoA reductase inhibitors in primary and secondary
prevention of coronary morbidity and mortality
• Use of beta-adrenoceptor blocking drugs in left ventricular dysfunction

You should know the:

• Indications for invasive and non-invasive cardiac investigation

• Principles of these investigative methods, their limitations and the
clinical relevance of the results

Knowledge of the practical aspects of the investigative techniques is not

required.

Examples of question topics might include:

• Common ECG abnormalities

• Basic echocardiographic abnormalities such as hypertrophic obstructive
cardiomyopathy or pericardial effusion
• Indications for coronary angiography

26
R ESPIRATORY MEDICINE

Anatomy and physiology

You should understand clinically relevant anatomy of the upper and lower
respiratory tract and thorax including radiological anatomy.

You should have knowledge of the principles of respiratory physiology

including:

• How respiration is controlled

• Principles of gas exchange and oxygen transport
• Ventilation-perfusion relationships
• Lung volumes and transfer factor
• Respiratory aspects of sleep and exercise physiology
You should understand the:

• Physical, humoral and cellular aspects of respiratory defence mechanisms

• Physiology of the proteinase inhibitors and pulmonary surfactant
Pathophysiology and pathology
You should understand the effects of disease on pulmonary physiology and
anatomy including:

• The pulmonary and bronchial circulations and gas exchange

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

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

27
 The microbiology of acute and chronic respiratory infections should be
known.

Cell biology and genetics

You should have knowledge of:

• Lung inflammation and repair

• Vasculitis
• Cystic fibrosis
• Anti-protease deficiency
You should understand the genetics of:

• Asthma
• Cystic fibrosis
• Alpha 1 antitrypsin deficiency
The role and value of gene therapy should be understood.

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

Clinical conditions
The clinical features, investigation and management of respiratory disease
likely to be encountered by a general physician must be known.

Examples of question topics might include:

• Pleural effusion
• Chest pain
• Haemoptysis
• Breathlessness

28
 The impact of systemic disease on the respiratory system should be known.

Examples of question topics might include:

• Vasculitis
• Neuromuscular diseases
• HIV infection
Knowledge of occupational lung disease, particularly asthma,
pneumoconiosis, and asbestos related disease is required.

You should know how to assess respiratory malignant conditions and

understand the general principles of oncological management including the
indications for surgery.

The indications for specialised investigations, including bronchoscopy, CT

scanning, lung biopsy, lung volumes and exercise testing should be known.

You should have knowledge of the investigation of sleep related disorders

and of the radiological aspects of respiratory disease.

You should know the indications for, and problems of, lung transplantation.

You should have knowledge regarding the control of Mycobacterium

tuberculosis infection.

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

29
 N EUROLOGY

Neuroanatomy
You are not expected to have detailed knowledge of neuroanatomy.
Questions with an anatomical bias will be confined to circumstances where
an understanding of anatomical structure is of critical importance in
appreciating the localisation of a particular neurological problem.

Examples of question topics might include:

• The clinical features of a lesion within the cavernous sinus

• The manifestations of a particular nerve root or peripheral nerve disorder
• The organisation of pathways within the spinal cord
Neurophysiology
Detailed knowledge of neurophysiology is not expected but, as with
neuroanatomy, certain aspects of the subject are particularly relevant to the
understanding of neurological disease and may be tested.

Examples of question topics might include:

• The formation, circulation, absorption and content of the cerebrospinal

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

Neurogenetics
You are expected to have knowledge of recent advances in the
understanding of the genetic basis for various neurological disorders.

Examples of question topics might include:

• The role of dystrophin in muscle disease

• Genetic aspects of myotonic dystrophy
• Genetic aspects of Alzheimer's disease

30
Cell biology
Questions in this area will relate to advances in the cellular mechanisms of
certain neurological disease processes which have provided better
understanding of disease mechanisms and which might, in the future, lead
to more rational therapy.

Examples of question topics might include:

• The genesis of tissue damage in stroke and the role of certain excitatory
neurotransmitters
• The role of the dopaminergic system in various extrapyramidal disorders
• The role of other neurotransmitters in certain diseases, for example, in
Alzheimer's disease

Neuropharmacology
You are expected to have some knowledge of new drug developments in
neurology, as well as the established drug therapies.

Examples of question topics might include:

• The role of some recently introduced anticonvulsants

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

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

31
 either led to better definition of disease entities, or have led to their
improved management.

In the field of cerebrovascular medicine, examples of question topics might

include:

• Epidemiological aspects, in particular the risk factors for stroke

• The evidence for the role of anti-platelet agents in transient ischaemic
attacks
• The role of carotid endarterectomy in the management of stroke patients

32
P SYCHIATRY

Mental state
You should understand the conduct and scope of a mental state
examination.

You are expected to be familiar with the features of abnormal mental states
and particularly those that present commonly to physicians and to Accident
and Emergency Departments.

Aetiological factors in psychiatric illness

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

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

• Psychometric testing
• EEG
• Brain imaging
Syndromes of psychiatric disorder and their treatment
You should have knowledge of:

• Organic brain syndromes (delirium, dementia, focal brain syndromes,

head injury)
• Schizophrenia and related syndromes
• Paranoid disorders and related syndromes
• Affective disorders (anxiety states, phobic disorders, bipolar affective
disorders)
• Grief and bereavement

33
 • Self-harm, attempted suicide, suicide
• Substance misuse (including alcohol dependence)
• Eating disorders
• Obsessive compulsive disorder
• Abnormal illness behaviour
• Syndromes associated with medically explained physical symptoms
(including somatization and somatoform syndrome)

Psychiatric aspects of physical disease

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

• Endocrine and metabolic disorders

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

34
G ASTROENTEROLOGY

Clinical science
You should understand the:

• Structure and function of the gastrointestinal and hepatobilary tract

• Neurohormonal control of gut motility
• Secretory and absorptive functions of the gastro-intestinal tract
and liver
• Symptoms and signs of gastrointestinal, hepatobiliary and pancreatic
diseases
• Genetics of the more common gastrointestinal and liver disorders
• Clinical pharmacology of drugs used in gastrointestinal disorders
including their actions, interactions and adverse effects

Examples of question topics might include:

• Control of gastric acid secretion

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

• Nutritional requirements in health

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

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

35
 • Essential dietary constituents
• Vitamin requirements
• Pathogenesis and management of obesity
Disorders of the mouth, tongue and salivary glands
You should have an understanding of:

• Mouth ulcers, periodontal and salivary disorders

• Oral manifestations of systemic and dermatological disorders
Examples of question topics might include:

• Causes of mouth ulcers and their management

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

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

• Presentation, investigation and management of oesophageal strictures

• Role of Helicobacter-associated gastritis in peptic ulcer disease
• Management of hypovolaemic shock
Functional disorders
You should have a knowledge of:

• Functional chest pain and functional dyspepsia

• Irritable bowel syndrome and functional abdominal pain
• Functional constipation and diarrhoea

36
 Examples of question topics might include:

• Neural control of visceral nociception and gut motility

• Role of emotional and psychosocial factors in illness
• Management of chronic pain and the use of pain-modifying drug therapy
Disorders of the small intestine
You should have knowledge of:

• Malabsorption syndromes and gluten enteropathy

• Hormone-secreting tumours of the gut
Examples of question topics might include:

• Aetiology, clinical and histopathological features of gluten enteropathy

• Investigations commonly used in the assessment of suspected
malabsorption

Disorders of the liver, biliary tree and pancreas

You should have knowledge of:

• Bilirubin metabolism and the enterohepatic circulation of bile acids

• Causes of jaundice and cholestasis
• Common pancreatic disorders including carcinoma
• Fulminant liver failure
• Acute and chronic hepatitis
• Drugs, toxins, alcohol and the liver
Examples of question topics might include:

• Aetiology, clinical and histopathological features of acute and chronic

hepatitic disorders
• Hepatorenal syndromes and their management
• Aetiology, presentation and management of acute and chronic
pancreatitis

37
 The acute abdomen
You should have knowledge of:

• Perforated viscus and peritonitis

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

• Common causes of acute abdominal pain and their investigation and

management
• Management of septic shock associated with intra-abdominal sepsis

Inflammatory bowel diseases

You should be familiar with:

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

• Causes, investigation and management of acute and chronic enteric

disorders
• Manifestations of inflammatory bowel disease and its complications

Colorectal disorders
You should have knowledge of:

• Polyps
• Carcinomas
• Diverticular disease
• Anorectal disorders

38
Examples of question topics might include:

• Pathology and clinical genetics of disorders presenting with colonic

polyps
• Causes and treatment of haemorrhoids, anal fissures and ano-rectal
fistulae

39
 E NDOCRINOLOGY
Although you are not expected to have a detailed knowledge of
biochemistry, it is anticipated that you will have an insight into the
mechanisms of hormone action and the importance of receptors and
substances involved in control of intracellular metabolism. You should have
a knowledge of the clinically relevant anatomical aspects of this specialty.

Examples of question topics might include:

• Factors involved in cell signalling

• Anatomical relationships of the pituitary gland
• The cell types in the pancreatic islets
• A broad understanding of the pathways of carbohydrate, protein and fat
metabolism
• Endocrine tests in routine clinical use
• Genetic aspects of endocrine disease
• Disorders affecting multiple endocrine systems

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

Examples of question topics might include:

• Thyroid hormone biosynthesis and its control

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

40
 Examples of question topics might include:

• The physiology and pathophysiology of control of pituitary hormone

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

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

Examples of question topics might include:

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

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

Ovary
You are expected to be conversant with the physiology of ovarian function
and with the conditions presenting to a physician.

Examples of question topics might include:

• Hormonal changes across the menstrual cycle

• Physiological changes in pregnancy
• The differential diagnosis of hirsutism and virilism
• Causes of amenorrhoea and anovulation
• Endocrine causes of infertility

41
 Testis
You are not expected to have a detailed knowledge of the urological
investigation of infertility but some concept of relevant investigations and of
the endocrine aspects of testicular function is required.

Examples of question topics might include:

• The aetiology of hypogonadism both primary and secondary

• Causes of male infertility related to general medical disease and its
treatment
• Causes of erectile dysfunction and its investigation
• Androgen replacement therapy

Growth
Growth is a very important topic in relation to general medicine as well as
endocrinology.

You are expected to be conversant with:

• Factors controlling growth hormone secretion

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

Examples of question topics might include:

• Control of calcium metabolism

• Laboratory tests of parathyroid function
• The causes of hypercalcaemia
• The mechanisms of osteomalacia

42
 • Hyperparathyroidism, both primary and secondary
• The differentiation of primary, secondary and pseudo-hypoparathyroidism
• The prophylaxis and treatment of osteoporosis
• Calcitonin and its role in metabolism
Diabetes mellitus
You are expected to have detailed knowledge of this very common condition.

Examples of question topics might include:

• Control of carbohydrate metabolism

• Genetics of diabetes
• Aetiology of type 1 diabetes and type 2 diabetes
• Long-term complications of diabetes
• Insulin resistance
• Management of diabetic emergencies
• Differential diagnosis and treatment of hypoglycaemia
Disorders of lipid metabolism
Although a detailed knowledge of lipid metabolism is not required, you are
expected to have an understanding of the importance of this group of
disorders.

Examples of question topics might include:

• Control of cholesterol metabolism

• Aetiology of different types of hyperlipidaemia including both
cholesterol and triglyceride disorders
• Indications for lipid lowering agents and their complications
• Types of secondary hyperlipidaemia

43
 N EPHROLOGY

Physiology
You should have knowledge of:

• Discrete functions of glomerular ultrafiltration and tubular function

• Proximal and distal parts of the nephron, with particular reference to
control of water and electrolyte balance
• Renal tubular acidosis
• Cystinuria
• Fluid, electrolyte, and acid-balance disturbances

Molecular biology and genetics

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

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

Glomerular and tubular disorders

You are expected to have some knowledge of glomerular ultrastructure
based upon techniques of light microscopy, electron microscopy and
immunofluorescence as applied to renal biopsy. These techniques form the
basis of current understanding of primary glomerular disorders as in
idiopathic glomerulonephritis, and nephropathies of systemic diseases.

Examples of question topics might include:

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

44
 Knowledge of interstitial nephritis (especially those cases with reversible
aetiology such as drugs , heavy metals and analgesics) is expected.

You should be acquainted with the metabolic sequelae of acute nephritic

and nephrotic syndromes.

You should be aware of the investigation and assessment of glomerular and

tubular disorders, including ultrasonic studies and nuclear medicine.

You should have an understanding of disturbed renal and metabolic

functions in nephrotic syndrome from a variety of causes.

Infections of the kidney

You should be familiar with the management of urinary tract infections
including their detection, predisposing factors, prevention and treatment. A
knowledge of anatomical abnormalities leading to repeated urinary tract
infection is expected.

Examples of question topics might include:

• Reflux nephropathy
• Prostatic hypertrophy
You should be aware of other infections that could affect the kidney by direct
invasion or by immune-complex deposition.

Examples of question topics might include infection of the urinary tract with:

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

45
 stone formation, their investigation, prevention and treatment.

Examples of question topics might include:

• Idiopathic hypercalciuria
• Primary hyperparathyroidism
• Cystinuria
• Hyperoxaluria
Acute and chronic renal failure
A knowledge of the management of acute and chronic renal failure and of
the disturbed physiology involved is expected. You should be familiar with
pathophysiological changes and non-dialytic treatment in different stages of
progressive renal failure.

Principles of nutritional requirements and dietary intervention for patients

with chronic renal failure is required.

Other therapeutic means to slow down the progression of renal failure

should be understood.

Hypertension and renal problems in pregnancy

You are expected to be familiar with renal adaptation to pregnancy, the
management and prophylaxis of renal disease and hypertension in
pregnancy.

Drugs and the kidney

A knowledge of the role of the kidney in the normal elimination of drugs is
expected and you should understand the mechanisms by which drugs cause
nephrotoxic damage. The principles of dose adjustment according to
residual renal function should be known.

Renal replacement therapy

A knowledge of different dialysis modalities and their complications is
expected. You should know the complications related to immunosuppressive
therapy following renal transplantation.

46
D ERMATOLOGY

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

Clinical dermatology
Many diseases affecting internal organs will present with skin signs or
symptoms. You are expected to be able to recognise the cutaneous
symptoms and signs of systemic diseases.

Examples of question topics might include:

• Collagen vascular disease such as SLE, systemic sclerosis

• Metabolic and endocrine disorders
• Infectious diseases
• Cancers
• Leukaemias
• Respiratory and cardiovascular diseases
• Common inherited diseases such as neurofibromatosis
You should have knowledge of the main dermatological complications of
therapeutic immunosuppression (for example, systemic corticosteroid
therapy, cyclosporin etc.) or of diseases such as HIV which cause
immunosuppression.

In addition you should know the differential diagnosis and plan of

investigation of patients who present with the following cutaneous signs or
symptoms which may indicate internal disease:

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

47
 • Erythema multiforme
• Purpura
• Ulceration
• Vasculitis
A knowledge of the clinical features of the following skin diseases is
required:

• Psoriasis
• Eczema
• Urticaria
• Superficial fungal infections (dermatophytosis, pityriasis versicolor)
• Common skin cancers such as melanoma
• Vitiligo and alopecia areata
• Pemphigus and pemphigold
• Cutaneous herpes virus infections (herpes simplex, varicella zoster)
• Cutaneous staphylococcal and streptococcal infections
• Leprosy
Investigation
You should know the principles but not details of dermatological
investigation such as patch testing.

Drugs and therapy

You will not be expected to have a detailed knowledge of the treatment of
skin diseases or dermatoses. However you should know the drugs which
cause life-threatening skin conditions such as erythroderma or Stevens-
Johnson syndrome, angio-oedema and toxic epidermal necrolysis.

48
 The publication of this Syllabus for the MRCP (UK) Part 1

Examination is a key element in the Royal Colleges of

Physicians commitment to candidates and their tutors. The

Syllabus is indicative of those areas of knowledge required to

pass the Examination. Although each diet will not test every

area of knowledge detailed in the Syllabus, the Examination

should be viewed as a representative sample of the items of

knowledge set out in the Syllabus.

This Syllabus should be used in conjunction with the

MRCP (UK) Part 1 Questions 2003.

Design & Print Production by Metro Press, Edinburgh

Royal College of Physicians of Edinburgh

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