MRCP UK syllabus(3 continue)

RHEUMATOLOGY

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)

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

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
CARDIOLOGY

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.

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

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.

RESPIRATORY MEDICINE

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

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.

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
NEUROLOGY

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

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

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
PSYCHIATRY

• 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.

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

GASTROENTEROLOGY

• 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

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

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

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

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.

ENDOCRINOLOGY

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

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

• 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

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

NEPHROLOGY

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
\
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.

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

DERMATOLOGY
• 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.