Cardiovascular Diseases
Hypertension
Hypertension is a common disorder that is defined as a sustained elevation of systolic blood pressure (BP) > 160 mmHg and/or diastolic BP > 90 mmHg.
Three successive readings are typically required for diagnosis.
What to learn
Risk factors and causes of primary and secondary hypertension
Long-term risks of uncontrolled hypertension
Drug treatment of hypertension
Ischemic heart disease - IHD
Ischemic heart disease is a condition caused by reduction or cessation of the blood supply to the myocardium. It gives rise to four main syndromes: stable angina, unstable angina, myocardial infarction, and sudden cardiac death. The most important cause of IHD is atherosclerosis.
What to learn
Pathophysiology and causes of atherosclerosis
Cardiac risk factors
Diagnosis and management of myocardial infarction
Interventions and drugs in the long-term management of IHD
Heart failure
Heart failure can be defined as the inability of the heart to maintain sufficient cardiac output to adequately perfuse the tissues for normal metabolism. It can be caused by conditions that damage heart muscle (e.g., IHD or cardiomyopathies) or that demand increased work of the heart (e.g., systemic hypertension or valvular heart disease).
What to learn
Causes of heart failure
Symptoms and signs of right- and left-sided heart failure
Compensatory mechanisms in heart failure
Medical management of heart failure
Arrhythmia
Any deviation from the normal sinus rhythm of the heart is known as an arrhythmia. Arrhythmias are classified clinically by the site of origin (supraventricular or ventricular) and heart rate (bradycardia or tachycardia).
What to learn
How to spell 'arrhythmia'
Causes of and risk factors for arrhythmia
Recognition of the big four: atrial fibrillation (AF), heart block, ventricular tachycardia (VT) and ventricular fibrillation (VF).
Treatment protocols: drugs, cardioversion, ablation, and defibrillation
Thromboembolic disease
This condition involves the pathological formation of thrombus and its acute complication of embolus, especially to the pulmonary vasculature. Pulmonary embolus accounts for 1% of all hospital deaths. Ninety percent of deep vein thromboses (DVTs) occur in the deep veins of the lower limb.
What to learn
Understand Virchow's triad and learn the specific risk factors for thrombosis: immobility, cardiac failure, pregnancy, the combined oral contraceptive pill (COCP), and varicose veins
Symptoms and signs of DVT and pulmonary embolism (PE)
Classification of PE from major to minor and the emergency management of PE
Anticoagulation and its role in thromboembolic disease
Heart valve disorders
Diseases of the heart valves produce two types of disorders, stenosis, and regurgitation, which can coexist in the same valve. The valvular disease can be caused by damage to the valve leaflets or to the valve ring or can be secondary to damage to the papillary muscles or chordae. Important mechanisms include degenerative calcification, rheumatic heart disease (the incidence of which is declining), and infective endocarditis.
What to learn
Concentration on the big four: mitral stenosis, mitral regurgitation, aortic stenosis, and aortic regurgitation.
Symptoms and signs of aortic and mitral valve disease.
Causes, in particular, calcification, endocarditis, and rheumatic heart disease.
Types of valve replacement and the precautions necessary in patients who have replacements.
Peripheral vascular disease
Peripheral vascular disease is a common degenerative disease of the blood vessels, in particular of the arteries. It results in a number of specific problems, including acute and chronic ischemia of the legs, ischemia of the organs (e.g. kidneys, brain, bowel), and aortic aneurysm. It can be due to a number of pathological processes, including arteriosclerosis and atheroma formation.
What to learn
Risk factors for peripheral vascular disease: smoking, hypertension, lipids, etc.
Mechanisms of arteriosclerosis and atherosclerosis and the changes that occur in the artery walls.
Ischaemia of the legs: symptoms, signs, and management.
Aortic aneurysm: definitions, diagnosis, and treatment.
Respiratory Diseases
Chronic obstructive pulmonary disease - COPD
Chronic obstructive pulmonary disease is a common condition occurring in 17% of men and 8% of women between the ages of 45 and 64 years. It could perhaps more correctly be called ”chronic bronchitis and emphysema” because both conditions coexist in all patients with COPD, to varying degrees. Virtually confined to smokers, mortality from COPD is related to the number of cigarettes smoked per day.
What to learn
Diagnostic definitions - clinical history for bronchitis and pathological for emphysema.
Symptoms and signs, and the two subtypes of the patient: pink puffers and blue bloaters.
Management of acute exacerbations and long-term prophylaxis.
Interpretation of arterial blood gas results.
Asthma
Asthma is a common chronic inflammatory condition of the airways that causes reversible obstruction. The airways are characteristically hyperresponsive to a wide range of stimuli. Edema, smooth muscle hypertrophy, and mucous plugging cause obstruction.
What to learn
Classification into extrinsic and intrinsic asthma, and the triggering, exacerbating and relieving factors
Structural changes that occur in the airway, and their clinical features
Emergency management of acute asthma
Medical management of chronic asthma and inhaler technique
Lung cancer
Bronchogenic carcinoma is the most common cause of death from cancer in the UK, affecting 30,000 people per year. Males are affected more often than females, but an increasing incidence is occurring in women. Peak incidence is between 40 and 70 years of age. The UK has the highest incidence of this disease in the world.
What to learn
The four main histological types: squamous cell (50%), small cell (20%), adenocarcinoma (20%) and large cell anaplastic (10%).
Risk factors, clinical features, and prognosis for each type.
Symptoms and signs of pulmonary involvement, local spread, metastatic spread, and endocrine and neurological syndromes.
Management and palliation.
Pneumonia
Pneumonia is defined as the consolidation of lung tissue caused by the formation of intra-alveolar inflammatory exudates as a result of a lung infection. This must be visible on X-ray to be properly called pneumonia, as opposed to 'chest infection'. Pneumonia is the fifth most common cause of death, according to US data.
What to learn
Predisposing factors to chest infection and pneumonia.
Common causative organisms and the distinction between community-acquired and hospital-acquired pneumonia.
Diagnostic and pathological features of bronchopneumonia, lobar pneumonia, and atypical pneumonia.
The special features of pneumonia in immunocompromised patients.
Appropriate antibiotic use for the various types of pneumonia.
Pulmonary tuberculosis - TB
This is a chronic granulomatous infection of the lung caused by Mycobacterium tuberculosis. It is uncommon in the UK, with an incidence of 7 per 100,000 per year, but is extremely common worldwide. Pulmonary TB is a very common exam topic because of the increasing incidence in elderly, immunocompromised, and homeless people, and the emergence of drug-resistant strains.
What to learn
Risk factors for infection and routes by which the organism can be spread.
Pathogenesis: primary and secondary TB; the histopathological sequence of events that leads to granuloma formation.
Symptom, signs, and diagnosis of TB.
Nonpulmonary TB.
Drug treatments for TB, public health measures to prevent spread and the problems of ensuring compliance with treatment.
Cystic fibrosis
Cystic fibrosis is a hereditary disease characterized by the production of abnormally thick mucus due to the presence of an abnormal transmembrane chloride ion transporter. It primarily affects the lung and pancreas. It is the most common autosomal recessive disorder, affecting 1 in 2000 newborns. Cystic fibrosis is a common exam topic.
What to learn
Pathogenesis: learn the genetic and molecular mechanisms and the physiological effects that produce the clinical features of the disease.
Symptoms, signs, and methods of diagnosis.
Prognosis and management of the pulmonary and pancreatic effects of the disease.
Diffuse interstitial diseases - alveolitis
These diseases comprise a group of noninfectious, nonmalignant disorders in which there is inflammation of the alveolar walls with a thickening of the interstitium between the alveoli, usually with fibrosis. Learning about the features of the general disease process and one or two of the conditions in more detail is worthwhile.
What to learn
Histopathological changes for this general group of diseases, and management, which is similar for all of them.
Symptoms, signs and diagnostic features of interstitial diseases.
The three main causes of chronic pulmonary fibrosis: (1) idiopathic (sarcoidosis and cryptogenic fibrosing alveolitis); (2) dust inhalation, which might be inorganic (coal workers' pneumoconiosis) or organic (farmers' lung); and (3) iatrogenic (radiation pneumonitis or drug-induced by amiodarone or anticancer drugs).
Pneumothorax
Pneumothorax is the presence of air in the pleural cavity. It is common and can be spontaneous or caused by trauma. The severity can range from mild to life-threatening.
What to learn
Causes of pneumothorax: spontaneous (idiopathic or secondary to underlying disease) and traumatic (accidental or iatrogenic).
Diagnosis and assessment of severity.
Management and risks of recurrence.
Neurological Diseases
Cerebrovascular disease
This is the third most common cause of death in the UK. Stroke is the common acute outcome of this disease, but the disease can also cause chronic multiinfarct dementia. The incidence of stroke in the general population is 2 per 1000 per year, but it is actually much more common than this in the elderly.
What to learn
Classification and causes of cerebrovascular events.
Clinical features of stroke and how they relate to the site of the lesion.
Acute management of the stroke patient.
Rehabilitation and prevention.
Epilepsy
Seizures are common in that 3% of the population has two or more seizures during their lives. An epileptic seizure is a convulsion or transient abnormal event that occurs due to the paroxysmal discharge of neurons. By definition, epilepsy is the continuing tendency to have such seizures.
What to learn
Classification of epilepsy and prognostic features: criteria for diagnosis.
Risk factors and causes of epilepsy: factors that might precipitate a seizure.
Emergency management of status epilepticus.
Long-term medical management with anticonvulsants.
Meningitis
Defined as inflammation of the meninges, this disease can be caused by bacterial, viral or, less commonly, fungal and protozoal infections. Bacterial meningitis is common and potentially life-threatening if not diagnosed and treated promptly.
What to learn
Causative organisms of meningitis.
Clinical features of bacterial meningitis and diagnosis.
Emergency management of bacterial meningitis and prophylaxis for contacts.
Long-term complications.
Head injury
This is a common cause of acute admission to the hospital. Approximately 200 to 300 patients admitted per 100,000 per year have head injuries, and of these, roughly 5% die from the injury. Many more suffer long-term disability as a result.
What to learn
Causes and classification of head injury: skull fracture, rupture of the meningeal artery or dural veins.
Mechanisms of brain damage: direct neuronal damage, raised intracranial pressure, oedema, ischaemia and hypoxia.
Clinical features, diagnosis and management.
Late sequelae of head injury.
Headache
Headaches are very common causes of presentation. Headaches are commonly benign but can occasionally indicate a serious underlying condition. A detailed history is essential in deciding whether to reassure the patient or investigate further.
What to learn
Causes and classification of headache.
What to look for in the history that could signify a serious cause.
Acute management and prophylaxis of migraine headache.
Diagnostic features of subarachnoid hemorrhage
Chronic pain
Chronic pain is a common presentation in primary care. It is a difficult problem to manage, and finding a diagnosis can be a long process. Although chronic pain is not a common exam topic, you will frequently have to deal with patients who have it.
What to learn
Common causes and risk factors for chronic pain.
Psychological and social factors that might exacerbate chronic pain.
Management options for chronic pain: medical, surgical, psychological, and social; don't go into a lot of detail but ensure that you know what is available.
Parkinson's disease
Parkinson’s disease is a degenerative disease of dopaminergic neurons in the substantia nigra, which causes an akinetic-rigid syndrome. It is characterized by resting tremor, slow voluntary movement, and rigidity. Prevalence is 1 in 1000 of all adults but rises to 1 in 200 in adults over 65 years of age.
What to learn
Underlying mechanisms of the disease; in addition, learn about other causes for the parkinsonian syndrome (as opposed to the disease).
Symptoms, signs, and diagnosis.
Medical management of Parkinson's disease and side-effects of primary treatment.
Alzheimer's disease
Alzheimer’s disease, a degenerative disease of the cortex, is the most common cause of dementia in Western countries. In the UK it affects 5% of people over 65 years of age, and 15% over the age of 80. Etiology and pathogenesis are not fully understood, but characteristic histological changes and atrophy of the frontal lobes occur in patients with Alzheimer’s disease.
What to learn
Characteristic histological features: senile plaques, neurofibrillary tangles, and neuropil threads.
New genetic studies: ApoEe4 genotype on chromosome 19 (often found in patients with Alzheimer’s disease).
Clinical features of dementia.
How to perform a mental state examination.
Prognosis and long-term management of Alzheimer's disease.
Multiple sclerosis - MS
Multiple sclerosis is the most common demyelinating disorder of the central nervous system (CNS). It affects 50 per 100,000 in the UK, and peak incidence occurs between 20 and 40 years of age. MS is characterized by relapsing and remitting episodes of immunologically mediated demyelination in the CNS.
What to learn
Current theories on etiology and pathogenesis: association with human leukocyte antigen (HLA).
Clinical features of MS.
Diagnostic tests: computerized tomography (CT) and magnetic resonance imaging (MRI); cerebrospinal fluid (CSF) examination for lymphocytes and oligoclonal bands.
Medical management of MS.
Motor neuron disease
Motor neuron disease is a progressive degenerative condition of motor neurons in the spinal cord, and of the somatic motor nuclei of the cranial nerves and the cortex. The prevalence in the UK is about 6 in 100,000, with onset mainly in the middle years of life. The cause is unknown.
What to learn
The three main patterns: progressive muscular atrophy, amyotrophic lateral sclerosis (ALS) and progressive bulbar palsy.
Clinical features of the three types of motor neuron disease.
Diagnosis: no specific tests exist; diagnosis is made on clinical grounds alone.
Management options.
Gastrointestinal Diseases
Gastritis, gastroesophageal reflux disease -GORD - and peptic ulceration
Gastrointestinal tract diseases include a spectrum of diseases comprising inflammation and ulceration of the esophagus, stomach, or duodenum caused by mucosal damage due to particularly acidic gastric secretions. In the West, 10% of the population experience GI tract disease at some time in their lives. GORD and ulcers normally develop in adulthood and follow a history of repeated healing and relapse over many years.
What to learn
Risk factors, causative agents, and protective mechanisms, in particular, the role of Helicobacter pylori.
Symptoms and signs of gastritis, gastroesophageal reflux, and peptic ulcers.
Diagnostic tests in peptic ulcer disease.
Medical and surgical management.
Inflammatory bowel disease - IBD
Inflammatory bowel disease comprises a group of common disorders characterized by idiopathic inflammation of the intestinal wall. Crohn's disease and ulcerative colitis (UC) are the two most common conditions. Prevalence in the UK is 30 to 50 per 100,000 for Crohn's disease and 80 per 100,000 for UC. Neither etiology is fully understood.
What to learn
The clinical and pathological features of UC and Crohn's disease; a common theme for questions is to compare and contrast the two.
The complications and sequelae of IBD.
The systemic manifestations of IBD.
Medical and surgical management.
Viral hepatitis
This is a common condition caused by a group of unrelated hepatotropic viruses, all of which cause primary hepatitis or inflammation of the liver. Clinical features are similar regardless of etiology. Hepatitis viruses A to G are now recognized and other, nonhepatotrophic viruses such as Epstein-Barr and cytomegalovirus have also been known to cause hepatitis.
What to learn
The characteristics and route of infection of hepatitis viruses A to E, with emphasis on B and C.
Symptoms and signs of hepatitis, and diagnostic tests.
The presence of serum antibody and an antigen for hepatitis B and C through the course of the infection.
Methods of treatment and immunization.
Colorectal carcinoma
Colorectal carcinoma is an adenocarcinoma derived from glandular epithelium in the mucosa of the large bowel. This is the second most common cause of death from neoplasia in the UK, with a peak incidence between 60 and 70 years of age.
What to learn
Etiology and risk factors for colorectal cancer.
Understand the progression from previous adenomas and the genetic model of successive mutations that cause neoplasia.
Symptoms, signs, and diagnosis.
Classification, staging, and grading.
Methods of treatment and prognosis.
Oesophageal cancer
Oesophageal cancer has an incidence of 5-10 per 100 000 per year in the UK. Squamous cell and adenocarcinoma are the most common types. Prognosis is usually poor because the disease is advanced by the time symptoms arise.
What to learn
Etiology and risk factors for oesophageal cancer. Understand the concept of metaplasia in Barrett's esophagus and how this can progress
Symptoms and signs, diagnosis by gastroscopy
Management options and prognosis
Gastric adenocarcinoma
Gastric adenocarcinoma is a common cancer arising from the mucus-secreting epithelial cells in the stomach. Incidence is 20 to 40 per 100.000 per year in the UK. It is typically seen after the age of 30, with an increased incidence of over 50 years of age. The male: female ratio is 3:2.
What to learn
Etiology and risk factors for gastric cancer.
The geographical distribution.
The sequence of genetic changes leading to neoplasia.
Classification of gastric cancers.
Symptoms, signs, and methods of diagnosis.
Surgical and medical management.
Malabsorption syndromes
Malabsorption disorders comprise a spectrum of disorders that produce symptoms of weight loss, abdominal distension, diarrhea with loose bulky stool, steatorrhea, and anemia. Mechanisms include disorders of intraluminal digestion by pancreatic enzymes, solubilization by bile acids, terminal digestion by mucosal enzymes, and transepithelial transport.
What to learn
The physiological mechanisms involved in digestion and how they can fail in the various types of malabsorption syndromes.
Clinical and pathological features of celiac disease and its treatment.
Know an example for each of the types of malabsorption mentioned above.
Esophageal cancer
Esophageal cancer has an incidence of 5 to 10 per 100,000 per year in the UK. Squamous cell and adenocarcinoma are the most common types. Prognosis is usually poor because the disease is advanced by the time symptoms arise.
What to learn
Symptoms and signs, diagnosis by gastroscopy.
Management options and prognosis.
Understand the concept of metaplasia in Barrett's esophagus and how this can progress.
Etiology and risk factors for esophageal cancer
Endocrine And Metabolic Diseases
Diabetes mellitus
Diabetes mellitus is a metabolic disorder, which presents as a spectrum of clinical disorders, which vary in severity. It is characterized by chronic hyperglycemia due to relative insulin deficiency. It is common and affects around 40 million people worldwide. It is a large and important topic in medicine because of its numerous complications, which affect almost all parts of the body.
What to learn
Have a reasonable overview of normal glucose metabolism.
Classification of diabetes mellitus - types 1 and 2.
Symptoms, signs and diagnostic criteria.
Complications of diabetes: cardiovascular, eyes, kidneys, neuropathy, feet, infections, skin, and joints.
Long-term management with diet, oral hypoglycemics, and insulin.
Diabetic emergencies: ketoacidosis and hyperosmolar nonketotic coma.
Monitoring treatment.
Obesity
A common and increasing problem in the West, obesity is defined as a body mass index (BMI) above 29 and is a risk factor for a number of chronic illnesses, including hypertension, ischemic heart disease, and diabetes.
What to learn
BMI and classification of obesity.
Socioeconomic risk factors for obesity.
Long-term problems associated with obesity.
Management of obesity: diet, exercise, medication, and surgery.
Protein-energy malnutrition
Starvation is a major cause of morbidity and mortality worldwide. Although not common in developed countries, poverty, inappropriate diet, and coexisting medical conditions, such as surgery, sepsis, cancer, anorexia nervosa, and malabsorption syndromes, can produce degrees of starvation.
What to learn
Pathophysiology of starvation: understand carbohydrate, fat, and protein metabolism in the fed and starved body states.
Classification and clinical features of protein-energy malnutrition.
Assessing the degree of malnutrition.
Treatment: resuscitation, refeeding, and rehabilitation.
Thyroid dysfunction
The metabolic activity of many tissues is regulated by the thyroid gland; over- and under activity of the thyroid are the most common of all endocrine problems. Hypothyroidism can be caused by primary thyroid disease or be secondary to hypothalamic or pituitary disease. Hyperthyroidism is nearly always caused by intrinsic thyroid disease and affects 2% to 5% of females at some time, with a female: male ratio of 5:1.
What to learn
Causes and clinical features of hypothyroidism.
Investigation and treatment of hypothyroidism.
Causes and clinical features of hyperthyroidism.
Graves' disease and thyroid eye disease.
Acute and long-term management of hyperthyroidism.
Adrenal dysfunction
The adrenal cortex secretes three main groups of steroid hormones: glucocorticoids, mineralocorticoids, and adrenal androgens. These have wide-ranging effects throughout the body, and therefore the clinical features of adrenal dysfunction are complex. Cushing's syndrome is common, but the main cause is iatrogenic through the use of steroid therapy. Addison's disease is rare but is a common topic for exam questions.
What to learn
The normal function of the adrenal axis - glucocorticoids and mineralocorticoids.
Investigation and diagnostic tests in adrenal disease.
Causes, clinical features, and management of Cushing's syndromes.
Causes, clinical features, and management of Addison's disease.
Hyperaldosteronism and Conn's syndrome.
Problems associated with corticosteroid therapy.
Parathyroid dysfunction
Parathyroid hormone (PTH) is a polypeptide secreted by the chief cells of the parathyroid glands. It acts on the bones and kidneys to increase levels of serum calcium and decrease levels of serum phosphate. Primary hyperparathyroidism is the most common of thyroid disorders and has a prevalence of 1 per 800 in the UK. Over 90% of patients are over 50 years of age, and the female: male ratio is 2:1.
What to learn
Understand the basics of normal calcium metabolism and the mechanisms by which PTH acts to regulate calcium and phosphate
Causes, clinical features, and management of primary hyperparathyroidism
Definitions of secondary and tertiary hyperparathyroidism, and of renal osteodystrophy
Hypoparathyroidism and clinical features of hypocalcemia
Pituitary tumors
Pituitary tumors are the most common cause of pituitary disease. Clinical features are the result of excess hormone secretion, local effects of the tumor, or inadequate hormone production by the remainder of the gland.
What to learn
Understand the normal function of the hypothalamus and pituitary.
The common tumor types and clinical syndromes that they cause: prolactinoma, acromegaly, Cushing's disease, non-functioning tumors.
Diagnostic tests used in pituitary disease
Musculoskeletal And Connective Tissue Diseases
Back pain
Back pain is an extremely common complaint, accounting for 6% of all General Practice consultations. In the UK nearly 400,000 people lose time from work each year because of back pain. No cause will be found in 30% of patients, but more serious problems, such as disc disease, spondylolisthesis, spinal stenosis, and malignancy must be excluded.
What to learn
How to take a good history of back pain and the important points (site, radiation, onset, aggravating factors, and time pattern) that will lead to a diagnosis.
Clinical features of the serious causes: disc disease, spondylolisthesis, spinal stenosis, infection, and malignancy.
An approach to the management of psychogenic and nonspecific back pain.
Osteoarthritis
Osteoarthritis is the most common type of arthritis, occurring in 20% of the population as a whole and in 50% of those over 50 years of age. This disease involves the cartilage, which becomes eroded and progressively thinned as the disease proceeds.
What to learn
The pathophysiological changes that occur in cartilage to cause the disease.
Symptoms, signs, and x-ray findings in osteoarthritis.
Differentiation from other types of arthritis.
Management of osteoarthritis.
Rheumatoid arthritis
Rheumatoid arthritis is a common, chronic systemic disease characterized by asymmetrical inflammatory polyarthritis that causes progressive joint damage and disability in young people, and extraarticular involvement of lungs and other organs. It affects about 2% of the population worldwide. Women are affected more often than men (3:1), and there is an association with HLA-DR4 in 70% of sufferers.
What to learn
The pathophysiological changes that occur in the synovium.
Symptoms, signs, and x-ray changes in rheumatoid arthritis, especially features of the rheumatoid hand.
Extraarticular complications.
Disease-modifying drugs for rheumatoid arthritis.
Osteoporosis
Osteoporosis is a common disorder in which a reduction in bone mass exists, includes all components of the bone, not just calcium, as in osteomalacia. Osteoporosis is a major problem that will cause fractures in 40% of Caucasian women and 20% of men.
What to learn
Etiology and risk factors for osteoporosis.
Classification into type 1 (postmenopausal) and type 2 (senile).
Clinical features and diagnostic tests.
Management and preventive measures.
Septic arthritis
This results from infection of joints with pyogenic organisms, the most common being Staphylococcus aureus, which can reach the joint via the bloodstream, a local site of infection such as a boil, or occasionally from an adjacent site of osteomyelitis. Septic arthritis constitutes a medical emergency, and the joint can be ruined within 24 hours without treatment.
What to learn
Clinical features of septic arthritis.
Diagnostic approach: joint aspiration and blood culture; x-rays are not useful.
Management with antibiotics and sometimes drainage.
Gout
This is an abnormality of uric acid metabolism in which crystals of sodium urate become deposited in the joints, soft tissue, and urinary tract. It presents primarily with acute arthritis, as well as tophi, tenosynovitis, and urate kidney stones.
What to learn
Normal uric acid metabolism and pathological mechanisms of urate crystal deposition.
Clinical features, x-ray, and joint aspiration findings in gout.
Acute and prophylactic management of gout.
Myasthenia gravis
This is an acquired condition with a prevalence of 4 in 100,000; it is twice as common in women as in men. It is characterized by weakness and fatigue in proximal limb, ocular, and bulbar muscles. The etiology is not fully understood but myasthenia gravis appears to be autoimmune, with immunoglobulin G (IgG) antibodies to the acetylcholine receptor protein found in the serum. Myasthenia gravis is a common exam topic.
What to learn
Signs and symptoms of myasthenia gravis.
Diagnostic tests: tensilon test and autoantibodies.
The clinical course of the disease and management.
Systemic lupus erythematosus - SLE
This is the most common of connective tissue diseases and is characterized by the presence of antibodies against nuclear components. It is a multisystem disease, with arthralgia and rashes the most common clinical features, but vasculitis and disorders of the lung, heart, kidney, nervous system and eye and involvement of the GI tract can all occur.
What to learn
Epidemiology and factors involved in pathogenesis, which is not fully understood.
Clinical features of SLE.
Diagnostic findings.
Management and disease-modifying therapy
Renal And Urological Diseases
Urinary tract infection - UTI
UTIs are common infections in women but rare in men because of the longer urethra. Recurrent or untreated infection can cause considerable morbidity, including renal disease and end-stage renal failure. A UTI is of particular significance in children because of the need for early diagnosis of abnormal urinary tracts.
What to learn
Common causative organisms and risk factors for infection.
Symptoms, signs, and diagnosis.
Complications of UTIs.
Management and further investigation (especially in children).
Benign prostatic hypertrophy - BPH
This commonly occurs in men over the age of 60 years. The etiology is not known, but BPH is characterized by hyperplasia of the glandular and connective tissue in the prostate, resulting in compression of the urethra and bladder outflow obstruction.
What to learn
Symptoms and signs of bladder outflow obstruction, or 'prostatism'.
Diagnostic procedures.
Medical and surgical management.
Prostate cancer
Carcinoma of the prostate is the fourth most common cause of death from malignancy in men in the UK, accounting for 7% of cancers in men. By the age of 80 years, 80% of men have malignant cells within the prostate, although most remain dormant.
What to learn
Clinical features and diagnosis.
Treatment with hormone analogs, radiotherapy, and surgery.
Prognosis.
Renal and vesical calculi
About 2% of the UK population have a urinary tract stone at any given time. Most stones are composed of calcium oxalate and phosphate, but mixed infective stones are also common. It is commonly a recurrent problem; 50% of patients will have formed a further stone within 10 years.
What to learn
Etiology and risk factors for the various types of stone.
Symptoms, signs, and diagnostic tests.
Conservative and surgical management of renal and vesical calculi.
Renal failure
This term refers to the failure of renal excretory function due to depression of the glomerular filtration rate. It is often associated with failure of other renal functions: acid-base balance; regulation of salt, water, and blood pressure; secretion of erythropoietin; and activation of vitamin D.
What to learn
Definitions of renal failure: prerenal, renal, and postrenal; acute versus chronic renal failure.
Causes of renal failure, which can be grouped into the failure of renal perfusion, disease of the renal vasculature, glomerulonephritis, and tubulointerstitial disease.
Symptoms, signs, and diagnostic tests.
Management of end-stage renal failure: Continuous Ambulatory Peritoneal Dialysis (CAPD), hemodialysis, transplant, and ancillary treatment (e.g. erythropoietin, calcium supplementation.
Reproductive Diseases
Pregnancy
Pregnancy is obviously not a disease and is a huge topic in its own right, with much-associated pathology. It is included here as a reminder of the most important pregnancy-related issues that students should understand.
What to learn
An overview of the developmental changes in the fetus through pregnancy and the physiological adaptations in the mother.
The stages of pregnancy and labor.
Complications of pregnancy and parturition - from early pregnancy (ectopic pregnancy and miscarriage), late pregnancy (abruption; placenta previa; preeclampsia; Hemolysis, Elevated Liver transaminases, and Low platelets [HELLP]; gestational diabetes; cholestasis) to those of labor and beyond (premature labor; instrumental and caesarean delivery; postpartum hemorrhage).
Drugs to be avoided during pregnancy and breastfeeding.
Subfertility
This is defined as the inability of a couple to conceive after 1 year of intercourse without the use of contraception. Infertility is a common problem and a cause of great distress. In 30% to 40% of couples, there is an identifiable malefactor, and in 40%, a female tubal or ovarian cause exists; 15% of cases are idiopathic with no identifiable cause.
What to learn
Male and female causes of subfertility.
Investigations required to investigate subfertility: sperm count, laparoscopy, and dye studies.
Techniques for assisted conception: hormonal, in vitro fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI).
Risks associated with fertility treatment.
Contraception
The aim of contraception is to prevent unplanned pregnancies. The ideal contraceptive is effective, acceptable, safe, and reversible. Contraception is a large and complex topic that is extremely important in primary care.
What to learn
The major classes of contraceptives and the mechanisms by which they operate.
Hormonal contraception: indications, contraindications, and side-effects of the combined pill, the progestogen-only pill, depot injections, implants, and emergency ”morning-after” pills.
Nonhormonal contraception: indications and contraindications of the assisted rhythm method (using temperature or hormone testing kits), barriers (condom and diaphragm), intrauterine devices.
Sterilization.
Abnormal menstruation
Disorders of menstruation fall into three categories: amenorrhea, dysmenorrhea (painful periods), and dysfunctional uterine bleeding.
What to learn
Refresh your memory of the hormonal control of the menstrual cycle and the physiological changes that occur.
Causes of primary and secondary amenorrhea and the investigations indicated for each.
Causes and management of dysmenorrhea - often primary with no other abnormality found; sometimes secondary to endometriosis, adenomyosis, infection, or uterine polyps.
Causes of dysfunctional uterine bleeding, and management.
Endometriosis
Endometriosis is a very common gynecological disorder that occurs in 12% of women, although not all have symptoms. It is caused by ectopic deposits of endometrial cells in the lower part of the peritoneal cavity.
What to learn
Etiology and epidemiology of endometriosis.
Sites at which endometriotic deposits are most likely.
Symptoms and signs of endometriosis, and methods of diagnosis.
Hormonal and surgical management.
The menopause and hormone replacement therapy - HRT
The menopause, or cessation of periods, occurs naturally between the ages of 45 and 55 years, with the mean age of onset currently 49 years in the UK. Most women notice irregular scanty periods for a variable period before symptoms of estrogen deficiency begin.
What to learn
Hormonal changes that occur in the menopause
Signs and symptoms of the menopause
Long-term risks involved in early menopause
HRT - methods available, risks and benefits
Breast cancer
This comprises 20% of all cancers in women and is the most common cause of death in the 35 to 55-year age group. Incidence is higher in the West than in developing countries.
What to learn
Etiology and predisposing factors for breast cancer.
Classification of neoplastic breast disease: ductal and lobular carcinoma; staging and grading of breast cancer.
Symptoms, signs, and diagnostic tests.
Treatment and prognosis.
Screening for breast cancer.
Cervical cancer
The vast majority of cervical carcinomas are a squamous cell in origin. Incidence is 3800 new cases per year in England and Wales; mortality is 1000 per year. It occurs from the teens onward, but the average age of onset is 50 years. It is preceded by the preinvasive phase of cervical intraepithelial neoplasia (CIN).
What to learn
Etiology and risk factors for CIN.
Classification and progression of CIN.
Cervical screening.
Clinical features and diagnosis of cervical cancer.
Treatment and prognosis.
Ovarian cancer
This is responsible for more deaths than any other gynecological malignancy -- over 4000 per year in the UK -- because it is usually advanced on presentation. Primary ovarian cancers account for 5% of malignancies in women. Seventy percent are surface epithelial tumors; 20% are germ-cell in origin, and the remaining 10% are sex-cord and stromal tumors.
What to learn
Classification of ovarian tumor types and clinical features.
Symptoms, signs, and diagnostic tests for ovarian carcinoma.
Treatment of ovarian cancer.
Impotence
This is the inability of the male to achieve or sustain an erection adequate for satisfactory intercourse. It is a common problem, but many patients have no definable organic cause. True erectile difficulty can be psychological, vascular, or endocrine or drug-related.
What to learn
Causes of impotence.
Medical and psychological methods of managing impotence.
Testicular cancer
Tumors of the testis are uncommon, affecting 1% to 2% of men, but are important because of their early age of onset and good response to chemotherapy. Ninety-seven percent of cases are germ-cell tumors (seminomas or teratomas), and the rest are derived from the support cells of the testis (Leydig- and Sertoli-cell tumors, lymphoma) and metastatic deposits.
What to learn
Symptoms and signs of testicular cancer.
Classification of testicular tumor types and clinical features.
Treatment and prognosis.
Menopause and hormone replacement therapy (HRT)
The menopause, or cessation of periods, occurs naturally between the ages of 45 and 55 years, with the mean age of onset currently 51 years in the UK. Most women notice irregular scanty periods for a variable period before symptoms of estrogen deficiency begin.
What to learn
Signs and symptoms of menopause.
Hormonal changes that occur in menopause.
Long-term risks involved in early menopause.
HRT: methods available, risks, and benefits.
Hematological Diseases
Anemia
Anemia is a state in which the level of hemoglobin in the blood is below the normal range for the patient's age and sex: 13.5-18.0 g/dL in males and 11.5-16.0 g/dL in females. Causes are numerous and can be divided roughly into three categories: (1) reduced the production of hemoglobin or red blood cells; (2) increased red cell destruction; or (3) blood loss (acute or chronic).
What to learn
The causes of anemia as outlined above.
Symptoms and signs of anemia.
Investigations to find the cause of anemia.
Sickle-cell disease
Sickle-cell disease is a common inherited disease caused by a point mutation in the beta globulin gene, which results in the substitution of valine for glutamate. The resultant hemoglobin variant, HbS, polymerizes at low oxygen saturations, causing the characteristic sickle deformity of the red cells, which 'sludge' in the small vessels and undergo hemolysis.
What to learn
Epidemiology and pathophysiology of sickle-cell disease: association with malaria-endemic regions.
Classification of sickle-cell disease: heterozygous and homozygous forms.
Clinical features of sickle-cell disease.
Management of sickle-cell crises.
Leukemia
Leukemia includes a spectrum of diseases caused by malignant proliferation of hemopoietic precursor cells in the bone marrow. These diseases are not common; the incidence is 5 per 100,000 per year for all types, but they are important because of their responsiveness to treatment.
What to learn
Classification of the four main types: acute lymphoblastic, acute myeloblastic, chronic lymphocytic and chronic myeloid; be aware of the subclassification within these main types (French American British (FAB), etc.).
Etiological factors: especially genetic mutations such as the Philadelphia chromosome and the translocation.
Symptoms and signs of leukemia.
Diagnostic tests (blood film, bone marrow biopsy, and cytogenetics).
Management of leukemia: chemotherapy -Granulocyte, Monocyte-Colony Stimulating Factor (GM-CSF) and (All-Trans Retinoic Acid (ATRA), and supportive treatment (i.e., blood transfusions).
Lymphoma
The lymphomas are caused by the neoplastic proliferation of cells in the lymphoid system. Classification is based on the histological appearance of the abnormal cells and is divided into Hodgkin's and non-Hodgkin's lymphoma (NHL).
What to learn
Classification of the lymphomas and how the disease is staged and graded.
Symptoms, signs, and methods of diagnosis.
Differential diagnosis of causes of lymph node enlargement.
Prognosis and management of lymphoma.
Myeloma
Myeloma is a disease caused by malignant proliferation of plasma cells in the bone marrow. It is part of a spectrum of diseases characterized by the presence of a serum paraprotein that can be demonstrated as a monoclonal band on electrophoresis. It occurs mainly in people over 50 years of age. The clinical features are caused by bone destruction, bone marrow infiltration and failure, and renal failure due to the deposition of the light chain paraprotein.
What to learn
Pathophysiology of the disease and mechanisms by which the clinical features are produced.
Symptoms, signs, and diagnostic tests: blood film, protein electrophoresis, Bence-Jones proteins in urine, and bone marrow biopsy in particular.
Prognosis and management.
Hemophilia A
Hemophilia A is an X-linked recessive inherited disease characterized by a deficiency of clotting factor VIII. The incidence is 1 in 7500 of the male population per year. Clinical features depend on the level of factor VIII: if it is less than 1% of normal, the patient will experience frequent spontaneous bleeds from early life. Bleeds commonly occur in the large joints (hemarthroses) and lead to crippling deformity if the condition is untreated.
What to learn
Understand the clotting pathway and how to factor VIII plays a central role; ensure that you are learning the up-to-date version and not the old intrinsic/extrinsic model.
Classification of the severity of hemophilia, and clinical features.
Management of hemophilia: factor VIII, activated factor VII, 1-diamino-8-D-arginine vasopressin, also known as desmopressin (ddAVP), and potential for gene therapy.
Risks of treatment with blood products and the effects of the human immunodeficiency virus (HIV) and hepatitis C infection in people with hemophilia
Psychiatric Diseases
Depression
Depression is a very common mood disorder that affects 18% of the population at some point in their lives. Females are at greater risk than males, with the female: male ratio 2:1. A first episode can occur at any age, with the mean onset being in the late 30s.
What to learn
Etiology and risk factors for depression.
Classification and diagnostic criteria for depressive illness.
Mental state examination and assessment of suicide risk.
Treatment of depression: medical, psychological, electroconvulsive therapy (ECT).
Schizophrenia
Schizophrenia is a common psychiatric illness characterized by disorders of thought and perception and leading to psychotic symptoms and social withdrawal. There is a lifetime prevalence of about 1% with no gender bias. Age of onset peaks at 15 to 25 years of age for males and 25 to 35 years of age in women.
What to learn
Risk factors and epidemiology.
Classification and diagnostic criteria for schizophrenia.
Risk assessment: harm to self, harm to others, risk of exploitation.
Medical and psychological management, and prognosis.
Bipolar affective disorder
The bipolar affective disorder is a mood disorder characterized by cyclical instability of mood, which can vary between depressive and manic states over time. Lifetime prevalence is about 1% with no gender bias.
What to learn
Etiology and risk factors.
Classification and diagnostic criteria.
Management with antidepressants, mood stabilizers, and psychological methods.
Anxiety disorders
These comprise a spectrum of disorders that include generalized anxiety disorder, panic attacks, phobias (agoraphobia, social phobia, and specific phobias), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder.
What to learn
Etiology, epidemiology, and risk factors for anxiety disorders.
Diagnostic criteria for anxiety disorders; focus on OCD and phobias for more specific symptoms.
Management with medication and psychological approaches, in particular, cognitive-behavioral therapy (CBT).
Addiction
Alcohol and substance dependence is a complex and common problem involving medical, psychological, and social disciplines in its management.
What to learn
Etiology and risk factors for alcohol and substance addiction.
Acute management of alcohol and drug withdrawal and intoxication.
Medical and psychological complications of alcohol and drug addiction.
Options for treatment.
Eating disorders
Anorexia nervosa and bulimia nervosa are predominantly diseases of young Caucasian women; the sex bias is 10:1 female to male. Anorexia has a prevalence of 0.2% to 1% in adolescent females, whereas bulimia is more common and has a prevalence of 1.5 to 2.5%. Eating disorders are associated with disorders of self-esteem and body image.
What to learn
Diagnostic criteria for anorexia and bulimia nervosa.
Management of eating disorders.
Medical complications of the eating disorders and indications for hospitalization
Pediatric Diseases
Premature birth
A neonate born before a gestational age of 37 weeks is ”preterm,” or ”premature.” Five percent of pregnancies end in spontaneous preterm delivery, and 70% of all perinatal deaths occur in preterm infants, especially if they are growth retarded. The cause of premature birth is often unknown, but there are a number of risk factors.
What to learn
Etiology and risk factors for preterm delivery.
Complications and morbidity associated with preterm and low birth-weight infants.
Management of the preterm neonate - both before and after delivery.
Bronchiolitis
Bronchiolitis is a very common cause of pediatric admissions. During the winter, ”bronchiolitis season” patients can fill all the beds in the ward. It is caused by the respiratory syncytial virus (RSV) and is most serious in infants and young children up to 3 years of age. Children who have bronchiolitis present with fever, respiratory distress, and a second failure to feed. Treatment is supportive with oxygen and nasogastric or intravenous hydration if necessary.
What to learn
Etiology and epidemiology of RSV infection.
Symptoms, signs, and diagnosis of bronchiolitis.
Management of bronchiolitis.
Croup
Acute laryngotracheobronchitis, also known as –“croup”, is a common and potentially dangerous complication of upper respiratory tract infection in children, especially those under 3 years of age. The most common cause is the parainfluenza virus infection. Inflammatory edema of the vocal cords and epiglottis causes the narrowing of the airway, which produces the characteristic cough and stridor.
What to learn
Etiology and epidemiology of croup.
Symptoms, signs and differential diagnosis.
Acute management of croup.
Cerebral palsy - CP
This term describes disorders apparent at birth or in childhood that are a result of brain injury in the neonatal period. This injury results in a nonprogressive neurological deficit. The precise cause can be difficult to determine, but common factors include hypoxia in utero or during birth, trauma, prolonged convulsions or coma, kernicterus, and cerebral hemorrhage or infarction.
What to learn
Etiology and risk factors for cerebral palsy.
Classification of cerebral palsy and clinical features.
Ensure that you can recognize and correctly name the gait disorders, which are common in clinical exams.
Failure to thrive
This is a common presentation with primary care and pediatric outpatients. A child's weight, height, or head circumference persistently falls below the expected percentiles when plotted against the standard growth curves. There are numerous causes; however, 95% of cases are due to insufficient or problematic feeding. Other causes include chronic infection and gastrointestinal or metabolic disease. Many cases are simply due to idiosyncratic growth patterns or parents of short stature.
What to learn
Etiology and risk factors; a differential diagnosis for failure to thrive.
The diagnostic tests that can be employed.
Strategies for management of failure to thrive.
Child abuse
Sadly, this is a common problem and a difficult one to tackle as a clinician. It is important to recognize the signs of child abuse and to know the correct way to proceed if you suspect it.
What to learn
Risk factors for child abuse.
Recognizing signs of child abuse.
The multidisciplinary approach to child abuse.
Protocols for dealing with a suspected case: as a junior doctor this invariably starts with calling your registrar or consultant; don't try to handle it on your own.
Infectious Diseases
Human Immunodeficiency Virus (HIV) disease/Acquired Immune Deficiency Syndrome (AIDS)
Acquired immune deficiency syndrome is caused by infection with the HIV retrovirus. It currently affects over 30 million people worldwide and is granted additional prominence because of its high media profile.
What to learn
The structure and characteristics of the HIV retrovirus.
Etiology, epidemiology, and clinical course of HIV infection; monitoring the disease (CD4 count, etc.).
Signs and symptoms of AIDS and AIDS-related complex: the presentations of the common opportunistic infections and tumors.
Management of HIV disease: antiretroviral therapy, treatment, and prophylaxis against opportunistic infections.
Social and psychological aspects of HIV disease.
Malaria
This protozoal infection affects 270 million people worldwide each year and has a mortality rate of 1%. Endemic and epidemic malaria are found in all countries between the latitudes 30° south and 40° north. The disease is caused by four species of protozoa: Plasmodium falciparum, P. vivax, P. ovale and P. malariae.
What to learn
The life-cycle of the Plasmodium parasites in the Anopheles mosquito (the definitive host) and humans (the intermediate host).
Symptoms, signs and diagnostic tests for malaria.
The clinical course of the disease and complications.
Acute management of malarial infection.
Antimalarial prophylaxis.
Cholera
Cholera is a common disease worldwide that is caused by the gram-negative bacillus Vibrio cholera, for which humans are the only host. It is transmitted by the femoral route, and contaminated water supply is the major factor in the spread of the disease. The classic feature is painless, profuse, watery diarrhea, which can cause death by dehydration and electrolyte imbalance if untreated.
What to learn
Etiology and epidemiology of cholera.
Characteristics of V. cholerae and the toxins it produces.
The clinical course of the disease and its diagnostic features.
Medical and public health management of the disease.
Immunization
Immunization is another important topic for exams and primary care. Monitoring and prescribing immunization can be a significant part of your workload in practice.
What to learn
Refresh your knowledge of the principles of immunization.
Types of vaccine: live attenuated, inactivated, and recombinant, and the merits and disadvantages of each type.
Current childhood immunization policy
Surgical Problems
Acute abdomen
Acute abdomen is most commonly a surgical presentation, rather than being a disease in itself. It is important to have a clear approach to the assessment and management of this condition.
What to learn
The differential diagnosis of an acute abdomen.
Symptoms and signs of peritonitis.
The diagnostic approach and investigations required.
Initial management.
Appendicitis
Appendicitis is a common surgical problem that can present at any age but with a peak incidence in the teen years and early adulthood. Diagnosis can be problematic because classic symptoms occur in only 55% of cases.
What to learn
Etiology of appendicitis, and vulnerable groups.
Symptoms, signs, and differential diagnosis of appendicitis.
The clinical course of the disease.
Management of acute appendicitis.
Diverticular disease
This is a very common condition in the West and is caused by a lack of dietary fiber. It affects two-thirds of the population by the age of 70 years and is more common in women than men (3:2). Many cases are asymptomatic, and the most common symptom on presentation is abdominal pain.
What to learn
Etiology and risk factors for diverticular disease.
Definitions of diverticular disease: diverticulosis, diverticulitis.
Symptoms, signs and differential diagnosis.
Clinical features and complications.
Conservative and surgical management.
Pancreatitis
This occurs in 10 to 20 per 100,000 people per year in the UK. Most cases of acute pancreatitis are caused by gallstones or alcohol. Pancreatitis is a potentially life-threatening condition with an overall mortality of 8% to 10%.
What to learn
Etiology and risk factors for pancreatitis.
Symptoms, signs, and diagnostic tests.
Ranson's criteria for the assessment of severity, and clinical course of the disease.
Management of acute pancreatitis.
Large bowel obstruction
This is a common cause of an acute abdomen and is characterized by the symptoms and signs of abdominal pain, distension, vomiting, and inability to pass stool or flatus. Common causes include simple constipation, cancer of the colon, diverticular stricture, and sigmoid volvulus.
What to learn
Symptoms, signs, and differential diagnosis of large bowel obstruction.
Diagnostic investigations.
Conservative and surgical management.
Cholecystitis
Gallstones are very common, but only a small minority of adults with gallstones develop acute cholecystitis, which is 95% of cases is due to the impaction of a gallstone in Hartmann's pouch.
What to learn
Etiology and risk factors for gallstones - the F's (Fat, Fertile Females).
Symptoms and signs of acute cholecystitis.
Clinical course and diagnosis of acute and chronic cholecystitis.
Conservative, endoscopic and surgical management.
Hernia
A hernia is an abnormal protrusion of a viscus, or of part of a viscus, through the coverings that contain it. Incisional hernias are the most common type, followed by inguinal, femoral, and finally, umbilical hernias. An inguinal hernia occurs in 1% to 2% of children, mostly boys (9:1), and 112 per 100,000 adults per year in the UK. The ratio of inguinal to femoral hernias is 40:1 in men and 3:1 in women.
What to learn
The anatomy of the inguinal and femoral canals, and etiology of hernias.
Classification of hernias by location, type, and severity.
Symptoms, signs, and differential diagnosis for the above types of hernia.
Conservative and surgical management.
Refresh your knowledge of regional anatomy.
Risk factors for testicular torsion.
Surgical management.
Testicular torsion
Testicular torsion is an acute and painful condition caused by rotation of testis on its mesentery, so that blood supply is impaired, resulting in ischemic pain and edema. It is a surgical emergency, and the torsion must be corrected within hours to save the testis. It occurs at any age but most often during adolescence.
What to learn
Etiology and risk factors for testicular torsion.
Symptoms, signs, and classification of testicular torsion.
Surgical management, and prognosis.
Hemorrhoids
Hemorrhoids constitute a common problem caused by hypertrophy of vascular cushions of tissue at the anal margin. It is a condition of mid-to-late adulthood; half of all patients are over the age of 50. Symptoms are rectal bleeding, prolapse, pain, mucous discharge, and pruritus ani.
What to learn
Symptoms, signs, and classification of hemorrhoids.
Conservative and surgical management, and prognosis.
Etiology and risk factors for hemorrhoids.
Dermatological Diseases
Eczema and dermatitis
Dermatitis implies inflammation of the skin, and the term is often used interchangeably with eczema. Characteristic features are hot, red skin; edema in the acute stages; weeping and oozing; excoriation; secondary infection and impaired thermoregulation in severe cases.
What to learn
Classification and patterns of eczema: atopic/endogenous, pompholyx, exogenous, and discoid.
Etiology and histological changes in eczema.
Clinical and diagnostic features of eczema.
Treatment.
Psoriasis
Psoriasis is a chronic skin disease seen commonly as erythematous, well-demarcated, silvery-scaled plaques over extensor surfaces. It affects 2% of the population in temperate countries. Arthropathy is associated with skin disease in 8% to10% of cases.
What to learn
Etiology and epidemiology.
Clinical and diagnostic features, and patterns of psoriasis.
Treatment of psoriasis.
Pemphigus and pemphigoid
These bullous disorders are rare but commonly crop up in exams. Both disorders are associated with autoimmune antibody deposition in the epidermis. The depth at which this occurs relates to the clinical features observed.
What to learn
Etiology and epidemiology of Pemphigus Vulgaris and pemphigoid.
Clinical features of the two diseases: be able to compare and contrast them.
Treatment and prognosis for each condition.
Erythema multiforme
In an acute and self-limiting condition, erythema multiforme affects the skin and mucosal surfaces. Lesions are typically concentric rings of papules, especially on the hands, forearms, and feet. Erythema multiforme is associated with herpes simplex and mycoplasma infections, drug reactions, connective tissue disease, and neoplasia. Immune complex deposition in the skin seems to play a role. This topic commonly appears on exams.
What to learn
Etiology and associated conditions.
Clinical and diagnostic features.
Treatment, especially of Stephens-Johnson syndrome, which can be life-threatening.
Erythema nodosum
This is an acute condition characterized by painful nodules on the shins and occasionally on the thighs and arms; it is most common in adult females. There are many causes, including drugs, sarcoidosis, IBD, infection, and pregnancy; no cause will be found in 50% of cases. It is not a common condition but is a favorite exam topic because of the variety of causes.
What to learn
The causes and clinical features of erythema nodosum.
Investigations to exclude serious causes.
Treatment: usually conservative with nonsteroidal anti-inflammatory drugs (NSAIDs); the condition usually resolves in a few weeks.
Skin cancer
The three most important malignancies of the skin are basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. All three types are associated with sun damage. Basal cell carcinoma is locally invasive, but metastasis is rare, whereas at the other end of the scale, malignant melanoma is highly aggressive, and the prognosis is poor if the melanoma is not treated early.
What to learn
Etiology, epidemiology, and risk factors for the three types of cancer.
Clinical and diagnostic features.
Staging and prognosis for malignant melanoma.
Management options: surgical excision and radiotherapy.
Source:
www.studentconsult.com
BY
Dr. Dan Horton-Szar
BSc(Hons) MBBS(Hons), Northgate Medical Practice, Canterbury, UK
Best Wishes: Dr.Ehab Aboueladab - Email:ehab10f@gmail.com
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