THEAPPLIEDKNOWLEDGETEST

CONTENTGUIDE

CONTENTS

1.

Introduction

2.
3.

p.3

Examplesofconsideringtopicswiththecurriculum

p.5

Section1ClinicalMedicine

p.10

p.12
p.14
p.16
p.18
p.20
p.21
p.22
p.23
p.24
p.25
p.26
p.27
p.29
p.30
p.32
p.33
p.35
p.36
p.37
p.38
p.39
p.41
p.43

Section2Research,statisticsandepidemiology

p.45

Section3Administration,ethicalandregulatory

frameworks

p48

Cardiovascularproblems

Digestiveproblemsincludingnutrition
Ear,noseandthroat,oralandfacialproblems
Eyeproblems

Genetics

Haematologyproblems

Immunologyproblems
Infectiousdiseases

Intellectualandlearningdisabilities
Mentalhealthproblems

Alcoholandsubstancemisuseproblems
Metabolicandendocrineproblems

Musculoskeletalproblemsincludingtrauma
Neurologicalproblems

Palliativeandendoflifecare

Pharmacotherapeutics
Renalproblems

Respiratoryproblems

Sexualhealthoverlappingwith

o Menshealth

o Womenshealth

Skinproblems

Childrenandyoungpeople

4.

5.

THEAPPLIEDKNOWLEDGETESTCONTENTGUIDE

THISISALEARNINGRESOURCEFORTHEAPPLIEDKNOWLEDGETEST(AKT)

ITSHOULDBEUSEDINCONJUNCTIONWITHTHERCGPCURRICULUM

ITCANNOTCOVEREVERYTHINGTHATMIGHTAPPEARINTHEAKT

Purpose

ThepurposeoftheContentGuideistoprovideasummaryoftheknowledgebasethatis
likelytobetestedintheAppliedKnowledgeTest(AKT).
ItshouldNOTbeconsideredanexhaustiveandcompletelistofgeneralpracticetopics,and
isprovidedasanaidtocandidatesandeducatorswhenpreparingfortheAKT.
Additionally,theContentGuidewillhelpexaminersastheyconstructablueprint(content
matrix/testspecification)toensurethattheAKTquestionssamplewidelyacrossthe
curriculum.

ContentGuideandRCGPCurriculum

TheContentGuideisaresourcetocomplementtheRCGPCurriculum(currentversion2013)
(http://www.rcgp.org.uk/gptrainingandexams/gpcurriculumoverview.aspx),which
definestheareasofcompetence,essentialfeatures,strategiesandresourcesoftheGP
specialtytrainingprogramme.Thecurriculumalsodefinesthelearningoutcomesrequired
toachieveaCertificateofCompletionofSpecialtyTraininginGeneralPractice.
TheContentGuidecontainsalistoftopicsthatshouldbeconsideredacrosstheareasof
competencedescribedinthecorecurriculumstatement,BeingaGeneralPractitioner:
o PrimaryCareManagement
o PersoncentredCare
o SpecificProblemsolvingSkills
o AComprehensiveApproach
o CommunityOrientation
o AHolisticApproach
TheRCGPCurriculumIntroductionandUserGuide(whichisstructuredinadifferentway
fromtheContentGuide)providesdetailonhowtoapproachlearningintheseareas.
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingand
exams/Curriculum2012/RCGPCurriculumIntroductionandUserGuide2012.ashx
ThecorecurriculumstatementBeingaGeneralPractitionerprovidesthebasisfortheclinical
exampleswhichfollowinthecurriculum.
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingand
exams/Curriculum2012/RCGPCurriculum1BeingaGP.ashx

LayoutandAlignmentwiththecurriculum
TheContentGuideisbasedonbodysystemclassifications,andalsocontainslistsofsymptomsas
wellasconditionsanddiseasestopromptcandidatestoconsiderdifferentialdiagnosesforcommon
presentations.However,patientsingeneralpracticeoftenpresentwithundifferentiatedsymptoms
andcomplexdiseasecombinations,sothelistofsymptomsshouldbeconsideredasatotalityrather
thaneachoneinisolation.

CandidatesandeducatorswillnotethattheGuidedoesnotcontainasectionforeveryclinical
examplestatement(e.g.CareofOlderAdults,CareofAcutelyIllPeople).Thebackground

knowledgeforthesetopicsiscoveredwithinthesystemsandsymptomslistedelsewhereinthe
ContentGuide.Conversely,theGuidelistsareasthatarenotgivenasclinicalexamplesinthe
curriculumstatements,whereknowledgeisnonethelessclearlyrequiredtomeettheoutcomes
describedinthecorecurriculumstatement,BeingaGeneralPractitioner.

Whenconsideringatopicnotspecifiedwithintheclinicalexamplestatementsofthecurriculum,the
corestatement(BeingaGeneralPractitioner)andthecontextualstatements(TheGPConsultationin
Practice,PatientSafetyandQualityofCare,TheGPintheWiderProfessionalEnvironment,
EnhancingProfessionalKnowledge)willguideinterpretationofthelevelandbreadthofknowledge
requiredintheAKT.

Changingcontent
TheContentGuidewillinevitablyevolveovertimeasthecontentandcontextofgeneralpractice
develop.Moreover,itwillreflectcontinuingdevelopmentsintheRCGPcurriculumandin
assessmentmethodologyandpolicy.

TheRCGPthereforeintendstoupdateitonaregularbasisBUTitisimportanttoemphasisethatit
DOESNOTattempttobeacompletelistofeverytopicthatmightbeincludedintheAKT.
Candidatesshouldensurethattheyrefertotheversioncurrentatthetimeoftakingtheexam.

Topicimportance
TheContentGuideisalistoftopics.Thereisnoattempttoattachaweighting(orrelative
importance)toitsvariousitems,andtheclinicalsectionsarelistedinalphabeticalorder.IntheAKT,
allquestionshaveanequalscorebutconsiderationisgivenatthepointofselectingthequestions
foreachAKTtosamplewidelyacrossthecurriculum.Therewillbequestionsonconditionsthatare
seenfrequentlyingeneralpractice(e.g.asthma)butalsoonrarerbutimportanttopics(e.g.
meningitis)whicheveryGPwouldbeexpectedtorecogniseandknowhowtomanage.

Levelofdetail
Candidatesoftenwonderhowmuchdetailtheyneedtoknowaboutatopic,andthisisbest
understoodbyreferringtothelearningoutcomesdescribedinthecurriculum.However,itis
impossibletodefinelearningoutcomesforeveryconditionandcandidatesshouldrefertothe
outcomesdescribedinthecoreandcontextualstatementsofthecurriculumandconsiderthelevel
ofknowledgetheywouldrequireworkingindaytodaygeneralpractice.Forexample,thiscould
includeknowledgeoftheappropriatenessofcommonhospitalinvestigationsthatapatientmay
undergobuttowhichaGPmaynothavedirectaccesse.g.MRIandCTscans.

RelevancetoUKGeneralPractice
TheMRCGPisthelicensingexaminationforthewholeUK.Therearedifferencesinthestructure
andadministrationoftheNHSinthefourHomeCountries(England,Scotland,Wales,Northern
Ireland),andthesedifferencesaretakenintoaccountwhentheAKTquestionsareconstructed.This
isparticularlyrelevanttoquestionswithintheAdministrationandRegulatoryFrameworksection.
Anyvariationinclinicalguidelinesbetweenthedevolvednationsisaccommodatedduringthe
questionwritingprocess.

Feedback
TheContentGuideisanewadditiontothelearningresourcesfortheMRCGPandwewelcome
feedbackonitsusefulnesstocandidatesandeducators.
Pleasesendanycommentstoexams@rcgp.org.uk

HOWTOCONSIDERTOPICSACROSSTHEDOMAINSOFTHECURRICULUM

Thetwofollowingexamples(AsthmaandFitnesstoDrive)areapracticalillustrationofhowthe
knowledgerepresentedinthisContentGuidemightbeappliedtotheareasofcompetence
describedinthecorecurriculumstatementBeingaGeneralPractitioner.

CLINICALEXAMPLEAsthma

Inordertodemonstratethesecoreareasofcompetenceforthetopicofasthma,youwillrequire
knowledge,skillsandattitudesinthefollowingareas:

The RCGP areas of competence

Asanexampletohelpyouunderstandhowgeneralpracticeknowledgecanbeappliedtoasthma,wehavelistedsome
oftheitemsyoushouldconsider.Thesehavebeenorganisedintotheareasofcompetencedescribedinthecore
curriculumstatement:

Knowledgeofthenaturalhistory,aetiologyandepidemiologyof
asthma
Knowledgeofthediagnosticcriteriaforasthmaandthefeaturesthat
differentiateitfromotherdiseases
Specificclinicalknowledgeofasthmainvestigationsandprinciplesof
Primarycaremanagement
managementofacuteandchronicasthmainadultsandchildren
Thisareaofcompetenceisabouthow
Comprehensiveknowledgeofdrugtreatmentsincluding
youmanageyourcontactwithpatients,
contraindications,adversereactionsanddruginteractions.Useof
dealingcompetentlywithanyandall
BNFfordrugtherapyincludingdevices,monitoringapproaches,drug
problemsthatarepresentedtoyou.
combinationsanddosages
ComprehensivefamiliaritywithcurrentguidanceBTS/SIGN
guidelines
Teamapproachtheroleofchronicdiseasemanagementclinics,
careplansandwhentorefertosecondarycare

Personcentredcare

Thisareaofcompetenceisabout
understandingandrelatingtothe
contextofyourpatientsasindividuals,
anddevelopingtheabilitytoworkin
partnershipwiththem.

Specificproblemsolvingskills

Thisareaofcompetenceisaboutthe
contextspecificaspectsofgeneral
practice,dealingwithearlyand
undifferentiatedillnessandtheskills
youneedtotolerateuncertainty,and
marginalisedanger,without
medicalisingnormality.

Approachestocommunicationofdiagnosisandtailoringof
treatmenttopersonalcircumstances
Explorationofhealthbeliefsastowhyasthmahasdeveloped

Riskbasedassessmentapproachesforasthmadiagnosisand
management
Approachestothemanagementofthefullspectrumofasthma
presentationsincludingchildhood,pregnancy,routinecareand
emergencymanagementofasthma
Techniquesforimprovingasthmamanagementinpatientswith
chaoticlifestylesorcomplexbackgroundissues
Knowledgeofhowsafeguardingconcernsmaypresentaspoorly
controlledasthmainchildren

Acomprehensiveapproach
Thisareaofcompetenceisabouthow
youasageneralpractitionermustbe
abletomanagecomorbidity,co
ordinatingcareofacuteillness,chronic
illness,healthpromotionanddisease
preventioninthegeneralpractice
setting.

Communityorientation
Thisareaofcompetenceisconcerned
withthephysicalenvironmentofyour
practicepopulation,andtheneedto
understandtheinterrelationship
betweenhealthandsocialcare,and
thetensionsthatmayexistbetween
individualwantsandneedsandthe
needsofthewidercommunity.

Aholisticapproach
Thisareaofcompetenceisaboutyour
abilitytounderstandandrespectthe
values,culture,familystructureand
beliefsofyourpatients,and
understandthewaysinwhichthese
willaffecttheexperienceand
managementofillnessandhealth.

Impactofexternalfactorsonasthmasuchassmokingandpollution
Impactofsmokinginpregnancyorinthehomeandtheincreased
riskofasthmainchildren
OccupationalasthmaandtheroleoftheGPasadvocateforthe
patientandsupportingreturntowork
Progressionofdiseaseanddifferentiation/coexistenceofCOPD
Comorbiditywithotherchronicdiseaseswheretheremaybe
conflictofmedication(e.g.betablockers)
Atopicdiseasessuchaseczemaandhayfeverandhowthesemay
affectoverallmanagement
Supportingselfcare,withknowledgeofmonitoringandtreatment
adjustmentandwhentoseekmedicalhelp
Theroleofhealthpromotioncampaignsinimprovingrespiratory
health
Differentpresentationsandprevalenceofasthmawithindifferent
demographicandgeographicgroupsandpossiblereasonsforthis
Roleofcommunityhealthworkerssuchasphysiotherapists,school
nurses,pulmonaryrehabilitationteams
Societalcostsofasthmaincludingillhealthanddrugcosts
Principlesofcosteffectiveprescribing;auditingchronicdisease
managementwithreducingexacerbationsandhospitaladmissions

Knowledgeofhowasthmamightimpactonlifeandidentity,e.g.
work/school/family/sociallife
Therelationshipsbetweenlongtermconditionsandmentalhealth
Theimpactofpatientshealthbeliefsandlifestylesonconcordance
Mediaportrayalofallergicdiseasesanddiagnosis

The essential features of you as a doctor

Thethreeessentialfeatures(EFs)belowareconcernedwiththefeaturesofyouasadoctorwhichmayinfluenceyour
abilitytoapplythecorecompetencesinreallifeintheworksetting.

Contextualfeatures
Thisessentialfeatureisabout
understandingyourowncontextasa
doctorandhowitmayinfluencethe
qualityofyourcare.Importantfactors
aretheenvironmentinwhichyou
work,includingyourworking
conditions,community,culture,
financialandregulatoryframeworks.

Attitudinalfeatures
Thisessentialfeatureisaboutyour
professionalcapabilities,values,
feelingsandethicsandtheimpact

HowtheinclusionofasthmaintheQualityandOutcomes
Framework(QOF)mayfocusinappropriateamountsofresourceat
theexpenseofotherdiseases
Howtheuseofnursesandchronicdiseasemanagementclinicsmay
deskillGPsorrequirenewskills
HowdifferentmanagementstrategiesbyGPswithinapracticemay
influencestandardsofcare
HowaccessibilitytoGPappointmentsmayinfluenceasthma
presentationsandtheabilityofpatientstoselfcare
HowasthmatargetsintheQOFmayproducepotentialconflictsof
interestforthedoctor(e.g.withpatientchoice)
Howdownwardcostpressuresonprescribingandmakingreferrals
mayaffectdecisionmaking

thesemayhaveonyourpatientcare.

Scientificfeatures
Thisessentialfeatureisabouttheneed
toadoptacriticalandevidencebased
approachtoyourwork,maintaining
thisthroughlifelonglearninganda
commitmenttoqualityimprovement.

Howpersonalfeelingsaboutsmokingrelatedillnessesorpatients
withasthmawhocontinuetosmoke,mayaffectcare
Howevidencerelatingtoasthmadiagnosisandmanagementisused
toinformthedoctorsclinicalpractice
HowQOFstandards,inclusionandexclusioncriteriaforasthmamay
affectpractice
Howknowledgeofinvestigationsandinterpretationofresultssuch
aspeakflowrates,spirometry,indicationsforxrayisappliedto
clinicalpractice
Howevidencefortheuseoravoidanceofalternativeand
complementarytherapiesinasthmaaffectsadvicetopatients
Howauditsandothertoolscanbeusedforevaluatingasthma
managementincludingoutcomemeasures(e.g.exacerbations
requiringoralsteroids,hospitaladmissions,deathsfromasthma,etc)

ETHICALEXAMPLEFitnesstoDrive

The RCGP areas of competence

Tohelpyouunderstandhowgeneralpracticeknowledgecanbeappliedtoadministration,ethicalandregulatory
frameworks,considerthefollowingscenarioofanelderlymanwithmildcognitiveimpairmentwhosefamilyare
concernedabouthisabilitytodrive.Theitemshavebeenorganisedintotheareasofcompetencedescribedinthe
corecurriculumstatement.
Knowledgeofnaturalhistory,aetiologyandepidemiologyof
cognitiveimpairment
Knowledgeofappropriateinvestigationsofpossibleearlydementia
Primarycaremanagement
Interpretationofresultssuchasscreeningtools,bloodtests,
Thisareaofcompetenceisabouthow
indicationsforandresultsofintracranialimaging
youmanageyourcontactwithpatients,
Knowledgeofappropriatetherapeuticinterventionsforcognitive
dealingcompetentlywithanyandall
impairment,includingdrugandnondrugtherapies
problemsthatarepresentedtoyou.
Referralroutestosecondarycare
Techniquesforsafetynettingandarrangingappropriatereview

Personcentredcare

Thisareaofcompetenceisabout
understandingandrelatingtothe
contextofyourpatientsasindividuals,
anddevelopingtheabilitytoworkin
partnershipwiththem.

Specificproblemsolvingskills

Thisareaofcompetenceisaboutthe
contextspecificaspectsofgeneral
practice,dealingwithearlyand
undifferentiatedillnessandtheskills
youneedtotolerateuncertainty,and
marginalisedanger,without
medicalisingnormality.

Acomprehensiveapproach

Thisareaofcompetenceisabouthow
youasageneralpractitionermustbe
abletomanagecomorbidity,co
ordinatingcareofacuteillness,chronic
illness,healthpromotionanddisease
preventioninthegeneralpractice
setting.

Communityorientation
Thisareaofcompetenceisconcerned
withthephysicalenvironmentofyour
practicepopulation,andtheneedto
understandtheinterrelationship
betweenhealthandsocialcare,andthe

Ethicalprinciplesincludingthoseofpatientautonomyinawider
socialcontext
Approachestothecommunicationofrisk
Theroleofthecarerandpatientindecisionsaboutcareplans

Specificknowledgeoftheassessmentofcognitiveimpairmentand
mentalcapacityandassessmentofphysicalfactors
DetailedfamiliaritywithcurrentguidanceincludingDVLA
regulationsandGMCGoodMedicalPracticeincludingtherules
regardingconfidentiality
Approachestocopingwithriskanduncertaintyintheearly
presentationofpotentialcognitiveimpairment

Social,physicalandmentalhealthreasonsforpotentialcognitive
impairment
Factorscontributingtotheprogressionorslowingofcognitive
impairment
Relationshipwithotherchronicdiseases(e.g.Parkinsonsdisease,
depression)
Roleoftherapeuticsinmanagementbutalsointhecausationof
cognitiveimpairment

Responsibilityofthedoctortotakeactiontoprotectthepatient
andgeneralpublic
Roleofcommunityhealthworkerssuchassocialservices,
communitymentalhealthteam,privatecare
Principlesofsafeandcosteffectiveprescribingespeciallyinthe
contextofmultimorbidityandoldage

tensionsthatmayexistbetween
individualwantsandneedsandthe
needsofthewidercommunity.

Aholisticapproach

Thisareaofcompetenceisaboutyour
abilitytounderstandandrespectthe
values,culture,familystructureand
beliefsofyourpatients,andunderstand
thewaysinwhichthesewillaffectthe
experienceandmanagementofillness
andhealth.

Approachestoensurerespectforanindividualpatientsrightto
makedecisionswhilstbalancingthedegreeofinsightanindividual
portrays
Explorationoftheimpactofcognitiveimpairmentonthepatients
life,e.g.personalidentity,independence,work,familyandsocial
life
Theroleofcarersandthefamilyinlivingwithandcaringfor
patientswithcognitiveimpairment

The essential features of you as a doctor

Thethreeessentialfeatures(EFs)belowareconcernedwiththefeaturesofyouasadoctorwhichmayinfluenceyour
abilitytoapplythecorecompetencesinreallifeintheworksetting.

Contextualfeatures
Thisessentialfeatureisabout
understandingyourowncontextasa
doctorandhowitmayinfluencethe
qualityofyourcare.Importantfactors
aretheenvironmentinwhichyouwork,
includingyourworkingconditions,
community,culture,financialand

regulatoryframeworks.

Attitudinalfeatures
Thisessentialfeatureisaboutyour
professionalcapabilities,values,
feelingsandethicsandtheimpact
thesemayhaveonyourpatientcare.

Scientificfeatures
Thisessentialfeatureisabouttheneed
toadoptacriticalandevidencebased
approachtoyourwork,maintainingthis
throughlifelonglearninganda
commitmenttoqualityimprovement.

Howtimeconstraintsofdealingwithpatientswithcognitive
impairmentmayaffectotherareasofpractice(e.g.extrahomevisits
ifthepatientisnolongerdriving)
Therelevantlegislationthatappliestopatientswithcognitive
impairment
Howgoodrecordkeepingisespeciallyimportant(e.g.whether
advicere:drivingisclearlyrecordedinthenotes)

Howcopingwithpotentialconflictsofinterestmightaffectpatients
withcognitiveimpairment(e.g.betweencarerandpatient)
Howethicalprinciplescanbeappliedtodecisionmaking
Howconcernsaboutsafeindependentlivingandabilitytodrive
mightaffectthedoctorpatientrelationship
Howpersonalfeelingsaboutpeoplewithcognitiveimpairment
mightaffectthedoctorsdecisionmaking

Howemergingknowledgeaboutcognitiveimpairmentandits
managementcanbeappliedandhowauditingdatacanimprove
patientcare

AKTCONTENTGUIDE
SECTION1CLINICALMEDICINE(80%ofthequestions)

ForeachproblemordiseaseintheContentGuide,considerthefollowingareaswithinthegeneral
contextofprimarycare:

Thenaturalhistoryoftheuntreatedconditionincludingwhetheracuteorchronic
Theprevalenceandincidenceacrossallagesandanychangesovertime
Typicalandatypicalpresentations
Recognitionofnormalvariationsthroughoutlife
Riskfactors
Diagnosticfeaturesanddifferentialdiagnosis
Recognitionofalarmorredflagfeatures
Appropriateandrelevantinvestigations
Interpretationoftestresults
Managementincludingselfcare,initial,emergencyandcontinuingcare,chronicdisease
monitoring
Patientinformationandeducationincludingselfcare
Prognosis

Theproblemsanddiseasesarelistedingroupsofconditionsclassifiedbybodysystemreflectingthe
currentrangeofgeneralpracticeworkloadintheUnitedKingdom.Thereisinevitablyoverlap
betweensystemclassificationsandareassuchaschildhealth.

AKTquestionsareconstructedtoreflecttheAPPLICATIONofknowledgeandsotheContentGuide
notonlylistsdiseases,butalsolistssymptomsthatrequiredifferentialdiagnosis.Thesearelisted
withinthesystemsectionsforconvenience.Manysymptomscouldrelatetomorethanonebody
systemsocommonpresentingsymptomsaregatheredtogetheratthestart.Forexample,vomiting
canhavegastrointestinal,neurological,psychological,druginduced,metabolic,orrenalcauses,or
anycombinationofcontributingcauses.

COMMONPRESENTINGSYMPTOMS&SIGNS
Theseitemsarepresentedalphabeticallyratherthaninorderoffrequencyorimportance
Abdominalbloating/distension
Abdominalpain
Abnormalbleeding(excessivebruising,haemoptysis,haematemesis,haematuria,rectalbleeding)
Addictivebehaviour(smoking,alcohol,drugs,gambling)
Anxietyandpanicattacks
Appetiteloss
Behaviouraldisturbance(confusion,delirium,aggression,violence)
Breastlumpsandpain
Breathlessness
Chestpain
Collapseandunconsciousness,seizures
Constipationanddiarrhoea
Cough,wheezing,stridor
Depressionandlowmood
Dizziness
Dyspepsia
Dysphagia
ENTsymptoms(earache,hearingloss,vertigo,tinnitus)

10

Erectiledysfunction
Facialpain(includingdentalproblems)andoralsymptoms
Fever
Hairlossandexcessivehair
Headache
Incontinenceofurineandfaeces
Jaundiceandascites
Jointpains,jointswelling
Lackofconcentrationandmemoryproblems,cognitiveimpairment
Lethargy
Limb,backandneckpain
Lossoffunction(e.g.facialweakness,ptosis)
Lumps(e.g.skin,softtissue,bone,muscle,lymphadenopathy,hernias,tumours[benign&
malignant,primaryandmetastatic])
Menstrualdisorders
Nauseaandvomiting
Oedema
Palpitations
Pelvicpain
Pruritus
Psychoticsymptoms(hallucinations,delusions,thoughtdisorders)
Rashes
Sensory(e.g.numbness,paraesthesia,pain)andmotor(e.g.weakness,stiffness,tremor,gait,co
ordination)symptoms
Skinlesions
Speechproblems,hoarseness
Subfertility,pregnancy,sexualhealthbehaviours(e.g.contraception)
Thirstanddrymouth,polydipsia
Tirednessandlethargy
Urinaryfrequency,dysuria,retention,nocturia
Vaginaldischargeandabnormalbleedingpatternsincludinginpregnancy
Visualsymptoms(e.g.blurredorlossofvision,doublevision,painful/painlessredeye)
Weightgainandweightloss

KNOWLEDGEOFEMERGENCIESINGENERALPRACTICE
Symptomsandsignsoftheacutelyillchild
Symptomsandsignsofacuteillnessinadultsincludingpatientswithintellectualdisabilities,
dementia,communicationproblems
Featuresofsevereorlifethreateninginjuries
Featuresofseriousillnessrequiringanimmediateresponse(e.g.meningitis,respiratory
compromise,circulatoryshock,septicshock,anaphylaxis,etc.)
Featuresofmentalhealthemergenciesandfactorssuggestiveofahighriskofharmtoself
orothers

CurriculumLinksacrossallthetopicareasoftheContentGuide
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum301HealthyPeople.ashx
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum303AcutelyIllPeople.ashx
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum305OlderAdults.ashx

11

SYSTEMCLASSIFICATION

CARDIOVASCULARPROBLEMS

Symptomsandsigns
o Cardiacmurmurs
o Chestpain(includingfactorssuggestiveofcardiacorigin)
o Circulatorysymptomsofischaemia,thrombosis
o Dyspnoea
o Oedemaperipheralandcentral
o Palpitationsandarrhythmias
o Syncopeandcollapse

Investigations
SpecificcardiacinvestigationsincludingambulatoryBPmonitoring,ECG,exerciseECG,24
hourandeventmonitoringECGs,echocardiography
KnowledgeandapplicationofcurrentriskassessmenttoolssuchasCHADS2foratrial
fibrillation,QRISK/ASSIGN/FraminghamforCHD
Relevantbloodinvestigationssuchascardiacenzymes,natriureticpeptides
Secondarycareinterventionssuchascoronaryangiographyandstents,perfusionscanning,CT
scans

Specificconditions
Riskfactorsforcoronaryheartdiseaseandotherthromboembolicdiseasessuchaslipid
disorders,diabetes,hypertension.Screeningandriskmodificationsuchassmokingcessation
Acutecardiovascularproblemsincludingcardiacarrest,acutecoronarysyndrome,acute
myocardialinfarct,acuteleftventricularfailure,dissectinganeurysms,severehypertension
andlifethreateningarrhythmias,cardiogenicshock,acuteischaemiaoflimbsandgut
Coronaryheartdiseaseincludingcomplicationssuchasmuralthrombus,ventricular
aneurysm,rhythmdisturbance
Heartfailureacuteandchronicincludingleftventriculardysfunction,rightheartfailure,cor
pulmonale
Hypertensionessentialandsecondary,malignant
Arrhythmiasincludingconductiondefectssuchasatrialfibrillationandflutter,heartblock,
supraventriculartachycardia,ventricularrhythmabnormalities
AnticoagulationrelevanttocardiovasculardiseasessuchasAF,myocardialischaemia,
peripheralvasculardisease,stroke,includingheparin,thrombolysis,oralanticoagulation
Valvularproblemssuchasmitral,tricuspid,pulmonaryandaorticstenosisandregurgitation
Congenitalheartdiseasesuchascoarctationoftheaorta,VSD,ASD,PDAandpresentationof
thesebothinchildrenandadults
Circulationdisordersincludingarterialproblemssuchasperipheralvasculardisease,
vasculitis,aneurysms(cerebral,aorticandperipheral)andvenousproblemssuchasvenous
thromboembolism,pulmonaryembolism,varicoseveins,venousandarterialulcers
Pulmonaryhypertension;primaryandsecondarytounderlyingcausessuchasfibroticlung
disease,recurrentpulmonaryemboli
Cardiomyopathiesprimaryandacquired,includingdilated,hypertrophicobstructive
Infectionssuchasviralmyocarditis,infectiveendocarditis,pericarditis,rheumaticfeverand
complications

12

Knowledgeofpacemakersrelevanttoprimarycaresuchascomplicationsandmalfunction
Druginducedheartdiseasee.g.secondarytocancertreatmentwith
chemotherapy/radiotherapy,recreationaldrugs

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum312CardiovascularHealth.ashx

13

DIGESTIVEPROBLEMSINCLUDINGNUTRITION

Symptomsandsigns
o Abdominalmassesandswellingsincludingorganenlargementsuchassplenomegalyand
hepatomegaly
o Abdominalpainincludingthedifferentialdiagnosisfromnongastrointestinalcausese.g.
gynaecologicalorurological
o Ascites
o Chestpain
o Constipation,diarrhoea,changeinbowelhabit,tenesmus,faecalincontinence
o Cough
o Disturbanceofsmellandtaste
o Dyspepsia,heartburn
o Dysphagia
o Haematemesis
o Hiccups
o Jaundice
o Mouthulceration,leukoplakia,salivaryproblems
o Nauseaandvomitingincludingnongastrointestinalcauses
o Obesity,weightgain,anorexiaandweightloss
o Pruritus
o Rectalbleeding

Investigations
Investigationssuchasendoscopy,ultrasoundandotherscans,interpretationofrelevant
testssuchasthoseforHelicobacterpyloriinfection,coeliacdisease
Interpretationofstoolcultureresults
Testsofliverfunctionincludinginterpretationofimmunologicalresults,markersof
malignancye.g.CEAandAFP
Screeningprogrammesforcolorectalcancersuchasoccultbloodtesting,sigmoidoscopy,
colonoscopy
Knowledgeofsecondarycareinterventionssuchasendoscopy,laparoscopicsurgery,ERCP,
radiologicalinvestigationsincludingcontrastandCTscans

Specificconditions
Acuteabdominalconditionssuchasappendicitis,acuteobstructionandperforation,
diverticulitis,Meckelsdiverticulum,ischaemia,volvulus,intussusception,gastricand
duodenalulcer,pancreatitis,cholecystitis,biliarycolic,empyema,renalcolic
Chronicabdominalconditionssuchasirritablebowelsyndrome,inflammatorybowel
disease,diverticulardisease,coeliacdisease
o UpperGIconditions
Oesophagealconditionsincludingachalasia,malignancy,benignstricture,Barretts
oesophagus,globus
Gastrointestinalhaemorrhageincludingoesophagealvarices,MalloryWeisssyndrome,
telangiectasia,angiodysplasia,PeutzJegherssyndrome
Gastrooesophagealrefluxdisease,nonulcerdyspepsia,pepticulcerdisease,H.pylori,hiatus
hernia

14

LowerGIconditions
Constipationprimaryandsecondarytoothersystemicdiseasessuchashypothyroidism,
druginduced,hypercalcaemia
Diarrhoea
GastrointestinalinfectionincludingtoxinssuchasC.difficileandEcoli,bacterialcausessuch
assalmonella,campylobacter,amoebicdysentery,viralcausessuchasrotavirus,norovirus
andparasiticcausessuchasGiardialamblia
InflammatoryboweldiseasesuchasCrohnsdisease,ulcerativecolitis
Malabsorptionincludingcoeliacdisease,lactoseintolerance,secondarytopancreatic
insufficiencysuchaschronicpancreatitis,cysticfibrosis,bacterialovergrowth
Rectalproblemsincludinganalfissure,haemorrhoids,prolapse,polyps,malignancy
Gastrointestinalmalignanciesincludingoesophageal,gastric,pancreatic,colorectal,
carcinoid,lymphoma
o Liver,gallbladderandpancreaticdisease
Assessmentandinvestigationofabnormalliverfunctiontests.Differentialdiagnosisof
underlyingcausessuchasfattyliver/nonalcoholicsteatohepatitis,druginduced,infection,
cirrhosis,autoimmunedisease
Liverinfectionssuchasviralhepatitis,leptospirosis,hydatiddisease
Livertoxinsincludingdrugssuchasparacetamol,chemicalsandalcohol
Cirrhosisanditscausessuchasalcohol,nonalcoholicsteatohepatitis/fattyliverand
autoimmunediseasessuchasprimarybiliarycirrhosis,chronicactivehepatitis,1
antitrypsindeficiency,Wilsonsdisease,haemolysis
Secondaryeffectsofliverdiseasessuchasascites,portalhypertension,hepaticfailure
Livermalignancyprimaryandmetastatic
Gallbladderdiseasesuchasgallstones,cholecystitis,biliarycolic,empyema,malignancy
Pancreaticdiseasesincludingacutepancreatitis,chronicpancreatitis,malabsorption,
malignancyincludingisletcelltumours
o Nutrition
Nutritionalproblemssuchasvitaminandmineraldeficiencies,supplementarynutritionsuch
asdietary,PEGandparenteralfeeding
Complicationsandmanagementofstomas
Disordersofweight;obesityandweightlossincludingnonnutritionalcausessuchasthyroid
diseaseandotherendocrineconditions

Herniasinguinal,femoral,diaphragmatic,hiatus,incisional

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum313DigestiveHealth.ashx

15

EAR,NOSEANDTHROAT,ORALANDFACIALPROBLEMS

Symptomsandsigns
o Cough
o Dentalsymptomsrelevanttogeneralmedicalpractice
o Disturbanceofsmellandtaste
o Earacheanddischarge
o Epistaxis
o Facialdysfunctionsensoryandmotor
o Facialpain
o Hearingproblemsanddeafness,tinnitus
o Hoarseness
o Rhinitisandnasalobstruction
o Salivationproblemsincludingswellingandobstructionofglands,excessiveandreduced
salivation
o Sorethroatandmouth
o Soretongueandchangesintaste
o Vertigoanddizziness,falls

Investigations
Testsofhearingsuchastympanometry,audiometry,tuningforktestsincludingWebersand
Rinnes,neonatalandchildhoodscreeningtests
RelevantdiagnosticandtherapeuticclinicaltestssuchasHallpikeandEpleymanoeuvre
AppropriateuseofinvestigationssuchasCTandMRIscans,endoscopy,sleepstudies
Otoscopicappearances

Specificconditions
Nasalproblemsincludingperennialandallergicrhinitis,adversedrugeffect,polypsand
othercausesofnasalobstruction,epistaxis,trauma,foreignbodies,septaldeviation,trauma
Eardisordersearacheanddischargeincludingotitisexterna,otitismediawithandwithout
effusion,perforationoftheeardrum,barotrauma,cholesteatoma,mastoiditis,disorders
affectingtheskinofthepinnasuchasinfection,solardamageandmalignancyandaffecting
thecartilagesuchasinjuriesandpolychondritis
Oralproblemsincludingpainsuchasulceration,lichenplanus,infectionssuchasgingivitis,
herpessimplex,candidiasis,premalignantconditionssuchasleukoplakia,malignancies
includingtonsils,tongue,lipsandbuccalmucosa
Throatproblemssuchasinfections,globus,pharyngealpouch
Disordersofthesalivaryglandssuchasinfection(e.g.mumps),salivaryductstones,
connectivetissuediseasessuchasSjgrenssyndrome,tumourssuchaspleomorphic
adenoma,lymphoma
Dentalproblemspresentingingeneralmedicalpracticesuchasabscesses;dentaldisease
duetounderlyingmedicalcausessuchasanorexia,xerostomia,druginduced
Sinusproblemsincludingacuteandchronicinfection,polyps,allergicrhinosinusitis,
barotrauma
Headandneckmalignanciesincludinglaryngeal,nasopharyngeal,sinuses,salivaryglands,
tongue,lipsandoralcavity,tonsillarincludinglymphomas,unidentifiedmalignancies
presentingwithlymphadenopathy
Hearingproblemsincludingdeafnesssuchasoccupational,presbyacusis,otosclerosis,
tinnitusandassociatedspeechorlanguagedisorders

16

Hearingaidsandcochlearimplants,tinnitusmaskers
Vertigocentrale.g.brainstemstrokeandperipherale.g.benignparoxysmalpositional
vertigo,vestibularneuronitis,Mniresdisease,acousticneuroma.Factorsdifferentiating
vertigofromdizzinessandlightheadedness
CranialnervedisorderssuchasRamsayHuntsyndrome,Bellspalsy,trigeminalneuralgia,
ototoxicitysecondarytodrugs
Vocaldisorderssuchashoarseness,dysphonia,aphoniaandunderlyingcausessuchasvocal
cordnodules,laryngealnervepalsy.Associationswithsmoking,occupationand
environmentalfactors
Congenitalabnormalitiese.g.cleftpalate/lip,absentpinna
Aestheticandreconstructivesurgeryandbotulinumtoxintherapiesasmaybeencountered
inGP
Emergencytreatmentssuchastracheotomy
Tracheotomymanagementinprimarycare

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum315ENTOralandFacialProblems.ashx

17

EYEPROBLEMS

Symptomsandsigns
o Colourblindness,changesincolourvision
o Diplopia,squintandamblyopia
o Dischargefromtheeye
o Dryeyes
o Entropion/ectropion
o Epiphora
o Eyelidswellings
o Orbitalswellings
o Redeyepainfulandpainless
o Visualdisturbancecomplete/partiallossofvision,distortedvision,floaters,flashes
o Visualfielddisturbance

Investigations

Interpretationoffundoscopyappearances,visualacuityresults,visualfieldtests,tonometry,
Amslercharts,testsofcolourvision

Specificconditions

Redeyedifferentialdiagnosesandappropriatemanagementincludingtimescaleof
urgency

Lossofvisionorvisualdisturbance;differentialdiagnosesandappropriatemanagement
includingtimescaleofurgency

Refractiveerrorincludingmyopia,hypermetropia,astigmatism

DisordersofthepupilsuchasHornerssyndrome,HolmesAdie

Congenital,neonatalandchildhoodeyeproblems,suchasprematurity,congenitalcataract,
vitaminAdeficiency

Geneticeyeproblemssuchasretinoblastoma,retinitispigmentosa

Colourblindness

Keratoconus

Ophthalmicherpeszoster

Orbitalinfectionssuchascellulitis,tumours

Conjunctivitisincludinginfectionincludingbacterial,viral,parasiticandchlamydialcauses,
andallergiccauses

Uveitisincludingknowledgeofunderlyingassociationse.g.inflammatoryboweldisease,
connectivetissuediseases

Episcleritis,cornealordendriticulcers,pterygium,pinguecula,cornealinjuryanderosions

Subconjunctivalhaemorrhage

Contactlensuseincludinginfectionssuchasacanthamoeba,cornealdamage

Keratitisincludingassociationwithotherdiseasessuchasrosacea,thyroiddisease

Cataractscongenital,acquiredsuchasdruginduced

Glaucomaacute,closedangleandchronicopenangle

Ophthalmicmanifestationsofinfectionssuchassyphilis,TB,toxocariasis,toxoplasmosis

Retinalproblemsincluding
o detachment
o vascularlesions
o atrophy

18

tumourssuchasmelanoma,neuroblastoma
associatedwithsystemicdiseasessuchashypertension,diabetes,haematological
diseasescausinghaemorrhage,exudates,bloodvesselchanges
Malignancysuchasretinoblastoma,lymphoma,melanoma
Systemicdiseaseswithassociatedeyesymptoms/signs,suchashypertension,diabetes,
raisedintracranialpressure,multiplesclerosis
Thyroideyedisease
Eyelidproblemssuchasblepharitis,ectropion,entropion,chalazion,Meibomiancysts
Disordersoftearsandtearductssuchasdacryocystitis,siccasyndrome,epiphora,dryeyes
Squintchildhoodandacquiredduetonervepalsy,amblyopia,blepharospasm
Maculardegenerationagerelated(wetanddry),drusen
Eyetraumaincludingpenetratingtrauma,cornealabrasions,chemicalburns,contusions
o
o

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum316EyeProblems.ashx

19

GENETICS

Geneticconditionsencounteredinprimarycaresuchascysticfibrosis,
haemoglobinopathies,haemophiliaandrelatedclottingdisorders,musculardystrophies,
neurologicalconditionssuchasHuntingtons,FragileX
Inheritancepatternsofgeneticdisorderssuchasautosomaldominant,autosomalrecessive,
sexlinkedinheritance
ChromosomaldisorderssuchasDownssyndrome,trisomy18,Turnerssyndrome,
Klinefelterssyndrome
Knowledgeofriskofinheritancethroughgenerations,genograms
Polygenicdiseasesuchasfamilialhypercholesterolaemia
Ethicsofgenetictesting(seeAdministration,EthicalandRegulatoryFrameworks)
Familialcancersyndromesandassociatedtestse.g.BRACanalysis

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum302GeneticsInPrimaryCare.ashx

20

HAEMATOLOGYPROBLEMS

Symptomsandsigns
o Bruising,petechiaeandpurpura
o Goutassociatedwithhaematologicalmalignanciesandmyelodysplasias
o Jaundicesecondarytohaemolysis
o Lymphadenopathy,splenomegalyandhepatomegaly
o Pallorandanaemia
o Recurrentinfection
o Skinmanifestationsofhaematologicaldiseasee.g.mycosisfungoides
o Systemicmanifestationsofhaematologicaldiseasee.g.sicklingcrisis

Investigations

Normalhaematologicalparametersandinterpretationoflaboratoryinvestigationssuchas
fullbloodcount,haematinics,monitoringofanticoagulantsandinvestigationofcoagulation
disordersincludingthrombophiliaandexcessivebleeding,proteinelectrophoreses,
immunoglobulins

Bloodgroupingsuchasrhesusstatusincludingantenatalblooddisorders;safetransfusion
practice

Otherrelevantprimarycareinvestigationse.g.xrays,paraproteinurinetestinginmyeloma

Relevantsecondarycareinvestigationssuchasbonemarrow,bonescans

Specificconditions

Haematologicalmalignanciessuchasacuteandchronicleukaemias,lymphomasincluding
Hodgkins,nonHodgkinslymphomas,gutandskinlymphomas,multiplemyeloma

Myeloproliferativedisorderssuchaspolycythaemiarubravera,thrombocytosis

Polycythaemiaprimaryandsecondarysuchastohypoxia,malignancy

Myelodysplasiaandaplasticanaemia

Enlargedlymphnodesofanycause+/splenomegalyincludinginfectionandmalignancy
bothprimaryandsecondary.Managementofasingleenlargedlymphnode

Lymphaticdisorderssuchasprimarylymphoedema

Splenectomyincludingfunctionalasplenia

Splenomegalyincludingunderlyingcauses,hypersplenism,complicationssuchasrupture
andsequestration

Anaemiaanditscausesincludingiron,folateandvitaminB12deficiency,sideroblastic,
haemolytic,chronicdisease

Haemoglobinopathiessuchasthalassaemia,sicklecelldisease;antenatalscreening

Haemolyticdiseasesincludingmanagementofrhesusnegativewomeninpregnancy,
autoimmuneandtransfusionhaemolysis

ClottingdisordersincludinggeneticcausessuchashaemophiliaandvonWillebrands
disease,infectivecausessuchasmeningococcalsepticaemiaanddisseminatedintravascular
coagulation

Thrombocytopeniaanditscausessuchasidiopathicthrombocytopenicpurpura,drug
induced

Purpurarecognitionandcausessuchasdruginduced,HenochSchnlein

Anticoagulantsindications,initiation,managementandreversal/withdrawalincluding
heparin,warfarin,dabigatranandsimilarnewagents,includingdruginteractionsandcontra
indications

EnzymediseasessuchasG6PDdeficiency

Neutropaeniaprimaryandsecondaryincludingchemotherapyanddruginduced

Commonabnormalitiesofbloodfilmsandtheirmanagemente.g.macrocytosis,
microcytosis,spherocytosis,neutrophilia

21

IMMUNOLOGYPROBLEMS

Symptomsandsigns
o Anaphylaxis
o Atopyasthma,eczemaandhayfever
o Drugreactions
o Foodallergiesandintolerances
o Recurrentinfections
o Urticaria

Investigations
InvestigationssuchasimmunoglobulinlevelsincludingIgG,IgMandIgEserology,
complement,RASTtests,skinpatchandpricktesting,exclusionchallenges

Specificconditions
Immunedeficiencystatesinherited,primaryandacquiredsuchasHIV,chemotherapy
Skinmanifestationsofimmunediseasesuchasurticaria,atopiceczema,erythema
multiforme
Anaphylaxisrecognitionandmanagementincludingdosesofadrenalineandresuscitation
Typesofallergicreactionsimmediate,delayed,possiblemechanisms
Occupationalallergiessuchaslatexallergy,contactallergiessuchashairdye,metals,plants,
preservatives
Immunisationknowledgeofroutineprimarychildhoodimmunisationschedules,
contraindicationsandadversereactions
Immunisationknowledgeofantibodytestresultsusedinguidingmanagementofspecific
situationssuchaschickenpoxinpregnancy,rubellaimmunisation,hepatitisBandC
ImmunisationforoccupationalmedicinesuchashealthcareworkersandhepatitisB
KnowledgeofmanagementofneedlestickinjuriesandriskofhepatitisBandC,HIV
Knowledgeoftransplantationmedicineasapplicabletoprimarycareparticularlyin
managementoforgantransplantssuchasheart,lung,liver,kidney,cornea.Indicationsfor,
andcomplicationsoftransplantatione.g.immunosuppressionandimmunosuppressant
drugs
Mechanismsofdrugallergiesandinteractions

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INFECTIOUSDISEASES

ThisareainevitablyoverlapswithothertopiclistsandsomeinfectionssuchasTBappearinseveral
differentsystemssuchasrespiratory,gastrointestinal,musculoskeletalandneurological.

Investigations
Knowledgeoftheuseandinterpretationofappropriateinvestigationssuchas:serological
testing,samplingsuchasswabs,urineandstoolculture,imagingsuchasCXR

Immunisation
ImmunisationincludingindicationsandcontraindicationsreferencedtotheBNFandthe
GreenBook
Commoninfectionsseeningeneralpractice,e.g.bacterial(e.g.staphylococcal,
streptococcal),viral(e.g.childhoodexanthema),fungal,parasitic,infestations(e.g.scabies,
threadworm).Specificinfectionsarementionedintherelevantsystemssections
TravelmedicinetoincludediseaseswhichmaybecontractedintheUKand/orabroadbut
maypresentinUKprimarycare
o Malariaincludingpresentationsandprophylaxis
o GIinfectionssuchasamoebicdysentery,hydatiddisease,schistosomiasis,
leptospirosis,typhoid,hepatitis,brucellosis
o Skininfectionssuchasorf,animalringworm,leishmaniasis,cutaneouslarvamigrans
o Tickbornediseases

HumanImmunodeficiencyVirus(HIV)includingpreventionandtransmissionandassociated
diseasessuchasPneumocystisjirovecii(carinii),Cryptococcusspp.cytomegalovirus,

Tuberculosis

Legionnairesdisease

InsectbornediseasessuchasLymedisease,malaria

Occupationalinfectionsandtheirmanagement,e.g.needlestickinfections

Nosocomialinfections:MRSA,C.difficile

Pandemics,e.g.pandemicinfluenza

StatutoryNotificationofdiseases,contacttracing

RoleofHealthProtectionAgencyorequivalent

23

INTELLECTUALANDLEARNINGDISABILITIES

Commoncausessuchasautisticspectrumdisorder,dyspraxia;geneticcausessuchasFragile
X,Williams,PraderWilliandDownssyndromes.Diagnosisthroughdelayedoraltered
development
Associatedphysicalhealthdisorders:unmetphysicalneedsuchasvisualandhearing
problems.Useofannualhealthchecks;commonassociationse.g.epilepsy,obesity,
diabetes;specificassociationse.g.Downssyndromeandhypothyroidism.Health
promotion,sexualhealth,contraception,cardiovasculardiseaserisks,smokingcessation
Impactoflearningdisabilityonmanagementandlongtermoutcomeofchronicdiseaseboth
physicalandmentale.g.diabetes,asthma,schizophrenia,bipolardisorder,epilepsy
Methodsoffacilitatingconsultationssuchasuseofadvocates/carerswithcommunication
expertise
Principlesofmanagementofbehaviouralproblemsinpeoplewithintellectualdisabilityand
possibleunderlyingcausessuchaspainorillness
Associatedmentalhealthproblems:increasedprevalenceanddifferentpresentationssuch
asearlydementia,depression;specificassociationse.g.autismspectrumdisorderandADHD
Mentalcapacityassessmentandassociatedlegislation.Implicationsfortreatmentconsent
andscreeningprogrammes.PowerofAttorneyanditsapplicationinmanagement.GMC
guidanceonconsentandcapacity,confidentiality
Protectionofvulnerableadults,ethicsofcaringforpeoplewithintellectualdisabilities

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum311PeopleWithIntellectualDisability.ashx

24

MENTALHEALTHPROBLEMS

Symptomsandsigns
o Acutepsychosisincludinghallucinationsanddelusions,thoughtdisorders
o Addictiveanddependentbehavioursuchasalcoholanddrugs
o Affectivedisordersincludingdepressionandmania,suicidalbehaviour
o Anxietyandpanicattacks
o Delirium
o Obsessivecompulsivebehaviour

Investigations
Assessmenttoolsformentalhealthproblemssuchasdepressionandpostnataldepression
screeningscales,dementiascreening,suicideriskassessmentandriskofselfharm
Relevantphysicalinvestigationssuchasbloodtestsandrelevantneurologicalinvestigations
Monitoringoftreatmentssuchaslithium,clozapine

Specificconditions
Behaviourproblemssuchasattentiondeficithyperactivitydisorder,enuresis,encopresis,
schoolrefusal
Psychologicalproblemsincludingpsychosocialproblemsandthoseassociatedwith
particularlifestagessuchaschildhood,adolescenceandolderpeople
Pregnancyassociateddisorderssuchasantenatalandpostnataldepression,puerperal
psychosis
Mood(affective)problemssuchasdepressionincludingfeaturesofamajordepressionsuch
aspsychoticandbiologicalsymptoms;bipolardisorder,assessmentofsuicidalrisk;detection
ofmaskeddepression
Severebehaviouraldisturbanceincludingpsychoticdisorderssuchasschizophrenia,acute
paranoiaandacutemania
Somatisationdisorderincludingmedicallyunexplainedproblems
Personalitydisordersincludingborderline,antisocial,narcissistic
Eatingdisordersincludingmorbidobesity,anorexiaandbulimianervosa,bodydysmorphia
Anxietyincludinggeneralisedanxietyandpanicdisorders,phobias,obsessivecompulsive
disorder,situationalanxietyandadjustmentreactions
Posttraumaticstressdisorder
Sleepdisordersincludinginsomnia,sleepwalking
Deliberateselfharmincludingoverdoses.Suicidalthoughtdisorders
Acutementalhealthproblemsincludingacutepsychoses,acuteorganicreactions,the
suicidalpatient,psychologicalcrisesandtheapplicationoftheMentalHealthActas
applicabletoalltheUKHomecountries
Abuseincludingchild,sexual,elder,domesticviolence,emotionalincludingnonaccidental
injury
Mentalhealthdisordersassociatedwithphysicalhealthdisorderse.g.psychosisassociated
withsteroidtherapy,depressionassociatedwithParkinsonsdisease,diabetesandother
chronicdiseases
Organicreactions(acuteandchronic)suchasdeliriumwithunderlyingcausessuchas
infection,adversereactionstodrugs
Electroconvulsivetherapyindicationsandsideeffects

25

Selfhelpandpsychologicaltherapiessuchascognitivebehaviouraltherapy,eyemovement
desensitisationandreprogramming,counselling,psychotherapy,psychoanalysis,aversion,
floodinganddesensitisationtherapies
Culturalandsocietalaspectsofmentalhealthincludingwork,spiritualandreligiousbeliefs
andpractices
Relationshipwithsubstancemisuseanddependenceincludingalcoholanddrugsofmisuse
andotherhabitdisorderssuchasgambling

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum310MentalHealthProblems.ashx

ALCOHOLANDSUBSTANCEMISUSEPROBLEMS
Knowledgeofthedifferentformsofharmfulalcoholanddruguseandhowthismaypresent
(e.g.excessiveuse,binges,risktakingbehavioursordependency)
Knowledgeofthebarrierstocareforpeoplewhomisusealcoholordrugs
Signsandsymptomsofdrug/alcoholmisuse,aswellasthesignsandsymptomsof
withdrawal
Evidencebasedscreening,briefinterventionsforalcoholmisuse
Effectiveprimarycaretreatmentsforalcoholandsubstancemisusedisorders
Principlesofharmreductionandhealthpromotionforpeoplewhomisusedrugsandalcohol
Screeningforbloodbornevirusesandindicationsforimmunisation
Theshorttermandlongtermsequelaeofalcoholanddrugmisuse,includingphysical,
mentalandsocialharmsandtheimpactonchildren,familiesandworklife
Knowledgeofthedangersofdrink/drugdrivingandtheGPsresponsibilitiesinrelationto
advisingandreportingonthis
Roleofwiderprimaryhealthcareteamincludingpharmacists,specialistservices,the
voluntaryandcriminaljusticesectors
Knowledgeofsafeguardingproceduresforchildrenandvulnerableadultsandhowthese
mustshapeclinicaldecisionsandbehaviour
Legalaspectsrelatingtoalcoholandsubstancemisuseandopiatesubstitutionprescribing

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum314DrugandAlcoholMisuse.ashx

26

METABOLICANDENDOCRINEPROBLEMS

Symptomsandsigns
o Changesinreproductiveandsexualfunctionsuchasmenstrualdisorders,lossoflibido,body
hairchangesanderectiledysfunction
o Collapseandcoma
o Gastrointestinalsymptomssuchasnausea,vomiting,diarrhoea,constipation
o Headacheandvisualproblems
o Jointpainsandmuscleproblems
o Polydipsiaandpolyuria
o Pruritus
o Thirst
o Tiredness,lethargy
o Weightgain/weightloss

Investigations
Normalbiochemicalparametersandinterpretationoflaboratoryinvestigationssuchas
renal,liver,thyroid,glucose,pancreatic,adrenal,pituitary,hypothalamic,ovarianand
testicularfunction
Imagingandtestsofendocrineandmetabolicdynamicfunction

Specificconditions
Diabetesmellitustype1,type2,andrarertypessuchasMODY(maturityonsetdiabetesof
theyoung).Disordersofglucosemetabolismsuchasimpairedfastingglucose,impaired
glucosetolerance,insulinresistance,gestationaldiabetes,associatedsystemdisorderssuch
asskinandeyemanifestations,renalandneurologicalcomplications.Acutecomplications
suchashypoglycaemia,diabeticketoacidosis,nonketotichyperglycaemia
Thyroiddiseasesincludinggoitre,hypothyroidism,hyperthyroidism,benignandmalignant
tumours,thyroideyedisease,thyroiditis,neonatalhyperandhypothyroidism
AdrenaldiseasesincludingAddisonsdisease,Cushingssyndromeanddisease,
phaeochromocytoma,hyperaldosteronism,primaryandsecondarymalignancy,ACTH
secretingtumours,congenitaladrenalhyperplasia
Replacementandtherapeuticsteroidtherapy
Carcinoidsyndrome,multipleneuroendocrineneoplasia
Pituitarydiseasesincludingacromegaly,primaryandsecondaryhypopituitarism,diabetes
insipidus
Hypothalamiccausesofhormonaldisturbancesincludinghyperprolactinaemia,druginduced
Causesofhyperprolactinaemiasuchasdruginduced,chronicrenalfailure,bronchogenic
carcinoma,hypothyroidism
Disordersofsexhormonessuchashirsutism,virilism,gynaecomastia,impotence,androgen
deficiency,androgeninsensitivitysyndrome
Endocrinemanifestationsofnonendocrinediseasese.g.bronchogeniccarcinomawith
inappropriateADHsecretion
Inheritedmetabolicdiseasese.g.phenylketonuria,glycogenstoragediseases
Hyperuricaemiaprimaryandsecondaryincludinghaematologicalcauses,druginduced
Haemochromatosisprimaryandsecondary,andotherdisordersofironmetabolism
Disordersofcalciummetabolismhypoparathyroidism,hyperparathyroidism,osteomalacia
andvitaminDdisorders,associationwithchronickidneydisease,malignancysuchasbony
metastasesandmyeloma

27

Hyperlipidaemiasfamilialandacquired
Metaboliccausesofunconsciousnesse.g.hypoglycaemia,diabeticketoacidosis,
hyponatraemia,hypothyroidism,adrenalcrisis
Poisoningincludingbyfood,drugs(prescribed,overthecounterornonmedicinal)orother
chemicalswhetherdeliberatelyorunintentionally
Adversemetaboliceffectsofprescribeddrugse.g.hypokalaemiawithdiuretics

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum317MetabolicProblems.ashx

28

MUSCULOSKELETALPROBLEMSINCLUDINGTRAUMA

Symptomsandsigns
o Associatedsymptomswithconnectivetissuediseasessuchasskin,eye,GImanifestations
o Falls
o Jointpain,stiffness,swelling,deformity,rednessincludingindividualjointssuchasbackand
neck,jaw,hip,knee,ankle,foot,shoulder,elbow,wrist,handorgeneralised
o Lumpsanddeformitiesofbone,jointorsofttissue
o Musclepainandweakness

Investigations

Xrays,CTandMRIscans,DEXAscans,bonescans,ultrasound,biochemicaland
immunologicalindicatorsofmusculoskeletalproblems,nerveconductionstudies,tissue
biopsy

Specificconditions

Spinaldisordersincludingmechanicalbackpain,disclesions,malignancyprimaryor
metastatic,infectionincludingosteomyelitis,osteoarthritis,spinalstenosis,osteochondritis,
developmentaldisorderssuchasscoliosisandkyphosis,traumaincludingvertebralfracture
andlongtermconsequences

Cervicalspinaldisordersincludingcervicalspondylosis,torticollisandwhiplashinjuries,
vertebralfractureandlongtermconsequences

Infectionsuchassepticarthritis,osteomyelitis

Softtissuedisorderssuchasepicondylitis,Achillestendonproblems,handdisorderssuchas
triggerfinger,Dupuytrenscontracture,carpaltunnelsyndrome,ulnarnervecompression,
footdisorderssuchasplantarfasciitis,digitalneuroma

Muscledisorderssuchaspolymyalgiarheumaticaandgiantcellarteritis,polymyositisand
dermatomyositis,fibromyalgia,musculardystrophiesandmyastheniagravis

Osteoarthritisincludingjointreplacementsurgeryrisksandcomplications

Osteoporosisprimaryandsecondary

Crystalarthropathiessuchasgout,pyrophosphatearthropathy

Inflammatoryarthritidesandconnectivetissuediseasessuchas:rheumatoidarthritis,sero
negativearthritissuchaspsoriaticarthropathy,ankylosingspondylitis,reactivearthritis,viral
arthropathy,connectivetissuedisorderssuchassystemiclupuserythematosus,
scleroderma,systemicsclerosis

Skeletalproblemsincludingdisordersofcalciumhomeostasis(overlappingwith
metabolic/endocrinedisorders)suchasosteomalacia,rickets,Pagetsdisease

Congenital/inheriteddiseasessuchasosteogenesisimperfecta,Marfanssyndrome,Ehlers
Danlossyndrome,Gauchersdisease,hypermobilitysyndromes

Traumaincludingfracturesandprimarycaremanagementofinjuries/firstaid

Wounds(includingsurgical)andlacerations:managementandprinciplesofcare

Fractures,dislocations,sprains,strainsandothersignificantsofttissuetrauma:recognition
andprinciplesofmanagement

Externalandinternalinjuriesofthechest,abdomenorpelvis:recognitionandprinciplesof
management

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum320MusculoskeletalProblems.ashx

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NEUROLOGICALPROBLEMS

Symptomsandsigns
o Cognitiveimpairmentsuchasmemoryloss,deliriumanddementia
o Disturbanceofsmellandtaste
o Falls
o Featuresdifferentiatingbetweenupperandlowermotorneuronefunction
o Headache
o Movementdisorderssuchasathetosis,chorea,tremor
o Neuralgicandneuropathicpain
o Nystagmus
o Peripheralnerveandrootsymptomsandsignsincludingdermatomesandreflexes
o Seizures,convulsions,collapse,dizziness
o Sensoryandmotorsymptomsweakness,spasticity,paraesthesia
o Speechandlanguagedeficits
o Visualproblemssuchasdiplopia,ptosis,pupillaryabnormalitiesandvisualfielddefects

Investigations

Knowledgetointerpretclinicalfindingssuchasreflexes,sensoryandmotortesting,testsof
cranialnervefunction,fundoscopyandvisualassessmente.g.visualfields

RelevantinvestigationssuchasCT,MRIscans,nerveconductionstudies,lumbarpuncture

Testsofcognitionandinterpretationinrelationtodementiaandassociateddiseases

Specificconditions

Headachesincludingtension,migraine,cluster,raisedintracranialpressureincluding
idiopathicintracranialhypertension

Infectionssuchasmeningitis,encephalitis,arachnoiditis

Intracranialhaemorrhageincludingsubarachnoid,subduralandextraduralandthrombosis
suchassinusthromboses,congenitalaneurysms

Strokeincludingtransientischaemicattacks,withunderlyingcausessuchascardiac
arrhythmias,arterialdisease,thrombophilia

Cerebellardisordersincludingtumours,demyelinationsuchasmultiplesclerosisand
inheritedsuchasFriedrichsataxia

Epilepsyincludinggeneralisedandfocalseizures,febrileconvulsionsandothercausesof
seizuressuchashypoglycaemia,alcoholanddrugs

Speechdisordersincludingstroke,cerebellardisease,cerebralpalsy,motorneuronedisease

Sensoryand/ormotordisturbances(peripheralnerveproblems)includingmonoandpoly
neuropathiessuchasnervecompressionandpalsies,GuillainBarrsyndrome

Autonomicneuropathiessuchasdiabetic,druginduced,metabolic,multisystematrophy

Spinalcorddisorderssuchasrootandcordcompression,caudaequinasyndrome,spinal
stenosis,syringomyelia

Movementdisordersincludingtremorandgaitproblemsincludingathetosis,chorea,tardive
dyskinesia,dystonia,tics.UnderlyingcausessuchasSydenhamschorea,Huntingtons
disease,druginduced,Parkinsonism

Multiplesclerosisandotherdemyelinatingdisorderssuchastransversemyelitis

ParkinsonsdiseaseandParkinsonismsecondarytoothercausessuchasdrugs

Motorneuronediseaseincludingprogressivebulbarpalsyandmuscularatrophy

30

InheritedneurologicaldiseasessuchasHuntingtonsdisease,CharcotMarieTooth,
myotonicdystrophy,neurofibromatosis
Tumoursofthebrainandperipheralnervoussystemsuchasmeningiomas,glioblastomas,
astrocytomas,neurofibromatosis,secondarymetastases
Acuteconfusionalstatesorcomawithunderlyingcausessuchasmetabolic,infective,drug
induced
DementiasuchasAlzheimers,vascular,Lewybody,Picksdisease,normalpressure
hydrocephalus,othercausesofmemorylossandconfusion
Muscledisorderssuchasmusculardystrophy,myastheniagravisandassociatedsyndromes
Chronicfatiguesyndrome
Headinjurieswithorwithoutlossofconsciousness,concussionandmoreseriouscranialor
intracranialinjuries,andrelevantlongtermcarewithbraininjuriesincludingsecondary
epilepsyandbehaviouralproblems
Spinalinjuriescausingparalysisandrelevantcareoftetraandparaplegicpatientsincluding
bowelandbladdercare,potentialcomplicationssuchaspressuresores,autonomic
dysfunction,aidstodailylivingandmobility
CranialnervediseasesuchasBellspalsy,trigeminalneuralgia,bulbarpalsy

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum318NeurologicalProblems.ashx

31

PALLIATIVEANDENDOFLIFECARE

Endoflifecareisoftensymptombasedandthereforeitwilloverlapwithalltheprecedingsystem
lists.Otherareastoconsiderwouldincludethefollowing:

Therapeutics(asdetailedintheBNF)forpalliativecareforcancerandotherlongterm
conditionsincludingsymptomaticreliefofpain;gastrointestinalsymptoms(e.g.nauseaand
vomiting,oralsymptomssuchasulceration,constipation,diarrhoea,hiccough);respiratory
symptoms(e.g.breathlessness,excessivesecretions,cough);cachexia,anorexiaandfatigue;
skin(e.g.itch)andpsychologicalproblems(e.g.insomnia,anxiety,depression,restlessness)
Emergenciesinpalliativecaresuchasseverepain,spinalcordcompression,haemorrhage,
hypercalcaemia,superiorvenacavacompression
EthicalissuesinpalliativeandendoflifecareusingcurrentGMCguidance:autonomy
(consent,confidentiality,breakingbadnews,bestinterests),beneficenceandnon
maleficence(principleofdoubleeffect,withdrawingtreatment),equity(ordinaryvs.
extraordinarymeans),euthanasia,advancecareplanning
Currentguidelinesforbestpracticecommunitycareforterminallyillpatients:Gold
StandardsFrameworkandintegratedcarepathwaysincludingholisticassessmentand
recognitionofendstagedisease
Approachestosupportingcarersandbereavement,includingawarenessofdifferent
religiousandculturalbeliefsandpractices

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum309EndOfLifeCare.ashx

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PHARMACOTHERAPEUTICS

BritishNationalFormulary(BNF)
TheBNFisthereferencetextforquestionsintheAKTonprescribing.Candidatesshouldreadeach
oftherelevantBNFchaptersinconjunctionwitheachsectionoftheContentGuide.Thiswillinclude
theBritishNationalFormularyforChildren(BNFC).Candidatesmustensurethattheyareusingthe
currentedition.

CandidatesshouldalsobefamiliarwiththeintroductorychaptersoftheBNF

Palliativecare,computerprescribing,controlleddrugs,safeprescribingincludingchildren(as
detailedinBNFC)

Appendicesoninteractionsandspecialconsiderationssuchasprescribinginpregnancyand
breastfeeding,renalandhepaticfailure,borderlinesubstances

Prescribingguidelinessuchasantibioticsininfections

Otherareasinwhichcandidatesmayberequiredtodemonstrateanadequatelevelofknowledge
include:

Applicationoftheconceptofclinicalandcosteffectiveprescribing,especiallywithregardto
patientsafety

Genericandbrandedprescribing

Multipledruginteractionscommoninprimarycareprescribing

Drugcontraindications,adverseeffects,iatrogenicdisordersandpotentialinteractions

Complexityofprescribingincomorbiditiesandthebalanceofriskandbenefit

Methodsofexplainingriskstopatientsincludingtheuseofdecisionaids

Safetyproceduresinvolvedinprescribingcontrolleddrugsincludingknowledgeofthelegal
requirementsforprescribing,storageanddisposal

Factorsaffectingdrugdosage,includingrenalorhepaticdisease;pregnancyand
breastfeeding;drugrequirements,andmonitoring

Calculationofdrugdosages

Compliance/concordanceincludingknowledgeofwhypatientsmaynottaketheir
medicationandmethodstoenhanceconcordance

Potentialrisksandbenefitsofprescribingunlicenseddrugs

Risksandbenefitsofoverthecounter(OTC)medicationsandinteractionswithprescribed
drugs

Issuesarisingintheuseofcomplementaryandalternativetherapiesandpotentialrisksand
interactionswithconventionaldrugs

Monitoringofprescribeddrugse.g.DMARDS,warfarin,lithium

Safevaccinationprescribingandregimes

Drugstorageanddisposal

Patientgroupdirectives,rolesofpracticenurses

Responsibilityforprescribingincludingnonmedicalprescribers,doctorsintrainingand
acrossthesecondaryprimarycareboundary

Roleofthepharmacistinmedicationreviewsandsupportingsafeprescribing

Reportingmechanismsforadversedrugreactionsormedicaldevicefailurestotherelevant
regulatoryauthoritysuchasMHRA

Roleofdrugrepresentativesanddrugpromotionregulationsethicalconsiderations,codes
ofconduct,conflictsofinterest

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Prescribingforchildren
Theuseofdrugswhichareunlicensediscommoninpaediatricprescribingandrequiresparticular
careandconsideration.TheBNFforChildrengivesdetailedinformationforacceptableprescribing
forchildrenandisconsideredthedefinitiveguidanceforthisarea.Candidatesshouldensurethey
areusingthecurrentedition.

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum202PatientSafetyandQualityOfCare.ashx

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RENALPROBLEMS

Symptomsandsigns
o Abdominalmasses
o Dysuria
o Haematuria
o Incontinence
o Loinandabdominalpain
o Oliguria,polyuria,frequencyandnocturia
o Proteinuria
o Pruritus
o Thirst

Investigations

Interpretationofresultssuchasultrasoundofrenaltract,urineanalysisincludingculture
andbiochemistry,serumbiochemicalparameterssuchascalcium,parathyroidhormone,
vitaminDmetabolism,creatinineandeGFR

Knowledgeofsecondarycareinvestigationssuchasintravenousurograms,cystoscopyand
ureteroscopy,urodynamicstudies

Specificconditions

Chronickidneydiseaseincludingunderlyingcausessuchasglomerulonephritis,connective
tissuediseases,diabetes,hypertension.Monitoringandreferralcriteria

Acuterenalfailureincludingdiagnosis,underlyingcausesincludingdruginduced

Proteinuria(includingmicroalbuminuria)ofanycauseincludingnephroticsyndrome,
glomerulonephritis,secondarytosystemicdiseasessuchasdiabetesandhypertension,
malignancysuchasmultiplemyeloma,connectivetissuediseases

Haematuriaofanycauseincludinginfection,glomerulonephritis,nephriticsyndrome,
malignancy,stones

Urologicalmalignancysuchasrenal,uretericandbladder

Urinarytractinfectionsinchildrenandinadults

Inheritedkidneydiseasessuchaspolycystickidneydisease

Urinarytractobstructionandstructuralabnormalities(strictures,posteriorurethralvalves,
duplexsystems)calculus

Renalcolicincludingknowledgeofsecondarycaremanagementsuchasstentsand
lithotripsy

Catheterstypes,indications,management.Useinparaplegicpatients,selfcatheterisation

Renovasculardiseasesuchasrenalarterystenosis,diabetes

Knowledgeofrenaldialysisincludingperitonealandhaemodialysisincludingcomplications
thatmaybeencounteredinprimarycaresuchasinfectionofcathetersites,fluidbalance
disturbance

Transplantationandprimarycaremanagement

PrescribinginrenaldiseaseasperBNFguidance:principlesofdoseadjustmentinrenal
impairment

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RESPIRATORYPROBLEMS

Symptomsandsigns
o Chestpain
o Clubbing
o Collapse
o Cough
o Cyanosis
o Dyspnoeaacuteandchronic
o Haemoptysis
o Pleuraleffusion
o Stridor&hoarseness
o Wheezing

Investigations

Interpretationofprimarycareinvestigationssuchaspeakexpiratoryflowrates,spirometry,
pulseoximetry,sputumculture

IndicationsforchestxraysandCTandMRIscans,bronchoscopy

Diseasescoringtoolse.g.CURBforcommunityacquiredpneumonia

Specificconditions

Upperrespiratorytractinfectionsincludingtonsillitis,peritonsillarabscess,epiglottitis,
laryngitisandtracheitis

Lowerrespiratorytractinfections,e.g.bronchiolitis,bronchitisandpneumonia(ofany
cause),atypicalpneumoniasincludingLegionnairesdisease,tuberculosis

Bronchiectasis

Emphysemaincluding1antitrypsindeficiency

Cysticfibrosis

Pneumothoraxincludingsimpleandtension

Pulmonaryembolism

Pleuraleffusioncausesincludinginfection,connectivetissuediseases,malignancies

Asthmaacuteandchronicinchildrenandadults

Chronicobstructivepulmonarydisease

Coughincludinghaemoptysis,andnonrespiratorycausessuchasGORD

Respiratorymalignanciesincludinglaryngeal,bronchialandpleuralsuchasmesothelioma.
Primaryandsecondarylungmalignancies,andrelatedparaneoplasticsyndromes

Stridorandhoarsenessdifferentialdiagnosisincludingassessmentofurgencyfor
investigationandmanagement

Occupationalrespiratorydiseasessuchasthepneumoconioses,asthma,extrinsicallergic
alveolitis

Connectivetissuediseasesaffectingthelung,suchasrheumatoidarthritis,SLE,sarcoidosis

Lungfibrosisandassociatedcausesincludingadversedrugreactions

Immunosuppressionaffectingtherespiratorysystemincludingopportunisticinfectionssuch
asTB,fungal,parasitic

RespiratoryfailureandmethodsofventilationsuchasCPAPforsleepapnoea

Indicationsfortheuseofoxygeninemergency,acuteandchronicmanagementincluding
domiciliaryoxygenanduseinpalliativecare

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum319RespiratoryHealth.ashx

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SEXUALHEALTHOVERLAPSWITHMENANDWOMENSHEALTH

Symptomsandsigns
o Dysuria
o Erectiledysfunction
o Genitalulcers
o Infestations
o Pelvicandabdominalpain
o Systemicmanifestationsofsexuallytransmittedinfections(STI)suchasreactivearthritis
o Vaginalandpeniledischarge

Investigations

InvestigationsofSTIincludingappropriatesamplingswabs,urine,blood

Interpretationofresultsincludingtimingoftestingforbloodborneviruses

Specificconditions

Contraception
o maleincludingcondomsandspermicides,vasectomy
o female
nonhormonalmethodssuchasfemalecondoms,diaphragms,naturalcycle
control,nonhormonalIUCDs,sterilisation
hormonalcombinedoral/patch/ringcontraception,progesteroneonly
methodssuchasoral,intrauterinesystem,depotinjection,implant
postcoitalcontraception

Terminationofpregnancyindications,methodology,complications,legalandethical
aspects

Infertilityandsubfertilityincludingbothmalee.g.impairedspermproductionanddelivery
(druginduced,cysticfibrosis)andfemalecausese.g.tubalocclusion(afterinfectionor
ectopicpregnancy),ovulatorydisorderssuchaspolycysticovarysyndrome,anovulation,
geneticdisorders(e.g.Turnerssyndrome)

Principlesofassistedconceptionwithknowledgeofthemenstrualcycleandassociated
investigations.Knowledgeofdrugtherapiesusedinassistedconceptionthataredelegated
toprimarycare

Sexualabuse(bothadultandchild)includingindicatorssuchasSTIinchildren,skindisorders
suchaslichensclerosus

SexuallytransmittedinfectionsincludingsafesexandcontacttracingincludinghepatitisB
&C,HIV,chlamydia,gonorrhoea,syphilis,lymphogranulomavenereum,genitalwarts,
genitalherpessimplex

Sexualproblemsincludinglossoflibido,anorgasmia

Erectiledysfunctionincludingorganiccausessuchasdiabetes,vasculardisease,neurological
disease,druginduced,psychologicalcauses

Issuesofsexualidentityandsexualorientationsuchastransgender,genderreassignment,
menandwomenwhohavesexwithmenand/orwomen

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum308SexualHealth.ashx

37

MENSHEALTH

Symptomsandsigns
o Haematospermia
o Incontinencefaecalandurinary
o Prostatismincludinghesitancy,frequency,nocturia
o Scrotalpainandswelling
o Testicularpainandswelling
o Urinaryretention

Investigations

Assessmentofsymptomsincludinginvestigationssuchasurodynamics,semenanalysis,
ultrasoundandappropriateuseoftestssuchasPSAandurinalysis

Specificconditions

Testicularproblemsincludingundescendedandmaldescendedtestes,orchitis,epididymitis,
hydrocele,varicocele,spermgranuloma,torsion,testiculartumourssuchasteratoma,
seminoma

Prostaticproblemssuchasacuteandchronicprostatitis,benignprostatichyperplasia,
prostaticcarcinoma

Urinaryproblemsincludingacuteandchronicretention,bladderandrenalcalculiand
bladdermalignancy(overlapwithRenal)

Penileproblemssuchasphimosis,paraphimosis,circumcision,malignancy,skindisorders,
Peyroniesdisease,priapism

Breastdisorderssuchasgynaecomastiaandbreastcancer

Recognitionandsaferesponsetodomesticviolenceaffectingmen

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum307MensHealth.ashx

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WOMENSHEALTH

Symptomsandsigns
o Breastdevelopmentandsize
o Breastlumps
o Incontinencefaecalandurinary
o Mastalgia
o Menstrualproblemssuchasamenorrhoea,polymenorrhoea,menorrhagia,dysmenorrhoea,
intermenstrualbleeding,postcoitalbleeding,premenstrualsyndrome
o Nippledischarge
o Postmenopausalbleeding
o Vaginaldischarge,lumpsandprolapse
o Vulvalpain,ulceration,pigmentation,leukoplakia,lesions

Investigations

ScreeningandpreventionprogrammessuchascervicalscreeningincludingHPV,HPV
vaccinationprogramme,screeningmammography,breastawareness

Investigationswithinprimarycaresuchashormonallevels,cervicalsmears,swabs,pelvic
examinations,ultrasoundabdominalandpelvic,andsecondarycaresuchaslaparoscopy
andhysteroscopy,urodynamics

PregnancyinvestigationsincludingurinaryandserumHCGandtestingforcongenital
abnormalities
o routineultrasound
o chorionicvillussampling,amniocentesis
o bloodtestssuchastripletests,immunitytesting
o infectionscreeningsuchassyphilis,HIV,rubella

Investigationsforgynaecologicalmalignancye.g.colposcopy,bloodtestssuchasCA125,
transvaginalultrasound

Mammographyandbreastultrasound

Specificconditions

Breast
o Breastproblemsincludingtherangeofnormalsizeandvariation,mastalgia,lumps
includingcysts,fibroadenoma,malignancyincludingDCIS,invasiveductaland
lobular,Pagetsdiseaseofthenipple,secondarymalignancysuchaslymphoma
o Breastreconstruction/implants

Pregnancy
o Nationalguidelinesonpreconceptualcareandnormalantenatalcareincluding
routinechecks,investigationsandtreatmentsuchassupplementse.g.folicacid,
vitamins,iron
o Antenatalcomplicationssuchas
bleedingincludingmiscarriage,ectopicpregnancy,placentapraevia,
placentalabruption
metabolicproblemssuchashyperemesis,obesity,gestationalandpre
existingdiabetes,thyroiddisorders,causesofjaundiceinpregnancy
includingcholestatic,hepatitis,drugs
infectionssuchasrubella,cytomegalovirus,groupBstreptococcus,
chickenpox,parvovirus,listeriosis,herpessimplex,hepatitis

39

neurologicalproblemssuchasepilepsyandassociateddrugtreatment,
migraine,thrombosis
preeclampsiaandeclampsia
haematologicalproblemssuchashaemolyticdiseaseincludingrhesus
incompatibilityandprophylaxis,haemoglobinopathiessuchassicklecell
diseaseandthalassaemia,thromboembolism
urinarytractinfections
multiplepregnanciesandassociatedcomplications
o Problemsoflabourincludingpremature,late,breech,obstructeddeliveries,
Caesareansectionsandassociatedcomplications
o Postnatalproblemsincludingretainedproducts,uterineinfection,postnatal
depressionandpsychosis,breastfeedingproblems
o Trophoblasticdiseaseincludinghydatidiformmolesandchoriocarcinoma
Vaginalbleeding
o Abnormalvaginalbleedingincludingintermenstrual,dysfunctionaluterinebleeding,
postcoitalorpostmenopausalbleedingandcausessuchasdruginduced,
endometrialhyperplasia,endometrialmalignancy,cervicalandendometrialpolyps,
cervicalectropion,cervicaldysplasiaandcarcinoma
o Premenstrualsyndrome
o Menstrualproblems
painsuchasendometriosis,primaryandsecondarydysmenorrhoea
bleedingsuchasmenorrhagia,amenorrhoeaandunderlyingcausessuchas
druginduced,weightrelated,pregnancy
irregularcyclessuchasanovulatory
o Uterinefibroidsandadenomyosis
Menopause
o Menopauseincludingprematuremenopause,perimenopause,typesofhormone
replacementtherapy,atrophicvaginitis,postmenopausalbleeding.Non
gynaecologicalsymptomssuchasskinchanges,psychologicalsymptoms
Ovarianproblems
o Polycysticovarysyndrome:gynaecologicalandassociatedmetabolicdisorderssuch
asinsulinresistanceandhirsutism
o Ovariancysts,endometriosis,malignancyincludingadenocarcinomaandteratoma
InfectionincludingSTIsuchaspelvicinflammatorydisease(overlapwithSexualHealth)
Uterineprolapse
Chronicpelvicpain,dyspareunia,sexualdysfunction,psychosexualproblems
Urinaryproblemssuchasprolapse,overactivebladdersyndrome,stressand/orurge
incontinence
Vulvalandvaginalproblems
o Discharge,includinginfectionssuchasbacterialvaginosis,candidiasis,genitalwarts
o Painwithcausessuchasatrophicchanges,dysaesthesia,vulvadynia
o Malignancyincludingvulvalintraepithelialneoplasia(VIN),melanoma
o Skindiseasessuchaslichensclerosus,psoriasis,intertrigo,pigmentedlesions
Femalegenitalmutilation/cosmeticgenitalsurgery
Recognitionandsaferesponsetodomesticviolenceaffectingwomen

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum306WomensHealth.ashx

40

SKINPROBLEMS

Symptomsandsigns
o Birthmarks
o Blisters
o Dryskinandscaling
o Erythema
o Hairlossandhirsutism
o Hyperandhypopigmentation
o Naildystrophies
o Pruritus
o Purpura,petechiae
o Pustules,boils
o Rashesanderuptions
o Scalyanditchyscalp
o Skinlesionsincludingdermalandsubcutaneouslesions
o Ulcerationincludinglegulcersandpressuresores

Investigations
Investigationssuchasskinandnailsampling,immunologicaltestsincludingpatchandprick
testing,biopsy,photographyanddermoscopy
Relevantbloodtestsforunderlyingcausesofskinconditionse.g.lupus,thyroiddisease

Specificconditions
Acnevulgarisincludingindicationsandsideeffectsofisotretinoin,hidradenitissuppurativa
Acnerosacea,rhinophyma,perioraldermatitis
Eczema:infantile,childhood,atopic,seborrhoeic,contactallergic,irritant(including
occupational),discoid
Psoriasis;guttate,plaque,flexural,scalp,nails,pustularanderythrodermic.Associated
morbidity;physicalsuchascardiovasculardiseaseandpsychologicalsuchasdepression
Infections;viral(e.g.warts,molluscumcontagiosum,herpessimplexandzoster),bacterial
(e.g.staphylococcal+MRSA,streptococcal),fungal(skin,nails),spirochaetal(Lymedisease,
syphilis),TB,infestations(scabies,lice),travelacquired(e.g.leishmaniasis)
Pityriasisrosea
Lightsensitivedisorderssuchaspolymorphiclighteruption,porphyria,drugreactions
Skintumoursincludingbenignlesionssuchaspigmentednaevi,dermatofibroma,cystsand
malignantlesionssuchasmalignantmelanoma,squamouscellcarcinoma,basalcell
carcinoma,mycosisfungoides,Kaposissarcoma,metastatictumours.Lesionswith
malignantpotentialsuchassolarkeratoses,Bowensdisease,cutaneoushornsand
keratoacanthoma
Skinmanifestationsofinternaldiseaseincludingpyodermagangrenosum,systemiclupus
erythematosus(SLE)anddiscoidlupuserythematosus(DLE),necrobiosislipoidica,erythema
nodosum,erythemamultiforme,dermatitisherpetiformis,dermatomyositis,vitaminand
mineraldeficienciessuchasscurvy
Vitiligo,hyperpigmentationsuchasacanthosisnigricans
Lichenplanus,granulomaannulare,lichensclerosus,morphoea
Ulcersdistinguishingarterialandvaricose,vasculitic,malignant
Hairdisordersincludingalopecia,hirsutism,fungalinfection,infestationsincludinglice

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Blisteringdiseasesincludingpemphigoid,pemphigus,porphyria
Prurituseithergeneralisedorlocalisedunderlyingnondermatologicalcausessuchas
thyroiddiseaseandirondeficiency
Psychiatricassociationsofskindiseasesuchasdermatitisartefacta,depression
Woundsincludingburnsandscalds,scarformationandcomplications
Urticariaandallergicskinreactionsincludingadversedrugreactions
DrugrelatedskineruptionssuchasStevensJohnsonsyndrome,toxicepidermalnecrolysis
LighttreatmentssuchasUVB,PUVA

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum321SkinProblems.ashx

42

CHILDRENANDYOUNGPEOPLE

Normality
Averyimportantelementofchildhealthingeneralpracticeistherecognitionoftherangeof
normalityinphysical,psychologicalandbehaviouraldevelopmentsuchas:
Normalityintheneonatalperiodincludingscreeninge.g.phenylketonuria,hypothyroidism,
cysticfibrosis,
Normalityofphysicaldevelopmentwithnormalvariationse.g.orthopaedicsuchasgenu
valgusandvarus
Normalmaturationincludingpuberty
Normaldevelopmentalmilestonesandassessmentofdevelopmentdelayincludinglanguage,
grossandfinemotorandsocialdevelopment
Normalgrowthincludinginterpretationofgrowthcharts

Symptomsandsigns
Akeyfeatureofknowledgeaboutchildhealthistheinterpretationofsymptomsandsignsin
differentageranges.Forexample,backpainorabdominalpaininchildhood,adolescenceand
adulthoodarelikelytohavedifferentunderlyingcausesandnaturalhistories.Thiscanhave
significantandpotentiallyseriousconsequencesifnotfullyrecognisedwhenconsideringdifferential
diagnoses.

Therelevantsymptomsandsignsarelistedineachofthesystemssectionsaswellasmorespecific
paediatricthemessuchas:
Failuretothrive
Behaviouralproblems
Developmentalproblems
Featuresoftheacutelyunwellchildincludingfever,rashes,irritability,breathingand
circulatorysigns

Investigations
PrenataldiagnosisincludingcurrentscreeningavailableinUKfordisorderssuchasDowns
syndrome,spinabifida,structuraldefectssuchascongenitalheartdisease,renaltract
abnormalities
Appropriateinvestigationsforspecificdiseasese.g.asthma,urinarytractinfection

Specificconditions
Neonatal:
o jaundice(e.g.breastfeeding,haemolyticandhaemorrhagicdiseaseofthenewborn,
biliaryatresia)
o feedingproblems(breastandbottlefeeding),hypoglycaemia
o skindisorderssuchasbirthmarks,urticaria,milia
o congenitalabnormalitiesasbelow
Failuretothriveandunderlyingcausessuchascysticfibrosis,coeliacdisease,chronic
infection,parentingdifficulties
Diagnosisandmanagementofsystemicdisease(listedelsewhere)inchildhoodsuchas
asthma,diabetes,epilepsy,respiratoryinfectionssuchaspneumonia,bronchiolitis,croup
Musculoskeletalproblemsrelevanttochildrensuchasinflammatoryarthritides(infective,
autoimmune),osteochondritis,Perthesdisease,slippedepiphysis,injuriessuchasgreenstick
fractures,pulledelbow

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GIdiseasesrelevanttochildrensuchasappendicitis,Meckelsdiverticulum,intussusception,
malabsorptionsuchascoeliacdisease,lactoseintolerance,cysticfibrosis
Neurologicalproblemsrelevanttochildrenincludingseizuressuchasfebrileconvulsions,
epilepsy,degenerativeneurologicaldiseasessuchasRettssyndrome
Renaldiseasesrelevanttochildrenincludingrecurrenturinarytractinfections,structural
anomaliessuchasposteriorurethralvalves
Sexidentityandintersex,appearanceofgenitalsincludingfusedlabia,hypospadias,clitoral
hypertrophy
Congenitalabnormalitiessuchas:
o CVScongenitalheartdisease(cyanoticandnoncyanotic),coarctationoftheaorta,
situsinversus
o renalstructuralabnormalitiessuchasduplexkidneys,urethralvalves
o gutabnormalitiese.g.imperforateanus,tracheooesophagealfistula,Hirschsprungs
disease,volvulus,pyloricstenosis,diaphragmatichernia,gastroschisis
o neurologicalabnormalitiessuchascerebralpalsy,microcephaly,plagiocephaly,
hydrocephalus
o musculoskeletalsuchastalipesequinovarus,absentorreducedlimbdevelopment,
hipdysplasia
o endocrinesuchashypothyroidism,congenitaladrenalhyperplasia
o sensoryimpairmentsuchassighte.g.congenitalcataract,hearinge.g.inherited
sensorineuraldeafness
ChromosomaldisorderssuchasDownssyndrome,FragileX,Klinefelterssyndrome,trisomy
18,Turnerssyndrome
Childhoodinfectionsincludingexanthematasuchasmumps,measles,rubella,chickenpox,
herpessimplex,parvovirus,Coxsackie,otherinfectionslistedinSkindisorders
Learningdisabilitiesinchildrensuchasautism,dyspraxia,Aspergerssyndrome
Immunisationinchildrenroutineprimaryscheduleandotherimmunisations
Safeguardingchildrenrecognitionofnonaccidentalinjuryincludingphysical,emotionaland
sexualabuse,andappropriateactions
Acutepaediatricemergenciessuchasfebrileconvulsions,anaphylaxis,epiglottitis,asthma,
septicaemia,meningitis,surgicalconditions
Behaviouralproblemssuchasenuresis,encopresis,eatingdisorders,sleepdisorders,
tantrums
Childhoodmalignanciessuchasretinoblastoma,neuroblastoma,nephroblastoma,
leukaemias,sarcoma,braintumours

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum304ChildrenandYoungPeople.ashx

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SECTION2RESEARCH,STATISTICSANDEPIDEMIOLOGY(10%ofthequestions)

ThiselementoftheAKTisdesignedtoexaminethecandidatesabilitytouseevidenceanddatato
underpinclinicaldecisionmaking,andthepossessionofcriticalappraisalskillssufficienttorecognise
goodevidenceandadoptguidelinesasappropriate.

Researchdesign

Themostappropriateresearchdesigntoexaminethehypothesisproposedinprospective
andretrospectivestudies:
o thelimitationsandstrengthsofresearchmethodologies
o knowledgeofthehierarchyofevidencerangingfromcasereportsthroughcase
controlandcohortstudiestorandomisedcontrolledtrialsandsystematicreviews
andmetaanalyses

Thehierarchyofdesignandtheadvantagesanddisadvantagesofstudydesignsincluding:
o systematicreviewsandmetaanalysis
o experimental:randomisedcontrolleddoubleblind
o quasiexperimental:nonrandomisedcontrolgroup
o observational:cohort(prospective,retrospective),casecontrol,crosssectional

Qualitativeresearchandquantitativeresearch:
o Differencesinformsofresearchandwheneachisappropriate
o Techniquessuchaspilotstudies,questionnairedesign,fieldobservations,
interviews,focusgroupsandanalysisoftranscriptsofnarrativematerial,
ethnographyandobservation,actionresearch,casestudy;consensusmethodssuch
asDelphiornominalgroups

Statisticalterminology
Knowledgeofbasicstatisticalterminologyincludingthefollowing:

Sensitivity
Specificity
Incidence
Prevalence
Mode
Median
Mean
Range
Confidenceintervals
pvalues
Probability
Nullhypothesis
Standarddeviation(SD)
Reliability
Correlation
Discrimination
Positivepredictivevalue(PPV)
Negativepredictivevalue(NPV)
Riskreduction(RR)
Odds&OddsRatio
Relativeriskreduction(RR)
Absoluteriskreduction (ARR)
Numberneededtotreat(NNT)
Numberneededtoharm(NNH)
Riskratio
HazardRatio
Confounding
Bias
Type1and2errors
Eventrate
Cohort
Casecontrol
Systematicreview
Metaanalysis
Randomisedcontrolledtrial(RCT)
Blinding
Validity
Crossover
Crosssectional
Sampling
Trends
Groundedtheory

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Delphi
Focusgroup
Association
Triangulation
Generalisability
Ethnography
Inductivereasoning
Nondirectiveinterview
Inclusion/exclusioncriteria
Datatypes(categorical,ordinal,continuous)
Standardisedmortalityratesandratios
Distributions(normalandnonparametric)
QALY(qualityadjustedlifeyear)
DALY(disabilityadjustedlifeyear)
Bayesianprobability

Basicinferentialstatisticalconceptstoenableclinicalinterpretationofresultsfromcommon
statisticaltestsusedforparametricdata.
o e.g.ttests,analysisofvariance,multipleregressionandnonparametricdata(e.g.
chisquared,MannWhitneyU)
o Bayesianprobability
[Candidateswouldnotbeexpectedtobeabletoconductthesetests.]

Graphicalrepresentationsandinterpretation:
o includingsimple(symmetrical,skewed)distributions,scatterdiagrams,boxplots,
forestplots,funnelplots,statisticalprocesscontrolcharts,Catesdiagrams,decision
aids

Evidencebasedpracticeincludingsimplecalculations:
o specificity,sensitivity,
o riskabsoluterisk(AR),absoluteriskincrease(ARI),absoluteriskreduction(ARR),
relativerisk(RR),relativeriskincrease(RRI),relativeriskreduction(RRR)hazard
ratio(HR)
o predictivevaluenegativepredictivevalue(NPV),positivepredictivevalue(PPV)
o numberneededtoharm(NNH),numberneededtotreat(NNT)
o odds,oddsratio(OR)

Implicationsofresearchresultsandconclusions
o includingreliability,validityandgeneralisability
o theextenttowhichresultsorconclusionsofprimaryresearchmaybeappliedin
clinicalpractice,takingintoaccountcontemporaryviewsandpracticeanda
knowledgeofcosteffectivenessevaluations

Researchethicsandgovernanceincludingethicalapproval,conflictsofinterest,researchfraud,
patientsafety,consentandconfidentiality

Guidelines

Evaluationofguidelinesincludingmethodology,evidencebase,validity,applicability,
authorshipandsponsorshipinordertoguidethesuitabilityofapplicationtoclinicalpractice.

Epidemiologyconcepts
Knowledgeofdecisionsorinterventionsmadeintheinterestsofacommunityorpopulation
ofpatientssuchasimmunisation
KnowingtheconditionswhichconstitutethemainreasonsforpatientsconsultinginUK
primarycare
Populationstatisticsincludingincidence,prevalence,mortalityratios,deathrates

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Recognisingtheimpactofadverseenvironmentalfactorsonhealth,includingpoverty,
unemployment,poorhousing,malnutrition,occupationalhazardsandpollution
ThequalitativemeasurementsofhealthsuchasQALY
Demographicandepidemiologicalissuesandthehealthneedsofspecialgroups,andthe
wayinwhichthesefactorsmodifypeoplesuseofthehealthcareservices
Workingknowledgeofpopulationbasedpreventivestrategiesincludingimmunisation,
healthscreeningandpopulationscreening

Screening

Principlesofscreening(Wilsonscriteria)andapplyingtheconceptsofprimary,secondary
andtertiaryprevention;applicationtocurrentandintendedprogrammesofscreeningand
recallsystems

Knowledgeofrisksandbenefitsofscreeningprogrammesandinformationavailableto
patientstoaiddecisionmaking

Criticalappraisal

Criticalappraisalofinformationgiveninwrittenorgraphicalformatsuchastrialresultsor
abstracts,clinicalgovernancedata(audit,benchmarking,performanceindicators)anddata
presentedinmedicaljournals

CurriculumLinks
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum201GPConsultationInPractice.ashx
http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum301HealthyPeople.ashx

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SECTION3ADMINISTRATION,ETHICALANDREGULATORYFRAMEWORKS(10%ofthequestions)

ThiselementoftheAKTrelatestoworkingingeneralpracticewithintheUK,andknowledgeofthe
NHSanditsrelationtootherinstitutionsandregulators.ItisimportantthatGPshaveabroad
workingknowledgeofgeneralpracticeadministration,ethicalandregulatoryframeworks.The
topicsarethosethataGPislikelytoencounterinnormalworkingpracticealthoughsomemayoccur
infrequently.Candidateswouldbewelladvisedtoasktheirtrainertoshowanddiscussthese
administrativetaskswhentheyarisee.g.completionofinsurancereports.

EthicsandDutiesofaDoctor
GeneralMedicalCouncil
ThecandidateshouldbefamiliarwiththeGeneralMedicalCouncilscurrentguidanceGoodMedical
Practiceandthesupplementarydocuments.Theseareregularlyupdatedandcandidatesshould
checkthattheyarelookingatthemostrecentguidanceavailableontheGMCwebsite.

Questionsmayincludethefollowingtopicsbutthisisnotanexhaustivelist:
o Beginningoflifeissuesincludingtermination,adoption,surrogacy,antenatal
diagnosisofdisease
o CapacityincludingPowerofAttorney/MentalCapacity/advanceddecisionstorefuse
treatment.Awarenessofdifferencesbetweenthedevolvednations
o Chaperones
o Childrenincludingcapacity,safeguarding,confidentiality
o Confidentiality
o Consentanddissent
o Endoflifecareincludingwithholdingandwithdrawinglifeprolongingtreatments
o Ethicsofgenetictesting
o Medicalmanagementandworkingwithcolleagues
o Probitye.g.gifts,conflictsofinterest,financialprobity,effectofpaymentbyresults
suchasreferralmanagementandothertargets
o Raisingandactingonconcernsaboutpatientsafety,whistleblowing
o Referraltootherhealthcarepractitionersincludingselfreferral
o Researchethics
o Safeguardingincludingchildren,elderlyandvulnerableadults,domesticviolence
o Welfareofpractitionerssuchashealth,conductissues

EthicalPrinciples
Thiswillincludetheknowledgeandapplicationofprinciplessuchasbeneficence,nonmaleficence,
justice,autonomy

Certification
EverydayroutinepaperworkandregulationsaGPmayencounterprinciplesnotdetails
AND
Deathandcremationcertificatesincludingregulationsoncompletingcertificates,whento
refertotheCoroner/ProcuratorFiscal
Insurancecertificatesincludingforlifeinsurance,criticalillnessinsurance(PersonalMedical
Attendantsreports),travelinsurance
Notificationofinfectiousdiseases(seeInfectiousDiseases)
PowersofAttorneyincludingwelfareandfinancial,advanceddecisionmaking

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Privatecertificates/medicalsprinciplessuchasdisclosureofinformatione.g.firearms,
insurancecancellation,probation,adoption,criticalIllnesscover,fitnesstofly/travel
Registrationincludingvisualimpairment,disability
Relevantbenefits&allowancese.g.DS1500,maternitybenefits
RelevantregulationsforMentalCapacityandMentalHealthActs
StatementsofFitnesstoWorkcertificatesandrelatedsicknessregulationssuchasStatutory
SickPay,EmploymentSupportAllowance,principlesofreturningtowork
Terminationofpregnancyregulations

NationalRegulations,ContractualandLegalFrameworks
Equalityanddiversityincludingdisabilityrightsandaccess,discriminationlawincludingrace,
gender,disability,age,sexualorientation
DrivingregulationsfitnesstodriveandDVLAregulations
OtherActsandregulationsrelevanttomedicalpracticeincluding;
o Abortionlaw
o AccesstoMedicalRecordschildren,deceased,compensation,research,whatto
withhold
o ChildrensAct
o Controlleddrugregulationsincludingregister,prescribing,storing,destruction
o DataprotectionCaldicottprinciples,recordkeeping,lostrecords,sharing
electronicrecords
o FreedomofInformation
o HealthandSafetyatworkregulationsrelevanttogeneralpracticeincludinginfection
control,vaccinestorage,spillage(COSSHregulations),safepracticeandmethodsin
theworkingenvironmentrelatingtobiological,chemical,physicalorpsychological
hazards,whichconformtohealthandsafetylegislation
o MentalCapacity
o MentalHealth
o MisuseofDrugs
o NHSComplaintsprocedureandprinciples,litigationandmedicalnegligence
o NHSPrescriptionregulations
o PerformersList/HealthCareBoardregulations
o Principlesofcommissioning
o Principlesofemploymentregulationasappliedtopartnershipsandemployedstaff
includingappointment,discrimination,redundancy,dismissal
o Registeringbirthsanddeaths
o RemovingpatientsfromaList
o VariousmeansbywhichGPsarecontractedincludingGMS&PMS
o ViolenceagainstNHSstaff
Voluntarysectorinvolvementinpatienteducation,provisionofservices,socialenterprises
RelationshiptoPublicHealthcolleaguesandrolesofeachwithareasofoverlap
Medicalindemnityappliedtoprimaryandsecondarycareincludingmedicalnegligence

PracticeManagement
SeeActsandregulationsrelevantformedicalpracticeasabove
AND
AwarenessofUKhealthprioritiesandregionalandlocalvariations
ContractrequirementssuchasQualityandOutcomeFrameworks,enhancedservices(local
andnational)

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Employmentlawfundamentalsapplicabletogeneralpracticeincludingstaffappointment,
performanceanddismissal
Financialaspectsofmedicalpracticeinterpretingsimpleaccounts,sourcesofincomeand
expenditure
Immunisationregulations(seeInfectiousDiseases)
InformationgovernanceincludingCaldicottguardians,managementofdata,confidentiality
Localpublichealthneedsassessmentrelevanttodifferentpopulationswithdifferent
demographics
MajorincidentplanningandtheroleoftheGP
Makingfullandappropriateuseofavailableinformationtechnologytofacilitateclinical
practice,audit,chronicdiseasesurveillance
Medicinesmanagementincludinggenericandbrandedprescribing,implicationsofdrug
switchingforcosteffectiveness
Occupationalhealthforstaffincludingimmunisation,illhealth,infectiousdisease
PatientGroupDirectives
PatientParticipationGroups
Principlesofpartnershipagreementsandselfemployment,employeddoctorssuchas
salarieddoctor,locumsanddoctorsintrainingcontracts
Recordkeepingclear,accurate,legibleandcontemporaneousrecordkeeping,amending
records
Simplemanagementprinciplesincludingmanagementofchange,decisionmaking,risk
assessment,negotiation,motivationskills
Knowledgeofthevarietyofgeneralpractice(e.g.singlehanded,grouppractice,rural,inner
city,urban,academic,prison)andimplicationsforservicedeliverysuchasinterpreters,
accesstosecondarycare
Workloadissuesincludingactivitiessuchassurgeries,clinics,telephoneconsultations,home
visiting,minorsurgery,teaching,outsidecommitmentsandoutofhours(OOH)care,
includingdataonconsultationandreferralrates

ClinicalGovernance
Clinicalaudittheprinciplesandinterpretationofresults
Criticalappraisalskills(seeResearch,StatisticsandEpidemiology)tofacilitateauditand
improvepractice
Externalqualityassurancebodiese.g.CareQualityCommissionortheequivalentinthe
devolvedcountries
GPsasgatekeepersandcommissionersprinciplesaccordingtothedifferentneedsofa
widevarietyofpatientsirrespectiveoftheirage,gender,cultural,religiousorethnic
background,sexualorientationoranyotherspecialneeds
Leadershipmedicalleadershipcompetencyframework
o Licensingandrevalidation
LocalSystemsofClinicalGovernanceincluding
o MethodssuchasMSF,360ofeedback,patientsatisfactionsurveys,learninglogs,
audits
NationalGMC,NICE,SIGN,NCAS,QOF
o NHSComplaintssystem
o PerformanceIndicators(prescribing,referral,chronicdiseasemanagement)the
principlesandinterpretationofinformation
Poorperformance(NCAS,LMC,Deanery,GMC,primarycareorganisation,Occupational
Health)
ProfessionalDevelopmentandNHSAppraisal

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Qualityimprovementprinciples,QIPPandauditcycles
o Raisingandactingonconcernsaboutpatientsafety
Roleofpublichealthlinkingwithgeneralpracticee.g.inmanagementofinfectionssuchas
meningitis,influenzaepidemic,foodsafety
o Significanteventanalysisknowledgeoftheprinciples,andinterpretingand
reportingtheresults

Riskmanagement
Basicprinciplesofhumanerrorandriskassessment
Theapplicationofriskassessmenttools
Methodsofcalculating,demonstratingandexplainingrisktopatientsforinformeddecision
making.Useofdecisionaids
Obligationsandmechanismsfornotifyingoutsideagencies,e.g.suspectedadversedrug
reactionsinaccordancewiththerelevantreportingscheme;safetyofmedicinesanddevices
totheMedicinesandHealthcareproductsRegulatoryAgency(MHRA);notifiablediseases
Radiologicalguidelinesrelevanttogeneralpracticee.g.indicationsforxrays,safetyin
pregnancy

CurriculumLinks

http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum202PatientSafetyandQualityOfCare.ashx

http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum203GPInWiderProfessionalEnvironment.ashx

http://www.rcgp.org.uk/gptrainingandexams/~/media/Files/GPtrainingandexams/Curriculum
2012/RCGPCurriculum204EnhancingProfessionalKnowledge.ashx

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