Table of content
Module A.
1. Paediatrics……………………………………………………………………………………………………………………………………………….
1.1 Acute…………………………………………………………………………………………………………………………………………………
1.2 Cardiology….………………………………………………………………………………………………………………………………………
1.3 Respiratory…………………………………………………………………………………………………………………………………………
1.4 Endocrinology…………………………………………………………………………………………………………………………………….
1.5 Gastroenterology……………………………………………………………………………………………………………………………….
1.6 Gastrointestinal surgery….………………………………………………………………………………………………………………….
1.7 MSK……………………………………………………………………………………………………………………………………………………
1.8 Nephrology….…………………………………………………………………………………………………………………………………….
1.9 Infectious diseases……………………………………………………………………………………………………………………………..
1.10 Haematology/vascular……………………………………………………………………………………………………………
1.11 Neurology………………………………………………………………………………………………………………………………
1.12 Child and adolescent mental health (CAMHS)…………..…………………………………………………………….
1.13 Dermatology…………………………………………………………………………………………………………………………..
1.14 Urology….……………………………………………………………………………………………………………………………….
1.15 Oncology….…………………………………………………………………………………………………………………………….
1.16 Genetic….……………………………………………………………………………………………………………………………….
1
,Module B
1. Obstetrics….…………………………………………………………………………………………………………………………………………….
2. Gynaecology…………………………………………………………………………………………………………………………………………….
3. Sexual health……………………………………………………………………………………………………………………………………………
4. Urology……………………………………………………………………………………………………………………………………………………
5. Breast….…………………………………………………………………………………………………………………………………………………..
6. Dermatology….………………………………………………………………………………………………………………………………………..
Module C
1. Psychiatry………………………………………………………………………………………………………………………………………………..
2. Geriatrics…………………………………………………………………………………………………………………………………………………
3. Ophthalmology………………………………………………………………………………………………………………………………………..
4. Cancer and palliative care………………………………………………………………………………………………………………………..
3.1 Cardiac myxoma…………….…………………………………………………………………………………………………………………..
3.2 Lung cancer……..…………………………………………………………………………………………………………………………………
3.3 Oesophageal cancer and differentials………………………………………………………………………….……………………..
3.4 Gastric cancer and differentials………………………………………………………………………………………………………….
3.5 Hepatocellular carcinoma……..…………………………………………………………………………………….…………………….
3.6 Pancreatic cancer and cholangiocarcinoma………………………………………………………………….…………………….
3.7 Carcinoid tumours…..…………………………………………………………………………………….…………………………………..
3.8 Phaeochromocytoma………………………………………………………………………………….……………………………………..
3.9 Colorectal cancer and lynch syndrome……………………………………………………………………………………………….
3.10 Anal cancer…..…………………………………………………………………………………………………………….………….
3.11 Haematological malignancies………………………………………………………………………………………………….
3.12 Head and neck cancer……..………………………………………………………………………………………………………
3.13 Salivary gland tumours…..……………………………………………………………………………………………………….
2
,3.14 Thyroid cancer……..………………………………………………………………………………………….…………………….
3.15 Breast cancer…..……………………………………………………………………………………………………………………..
3.16 Cervical cancer…..…………………………………………………………………………………………………………………..
3.17 Ovarian cancer…..…………………………………………………………………………………………………………………..
3.18 Endometrial cancer………………………………………………………………………………………….…………………….
3.19 Vulvar cancer…………………………………………………………………………………………………..……………………..
3.20 Prostate cancer…..…………………………………………………………………………………………..……………………..
3.21 Testicular cancer…..………………………………………………………………………………………………………………..
3.22 Bladder cancer……………………………………………………………………………………………………………………….
3.23 Renal cancer…..……………………………………………………………………………………………….……………………..
3.24 Skin cancer (Benign lesions and malignant)……………………………………………………………………………..
3.25 Eye and eyelid tumours….………………………………………………………………………………..……………………..
3.26 Cancer screening…………………………………………………………………………………………………………………….
3.27 2 week wait referrals…………………………………………………………………………………..………………………….
3.28 Tumour markers….…………………………………………………………………………………………..…………………….
3.29 Oncological emergencies……………………………………………………………………………..…………………………
3
, Mod A
Paediatrics
Paeds Acute
● Paediatric shock = failure of circulatory
system to adequately perfuse organs:
- Causes/differential diagnosis:
🡺 Distributive shock:
o Sepsis (RF =
immunocompromised/very
young), anaphylaxis (RF =
history of allergies/new medication) or high spinal cord injury => leads to release of
inflammatory cytokines => leads to systemic vasodilation due to shifts of blood flow
within the vascular system, resulting in reduced blood flow to major organs despite
a normal blood volume
🡺 Hypovolaemic shock:
o Dehydration (due to diarrhoea, vomiting, burns, inadequate feeding, or diuresis in DKA),
third spacing (due to sepsis and anaphylaxis releasing inflammatory mediators => leading
to movement of fluid from the intravascular compartment to an extracellular
compartment i.e. the interstitial space) and haemorrhage => leading to reduced
circulating volume => decreasing CO => decreasing MAP (MAP = CO x SVR) => decreasing
perfusion to organs
🡺 Cardiogenic shock:
o Viral myocarditis or acute deterioration of heart failure secondary to cardiomyopathies or
congenital heart defect => leads to decreased CO => decreased MAP => reduced perfusion
of organs
o Won’t respond to fluid therapy and BP remains low and/or is demonstrating signs
of pulmonary overload (tachypnoea, respiratory distress, hepatomegaly)
🡺 Obstructive shock (least common cause of shock):
o Coarctation of the aorta, cardiac tamponade, tension pneumothorax or massive
pulmonary embolism => leading to obstruction to the outflow of blood from
the heart itself or the great vessels => decreases CO + => MAP => decreases perfusion of
the major organs.
- Signs and symptoms:
🡺 On history:
o Change in mental state = agitation, restlessness, sedation, confusion, or reduced GCS
o Symptoms of any cause, e.g. cough, thirst, choking
🡺 From examination:
o Signs of causes = non-blanching rash for sepsis or stridor for anaphylaxis
o Compensated shock (BP increased to still be able to perfuse organs) = altered mental
state, tachycardia, tachypnoea, decreased urine output, increased CRT
o Uncompensated/decompensated shock (if cause not treated => can't maintain BP and
organ perfusion) = hypotension, decreased oxygen sats, chest/abdominal pain, weak,
thready pulse, cold, grey, or mottled skin, decreased body temperature
o Irreversible shock = unconsciousness, slow, irregular pulse, unrecordable BP, progressing
to cardiac arrest
- Management:
🡺 Initial:
4
Module A.
1. Paediatrics……………………………………………………………………………………………………………………………………………….
1.1 Acute…………………………………………………………………………………………………………………………………………………
1.2 Cardiology….………………………………………………………………………………………………………………………………………
1.3 Respiratory…………………………………………………………………………………………………………………………………………
1.4 Endocrinology…………………………………………………………………………………………………………………………………….
1.5 Gastroenterology……………………………………………………………………………………………………………………………….
1.6 Gastrointestinal surgery….………………………………………………………………………………………………………………….
1.7 MSK……………………………………………………………………………………………………………………………………………………
1.8 Nephrology….…………………………………………………………………………………………………………………………………….
1.9 Infectious diseases……………………………………………………………………………………………………………………………..
1.10 Haematology/vascular……………………………………………………………………………………………………………
1.11 Neurology………………………………………………………………………………………………………………………………
1.12 Child and adolescent mental health (CAMHS)…………..…………………………………………………………….
1.13 Dermatology…………………………………………………………………………………………………………………………..
1.14 Urology….……………………………………………………………………………………………………………………………….
1.15 Oncology….…………………………………………………………………………………………………………………………….
1.16 Genetic….……………………………………………………………………………………………………………………………….
1
,Module B
1. Obstetrics….…………………………………………………………………………………………………………………………………………….
2. Gynaecology…………………………………………………………………………………………………………………………………………….
3. Sexual health……………………………………………………………………………………………………………………………………………
4. Urology……………………………………………………………………………………………………………………………………………………
5. Breast….…………………………………………………………………………………………………………………………………………………..
6. Dermatology….………………………………………………………………………………………………………………………………………..
Module C
1. Psychiatry………………………………………………………………………………………………………………………………………………..
2. Geriatrics…………………………………………………………………………………………………………………………………………………
3. Ophthalmology………………………………………………………………………………………………………………………………………..
4. Cancer and palliative care………………………………………………………………………………………………………………………..
3.1 Cardiac myxoma…………….…………………………………………………………………………………………………………………..
3.2 Lung cancer……..…………………………………………………………………………………………………………………………………
3.3 Oesophageal cancer and differentials………………………………………………………………………….……………………..
3.4 Gastric cancer and differentials………………………………………………………………………………………………………….
3.5 Hepatocellular carcinoma……..…………………………………………………………………………………….…………………….
3.6 Pancreatic cancer and cholangiocarcinoma………………………………………………………………….…………………….
3.7 Carcinoid tumours…..…………………………………………………………………………………….…………………………………..
3.8 Phaeochromocytoma………………………………………………………………………………….……………………………………..
3.9 Colorectal cancer and lynch syndrome……………………………………………………………………………………………….
3.10 Anal cancer…..…………………………………………………………………………………………………………….………….
3.11 Haematological malignancies………………………………………………………………………………………………….
3.12 Head and neck cancer……..………………………………………………………………………………………………………
3.13 Salivary gland tumours…..……………………………………………………………………………………………………….
2
,3.14 Thyroid cancer……..………………………………………………………………………………………….…………………….
3.15 Breast cancer…..……………………………………………………………………………………………………………………..
3.16 Cervical cancer…..…………………………………………………………………………………………………………………..
3.17 Ovarian cancer…..…………………………………………………………………………………………………………………..
3.18 Endometrial cancer………………………………………………………………………………………….…………………….
3.19 Vulvar cancer…………………………………………………………………………………………………..……………………..
3.20 Prostate cancer…..…………………………………………………………………………………………..……………………..
3.21 Testicular cancer…..………………………………………………………………………………………………………………..
3.22 Bladder cancer……………………………………………………………………………………………………………………….
3.23 Renal cancer…..……………………………………………………………………………………………….……………………..
3.24 Skin cancer (Benign lesions and malignant)……………………………………………………………………………..
3.25 Eye and eyelid tumours….………………………………………………………………………………..……………………..
3.26 Cancer screening…………………………………………………………………………………………………………………….
3.27 2 week wait referrals…………………………………………………………………………………..………………………….
3.28 Tumour markers….…………………………………………………………………………………………..…………………….
3.29 Oncological emergencies……………………………………………………………………………..…………………………
3
, Mod A
Paediatrics
Paeds Acute
● Paediatric shock = failure of circulatory
system to adequately perfuse organs:
- Causes/differential diagnosis:
🡺 Distributive shock:
o Sepsis (RF =
immunocompromised/very
young), anaphylaxis (RF =
history of allergies/new medication) or high spinal cord injury => leads to release of
inflammatory cytokines => leads to systemic vasodilation due to shifts of blood flow
within the vascular system, resulting in reduced blood flow to major organs despite
a normal blood volume
🡺 Hypovolaemic shock:
o Dehydration (due to diarrhoea, vomiting, burns, inadequate feeding, or diuresis in DKA),
third spacing (due to sepsis and anaphylaxis releasing inflammatory mediators => leading
to movement of fluid from the intravascular compartment to an extracellular
compartment i.e. the interstitial space) and haemorrhage => leading to reduced
circulating volume => decreasing CO => decreasing MAP (MAP = CO x SVR) => decreasing
perfusion to organs
🡺 Cardiogenic shock:
o Viral myocarditis or acute deterioration of heart failure secondary to cardiomyopathies or
congenital heart defect => leads to decreased CO => decreased MAP => reduced perfusion
of organs
o Won’t respond to fluid therapy and BP remains low and/or is demonstrating signs
of pulmonary overload (tachypnoea, respiratory distress, hepatomegaly)
🡺 Obstructive shock (least common cause of shock):
o Coarctation of the aorta, cardiac tamponade, tension pneumothorax or massive
pulmonary embolism => leading to obstruction to the outflow of blood from
the heart itself or the great vessels => decreases CO + => MAP => decreases perfusion of
the major organs.
- Signs and symptoms:
🡺 On history:
o Change in mental state = agitation, restlessness, sedation, confusion, or reduced GCS
o Symptoms of any cause, e.g. cough, thirst, choking
🡺 From examination:
o Signs of causes = non-blanching rash for sepsis or stridor for anaphylaxis
o Compensated shock (BP increased to still be able to perfuse organs) = altered mental
state, tachycardia, tachypnoea, decreased urine output, increased CRT
o Uncompensated/decompensated shock (if cause not treated => can't maintain BP and
organ perfusion) = hypotension, decreased oxygen sats, chest/abdominal pain, weak,
thready pulse, cold, grey, or mottled skin, decreased body temperature
o Irreversible shock = unconsciousness, slow, irregular pulse, unrecordable BP, progressing
to cardiac arrest
- Management:
🡺 Initial:
4
