PRIMARY EXAMINATION PREPARATION SERIES PRIMARY …

PRIMARY EXAMINATION PREPARATION SERIES

Adapted from DR TIM HARRAWAY (2001)

PHYSIOLOGYImportant:

• Body fluid compartments (particularly volumes and how they are measured).• Transport across cell membranes & membrane potentials.• Na+ / K+ ATP-ase.• Diffusion and Fick’s Law.• Gibbs-Donnan effect.• Membrane potential.• Sodium / Potassium distribution and Osmolality.• Know fundamentals of Intercellular Communication and 2nd messengers (some overlap with

Pharmacology).

Less important:• Read “Functional morphology of the cell” once only or not at all.• Ditto with the DNA / RNA / meiosis / mitosis stuff.

Definitions:• Transcellular fluid.• Moles vs. Osmoles.• Equivalents.• Osmolarity vs. Osmolality.• pH.• Buffer.• Diffusion.• Solvent drag.• Osmosis.• Osmotic pressure.• Tonicity.• Donnan effect.• Filtration.• Oncotic pressure.

Viva questions:• Describe the body’s fluid compartments and their volumes.• How is TBW / ICF volume / Interstitial fluid volume / ECF volume / plasma volume / red cell mass

measured ?• In what ways may ions and other small molecules be transported across cell membranes ?• Describe the Na+ / K+ ATP-ase pump.• What are the net ionic transport results of it’s operation ?• What is Fick’s law ?• How can you calculate osmolality ? ( And what is the normal value ?)• How is the resting membrane potential of a neuron created ?• What is a second messenger ?• What second messenger systems can you describe ?

GOL D COAST HOS PITAL EMERGENCY DEPARTMENT February 2009

PRIMARY EXAMINATION STUDY GUIDELINE: WEEK 01


PHARMACOLOGYImportant:

• Ionisation of weak acids / bases (and the effects on their ability to cross membranes).• Dose - response curves.• Types of antagonists.• Second messengers.• Efficacy vs. Potency.

Definitions: • Drug.• Receptor.• Pharmacodynamics.• Agonist.• Partial agonist.• Antagonist.• Potency.• Efficacy.• ED50.• TD50.• LD50.• Therapeutic index (aka Therapeutic ratio).• Pharmacokinetics.• Volume of distribution.• Clearance.• Elimination - capacity-limited vs. flow-dependent.• Zero, First and Mixed order kinetics.• Half-life. (including formula)• Bioavailability.• First-pass elimination.• Extraction ratio.• Phase 1 & phase 2 reactions.• Enzyme induction & inhibition

Viva questions:• Draw a dose/response (or log dose/response) curve.• Draw the curve after addition of a competitive antagonist / irreversible antagonist / partial agonist.• Use the dose/response curve to demonstrate the difference between efficacy and potency. (classical

viva question)• How may drug receptors cause a response ?• How do you calculate Loading dose ?• How do you calculate Maintenance dose ?• What is steady state ?• What substances may induce/inhibit hepatic enzymes


This handout is produced for the use of GCH Emergency Staff as part of the Emergency Medicine Primary Examination Series. All care is taken to ensure accurate and up to date content. Please contact me with any problems, concerns, questions or comments...

Dr Leo Marneros (Senior Staff Specialist, GCH Emergency Department) E-mail: [email protected] Mobile: 0416 085 665

mailto:[email protected]


ANATOMYImportant:

• Tension lines in skin.• Types of cartilage (and examples).- • Muscle form types (unipennate, bipennate etc.) and examples.• Types of joints (and examples).• Hilton’s Law.• Stability of joints (i.e. bony, ligamentous & muscular factors).• Dermatomes / axial lines. (popular MCQ and viva question.)• Myotomes. (popular MCQ and viva question.)• Organisation of autonomic nervous system.• Organisation of a spinal nerve.• Vessels • Lymphatics• Fascia

Viva questions:• Nil relevant



PATHOLOGYImportant:

• Causes of cell injury.• Sequence of events & appearances in reversible cell injury / irreversible cell injury / necrosis.• Free radical and chemically-induced injury.• Types of necrosis (with examples).• Morphological changes in apoptosis.

Definitions:• Hypertrophy• Hyperplasia• Atrophy• Metaplasia• Cell injury – Reversible vs. Irreversible.• Cell death.• Necrosis.• Apoptosis• Ischaemia• Hypoxia• Reperfusion Injury

Viva questions:• Can you give me a definition of…… (as above).• What agents may cause cell injury ?• In what ways may a cell respond to injury ?• Tell me about the events during reversible / irreversible cell injury.• What are the characteristic features of irreversible cell injury ?• Define necrosis and give examples of types of necrosis.• Intracellular accumulations (especially calcium)





• Resting nerve membrane potential. • Nerve action potential. • Refractory period. • Electrogenesis of the action potential. • Saltatory conduction. • Ionic basis of excitation and conduction. • Nerve fibre types and function. (This table is a source of MCQs). • Morphology of skeletal muscle. • Excitation-Contraction coupling. • Morphology of cardiac muscle (contrast with skeletal). • Cardiac muscle action potential. • Length-tension relationship for cardiac muscle. • Smooth muscle.

Viva questions:• Draw a nerve action potential • Draw a cardiac muscle action potential (& correlate with ECG, refractory period and contractile

response) • Explain excitation-contraction coupling in skeletal muscle. • How is the resting neuronal membrane potential created ? • How is the neuronal action potential created ? • Explain how a nerve impulse is conducted in a myelinated (or unmyelinated) neuron. • Describe the morphology of a cardiac (or skeletal) muscle cell. • Explain the significance of the long refractory period of cardiac muscle.





• Non-depolarising muscle relaxantsPancuronium. Vecuronium. Atracurium. Rocuronium

• Depolarising muscle relaxants:Suxamethonium- IMPORTANT drug.Understand differences in action vs. NDPMRs. Phase II block. Contraindications. Side effects. Pseudocholinesterase deficiency. Malignant Hyperthermia.

• Passing familiarity with Dantrolene. • Forget about the rest of the section “Spasmolytic drugs”.

Viva questions:• Contrast the actions of nondepolarising and depolarising muscle relaxants. • Compare Suxamethonium and Rocuronium • Tell me about Suxamethonium. • What is Phase II block ? • Tell me about the NMDR’s • Tell me about local anaesthetics • Bupivocaine• Prilocaine



ANATOMYViva questions:

• Bony features of the clavicle • Describe/show me the boundaries and contents of the axilla. • Draw the brachial plexus. (Important to know this, including all the branches). • Describe the movements and stability of the Sterno-clavicular joint. • What are the branches of the axillary artery ? • Describe the lymph nodes of the axilla. • Describe the lymph drainage of the breast.



PATHOLOGYAcute inflammation:

• Components / Sequence of events. • Mechanisms. • Chemical mediators ( need to read Histamine, Serotonin, Complement (popular question.),

Kinins, clotting system, eicosanoids & PAF.) • Cytokines:- Terms & definitions; General properties and functional classes; IL-1 and TNF. Don’t get

too carried away with other individual agents. • Fig 3-21 could easily produce a MCQ. • Tables 3-6 & 3-7 are important. • Outcomes.

Chronic inflammation• definition / examples. • histologic features. • macrophages and the mononuclear phagocyte system. • other cell types in chronic inflammation. • Granulomatous inflammation (TB as a popular example). • Morphologic patterns in inflammation. • Systemic effects of inflammation.

Viva questions:• Tell me about acute inflammation • Tell me about the chemical mediators of inflammation. • Tell me about the role of Histamine / Serotonin / Kinins / PAF / the clotting system. • What are cytokines ? • Tell me about complement:

What activates the two pathways ? What does the MAC do ? What are anaphylatoxins, and what do they do ? Which components of complement act as inflammatory mediators ?

• What are the potential outcomes of acute inflammation ? • Give me a definition of chronic inflammation. • What are the histologic characteristics of chronic inflammation ? • What other cells are involved in chronic inflammation ? • Give me a definition and some examples of granulomatous inflammation. • What morphological patterns of inflammation can you name ? • Tell me about the systemic effects of inflammation .







PHYSIOLOGYImportant:Chapter 4

• EPSPs • IPSPs • Generation of the A.P. in the postsynaptic neuron • Inhibition & Facilitation • Ach. & receptors • Adr. / NorAdr. & receptors • Serotonin (Important because of SSRIs etc.) • GABA • Opioids & receptors • Neuro-muscular transmission

Chapter 13:• Organisation of Autonomic N.S. • Autonomic neurotransmitters and their receptors / effects.

Viva questions:Chapter 4:

• Describe cholinergic synaptic transmission. • Describe adrenergic synaptic transmission. • Describe neuromuscular transmission at the motor end plate. • What are the different types of opioid receptors and their actions ? • What is an EPSP / IPSP ? • How is Ach. Synthesised / metabolised ? (Be able to discuss pseudocholinesterase) • Describe the synthesis of catecholamines. • How are catecholamines metabolised ?

Chapter 13:• Describe the organisation of the Autonomic nervous system. • Describe the distribution of cholinergic / noradrenergic / a1 / a2 / b1 / b2 receptors. • What would be the effect of a cholinergic / adrenergic agonist / antagonist on the eye / heart /

Peripheral vessels / lung / G-I system / bladder / skin etc.





• Anatomy & neurotransmitter chemistry of the Autonomic Nervous System. • Autonomic receptors. • Presynaptic & postsynaptic regulation. • Pharmacology of the eye (past viva question; “What drugs affect the pupil ?”). • Direct-acting cholinergics (nicotinic / muscarinic). • Indirect-acting cholinergics (i.e. Cholinesterase inhibitors).• alcohols (Edrophonium). • carbamates (Neostigmine). • organophosphates (including poisoning & Pralidoxime). • Anticholinergics (Atropine).

Viva Questions• What drugs affect the eye. • Indirect cholinomimetics • Organophosphates • Atropine




• Tell me about the shoulder joint. (Need a general answer template for joints). • Describe the stabilising factors of the shoulder joint (i.e. bony, ligamentous & muscular). • What features of the shoulder joint make it inherently unstable ? • What is the rotator cuff ? • Show me the muscular/tendinous attachments to the scapula • Tell me about this bone (proximal end of humerus);

bony features attachments of rotator cuff muscles capsular attachments contents of bicipital groove

• Show me the features of this shoulder X-ray • Review Brachial plexus organisation:

Roots between the muscles (that is scalenus anterior & scalenus medius) Trunks in the triangle (that is the posterior triangle of the neck) Divisions behind the clavicle (at the outer border of the first rib) Cords in the axilla (clasping the second part of the axillary artery) Definitive nerves of supply forming in the lateral part of the axilla.



PATHOLOGYImportant

• Repair / Healing very important: • Fibrosis. • Wound healing by primary / secondary intention. • Factors influencing healing. • Pathological aspects of wound repair. • Overview of cell cycle • Regulation of cell division / Growth inhibition / Growth factors don’t spend too much time on this

stuff. • Collagen: Characteristics of different types • Other constituents of extracellular matrix: Know what they are, but not too much more than

that.

Viva questions:• Tell me about wound healing by primary intention. • Tell me about wound healing by secondary intention. • Tell me about the sequence of events in fibrosis. • Tell me about the time course of the recovery of tensile strength in a wound. • What factors could affect wound healing ? • Tell me about scar formation







PHYSIOLOGYChapter 6

• Monosynaptic reflexes (stretch receptor). • Polysynaptic reflexes (withdrawal reflex).

Chapter 7 • Organisation of the spinal cord • Sensory homonculus

Chapter 8 (Vision):• Visual pathways and lesions • Pupillary reflexes

Chapter 9 (Hearing and equilibrium): • Overview of anatomy and auditory pathways if you have time. • Table 9-1 (Tuning fork tests). • Vestibular function is worth a quick look too (particularly nystagmus and caloric stimulation).

Vivas• Tell me about the stretch reflex • Explain the sensory and motor tracts o the spinal cord • What is the effect of various lesions to the visual pathways • How does the pupillary reflex work





• Adrenoceptor types & distribution. Second messengers (broad concepts). Organ system effects.

• Adrenalin. • Noradrenalin. • Isoprenalin. • Dopamine. • Dobutamine. • Beta blockers:

Organ system effects. • Specific agents:

Propranolol. Metoprolol / Atenolol. (b1 selective). Labetalol worthy of superficial knowledge. Esmolol also interesting because of short T1/2 and use in SVT.

• Know which agents exhibit Cardioselectivity, Intrinsic sympathomimetic activity, Local anaesthetic action, etc.

• Clinical pharmacology of beta blockers. Beta blocker toxicity / overdose. In general, b-blockers are more important than a-blockers, at least for the vivas.

• Alpha blockers: Phentolamine/Phenoxybenzamine/ Prazosin - Superficial knowledge is OK Clinical pharmacology of alpha blockers.

Viva questions:• Tell me about the pharmacodynamics of Adrenaline. • What are the therapeutic uses of Adrenalin • What are the actions of noradrenaline ? • What effects might you see in a patient who had taken amphetamines? • What drugs have alpha blocking effects? • Name a drug which specifically blocks a1 receptors. • When might alpha antagonists be used ? • What are the organ system effects of beta antagonists ? • What agents possess b1 selectivity ? • What agents possess intrinsic sympathomimetic activity ? What are the theoretical benefits of this ? • What are the toxic effects of beta blockers ? • What are the contra-indications to beta blockers ? • What are the therapeutic uses for beta blockers ?




• Draw a cross-sectional view of the upper arm at the level of the mid-humerus. • Describe the course of the median / ulnar / radial (etc) nerve through the upper arm. • Tell me about the elbow joint. (Use your generic joint answer schema). • Tell me about this x-ray of the elbow. At what age does each bone ossify (C-R-I-T-O-E) • Show me the features of this bone (distal humerus). • Tell me about the cubital fossa



PATHOLOGY• None







PHYSIOLOGY• Platelets. • Red cells. • Haemoglobin. • Blood types (especially ABO, Rhesus). • Transfusion reactions. • Plasma proteins & their functions. • Haemostasis. • Anti-clotting mechanisms.

Viva questions:• What is the structure of Haemoglobin ? • What blood grouping systems are you aware of ? Which ones are the most important, and why ?

(Know ABO and Rhesus well, plus know the names of a few others e.g. Kell, Duffy, Kidd etc.). • What types of transfusion reactions are you aware of ? • What are the major steps involved in haemostasis ? • Tell me about the role of platelets. • What are the intrinsic and extrinsic systems ? • Draw the clotting cascade • Describe the fibrinolytic system (e.g. “ What stops blood from clotting within normal blood

vessels ?”).




PHARMACOLOGY• Review of haemostatic and fibrinolytic systems. • Heparin (unfractionated). • LMW Heparin. • Protamine. • Warfarin. • Streptokinase. • t-PA. • Aspirin (antithrombotic effects) • Clopidogrel • G2b/3a inhibitors • Vitamin K. • Blood products: • FFP. • Cryoprecipitate. • Factor VIII. • Factor IX.

Viva questions:• Tell me about Heparin. • What are the differences between unfractionated Heparin and LMW Heparin ? • How can you reverse the actions of Heparin ? • Tell me about warfarin • Tell me about the PK/PD/interactions of Warfarin. • How can you reverse the action of Warfarin ? • Tell me about the antithrombotic efects of Asprin • Tell me about STK / t-PA. • What pharmacological agents could be used to treat a patient with a major haemorrhagic

complication following administration of STK ? • Tell me about clopidogrel • Tell me about Abciximab/Tirofiban/Eptifibatide



PATHOLOGY• Oedema: types & definition. • Haemostatic process:

Sequence of events and Coagulation pathways. • Thrombosis:

Definition Pathogenesis. Arterial vs. venous Predisposing conditions Potential outcomes of thrombosis.

• DIC • Embolism –Definition, Types & examples • Infarction –Definition & Types. • Shock

Definition. Types · Cardiogenic · Hypovolaemic · Septic (These are the types in the text book, but I prefer to use “distributive” to include septic shock, anaphylaxis, spinal shock). Stages, particularly features of irreversible shock.

Vivas• Tell me about types of oedema • Tell me about the pathogenesis of septic shock • What is the role of platelets in haemostasis • What types of embolism are you familiar with • Tell me about the pathology of DIC • Draw the coagulation cascade and discuss factors predisposing to thrombus formation • Tell me about the pathophysiology of shock • Tell me about haemorrhagic shock • Tell me about anticlotting mechanisms




• Tell me about the anatomical snuffbox (particularly boundaries / floor/ contents). • Explain the bony features of the radius and ulna • Tell me about the mechanism of pronation and supination of the forearm • Model of flexor or extensor forearm. • Show me the arrangement of the nerves / arteries / superficial veins of the forearm. • Show me the course of the ulnar / radial / median nerve through the forearm. • Ditto with radial / ulnar artery. • Extensor retinaculum

attachments. six compartments beneath. need to correlate with bones. contents of each compartment








• WBC functions (broad concepts) • Immune system:

Components MHC Immunoglobulins Complement Cytokines (broad concepts) (Immune system section overlaps significantly with Pathology)

Viva questions:• How is the Immune System organised ; i.e. what are it’s major components ? • What is the body’s response to an antigen ? • What is the MHC ? What is it’s role ? • Draw an immunoglobulin molecule. • Describe the complement system. • What are anaphylatoxins and what is their role ? • Tell me about the classical/alternative pathway. • What are cytokines and what do they do ?




Pharmacology• Mechanisms of antimicrobial action

Bacteriostatic vs. Bactericidal (definitions) Mechanisms of resistance

• Penicillins:Natural Penicillins e.g. Benzylpenicillin Semi-synthetic Penicillins e.g. Flucloxacillin, Dicloxacillin Extended-spectrum Penicillins e.g. Amoxycillin / Ampicillin. Ticarcillin. Piperacillin.

• Cephalosporins:3 generations (with examples). Be able to compare / contrast the three generations.

• Vancomycin. • Tetracyclines

Doxycycline. • Macrolides.

Erythromycin. Roxithromycin.

• Chloramphenicol




• Surface anatomy of the flexor retinaculum: What are it’s attachments ? What structures pass under / over / through it ?

• Describe the arterial supply of the hand. • Describe the innervation of the muscles of the hand. • Describe the sensory innervation of the hand. • Describe the contents of a web space. • Describe the actions of the interossei and the lumbricals. • Tell me about the wrist joint. • Tell me about the blood supply of the scaphoid. • Tell me the contents of the carpal tunnel • Tell me about the movements of the thumb (bone/joint/nerve/muscle) • Tell me about the movements of the MCP/PIP/DIP (bone/joint/nerve/muscle)



PATHOLOGY• Hypersensitivity Types 1-4 (very important) • Transplant rejection & graft vs host • Auto-immune diseases:

Know some for MCQs • SLE:- know the major clinical manifestations. • Immunodeficiency syndromes:

1' vs. 2'. What types of immune deficiency are you aware of ?

• HIV / AIDS: (Very important subject).Risk groups. Viral structure Mechanism of immunopathogenesis. Major abnormalities of immune function Natural history Clinical features. AIDS-defining illnesses:







PHYSIOLOGY• None




PHARMACOLOGY• Aminoglycosides.

Gentamicin. • Sulfonamides.

Trimethoprim. • Quinolones. • Metronidazole • Anti-mycobacterials & anti-fungals are worth a brief look • Same with antimalarials and antihelminthics • Anti-virals:

Aciclovir (has been asked). AZT. Principles of HIV therapy

• Disinfection vs. sterilisation (MCQ).

Vivas• Gentamycin • Ciprofloxicin • Metronidazole • Isoniazid • Tell me about anti-TB therapy • Rifampacin • Tell me about the treatment of Malaria • Tell me about the principles of HIV treatment



ANATOMY• What pierces the clavipectoral fascia • Distribution of cutaneous nerves • Dermatomes/myotomes/reflexes • Important to have a clear understanding of the sensory and motor innervation of the medial /

ulnar / radial / musculocutaneous / axillary nerves. • Nerve injury patterns:

Brachial plexusAxillary nerveRadial nerveMusculocutaneousUlnar nerve (at elbow & wrist)Median nerve

Vivas• Where is the _____ nerve most commonly injured ? • By what mechanism is it most commonly injured ? (if applicable) • What functional deficit would you expect to see in an injury of the median nerve at the wrist ? • How do you test the function of the _______ nerve ? • What is the venous drainage of the upper limb



PATHOLOGY• Categories of infectious agents. • Host barriers to infection. • How micro-organisms cause disease. • Spectrum of inflammatory responses to infection. • Specific infections:

TB. Infectious gastroenteritis. Staphylococcal. Streptococcal. Clostridial infections. HSV. Syphilis. EBV. Opportunistic infections. Malaria.

Viva questions:• What classes of infective agents could cause this infection ? • A lot of people run out of ideas after bacterial & viral. Just be able to mention Fungi, Protozoa,

Rickettsiae, and parasites etc. • Tell me about host defences against infection • How may micro-organisms cause disease ? • How may micro-organisms evade destruction by the immune system ? • What types of inflammatory response may occur due to infection ? • Tell me about infection with M. tuberculosis • Which agents can cause gastroenteritis ? • Tell me about staphylococcal infections • Tell me about staphylococcal toxins • Tell me about streptococcal infections • Tell me about clostridial infections (esp. wound infections) • Tell me about tetanus • Tell me about 1', 2' and 3' syphilis • Tell me about malarial infection (esp. falciparum) ? • Tell me about atypical pneumonia • Tell me about bacterial pneumonia • Tell me about legionella • Tell me about Varacella zoster







PHYSIOLOGY• Route of spread of cardiac excitation (potential viva question.). • Read ECG once (you know this anyway). • Read His bundle electrogram once, i.e. just know the principle of it. • Read arrhythmias once only. • Most of the ECG / arrhythmia stuff is likely to be seen in MCQs only. • You will not be given ECGs to look at. • You could get asked something like: “Tell me the principle underlying the recording of the ECG”.

Vivas• Pacemaker potentials -how are they generated ? • The cardiac cycle

This is important. Phases JVP waves (a,c,v) Heart sounds (including S3, S4)

• Cardiac outputHow to measure it. Average value. Fick principle (**different from Fick’s law).

• What factors control cardiac output ? (Fig. 29.5). • What is preload / afterload / contractility ? • Length-Tension relationship in cardiac muscle. (i.e. Frank-Starling law). • Factors affecting EDV (preload). • Pressure-volume loop for left ventricle (Fig. 29.7). • Factors affecting contractility (Fig. 29.8). • Remember to have a look at the CVS chapters in Guyton; (it’s good for this stuff and is an additional

prescribed text for CVS physiology).




PHARMACOLOGY• Review of electrophysiology of cardiac conduction. • Mechanisms of arrhythmias (re-entry etc.). • Anti-arrhythmic drugs are classified using the Vaughan-Williams system. (This name isn’t

mentioned in Katzung). Class 1A: Quinidine. Procainamide. Disopyramide. TCAs. Class 1B: Lignocaine. Phenytoin. Class 1C: Flecainide. Class 2: Beta-blockers (already covered, but revise). Class 3: Amiodarone (also Class 1,2 and 4). Sotalol (also Class 2). Class 4: Calcium channel blockers (Verapamil). Others: Adenosine. Digoxin & Digibind. Magnesium.

Viva questions:• Tell me about the Vaughan-Williams classification system • Tell me about class 1 agents (or 2, 3 etc.) • Tell me about Amiodarone • Tell me about Lignocaine • Tell me about digoxin overdose • Tell me about Magnesium • Tell me about Sotolol • Tell me about Adenosine • Tell me about Flecanide • Tell me about verapamil



PATHOLOGYImportant:

• Definitions:Neoplasia. Differentiation. Anaplasia. Pleomorphism. Dysplasia. Grading. Staging.

• Characteristics of benign and malignant neoplasms. • Metastasis. • Oncogenes (basic understanding). • Carcinogenesis (basic understanding). • Tumour immunity (basic understanding). • Clinical features of tumours.• Paraneoplastic syndromes. • Tumour markers.

Viva Questions:• Definitions as above • Outline the differences between benign and malignant tumours • How may neoplasms spread ? • Which agents are thought to be carcinogenic ? • What clinical effects may tumours have on their host ? • What is a paraneoplastic syndrome ? ( + examples) • What are tumour markers ? (+examples)



ANATOMYImportant:

• Bony Pelvis • Hip joint: • Adductor muscles:

Form part of floor of femoral triangle. Origins/insertions/nerve supply etc. for MCQs.

• Profunda femoris artery:Course. Relations. Branches.

• Gluteal region:Muscles/nerves/vessels. Sciatic nerve of particular importance.

• Trochanteric anastomosis:Important because provides blood supply to head of femur.

• Hamstring muscles. • Sciatic nerve in thigh.• Surface markings.

Viva questions:• Tell me about the hip joint • Tell me about the course of the sciatic nerve • Tell me about the muscles of the posterior thigh • Identify the muscles on a prosection of the posterior thigh. • Identify the muscles on a prosection of the gluteal region • What is the surface marking of the of the sciatic nerve in the thigh ?







PHYSIOLOGY• Measurement of BP. • What the different Korotkov sounds mean. • Capillary circulation • Starling forces & their values. (important). • Prostacyclin / Thromboxane A2. • EDRF (NO): • Endothelins: • Hormones:

Kinins. ANP (will be covered later, but be aware of it at this stage). ADH (Vasopressin). NA. Angiotensin II. (will also be covered later)

• Nervous regulation:innervation of blood vessels. innervation of the heart. the vasomotor centre. baroreceptors

where are they ? what is their action ?

be familiar with the other sites of receptors:atrial. LV. pulmonary.

be familiar (at least in passing) with the reflexes mentioned in the text:Bainbridge. Bezold-Jarisch. Cushing (probably the most askable).

Vivas• Tell me about the control of BP • Baroreceptor response to pressure change • Starling curve and factors effecting CO • Effects of Adrenaline/Norad on CO/HR/BP • Tell me about autoregulation • Tell me about the control of HR • What is the CVS response to a Valsalva ? • Know these Formulae

Flow = Pressure/Resistance Laminar flow / turbulent flow. Reynold’s number Poiseuille’s Law - explain physiological significance Laplace’s Law




--------------------------------------------------------------------------------PHARMACOLOGY

• Anti-hypertensive agents: • What classes of antihypertensives are you aware of ? (x4). • Tell me about the drugs used in hypertensive emergencies • Methyldopa: • Clonidine: • Beta-blockers • Alpha1 blockers (Prazosin). • Alpha1&2 blockers (Phentolamine, Phenoxybenzamine) • Sodium Nitroprusside: Interesting drug, particularly with regard to pharmacokinetics,

pharmacodynamics and toxicity. • Diazoxide: know basic features only, e.g. mechanism of action. • Hydralazine. • Ca2+ blockers • ACE inhibitors:

Generic features. Captopril. Enalapril (is a “prodrug”; important for MCQs). Angiotensin receptor blockers (e.g. Losartan)



ANATOMYImportant:

• Adductor muscles:Form part of floor of femoral triangle. Origins/insertions/nerve supply etc. for MCQs.

• Profunda femoris artery:Course. Relations. Branches.

• Gluteal region:Muscles/nerves/vessels. Sciatic nerve of particular importance. Know surface markings. Makes contact with bone (MCQ fact).

• Trochanteric anastomosis:Important because provides blood supply to head of femur.

• Hip joint:VERY important. Blood supply of head and clinical relevance. Relations (e.g. femoral nerve). Muscles and their effects

• Hamstring muscles. • Sciatic nerve in thigh.• Surface markings.

Viva questions:• Show me the muscle attachments in this area • Show me the muscle attachments on the proximal femur • Tell me about the sciatic nerve.• Nerve roots. • Course. • Surface markings. • Tell me about the hip joint• Use generic answer template for joints. • Or might ask specific points e.g. blood supply and its clinical relevance • Stabilising factors. • Identify the muscles on a prosection of the posterior thigh. • What is the surface marking of the sciatic nerve in the thigh ?



PATHOLOGY• Endothelial cell functions. • Arteriosclerosis:

Definition. • Atherosclerosis:

Definition. Risk factors. Pathogenesis. Clinical significance / complications.

• Hypertension:Causes / Pathogenesis.

• Vasculitides:Types (don’t get too carried away with these; they’re probably mainly MCQ fodder, e.g. temporal arteritis).

• Aneurysms:Sites. Causes / Pathogenesis. Complications.

• Aortic dissection. • Varicose veins:

Pathogenesis. Complications.

• Vascular tumours (MCQs).

Viva questions:• What is arteriosclerosis ? • What is atherosclerosis ? • Tell me about the causes of hypertension • Tell me about the pathogenesis of essential hypertension • What is an aneurysm ? • What types of aneurysm are you aware of ? • What is a false or pseudoaneurysm ? • Tell me about AAAs • What is an aortic dissection ? • Tell me about temporal arteritis







PHYSIOLOGY• Cerebral circulation:• CSF • Blood-brain barrier.

What is it’s function ? What substances cross it easily ? What are the circumventricular organs ?

• Circumventricular organs. • Measurement of cerebral blood flow.

How is it measured • Regulation of cerebral blood flow (Important):• Monroe-Kellie doctrine. • What is the normal ICP ? • Autoregulation (Fig. 32-9.) • Brain metabolism and O2 requirements. • Coronary circulation. • Skin circulation:

Triple response. • Placental and foetal circulation:• Changes at birth.

Viva questions:• Tell me about the control of cerebral blood flow • What is cerebral perfusion pressure ? • Tell me about the control of the coronary circulation. • What is the triple response ? • Describe the foetal circulation. • What changes occur in the foetal circulation at birth ?




PHARMACOLOGY• Nitrates:

Need good understanding of PK and PD. What is the coronary steal syndrome ?

• Calcium channel blockers:Dihydropyridines -Nifedipine (learn this one as representative). Amlodipine. Felodipine. Verapamil. Diltiazem. What are the differences between the dihydropyridines and Verapamil/Diltiazem ? Passing familiarity with Nimodipine.

• Tell me about the drugs used for angina



ANATOMY• Cutaneous innervation:

(branches of lumbar plexus & femoral nerve). Good chance to review dermatomes.

• Superficial veins:be able to describe path of great saphenous vein. know landmarks for: cutdown at the ankle. surface marking of the great saphenous vein at the knee. saphenous opening in the deep fascia.

• Inguinal lymph nodes:know arrangement of nodes and their areas of drainage. Know where they drain to.

• Femoral triangle:Popular viva question (Tell me about the femoral triangle). Brief overview e.g. the FT is a sub-fascial space in the upper anterior thigh boundaries. floor. roof. contents.

• Femoral muscle attachments • Femoral sheath:

contents. relations. femoral canal (including it’s purposes) boundaries of femoral ring.

• Femoral artery & vein. • Femoral nerve. • Quadriceps muscles. • Patellar stability:

Tell me about the stability of the patella i.e. bony, ligamentous & muscular factors as per usual. Practice demonstrating bony factors with the actual bones.

• Adductor canal:boundaries. contents



PATHOLOGY• CHF:

definition. causes.

• ventricular hypertrophy. LVF vs. RVF:organ system effects.

• IHD:definition. risk factors. pathogenesis

• Angina. • MI.

complications. thrombolysis.

• Valvular disease Rheumatic fever. Infective endocarditis. Artificial valves

• Cardiomyopathies • Myocarditis. • Pericarditis. • Congenital heart disease. -familiarity with major lesions. • Coarctation.

Viva questions:• Tell me about the pathogenesis of MI • What are the potential complications of MI ? • Tell me about the pathogenesis of IHD • What are the potential complications/sequelae of IHD ? • What are the microscopic and macroscopic features of MI ? • Define CHF. What are the causes ? • Compare and contrast RVF and LVF • What are the risk factors for IHD ? • Tell me about the aetiology of valvular heart disease • Tell me about the pathogenesis of rheumatic fever • Tell me about infective endocarditis. What are the main causative organisms ? • Tell me about the potential complications of artificial heart valves • What types of cardiomyopathy are you aware of ? • What are the causes of myocarditis / pericarditis ? • What are the main congenital causes of R → L shunt ? (or L → R shunt)







PHYSIOLOGY• Effects of gravity. • Effects of exercise (popular question). • Shock. • Types. • The body’s response. • Refractory (irreversible) shock. • Hypertension.- causes (Good MCQ or viva question). • Pathogenesis of CHF.

Viva questions:• Tell me the immediate compensatory mechanisms which operate upon assuming the upright

posture. • What types of shock are you familiar with? • What is the body’s response to the rapid loss of 1500 mls. of circulating blood volume ? • What is the body’s response to exercise




PHARMACOLOGY• Review of cardiac contractility and excitation-contraction coupling. • Review of factors affecting cardiac output. (“cardiac performance”). • Digoxin (Important drug):

Particularly PK, PD and interactions. Digoxin toxicity. Digoxin-specific antibodies (Digibind).

• Other drugs used in CHF:Aminophylline. Inotropes. Diuretics (covered later). ACE inhibitors (already covered in antihypertensives). Vasodilators.

• Forget about Amrinone / Milrinone.

Viva questions:• Tell me about Digoxin • Tell me about Digoxin’s interactions • Tell me about Digoxin toxicity (Digibind) • What drugs are used in the treatment of CHF ? • Try to show a systematic approach to this sort of question; i.e. quickly list the different classes; they

will probably then ask you to talk about a particular agent.



ANATOMYImportant:

• Popliteal fossa:Use the “generic answer for a region” guidelines. It may help if you practice drawing a schematic of Fig. 3.22.

• Knee joint:A really important joint; just learn the lot.

Viva questions:• Tell me about the popliteal fossa • Tell me about the course and relations of the popliteal artery as it passes through the popliteal fossa • Show me the capsular attachments of the knee joint on these bones • Tell me about the knee joint • Tell me about the stability of the knee joint • Tell me about the ligaments of the knee joint, and show me their attachments on these bones • Tell me about the menisci • What is the “screw-home” movement? • What structures attach to this area ? (Superior surface of the tibia)• Attachments are (from anterior to posterior):

Medial meniscus (anterior horn). Anterior cruciate. Lateral meniscus (anterior horn). Lateral meniscus (posterior horn). Medial meniscus (posterior horn). Posterior cruciate.

• Mnemonic: ”Many Amorous Ladies Like My P____” (your choice).



PATHOLOGY• Tobacco. • Alcohol: Organ effects. • Adverse drug reactions: Types. • OCP. • Air pollution (yes it has been asked !). • Lead poisoning • Radiation injuries. • Mechanical injuries / Wounds • Gunshots (MCQs). • Burns. • Cold injury. • Electrical in juries. • Blast injuries. • Gas embolism. • Decompression sickness. • Malnutrition / Vitamins: Probably MCQs only.

Viva questions:• What are the main substances responsible for air pollution ? • What are the effects/complications of tobacco smoking • What types of adverse drug reactions are you aware of ? • What are the organ system effects of alcohol abuse ? • What is the difference between a partial-thickness and a full-thickness burn? • Tell me about the potential systemic consequences of a major burn • Tell me about electrical injuries • Tell me about decompression sickness • Tell me about radiation injury







PHYSIOLOGY• You need to cover the corresponding sections in Respiratory Physiology by West. • Ideal gas equation. / Properties of gases. • Lung volumes (Important ++). • Compliance. • Pressure-Volume curves. • Surfactant. • Work of breathing (basic). • Dead space:

Anatomical. Physiological

• Other functions of the respiratory system (defence/metabolic /endocrine functions) • Regional differences in ventilation and blood flow. • Muscles of respiration. • Review of Poiseuille’s law.. • Bohr’s equation (best shown in West). • Diffusion in the lungs. • Review Fick’s law. • Perfusion-limited & diffusion-limited gas uptake. (and examples). • Pulmonary circulation.

Viva questions:• Draw the intrapulmonary / intrapleural pressure curve during respiration. • Draw a spirometry recording to demonstrate the different lung volumes. • Give me a definition of pulmonary compliance. • Tell me about the work of breathing. • Define anatomical and physiological dead space. How do you measure them ?. • Tell me about regional differences in pulmonary blood flow (or ventilation). • What is V/Q mismatch ? • Tell me about the non-respiratory functions of the lung. • Define surface tension. What is Laplace’s law ? What is the role of surfactant? • Describe the evolution of the airways from proximal to distal. From what level does gas exchange

occur ? • What is the ideal gas equation ?. • Give me a definition of partial pressure. • What is the composition of air ? • Tell me about the muscles of respiration. • Draw a pressure-volume curve. • What is diffusing capacity ? How is it measured ? • Tell me about the pulmonary circulation. • What is shunting ? Explain physiological shunt. • Where is the main site of airways resistance ?




PHARMACOLOGYAgents used for asthma:

• Sodium cromoglycate (basic). • Theophylline (worth knowing in detail, particularly PK/PD/Overdose). • Salbutamol. • Ipratropium.



ANATOMY• Anterior compartment of the leg • Muscles of the calf. • Ankle joint • Structures crossing the ankle joint

Viva questions:• Tell me about the compartments of the leg • What are the contents of the peroneal compartment. • Tell me about the Achilles tendon • Extensor retinacula of ankle • Front of ankle • Tell me about the structures passing behind the medial malleolus.• Tom Did A Night at Home. (D. Spain)

Tibialis posterior. Flexor Digitorum longus. Posterior tibial Artery. Posterior tibial Nerve. Flexor Hallucis longus.

• Tell me about the ligaments of the ankle joint. • Tell me about the stability of the ankle joint.







PHYSIOLOGY• Reaction between Hb and O2. • O2 - Hb dissociation curve: (This is important).• Be able to draw it and plot in some values

PO2 SaO2 10 10 20 35 26 (P50) 50 40 75 50 80 60 90 70 92 80 94 90 96 100 98

• Effect of H+, CO2, 2,3-DPG, temp. • Be able to draw dissociation curves for Myoglobin and foetal Hb. (superimposed on the Hb-O2

curve). • Buffers:• Definition. • Main buffers in vivo. • CO2 transport.

Viva questions:• Tell me about the structure of haemoglobin. • Tell me about the reaction of Hb with O2. • Draw the Hb-O2 dissociation curve.• What are the advantages conferred by it’s non-linear shape ? (See West). • What factors move the curve, and in which direction ? • What is the definition and typical value of the P50 ? • What is the Henderson-Hasselbalch equation ? • What is the definition of a buffer ? • What are the main buffers in the body ? • Tell me about CO2 transport. • Draw the CO2 dissociation curve • What is the chloride shift ? • What is the Bohr effect • What is the Haldane effect




PHARMACOLOGY• Anaesthetic agents• Inhaled anaesthetic agents:

Nitrous Oxide (Important). Volatile agents (Learn as a group rather than individual agents). PK and PD particularly. Need to understand concept of MAC.

• IV anaesthetic agents:Sodium thiopentone (important). Propofol. Ketamine. Benzodiazepines / Opiates (already covered).

• Sedative HypnoticsBenzodiazepines:Midazolam. Diazepam.

• Flumazenil. • Barbiturates. • Thiopentone • Ethanol:

PK (particularly metabolism). PD / Organ system effects. Withdrawal. Disulfiram (basic; what’s in Katzung should be enough).

• Methanol / Ethylene glycol:

Vivas• Tell me about Propofol • Tell me about Thiopentone • Tell me about Ketamine • Tell me about Halothane • Tell me about Benzodiazapines • Tell me about Midazolam• Tell me about Diazapam • Tell me about Flumazanil • Tell me about Ethanol • Tell me about Methanol



PATHOLOGY• The Lung: (This is an important chapter)• Atelectasis. • Pulmonary oedema and ARDS. • Pulmonary embolism. • Chronic obstructive pulmonary disease. • Asthma. • Bronchiectasis. • Pneumonia. • Lung Abscesses. • Pulmonary TB. • Interstitial lung disease. • Lung tumours. • Pleural conditions.

Viva questions:• Classify the causes of pulmonary oedema • What is ARDS and what conditions can cause it? • Tell me about the pathogenesis and types of emphysema. • Tell me about the pathogenesis of chronic bronchitis. • Tell me about COPD • Discuss asthma and its pathogenisis. • What types of pneumonia are there ? • What are the stages of lobar pneumonia ? • Tell me about pulmonary TB. • Tell me about the causes of interstitial lung disease. • Discuss the classification, morphology of lung tumors.



ANATOMY• Arches of the foot. • Layers of the sole • Review of innervation of the lower limb. • Review of vessels of the lower limb. • Nerve injuries.

Vivas• Tell me about the nerve/blood supply of the foot • Tell me about the layers of the sole • Tell me about the dermatomes of the lower limb • Tell me about myotomes of the lower limb • Tell me about reflexes of the lower limb • Tell me about the venous drainage of the lower limb







PHYSIOLOGY• Control of breathing• Buffer nerves• aortic and carotid bodies • What is special about the blood supply and O2 uptake of the carotid body? • Exercise. • Hypoxia (Important).• 4 types (and examples). • Cyanosis. • Hypoxic hypoxia:• Diseases causing it. • High altitude as a classical example. • V/Q mismatch. • O2 treatment / toxicity. • Cheyne-Stokes respirations. • Effects of reduced barometric pressure. (overlap with Pathology)

Viva questions:• Tell me about the control of breathing (a very popular question). • Where are the centres for respiratory drive ? • What different stimuli affect respiratory drive ? • Tell me about the ventilatory response to exercise. • What do you understand by the term “oxygen debt” ? • What factors operate to increase tissue oxygen offloading during exercise ? • What is cyanosis? • What forms of hypoxia are you aware of? • Tell me about the respiratory effects of ascending to altitude. • Tell me about the compensatory mechanisms which mediate acclimatisation to altitude. • Tell me about V/Q mismatch. • Tell me about O2 toxicity. • How are Cheyne-Stokes respirations produced ? • Tell me about decompression sickness.




PHARMACOLOGY• Precursor molecules. • Receptor types, distribution, and effects mediated by each. (Popular question). • Tell me about the opiates• Specific agents to know in detail:

Morphine. Pethidine. Fentanyl. Codeine.

• Need some familiarity with:Papaveretum. Methadone. Heroin. Buprenorphine (Temgesic) is of interest as a partial agonist. Naloxone. Naltrexone.







PHYSIOLOGY• Review of anatomy of the nephron. • Structure of the glomerulus. • Renal blood flow:

Know value. Renal plasma flow and how measured. Regulation of renal blood flow (including autoregulation).

• GFR:Know value. How measured. Control of GFR.

• Tubular function. Na+ handling. Glucose handling:Concept of renal threshold (NB 200 mg/dl » mmol/l.). Splay. PAH handling. Tubuloglomerular feedback / Glomerulotubular balance.

Viva questions:• Tell me about the structure of the glomerulus. • What is normal renal blood flow and how is it measured ? • What is the normal renal plasma flow and how is it measured ? • Tell me about the regulation of renal blood flow. • Tell me about autoregulation in the kidney. • Tell me about GFR and its regulation • Tell me about sodium handling by the kidney. • Tell me about glucose handling by the kidney. • Tell me about potassium handling in the kidney • Tell me about renal H+/HCO3- handling • Tell me about renal water handling. • What is tubuloglomerular feedback ? • What is glomerulotubular balance ? • Emptying of the bladder. • What is the countercurrent mechanism.




PHARMACOLOGY• Overview of renal function. • Classification & mechanism of action of diuretics as a group • Specific drugs:

carbonic anhydrase inhibitors osmotic diuretics loop diuretics thiazides K sparing agents aldosterone antagonists

Viva questions:• What types of diuretics do you know ? lead-in to discussion of specific agent. • How do diuretics work ? • Tell me about Frusemide. • Tell me about Thiazides • Tell me about spironalactone/amiloride • Tell me about mannitol.



PATHOLOGY• Acute renal failure:

Causes. Consequences. Very basic overview of glomerulonephritides.

• ATN:Causes. Pathogenesis. Stages.

• UTI:Causative organisms. Predisposing factors. Pathogenesis.

• Chronic renal failure:Systemic manifestations

• Haemolytic-Uraemic syndrome. • TTP. • Causes of urinary obstruction. • Renal stones:

Types. Complications.

Viva questions:• Tell me about the causes of ARF • Tell me about ATN. • Tell me about post strep GN • Tell me about pyelonephritis • Tell me about the metabolic and other consequences of ARF / CRF. • Tell me about kidney stones.



ANATOMY• Overview of lymphatic drainage of head & neck. • Meninges. • Regarding the brain itself, I wouldn’t bother with any neuroanatomy as such. I’d learn about the

ventricular system and the blood supply of the cerebral hemispheres (including venous drainage).

• Dural venous sinuses. • Cavernous sinus:

Relations. Contents. Cavernous sinus thrombosis.

• Osteology of the skull: • Orbit: • Control of the pupil / pupillary reflexes (Important). • Facial muscles (overview only). • Facial nerve (Important):

Extracranial course. Branches (“Two Zulus Buggered My Cat”).

• Sensory nerve supply of face. • Blood supply of face. • Nose • Blood supply of nose (particularly septum). • Venous drainage of face (Important because of communication with cavernous sinus and

potential for spread of infection and cavernous sinus thrombosis). • Layers of scalp. • Nerve and blood supply of scalp.

Viva questions:• Explain the blood supply to the head • Show me about the branches of the facial nerve. • Show me about the sensory innervation of the face. • Show me the dermatomes of the head and neck. • Tell me about the cutaneous nerves of the face • Name the bones of the orbit. What comes through the superior orbital foramen? • Tell me about the venous drainage of the face. What is the so-called “danger area” and why is it so

called ? • Tell me about ocular nerve palsies. • Name the bones of the face • What passes through the various foramina of the skull? • Show me the muscles of mastication and their attachments







PHYSIOLOGY• Defence of tonicity. • Defence of volume. • Defence of H+ concentration (Acid-base balance). • Definition of pH. • Buffers. • Acid-base disturbances. • Basic ABG interpretation • Definitions:

Anion gap. Standard bicarbonate. Buffer base. Base excess.

Viva questions:• Tell me about renal H+/HCO3- handling • Tell me about renal water handling. • What factors operate to maintain normal tonicity / osmolality ? • What factors operate to maintain normal ECF volume ? • Tell me about the main buffers in the body • How does the body respond to an acid load • Tell me about metabolic acidosis and compensatory mechanisms• Tell me about metabolic alkalosis and compensatory mechanisms• Tell me about respiratory acidosis and compensatory mechanisms • Tell me about respiratory alkalosis and compensatory mechanisms




PHARMACOLOGY• Aspirin (Important drug).

PK:Gastric trapping. Variable-order kinetics. Acceleration of excretion by urinary alkalinisation. PD. Aspirin overdose.

• Other NSAIDs:Know that there are 7 classes. Learn generic features rather then individual agents, but know which agents have specific uses e.g. Indomethacin for PDA. I wouldn’t bother learning other anti-rheumatic drugs (e.g. Gold, Penicillamine, Methotrexate, etc.)

• Steroids will be covered later. • Paracetamol (Important).

Paracetamol overdose. • N-acetylcysteine. (basic knowledge e.g. proposed mechanism of action, dose). • Colchicine (basic knowledge, relating particularly to overdose). • Allopurinol (basic knowledge only).

Viva questions:• Tell me about Aspirin . • Tell me about Aspirin overdose. • Tell me about the NSAIDs. • Tell me about Paracetamol. • Tell me about Paracetamol toxicity. • Tell me about Colchicine overdose. • What drugs can be used for gout ?



PATHOLOGY• CNS• Nerve regeneration. • Stroke



ANATOMY• Root of neck:• Relations of neck of first rib. • Relations of scalenus anterior. • Subclavian vein and its relations (important for obvious reasons). • Basic understanding of fascia / tissue spaces. • Sternomastoid (as an important landmark with lots of relations).• Posterior triangle: Boundaries & Contents. • Anterior triangle: Boundaries & Contents. • Dermatomes of the neck • Front of the neck (i.e. structures of importance when doing a surgical airway). • Thyroid gland. • Cervical trachea / oesophagus. • Carotid sheath. • Great vessels of the neck (CCA/ECA/ICA/IJV): • Surface anatomy. • Branches of ECA:

Some: Superior thyroid artery Anaesthetists: Ascending pharyngeal artery Like: Lingual artery Fun: Facial artery Others: Occipital artery Prefer: Posterior auricular artery S &: Superficial temporal artery M: Maxillary artery

Viva questions:• Prosection of root of the neck. • Prosection of Anterior / Posterior triangle • What is the surface anatomy of the CCA / ECA / ICA / IJV ? • What are the relations of the IJV ? • What are the relations of the subclavian vein ?







PHYSIOLOGY• Renin-Angiotensin system (popular question):• Synthesis of renin / angiotensin. • Actions. • Regulation of renin secretion • Erythropoietin • Atrial natriuretic polypeptide:• Actions. / Factors affecting secretion.

Viva questions:• Tell me about the Renin-Angiotensin system. • What things stimulate renin secretion ? • Tell me about Erythropoietin. • What factors stimulate Erythropoietin secretion ? • What are the endocrine functions of the kidney ?

Renin secretion. Erythropoietin secretion. Performs the 1-hydroxylation in the production of 1, 25-dihydroxycholecalciferol (the active metabolite of Vitamin D3). Production of kinins (Chapter 31).




PHARMACOLOGY• Review of seizure types. • Diazepam / Midazolam (already covered). • Phenytoin (IMPORTANT DRUG):• Pharmacokinetics of particular note (variable order kinetics; metabolism becomes saturated

within the therapeutic range). • Toxicity. • Interactions. • Carbamazepine. • Sodium valproate. • Superficial knowledge of:• Phenobarbitone. • Paraldehyde. • Newer drugs eg. Lamotrigine, Vigabatrin.

Viva questions:• Tell me about Phenytoin. • Tell me about the PK of Phenytoin. • Tell me about Phenytoin toxicity. • What drugs are of use in status epilepticus ? Remember to include oxygen and Thiopentone in your

initial list. • Tell me about carbamazapine • Tell me about Sodium Valproate



PATHOLOGY• Eyes



ANATOMY• Larynx (This is important):

Cartilages. Muscles (particularly cricoarytenoid). Nerve supply. Movements. View on laryngoscopy.

• General characteristics of vertebrae. Typical vertebraeCervical. Thoracic. Lumbar.

• Intervertebral discs / ligaments. (Important).

• Vertebral canal:Boundaries / contents.

• Vertebral column:Movements. Blood supply / venous drainage.

• Atypical vertebrae:C1 & C2 plus ligaments and movements

• Spinal cord:White matter (ascending / descending tracts). Blood supply (popular question). Patterns of injury (popular question)

Viva questions:• C1 / C2 as props (i.e. atlanto-axial joint)

Show me the important features of these bones. Tell me about their articulations and ligaments. Tell me about the blood supply of the spinal cord

• Show me the features of this C-Spine X-ray • Vertebrae as a prop:

Show me the features of this bone. Tell me about it’s articulations. What ligaments strengthen these articulations ?

• What region is this vertebrae from, and why ? • Tell me about the vertebral canal. • What is the significance of the drainage of the internal vertebral venous plexus ? • What structures are penetrated in performing a lumbar puncture ? • Tell me about your selection of a site for a lumbar puncture. • Model of transverse section through spinal canal with cord in situ:• Show me the major fibre tracts in this cross-sectional diagram. • What patterns of spinal cord injury are you familiar with ? • Explain the findings in:

complete transection. hemisection. central cord syndrome. anterior spinal artery syndrome.







PHYSIOLOGY• Cell types in Islets of Langerhans (and which cells secrete what ).• Insulin (Important):

Structure. Synthesis / secretion. Effects. Mechanism of action (basic). Factors affecting insulin secretion.

• Glucagon:Actions. Factors affecting secretion.

• Somatostatin:Actions. Factors affecting secretion.

• Pancreatic polypeptide. • Basic overview of “Endocrine regulation of carbohydrate metabolism”.

Viva questions:• Tell me about the endocrine functions of the pancreas. • Tell me about the exocrine functions of the pancreas. • Tell me about insulin. • Tell me about the actions of insulin. • What factors affect insulin secretion ? • How does insulin work ? • Tell me about Glucagon. • What factors affect glucagon secretion ? • Tell me about control of blood glucose level.




PHARMACOLOGY• Insulin secretion / structure / actions (overlap with Physiology). • Insulin (Important):• Preparations. • Delivery system. • Complications of therapy. • Oral hypoglycaemics:• Learn as groups rather than individual agents. • Sulphonylureas. • Biguanides. • Glucagon.• Effects. • Indications (e.g. Beta-blocker OD, Oesophageal FB).

Viva questions:• What pharmacological agents can be used to lower blood glucose ? • What pharmacological agents can be used to raise blood glucose ? • Tell me about insulin • Tell me about oral hypoglycaemic agents • Tell me about glucagon



PATHOLOGY• Acute pancreatitis• Aetiology. • Pathogenesis. • Complications / sequelae. • Ranson’s criteria (Yes, I know they’re not actually in the book as such). • Chronic pancreatitis:• Pathogenesis. • Complications. • Diabetes mellitus :• Types • Type I vs. Type II. • Pathogenesis. • Complications (some overlap with Physiology).

Viva questions:• Any of the above. • What are the complications of diabetes ?



ANATOMY• Superior mediastinum/Thoracic inlet (Fig 4.12). • Osteology:• Anatomy of a typical rib. • First rib (popular question). • Don’t worry too much about the other atypical ribs. • Surface anatomy is important in the thorax. • SVC. • Aortic arch. • Trachea / bifurcation. • Great arteries and veins. • Oesophagus. • Heart and its valves. • Pleura.

Viva questions:• Thoracic inlet / root of neck. • Show me the features of this Chest X-ray • Show me the features of the first rib • Show me the features of a typical rib • Posterior thoracic wall / contents of intercostal space. • Surface anatomy of pleura /lungs/heart valves/heart • Intercostal space and layers in chest drain insertion







PHYSIOLOGY• Overview of Iodine metabolism. • T3 / T4 synthesis / secretion. • Effects of T3 / T4. • Regulation of T3 / T4 secretion. • Overview of hypothyroidism / hyperthyroidism. • Overview of Ca2+ metabolism (Fig. 21-1). • Overview of bone physiology. • Vitamin D and OH-Cholecalciferols. • PTH.• Actions. • Regulation of secretion. • Calcitonin.• Actions. • Regulation of secretion.

Viva questions:• Tell me about the thyroid gland and thyroid hormones. • Tell me about the metabolism of calcium. • Tell me about Vitamin D and its role in calcium metabolism.




PHARMACOLOGY• Antipsychotic agents:• Basis of action (Dopamine hypothesis). • Types: • Phenothiazines (Learn Chlorpromazine) • Butyrophenones (Learn Haloperidol) • Thioxanthenes (Don’t learn, just know the name of one i.e. Thiothixene) • Miscellaneous (Know Olanzapine, Risperidone) • Lithium (with particular reference to overdose). • Antidepressants:• Basis of action (biogenic amine hypothesis). • TCAs: • Main thrust of questions will be toward overdose. • Heterocyclics:• Superficial knowledge. • SSRIs:• Fluoxetine as typical agent. • Serotonin syndrome. • MAO inhibitors:

Viva questions:• How do antipsychotics work ? • Tell me about Chlorpromazine. • Tell me about Haloperidol. • Tell me about Lithium and Lithium overdose. • Tell me about TCAs and TCA overdose. • Tell me about Fluoxetine / Fluoxetine overdose. • Tell me about Serotonin syndrome. • Tell me about MAOs. • Tell me about Benztropine



PATHOLOGYVivas

• Tell me about Hyper/hypothyroidism. • Tell me about Thyroiditis • Tell me about Cushing’s syndrome. • Tell me about Addison’s disease • Phaeo is worth a quick look. • Ditto hyperaldosteronism.



ANATOMY• Aorta. • Oesophagus. • Lymphatics. • Azygous veins. • Pleura: ** surface markings. • Lungs:• Lung roots/hila. • Surface markings (including of fissures). • Arrangements of lobes and segments. • Blood supply. • Trachea. • Vagus and phrenic nerves. • Middle mediastinum / Heart: • Surface markings of the heart. • Surface markings of cardiac valves. • Coronary arteries / veins.• dominance of coronary arteries etc. is a good MCQ.

Vivas• Play “name this structure” on a prosection of the mediastinum • Tell me about the course of the vagus / phrenic nerve. • What structures form the anterior surface of the heart ? • Tell me about the surface markings of the heart. • Tell me about the coronary circulation. • Tell me about blood supply of conduction system • Show me the surface markings of the thoracic organs • Show me the features of the Aortic Arch







PHYSIOLOGY• Adrenal morphology / architecture (MCQs). • Adrenal medulla:• Substances secreted and their effects. • Regulation of medullary secretion. • Adrenal cortex and Substances secreted. • ACTH. • Table of relative steroid potency. • Glucocorticoids are pretty important (use Cortisol as prototype). • Aldosterone actions and factors affecting secretion. • Pituitary:

• Know which hormones come from where and the functions of each.F: FSH L: LH A: ACTH BASOPHILS T: TSH P: PROLACTIN i: ignore ACIDOPHILS ("acid pig") G: GH

• Overview of growth hormone.

Viva questions:• What substances are secreted in the adrenal medulla ? • How is their secretion controlled ? • What substances are secreted in the adrenal cortex ? • What do glucocorticoids do ? • Tell me about Aldosterone.




PHARMACOLOGY• T3 / T4. • Anti-thyroid drugs (basic understanding):• Carbimazole. • Propylthiouracil. • Anion inhibitors. • Iodides. • Radioactive Iodine. • Overview of Clinical Pharmacology:• Thyroid storm. • Overview of other conditions. • Glucocorticoids: • Hydrocortisone. • Prednisone. • Effects (See Cortisol in Katzung). • Indications. • Table of relative potencies (MCQ). • Mineralocorticoids:• Aldosterone.

Viva questions:• Tell me about Thyroxine. • Compare and contrast T3 and T4. • Tell me about Hydrocortisone • How do glucocorticoids act ? • Tell me about Aldosterone.



PATHOLOGY• Fracture healing (popular viva question). • Osteomyelitis. • OA. • RA. • Septic arthritis. • Gout / Pseudogout. • Seronegative arthropathies.

Viva questions:• Tell me about the sequence of events in fracture healing. • Tell me about osteoarthritis • Tell me about rheumatoid arthritis • Tell me about osteomyelitis. • Tell me about AVN • Tell me about gout.



ANATOMY• Liver. • Spleen. • Posterior abdo. wall (prosection). • Lumbosacral plexus. • IVC. • Kidneys. • Ureters (course / course on Xrays / structures crossed). • Abdominal aorta and its branches. • Layers of the Abdominal wall. • Inguinal canal:• Borders. • Margins of deep / superficial rings. • Spermatic cord contents • Testis. • Transpyloric plane (events there). • Blood supply / venous drainage of gut. • Retroperitoneal viscera.

Viva questions:• Show me the features on AXR. What is the course of the ureters. • What structures lie on the transpyloric plane ? CT as prop • Prosection of the testis / epididymis / spermatic cord. • Prosection of the retroperitoneal viscera • Tell me about the relations of the duodenum • Show me / tell me the branches of the abdominal aorta. • Prosection showing the diaphragm from above or below: • Show me the attachments/origins of the diaphragm. • Show me the structures passing through the diaphragm.







PHYSIOLOGY• G-I hormones • Site of production. • Actions. • Control of release. • Saliva (contents and control of secretion). • Swallowing. • Regulation of gastric acid secretion and motility (possible viva question). • Other functions of the stomach. • Exocrine pancreas. • Functions of the liver. • Composition of bile. • Bilirubin metabolism / excretion. • Gallstones.

Viva questions:• Tell me about gastric acid secretion. • Tell me about the control of gastric secretion. • What are the functions of the stomach ? • What are the functions of the liver ? • Tell me about bilirubin metabolism. • Tell me about the function and composition of bile




PHARMACOLOGY• Antacids. • H2 antagonists:• Cimetidine as prototype (also interesting for it’s interactions). • Familiarity with the others as well. • PPI’s. • Anti-emetics:• Metoclopramide. • Prochlorperazine. • Ondansetron • Passing familiarity with laxatives & anti-diarrhoeals; I don’t see these as viva questions. • Antiseptics

Viva questions:• What agents can be used in the treatment of peptic ulcer ? • Tell me about omeprazole • Tell me about Ranitidine • What drugs have an anti-emetic action ? • Tell me about metoclopramide • Tell me about prochlorperazine • Tell me about ondansetron • Tell me about methods of disinfection and antiseptics



PATHOLOGY• Varices. • Barrett’s oesophagus. • Peptic ulcers:• Sites • Pathogenesis. • Complications. • Ca stomach:• Pathogenesis (MCQs). • Appendicitis. • Infective gastroenteritis.• Causative organisms • Inflammatory bowel disease• Crohn’s disease. • Ulcerative colitis. • Features / Complications. • Bowel obstruction.• Causes. • Diverticular disease:• Complications. • Ca bowel:• Complications.

Viva questions:What is Barrett’s oesophagus ? Tell me about the pathogenesis of peptic ulcers. Tell me about the organisms which can cause Gastroenteritis. Tell me about inflammatory bowel disease. Tell me about ischaemic gut



ANATOMY• Liver. • Spleen. • Posterior abdo. wall (prosection). • Lumbosacral plexus. • IVC. • Kidneys. • Ureters (course / course on Xrays / structures crossed). • Abdominal aorta and its branches. • Layers of the Abdominal wall. • Inguinal canal:• Borders. • Margins of deep / superficial rings. • Spermatic cord contents • Testis. • Transpyloric plane (events there). • Blood supply / venous drainage of gut. • Retroperitoneal viscera.

Viva questions:• Show me the features on AXR. What is the course of the ureters. • What structures lie on the transpyloric plane ? CT as prop • Prosection of the testis / epididymis / spermatic cord. • Prosection of the retroperitoneal viscera • Tell me about the relations of the duodenum • Show me / tell me the branches of the abdominal aorta. • Prosection showing the diaphragm from above or below: • Show me the attachments/origins of the diaphragm. • Show me the structures passing through







PHYSIOLOGY• Definition of metabolic rate. • Factors affecting metabolic rate. • BMR. • Respiratory quotient • Definition. • Factors affecting. • Overview of intermediary metabolism :• Carbohydrates. • Protein. • Fat (including lipid transport). • Overview of digestion:• Carbohydrates. • Protein. • Fat. • Water / electrolytes. • Iron.

Viva questions:• What is the respiratory quotient ? • What factors affect metabolic rate ? • Tell me about the digestion of carbohydrates (or proteins, or fats). • Tell me about the digestion of fats. • Tell me about the digestion of proteins. • Tell me about water handling by the G-I tract. • Tell me about the handling of dietary iron by the body.




PHARMACOLOGY• Drugs of abuse [Goodman & Gillman is better than Katzung]: • Definitions• Dependence • Addiction • Tolerance • Specific drugs:• Opioids • cocaine • other stimulants- amphetamine, nicotine, caffeine • psychedelic agents- LSD, ecstasy, PCP • benzodiazepines • alcohol • marijuana • inhalants • Withdrawal Syndromes• Opioid • Alcohol • Nicotine • Benzodiazepines • Marijuana • Carbon monoxide. • Hydrocarbons. • Organophosphates (covered previously) • Salicylate poisoning • Heavy metals:

Viva questions:• What is dependence, tolerance etc. • Tell me about the effects of acute intoxication with _______ . • What is withdrawal / give an example • Tell me about alcohol/ benzo/ opioid withdrawal. • Tell me about Heroin • Tell me about cocaine • Tell me about amphetamines • Tell me about carbon monoxide poisoning.



PATHOLOGY• Morphologic patterns of hepatic injury. • Cirrhosis:• Definition / Features. • Causes. • Pathogenesis. • Portal hypertension:• Causes. • Consequences. • Jaundice:• Overview of bilirubin metabolism. • Classification / Causes (popular viva question). • Hepatic failure:• Causes. • Clinical features. • Viral hepatitis (A, B & C):• Patterns of serological markers (popular viva question). • Clinical syndromes. • Alcoholic liver disease:• Three forms. • Gallstones:• Risk factors. • Pathogenesis / Constituents. • Complications.

Viva questions:• Any of the above.



ANATOMY• The bony pelvis. • The rectum (and structures palpable on PR examination). • The bladder / Control of micturition. • Blood supply / venous drainage of the rectum / anus. • The male urethra. • The S-I joint. • The lumbar and sacral plexuses.

Viva questions:• Show me the bony features of this pelvis • Name the structures on this prosection of the pelvis





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