English Medical Disciplines

Key Points in Anatomy and Physiology »show table...

	The heart
	The right heart – atrium and ventricle – receives blood from the central veins, sends blood to the pulmonary artery and lungs. Valves – tricuspid and pulmonary.
	The left heart – atrium and ventricle – receives blood from the pulmonary veins and sends blood to the aorta and the rest of the body. Valves – mitral and aortic.
	The pericardium surrounds the heart.
	The conducting system – sinoatrial node and atrioventricular node, left and right Bundles of His – control cardiac rate and rhythm.
	The peripheral vascular system
	clinically important arteries
	Aorta
	Carotid
	Subclavian
	Brachial
	Radial
	Ulnar
	Femoral
	Popliteal
	Posterior tibial
	Dorsalis pedis
	Veins
	Superior and inferior vena cava
	Jugular veins
	Femoral veins
	Saphenous veins
	*Lymphatic system*
	Thoracic duct

Major presentations of disease »show table...

History taking »show table...

General framework for history		Particular questions, if any, which are specific to the cardiovascular system (the vocabulary for general questions is listed in a different section).
Identification and demographics		name, age, height, weight
History of the present illness (HPI) - questions about the complaint(s)		Chest pain Where do you feel the pain? Does it go anywhere else? How did it start? How long did it last? How would you describe the pain? How severe is it? Do you feel any other symptoms at the same time? Does anything bring it on or make it worse? Does anything make it better?
		Breathlessness Do you ever feel short of breath? Is it only when you exert yourself, or does it happen at rest? Is it made worse by lying flat, e.g. in bed at night? Do you ever wake up in the night very short of breath? Does anything bring it on or make it worse? Does anything make it better?
		Palpitation Are you ever aware of your heart beat, like a fluttering in your chest, or like a “thump”? Does anything bring it on or make it worse? Does anything make it better?
		Syncope (fainting) Have you ever fainted? Did anything bring it on? Were you standing or lying down at the time?
		Oedema Have you noticed any swelling of your ankles?
		Hypertension Do you have high blood pressure? For how long? Are you on treatment?
		Intermittent claudication Do you get pain in your legs when you walk? How far can you walk before it happens? Does it go away when you rest?
		Gangrene Have you noticed any change in colour of your feet and toes? Is it painful?
Past Medical History (PMH) (including major illnesses, any previous surgery/operations, any current ongoing illness, childhood illnesses).		Ask about:
		Rheumatic fever
		High blood pressure
		Thyroid disease
		Diabetes
		Stroke
		High cholesterol
Review of systems (ROS) - Systematic questioning about different organ systems		Ask about above symptoms, plus:
		Fevers (? Subacute Bacterial Endocarditis)
		Abdominal pain (mesenteric ischaemia or embolism)

Social / Family Drug / Past Medical History »show table...

Physical Examination »show table...

	General
	Pallor Breathlessness Cyanosis Signs of hyperlipidaemia (corneal arcus, xanthelasma) Splinter haemorrhages (SBE) Oedema (ankles, sacrum) Crackles in lungs
	Pulse (radial, brachial, carotid, femoral, pedal)
	Rate Rhythm Volume Character
	Blood pressure
	may be high or low
	Jugular venous pressure
	measured in centimetres from the sternal angle with patient at 45 degree angle
	Praecordium
	Look (inspection): Scars Skeletal abnormalities, e.g. pectus excavatum
	Feel (palpation): Apex beat (? displaced, ? abnormal character) Ventricular “heave” due to hypertrophy Palpable Thrills
	Listen (auscultation): Heart sounds – first, second (normal), ? third and fourth (abnormal) Added sounds (clicks, opening snap, pericardial friction rub) Murmurs Systolic or diastolic Duration (e.g. short; pan-systolic) Character and pitch (e.g. harsh; blowing) Loudness Location and radiation

Investigation / Procedures »show table...

Differential Diagnosis – common clinical conditions »show table...

Management of diseases »show table...

download vocabulary in English

Key Points in Anatomy and Physiology »show table...

Major presentations of Disease »show table...

History taking »show table...

Identification and demographics:		name, age, height, weight.
History of the present illness (HPI) - questions about the complaint(s)		Breathlessness
		Have you been feeling breathless?
		How long were you breathless for?
		How quickly did you become breathless?
		Did it get better/worse?
		How long did it take to go away?
		How severe is it?
		What can you do to help when you become breathless?
		Cough
		Have you been coughing more than usual lately?
		Has the cough changed?
		Sputum (“phlegm”)
		Are you coughing anything up?
		Can you describe it to me?
		What colour is it?
		Haemoptysis
		Have you coughed up any blood?
		How much?
		How long have you been coughing up blood for?
		Wheeze
		Have you been wheezy?
		What brings it on?
		Chest pain
		Have you had any pain in your chest?
		Can you describe it to me?
		Is it a sharp chest pain, worse on inspiration (pleuritic pain)
		Stridor
		Is there a harsh noise when you breathe in?
		Hoarseness
		Have you been feeling or sounding hoarse?

Social/Family/Drug/Past Medical History »show table...

Past Medical History (PMH) (including major illnesses, any previous surgery/operations, any current ongoing illness, childhood illnesses).		Ask about any past history of respiratory disease, including tuberculosis or other infections.
Review of systems (ROS) - Systematic questioning about different organ systems		Ask about symptoms as above
Family history – especially conditions relevant to the patient's chief complaint.		Cystic Fibrosis
		α-1 antitrypsin deficiency
Social history (medicine) - including living arrangements, occupational history, marital status, number of children, smoking history, alcohol use, drug abuse, foreign travel, exposure to environmental pathogens.		Increased risk of respiratory disease:
		coal miners
		bird owners
		painters
		bakers
		farmers
		Smoking
		Do you smoke?
		Have you ever smoked?
		How many do/did you smoke a day?
		How long did you smoke for?
		Alcohol
		How much alcohol do you drink per week?
		Has it always been that much?
		Drugs
		Have you ever taken any recreational drugs?
Drug history - regular and acute medications (including those prescribed by doctors, and others obtained over-the-counter or alternative medicine)		What medicines are you taking at the moment?
		Have these changed recently?
Allergies - to medications, food, latex, and other environmental factors		Are you allergic to anything?

Physical Examination »show table...

	Physical Examination
	Some common questions/commands
	Is it OK if I examine you?
	Can I look at your hands, please? Could you turn them over for me?
	Can I examine your chest, please?
	Any pains? Is that sore?
	I'm just going to pull down your eyelid if you don't mind... look up for me
	I need to look inside your mouth and at your teeth.
	Can you stick your tongue out for me? And can you point it up? (towards the ceiling)
	I'm going to tap on your back/your chest.
	Take some deep breaths through your mouth, please.
	Breathe in …... And Out.....
	Look for (inspection):
	Nicotine/tar staining on the fingers..
	Kolionychia
	Finger clubbing
	Bounding pulse
	Flapping tremor
	Anaemia
	Peripheral cyanosis
	Central cyanosis
	Use of accessory muscles
	Intercostal in-drawing
	Ankle oedema
	Feel for (palpation):
	Tracheal deviation – is it in the midline?
	Where is the apex beat? - normally 5th Intercostal Space, midclavicular line
	Chest Expansion - is it normal or reduced?
	Percussion:
	Resonant (normal)
	Hyper-resonant (abnormal)
	Dull (abnormal)
	Stony dull (abnormal)
	Listen (auscultation):
	Vesicular Breath sounds with good air entry (normal)
	Reduced Air Entry (abnormal)
	Ronchi (abnormal)
	Wheeze (abnormal)
	Crackles (abnormal)
	Bronchial Breathing (abnormal)
	Friction Rub (abnormal)

Investigation/Procedure »show table...

Differential Diagnosis – common clinical conditions »show table...

Management of Diseases »show table...

Case »show table...

downlad vocabulary in English

Case 1	D: Can you tell me what brought you into hospital today?
	P: Well I think I have a chest infection; I've been getting very breathless and bringing up green stuff.
	D: Alright, has this happened to you before? Do you usually cough up something?
	P: Yes, most of the time I cough up something every day. It's not normally green though. I usually have to go to the doctor a few times a year and get told that I have a chest infection.
	D: I see. Tell me more about what you cough up. How much do you cough up?
	P: I'd say about a cup full of clear mucus every day, usually in the morning. Like I said before, it sometimes turns green and then I go to the doctors.
	D: Green you said? Have you ever coughed up any blood?
	P: No, never.
	D: You said you were breathless....Can you give me an idea of how bad the breathlessness is?
	P: Not too bad. Usually I'm not breathless but recently I've been unable to get about myself. I've been finding it difficult to do the shopping.
	D: And can you tell me how quickly this came on? How long ago were you your normal self?
	P: It came on suddenly, over a few days. I was able to get about as normal last week.
	D: Have you had any pain with that?
	P: Yes, a little right here on my left side. It's sharp when I breathe in.
	D: Ok, I see. Do you suffer from any wheeze at all?
	P: Sometimes I get a bit wheezy but only when my breathlessness is really bad.
	D: And are you on any medication?
	P: I sometimes take paracetamol for pain – but not often. I have a blue inhaler (salbutamol) for my chest but nothing else regularly. I've been taking antibiotics and steroids whilst in hospital.
	D: Ok, I see. Do you have any other health problems, either now or in the past?
	P: No, just the chest infections in the past.
	D: Any health problems that run in the family?
	P: No, not that I'm aware. My mother has angina.
	D: Ok, and do you smoke? Drink alcohol? Take drugs?
	P: Yes, I do smoke. I have done for the past 20 years – about one full pack per day. I don't drink much – just the odd glass of wine and drugs have never interested me; I've avoided them.
	D: Ok, and do you have any worries about your health? What do you feel about your condition?
	P: On the whole, it doesn't bother me, but I'm afraid it will get worse. I know smoking is bad and cancer is a worry – I've tried to give up in the past but I just find it really difficult. At the moment though, my health doesn't really bother me – just the odd chest infection. I just don't want to end up like my mother who needs the doctors a lot.
	D: I see, well let's talk about that....
Case summary	Here we have a 55yr old woman who presented to hospital with increasing shortness of breath and a change in character of her usual smoker's cough. She reports coughing more frequently and a change in the character of her sputum which has changed from clear, serous fluid to a thick green mucus over the past few days. This has been accompanied by a right sided pleuritic chest pain. Normally, she would cough up about half a cup of clear fluid in the morning. She takes salbutamol for breathlessness when it gets bad, but reports not taking anything regularly. She has not coughed up any blood.
	She has smoked 20 cigarettes per day for the last 20 years (20 pack year) and has the occasional glass of wine. There is no relevant family history.
	Based on the history, this woman has presented with a lower respiratory tract infection on a background of bronchiectasis.

Key Points in Anatomy and Physiology »show table...

Major presentations of disease »show table...

Investigation/Procedure »show table...

Differential Diagnosis – common clinical conditions »show table...

download vocabulary in English

Key Points in Anatomy and Physiology »show table...

	Key Points in Anatomy and Physiology
	Oral Cavity (tongue, gums)
	Oesophagus
	Stomach (cardia, fundus, body, pylorus)
	Duodenum (Duodeno-jejunal Flexure)
	Liver, Gall Bladder
	Pancreas
	Ampulla of Vater
	Jejunum
	Ileum (Terminal Ileum)
	Colon (Caecum, Appendix, Ascending Colon, Transverse Colon, Descending Colon, Hepatic/Splenic Flexure)
	Sigmoid Colon
	Rectum
	Anus
	Arterial Tree
	Aorta
	Coeliac Trunk (Left Gastric, Splenic, Common Hepatic Artery)
	Superior Mesenteric Artery
	Inferior Mesenteric Artery
	Surgical Divisions of the Abdomen
	Right Upper Quadrant
	Right Lower Quadrant
	Left Upper Quadrant
	Left Lower Quadrant
	Regions of the Abdomen
	Right Hypochondrium, Epigastrium, Left Hypochondrium, Right Flank, Umbilical Region, Left Flank, Right Iliac Fossa, Hypogastrium, Left Iliac Fossa
	Stomach
	Gastric Acid
	Parietal Cell
	Chief Cell
	Gastrin
	Somatostatin
	Amylase
	Insulin
	Glucagon
	Lipases (Lipase, Colopase)
	Proteolytic Enzymes (Trypsinogen, Chymotrypsinogen, Proelastase)

Major presentations of disease »show table...

History taking »show table...

General Framework For History		Particular questions, if any, which are specific to the renal system (the vocabulary for general questions is listed in a different section).
Patient ID and Demographics		Name, Age, Sex, Weight, Weight Loss? (Period?)
History of the Presenting Complaint (HPI) - questions about the complaint(s)		Dysphagia
		Do you ever feel yourself bringing it back up? (regurgitation)
		Is there any pain on swallowing?
		Is it getting worse? Does it ever stop/go away?
		How long has it been there for?
		Have you had it before?
		Is it mainly for liquids, solids or both?
		Can you point to where you feel the food sticking?
		Haematemesis/Melaena
		Have you ever suffered from (dyspepsia, ulcers, GI bleeding, liver disease) in the past?
		Have you been taking/prescribed NSAIDs/Steroids?
		Alcohol Intake?
		What did you vomit? Can you describe it for me?(Fresh blood/coffee grounds)
		Did this appear in your first vomit?
		Were you retching beforehand?
		Abdominal Pain
		Where is the pain? (Site)
		How long has it been there for? (Onset)
		What does the pain feel like? (Character - see pain vocabulary)
		Does the pain go anywhere? (Radiation)
		Is there any other symptoms with the pain? (Association)
		Is the pain constant or does it come and go? (Timing)
		Does anything make it worse/better? (Exacerbating/Relieving Factors)
		How severe is the pain? (Severity)
		Abdominal Distension (Ascites?)
		How long did it take to become distended?
		Has it ever been like this before?
		Have you ever had any fluid drained from your abdomen before?
		Bowel Habit Changes (frequency, consistency)
		How often do you usually go to the toilet?
		How has this changed?
		How has your stool changed?
		Constipation
		How long has it been there for?
		How often do you empty your bowels?
		Do you spend much time straining?
		Is there any pain when passing stool?
		Is there any blood? If so, is it on the paper?
		Have your medications changed recently?
		Has the stool itself changed? (Shape/Size)
		Diarrhoea
		How long has it been there for?
		How often do you go to the toilet? (frequency)
		Do you ever feel like you're going to be caught short? (urgency) Or have you ever not made it to the toilet? (Incontinence)
		Can you describe the consistency of the stool? (solid/semisolid/ricewater/liquid...)
		What volume is the stool?
		Is there any blood or mucus in the stool?
		Have you had any contact with people suffering from diarrhoea?
		Any travel abroad?
		Any change in medication?
		Do you ever have to wake up to go to the toilet?
		PR Blood/Melaena
		How often does it occur?
		How long has it been present?
		PR Blood - Is it on the paper/in the pan?
		PR Blood - How much blood is there?
		Wind/Flatulence
		How often?
		Do you ever hear your bowels? If so, how loud are they? How often?
		Jaundice
		Who noticed the jaundice?
		When did it occur?
		How long has it been present?
		Any recent travel or contact with infection?
		Is there any history of liver disease?

Social/Family/Drug/Past Medical History »show table...

Social History (medicine) Ask questions as appropriate, examples are given. Including living arrangements, occupational history, marital status, number of children, smoking history, alcohol use, drug abuse, foreign travel, exposure to environmental pathogens.		Smoking: Do you smoke?
		Have you ever smoked?
		How much do you smoke?
		How long have you smoked for?
		Alcohol: Do you drink alcohol?
		How much do you drink?
		Has it always been this much?
		Drugs: Have you ever used any recreational drugs? If so, which drugs?
		How did you take them? (Inject/smoke)
		How long did you take them for?
		Have you ever used any other medications (Over the counter/non prescribed)
		Foreign Travel: Have you ever travelled abroad?
		Where? When?
		Sexual History: Have you ever had any unprotected sex
		Have you ever had any sex with men? (homosexual) or have you ever used prostitutes?
		How many sexual partners have you had?
		Others: Have you ever had any tattoos?
		Have you ever received a blood transfusion/any blood products?
Family History – especially conditions relevant to the patient's chief complaint.		Has anyone in the family ever had trouble with their bowels?
		Is there any history of inflammatory bowel disease? (Crohn's/Ulcerative Colitis)
		Has anyone in the family suffered from colorectal cancer?
		Has anyone in the family been diagnosed with ... Wilson's Disease/Haemochromatosis/Gilbert's Syndrome?
		Has anyone in the family been found to have polyps in their colon?
Drug History - regular and acute medications (including those prescribed by doctors, and others obtained over-the-counter or alternative medicine)		Which medications are you taking at the moment?
		Have there been any changes lately?
Past Medical History (PMH) (including major illnesses, any previous surgery/operations, any current ongoing illness, childhood illnesses).		Do you suffer from any other health problems?
		Have you suffered from any health issues in the past?
		Have you ever been admitted to hospital? If so, what for?
		Have you ever had any abdominal surgery?
		Have you had any investigations of your (bowels/liver) carried out in the past?

Physical Examination »show table...

Investigation/Procedure »show table...

Differential Diagnosis – common clinical conditions »show table...

	Differential Diagnosis – common clinical conditions
	GORD (Gastro-Oesophageal Reflux Disease)
	Barrett's Oesophagus
	Mallory-Weiss Tear
	PUD (Peptic Ulcer Disease)
	Gastritis
	Whipple's Disease
	Coeliac's Disease (gluten enteropathy)
	Infective Disorders (Traveller's Diarrhoea, Bacillus Cereus Infection, Clostridium Difficile)
	Acute/Chronic Pancreatitis
	Hepatic Cirrhosis
	Viral Hepatitis (A-E) Infection
	Alcoholic Liver Disease
	Primary Biliary Cirrhosis
	Primary Sclerosing Cholangitis
	Auto-immune hepatitis
	Hepatocellular Carcinoma
	Cholecystitis
	Choledocholithiasis (gallstones)
	Crohn's Disease
	Ulcerative Colitis
	IBS (Irritable Bowel Syndrome)
	Colorectal Carcinoma
	Diverticulitis
	Constipation
	Anal Fissure

Management of diseases »show table...

Cases »show table...

download vocabulary in English

Key Points in Anatomy and Physiology »show table...

Major presentations of disease »show table...

History taking »show table...

General framework for history		Particular questions, if any, which are specific to the renal system (the vocabulary for general questions is listed in a different section).
Identification and demographics		Name, age, height, weight.
History of the present illness (HPI) - questions about the complaint(s)		Renal failure “Have you had problems with your kidneys not working properly”
		Pain “Have you had any pain in your sides or your lower abdomen?” “Is it ever sore when you pass urine”
		Disordered micturition “Do you have difficulty passing urine?” “How many times do you pass urine in the day and the night?” “Do you ever have to rush to the toilet urgently?” “Are you always able to control the need to pass urine?”
		Altered urine volume “Is the volume of urine you pass at the moment more or less than normal?”
		Abnormalities in urine “Have you noticed a red colour in your urine?” “Has anyone found blood or protein in your urine when it has been tested?”
Past Medical History (PMH) (including major illnesses, any previous surgery/operations, any current ongoing illness, childhood illnesses).		Ask about :
		Any previous renal disease
		Hypertension, diabetes (may damage kidneys)
		Vascular disease (may affect kidneys)
		Recurrent urinary tract infection
		Renal stones
		Symptoms of kidney failure - tiredness, itch, growth retardation, restless legs.
		Urinary abnormalities.
		Abnormal micturition
		Loin pain
Family history – especially conditions relevant to the patient's chief complaint.		Ask about:
		Hypertension, diabetes
		Adult polycystic kidney disease

Social/Family/Drug/Past Medical History »show table...

Physical Examination »show table...

Investigation/Procedure »show table...

Differential Diagnosis – common clinical conditions »show table...

Management of diseases »show table...

download vocabulary in English

Key Points in Anatomy and Physiology (incl. Glasgow Coma Scale) »show table...

	Key Points in Anatomy and Physiology
	Neurone = cell body, axon, synapse
	Astrocytes - form the blood brain barrier
	Oligodendrocytes, Schwann cells – form myelin sheaths

	Action Potentials pass along axons
	Synaptic transmission between neurones and/or muscle cells
	Ion Channels
	Neurotransmitters

	Central Nervous System (CNS)
	Brain
	White Matter
	Grey Matter
	Cerebral Hemispheres
	Corpus Callosum
	Parietal Lobe
	Frontal Lobe
	Occipital Lobe
	Temporal Lobe
	Broca's Area
	Wernicke's Area
	Cerebrospinal fluid (CSF)
	Dura mater
	Arachnoid
	Pia mater

	Cerebellum

	Brain Stem
	Pons
	Medulla
	Hypothalamus

	Pituitary gland
	Cranial nerves

	Spinal cord
	Dorsal Columns
	Lateral columns
	Ventral columns
	Dorsal root ganglia
	Anterior horns

	Peripheral nervous system (PNS)
	Motor Neurone
	Sensory Neurone
	Brachial Plexus
	Lumbo-Sacral Plexus
	Peripheral nerves

	Autonomic Nervous System (ANS)

	Cranial Nerves
	I - Olfactory
	II - Optic
	III - Oculomotor
	IV- Trochlear
	V - Trigeminal
	VI - Abducens
	VII - Facial
	VIII- Vestibulocochlear
	IX- Glossopharyngeal
	X - Vagus
	XI- Accessory
	XII - Hypoglossal

	Important Peripheral Nerves
	Radial Nerve
	Ulnar Nerve
	Median Nerve
	Musculocutaneous Nerve
	Sciatic Nerve
	Pudendal Nerve
	Lateral Cutaneous Nerve
	Femoral Nerve
	Common Peroneal Nerve

	Important Arteries/Veins
	Internal Carotid Artery
	Circle of Willis
	Anterior Communicating Artery
	Middle Communicating Artery
	Posterior Communicating Artery
	Anterior Cerebral Artery
	Middle Cerebral Artery
	Posterior Cerebral Artery
	Vertebral Artery
	Vertebro-basilar Circulation
	Anterior Circulation
	Middle Meningeal Artery
	Cerebral Venous Sinuses
	Watershed Area
	Lenticulostriate Arteries (site of lacunar infarction)

Glasgow Coma Scale (GCS)
Motor response	1 - No response
	2 - Extends to Pain
	3 - Abnormal Flexure to Pain
	4 - Flexes to Pain
	5 - Localises to Pain
	6 - Obeys Commands
Verbal response	1 - No Response
	2 - Incomprehensible Sounds
	3 - Inappropriate Words
	4 - Confused, Disoriented
	5 - Normal, Oriented
Eye opening	1 - No response
	2 - Eyes open to pain
	3 - Eyes open to verbal stimulus
	4 - Eyes open spontaneously

Major presentations of disease »show table...

	Presenting Problems / Symptoms and related vocabulary
	Headache
	Tension Headache Migraine (with/without aura) Cervicogenic Headache Analgesic overuse headache
	Facial Pain
	Trigeminal Neuralgia Temporal Arteritis
	Dizziness/Loss of Balance
	Ataxia Vesitibular Neuronitis Menière's Disease Drugs Demyelination (multiple sclerosis) Migraine
	Fits/Faints
	Epilepsy Cardiac arrhythmia Vasovagal syncope
	Numbness/Tingling
	Peripheral Neuropathy Dysaesthasia Multiple Sclerosis Guillain-Barré syndrome
	Weakness
	Muscular Dystrophies (Duchenne's/Becker's) Myaesthenia Gravis
	Visual/Hearing Problems
	Optic Neuritis Cortical Blindness Bitemporal Hemianopia Homonymous Hemianopia Amaurosis Fugax Tinnitus Scotoma Nystagmus Vestibular Neuronitis
	Speech/Swallowing/Eating
	Dysphagia Dysphasia/Aphasia Dysarthia Loss of taste Anosmia (loss of smell)
	Tremor
	Fine tremor Intention tremor Parkinsonian tremor Cerebellar Ataxia Apraxia/Dyspraxia Fasciculation
	Memory
	Dementia (e.g. Alzheimer's disease) Short term (working) Memory loss Long Term Memory loss Episodic Memory loss
	Personality Change
	Disorders of Gait
	Cerebellar Ataxia Waddling Gait Gait Apraxia Foot Drop Extra-pyramidal Gait (Parkinsonian)
	Sleep Disturbance
	Narcolepsy Daytime Somnolence Insomnia

History taking »show table...

	History of the present illness
	Headache
	Where is your head sore? Can you point to it? When did the headache start? Has it been there constantly? When does it come on? Is there anything that helps? Do bright lights upset you? (Photophobia) Is your neck stiff or sore? (Meningism) Is it worse at any particular time in the day? (Raised Intra-Cranial Pressure) Is it worse when you sneeze/cough? Have you been (feeling) sick? What medications have you taken? How often have you taken them? (Analgesic overuse Headache)
	Loss of Consciousness/Fits/Faints
	Did you get any warning? What were you doing at the time? (Vasovagal response) Was anyone with you? (Witness account) How quickly did you recover? Did you lose control of your bowels? Were you tired afterwards? How long for? Has this happened before? Have all the episodes been the same? Have you ever been diagnoses as having epilepsy in the past? What medications do you take to control this?
	Dizziness/Vertigo
	Does the feeling stop when you stay still? Is it present all the time? Have you had any ear problems? Is it worse at night?
	Numbness/Tingling
	Where is the tingling? When does it come on? Is it painful? When did it start? Has it got worse/better? Is it constant or intermittent? Does anything make it better? Does anything worsen the feeling? Have you had anything like this in the past?
	Weakness
	When does the weakness come on? What activities does it stop you doing? Is there any muscle pain? Does it affect swallowing? Chewing? Is your speech affected? Does it affect your breathing? Does anything make it better/worse?
	Visual/Hearing Problems
	How long have you had them? Are they intermittent/constant? Are they getting worse/better? Have you had them before? Is your balance affected? Do you ever struggle to understand what's being said to you? Do you ever have to struggle to hear people speak on the telephone/television/in conversation?
	Speech/Swallowing/Eating
	Do you have difficulty finding words? Do you have problems pronouncing things? Can you swallow easily? Which causes more problems; swallowing liquids or solids or are they both the same? Is there any pain on chewing? Have you noticed altered taste? Do you ever get tired (fatigued) when eating?
	Tremor
	When do you notice it? How long have you had it? Which parts of your body does it affect? Has it always been the same? Does it change? Is it present at rest? What difficulty (if any) does it cause you?
	Memory
	Have you been having memory problems? What do you have problems remembering? Can you remember things from years ago? Can you remember what you were doing yesterday? Can you remember names and faces? Has anyone remarked on your difficulties?
	Personality Change (this may be brought to your attention by a relative)
	How has your (or the patient's) personality changed? When did it start to change? Has it been a quick or slow change?

Social/Family/Drug/Past Medical History »show table...

Physical Examination »show table...

Physical Exam - Cranial Nerves
CN 1	Do you have a blocked nose?
	What can you smell? (offer different potent samples)
CN 2	Do you wear glasses?
Schnellen Chart (Visual Acuity)	Can you close one eye and read as much as this chart as you can?
Visual Fields	Look straight ahead, cover one eye and tell me when you can see my finger/hat pin.
Visual Inattention	Look at my fingers, tell me which one moves.
Fundoscopy	Look straight ahead for me, I would like to look into your eyes with this light.
CN 3, 4, 6	Keep your head still and follow my finger with your eyes.
Pupils	I’m just going to have a look at your eyes...
CN 5	Can you feel this cotton wool/pin?
(test opthalmic, maxillary and mandibular branches)	Does it feel the same on both sides?
	Can you clench your jaw for me?
if necessary - corneal reflex	I’m just going to touch your eye, this may be unpleasant (sorry!)
CN 7	Can you raise your eyebrows to the ceiling?
	Shut your eyes tightly, keep them closed as I try to open them.
	Puff out your cheeks for me.
	Show me your teeth.
	(Alternatively ask the patient to copy you...”Can I get you to copy me please?”)
CN 8	Ask the patient if they can hear you. “Can you hear me?”
CN 9/10	Can you cough for me?
Gag Reflex	I’m sorry, this might not feel nice. I’m just going to touch the back of your throat…
CN 11	Can you turn your head to the left/right? (While assessing strength of the trapezius muscle)
CN 12 (Assessing for dysarthia)	Can you repeat after me - “British Constitution”, “Baby Hippopotamus”, “The Leith police” ?
	Can you stick your tongue out for me?
	Waggle it from side to side.
Physical Examination - Motor/Sensory
*Notes*	Inspect each muscle group Tone Power Reflexes Co-ordination Fine Touch Proprioception Pain Temperature
Tone	Just relax while I move your legs/arms. Try not to help me, just go floppy.
Power	“Can you copy these positions for me?”
	Stop me pushing down.
	Stop me pulling up.
	Straighten/bend your arms for me
	Open/close your fingers.
	Show me your palm. Point your thumb to the roof for me.
	Squeeze my hand.
	Push down with your leg.
	Pull up with your leg for me.
Sensation	Does this feel the same on both sides?
	Close your eyes for me. Tell me when you feel this touching you.
	Tell me how this feels....
Co-ordination	Look at my finger... Touch my finger with your finger.... Now touch your nose.... And my finger again.
	Touch your (left) heel to your (right) knee....Run it down your shin for me...Ok, now lift it up and bring it back to your knee. And keep doing that for me....
Reflexes	Just relax while I tap you with this tendon hammer - it shouldn’t hurt.
Reinforcement	Can you hold your hands together tightly and when I count to 3, pull them apart. (Demonstrate!)
Proprioception	Demonstrate which way is ‘up’/‘down’ to the patient. Then ask them to “close your eyes”, move their finger/toe and then ask “which way is your (finger/toe) moving – up or down?”
Romberg’s Test	Can you stand up straight with your feet together for me. (Stand close to the patient and reassure;) Don’t worry, I’ll be here to hold on to if you feel unsteady. Now close your eyes for me.....OK, you can open them again.

Investigation/Procedure »show table...

Differential Diagnosis – common clinical conditions »show table...

	Differential Diagnosis - Common Clinical Conditions
	Alzheimer's Disease
	Amyotrophic Lateral Sclerosis (see MND)
	Anoxic brain injury
	Bell's palsy
	Benign Intracranial Hypertension
	Brain Abscess
	Brain Injury
	Brain Tumour
	Astrocytoma Glioma Meningioma Metastatic from elsewhere Cerebral Lymphoma
	Brown-Séquard Syndrome
	Carpal Tunnel Syndrome
	Cerebral Aneurysm
	Cerebral Atrophy
	Cerebral Palsy
	Charcot-Marie-Tooth Disease
	Creutzfeldt-Jacob Disease
	CMV Infection (Cytomegalovirus)
	Dementia
	Diabetic Neuropathy
	Encephalitis
	Epilepsy
	Essential Tremor
	Febrile Seizures
	Guillain-Barré Syndrome
	Herpes Zoster (HZV)
	Huntington's Disease
	Hydrocephalus
	Intracranial Hypertension
	Lumbar Spinal Stenosis
	Menieres Disease
	Meningitis (Bacterial/Viral)
	Motor Neurone Disease (MND)
	Multi-Infarct Dementia
	Multiple Sclerosis
	Muscular Dystrophy
	Myasthenia Gravis
	Narcolepsy
	Optic Neuritis
	Peripheral Neuropathy
	Pituitary Tumour
	Poliomyelitis
	Post-herpetic Neuralgia
	Rabies
	Shingles
	Spina Bifida
	Stroke
	Subdural Haematoma
	Subarachnoid haemorrhage
	Transient Ischaemic Attack (TIA)
	Trigeminal Neuralgia
	Wilson's Disease

Management of diseases »show table...

Cases: Alzheimer's Disease — Parkinson's Disease — Meningitis — Cerebral Tumor

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Key Points in Anatomy and Physiology »show table...

	Bones
	Head (Cranium)
	Frontal Bone Parietal Bone Occipital Bone Temporal Bone Maxilla Zygomatic Bone Sphenoid Ethmoid Mandible
	Thorax
	Clavicle Sternum Scapula Ribs
	Arms, wrists and hands
	Humerus Ulna Radius Carpal Bones Scaphoid Lunate Triquetrum Pisiform Trapezoid Trapezium Capitate Hamate Metacarpals Phalanges
	Pelvis
	Ilium Ischium Pubis
	Legs, ankles and feet
	Femur Patella Tibia Fibula Tarsals Calcaneus Talus Cuboid Navicular Medial/Intermediate/Lateral Cuneiform Metatarsals Phalanges
	Spine
	Cervical Vertebrae (Axis, Atlas, C1-7) Thoracic Vertebrae (T1-12) Lumbar Vertebrae (L1-5) Sacrum (S1-5) Coccyx Nucleus Pulposus Annulus Fibrosus
	Specific Joints
	Knee
	Medial/Lateral Collateral Ligaments Anterior Cruciate Ligament (ACL) Posterior Cruciate Ligament (PCL) Medial/Lateral Meniscus
	Hip
	Head of Femur Neck of Femur (NoF) Greater Trochanter Lesser Trochanter Acetabulum Ligamentum Teres
	Shoulder
	Spine of Scapula Inferior Angle of Scapula Acromion Glenoid Fossa Coricoid Process
	Elbow
	Medial/Lateral Epicondyle Anterior Ligament Olecranon Head of Radius Annular Ligament Medial/Lateral Collateral Ligaments
	Miscellaneous Vocabulary
	Abduction
	Adduction
	Ankylosis
	Arthrodesis
	Articular
	Bursa
	Dorsiflexion
	Elevation
	Epiphysis
	Eversion
	Extension
	Flexion
	Hyperextension
	Internal/External Rotation
	Inversion
	Joint Capsule
	Joint Space
	Kyphosis
	Osteotomy
	Plantar Flexion
	Pronation
	Scoliosis
	Spondylolithesis
	Spondylosis
	Subluxation
	Supination
	Synovium
	Tendon
	Tendon Sheath
	Torticollis
	Valgus
	Varus

Symptoms of Musculoskeletal Pathology and Major Presentation of Disease »show table...

	Symptoms of Musculoskeletal Pathology
	Monoarthritis (inflammation of one joint)
	Oligoarthritis (inflammation of a few joints)
	Polyarthritis (inflammation of many joints)
	Arthralgia (joint pain)
	(“SOCRATES” system)
	S - Site - “Where is the pain?”
	O - Onset - “How did the pain come on? (Gradually? Suddenly?)”
	C - Character - “Can you describe the pain?” (Dull/Sharp/Burning)
	R - Radiation - “Does the pain move anywhere?”
	A - Associated Features - e.g. fever, malaise
	T - Timing - “How often do you get the pain?” “How long does it last?”
	E - Exacerbating Features - “What makes the pain worse?” (e.g. movement, weight bearing, exercise)
	S - Severity - “How bad is the pain on a scale of 1-10?”
	Swelling (oedema)
	What joints are swollen?
	When did the swelling start?
	Has it changed at all?
	How often do they swell?
	Erythema
	Do your joints ever go red?
	Stiffness
	Are your joints ever stiff?
	What joints get stiff?
	When are they stiff? (e.g. in the morning?/after exercise?)
	What helps this stiffness?
	How long does the stiffness last?
	Locking/Triggering
	Do you ever feel your joints ‘locking’?
	Which joints?
	When does the locking occur?
	Do you feel your movement is restricted in anyway?
	Weakness
	Have you noticed any movements becoming weaker than they were before?
	Are there any activities that you find more difficult now? (e.g. going up stairs, opening bottles etc)
	How does your joint problem affect your life?
	Systemic
	Ask about
	Fever (Have you had any fever?) Malaise (Have you been feeling unwell?) Fatigue (Have you felt unusually tired?) Rash (Have you noticed any unusual rashes anywhere?) Weight loss (Have you noticed any weight loss? Were you trying to lose weight?) General Health

Social/Family/Drug/Past Medical History »show table...

	Past Medical History (PMH)
	Have you ever had any joint problems in the past?
	Any other health problems?
	- Diabetes
	- Heart Disease
	- Stroke
	- Obesity
	- Psoriasis
	Drug History (DHx)
	Which tablets are you currently taking?
	Any other medications? – e.g.
	Steroid therapy
	Other immunosuppressive drugs
	Statins
	ACE inhibitors
	Quinolones
	Family History (FHx)
	Are there any health problems that run in the family? – e.g.
	Rheumatoid Arthritis
	Osteoarthritis
	Ankylosing Spondylitis
	Marfan's syndrome
	Ehlers-Danlos syndrome
	Charcot-Marie-Tooth Disease
	Osteogenesis Imperfecta
	Occupational History
	What do you/did you work as?
	How long for?
	Social History
	Are you able to manage on your own?
	Do you have any difficulty with dressing yourself?
	Is there anyone at home to help?
	Are there any stairs in the house?
	How far can you walk?
	Do you use a walking-aid?
	Do you smoke? Have you ever?
	Do you drink alcohol? How much?
	Have you ever taken any recreational drugs?

Physical Examination »show table...

	Physical Examination
	General Examination	Rashes (Face/hands)
	Nails	Nail Pitting
		Onycholysis
	Hands	Heberden’s Nodes
		Raynaud’s syndrome
	Arms	Rheumatoid Nodules
		Olecranon Bursitis
		Gouty Tophi
		Purpura
	Axilla	Lymphadenopathy
	Eyes	Conjunctivitis
		Scleritis/Episcleritis
		Anterior Uveitis
	Neck/Mouth	Lymphadenopathy
	Chest	Crepitations (e.g. pulmonary fibrosis)
	Abdomen	Organomegaly
	Urine	Dipstick Urinalysis (blood, protein)
	Examine all relevant JOINTS for:	Redness (erythema)
		Swelling
		Increased skin temperature
		Tenderness
		Pain on movement
		Limited range of movement
	Examples:
	Shoulder	Adduction, abduction, flexion, extension, internal and external rotation
	Hip	Adduction, abduction, flexion, extension, internal and external rotation
		Trendelenburg Test
		Fixed Flexion Deformity
		“Can you undress to your underwear so that I may examine you please?”
		Are any of your joints painful at the moment?
	Gait	Can you walk towards me?
		And turn around and walk back....
		Can you walk on your tiptoes?
		And now on the back of your heels?
	Arms	Check for tenderness - “Let me know if this is uncomfortable when I press”
		Can you put your hands behind your head?
		And up your back?
		Can you tuck your elbows in and put your palms to the ceiling? And turn them towards the floor?
		Put your hands together for me like you are praying?
		Can you make the backs of your hands touch?
		Clench your fists
		Open your hands
		Squeeze my fingers (with your left/right hand)
		Can you touch each finger with your thumb?
	Legs	Can you lie up on the couch please?
		“Just relax, I’m going to move your legs around... let me know if it feels uncomfortable and I’ll stop”
		Hip Flexion/Extension Internal/External Rotation
	Spine
	Thoracic and lumbar spine	Can you stand up for me and put your back against the wall?
	Extension	Can you lean back as far as you can for me? I’ll stand behind you so that you don’t fall.
	Flexion	Can you try to touch your toes for me?
	Lateral Flexion	Can you slide your (right/left) hand down your (right/left) thigh? And do the same for the other side?
	Rotation	Can you sit on the bed for me? Ok can you turn to the (right/left) as far as you can?
	Cervical spine
	Extension	Can you look up as far as you can?
	Flexion	And make your chin touch your chest?
	Lateral Flexion	Can you bring your ear to your shoulder please
	Rotation	Turn your head to the left/right

Investigation/Procedure »show table...

Differential Diagnosis – common clinical conditions »show table...

	Significant musculoskeletal pathologies
	Ankylosing Spondylitis
	Avascular Necrosis – usually of the hip joint
	Carpal Tunnel Syndrome
	Cauda Equina Syndrome
	Cervical Rib
	Cervical Spondylosis
	Charcot’s Joints
	Club Foot (Talipes Equinovarus)
	Compartment syndrome
	Disclocation of a joint (e.g. shoulder)
	Dupuytren’s Contracture
	Fibromyalgia
	Fracture
	Frozen Shoulder
	Ganglia
	Giant Cell / Temporal Arteritis
	Gout
	Henoch-Schonlein Purpura
	Kyphosis
	Mechanical Back Pain
	Olecranon bursitis
	Osteoarthritis
	Osteogenesis Imperfecta
	Osteomyelitis
	Osteosarcoma
	Perthes Disease
	Pes Planus (“flat feet”)
	Polymyalgia Rheumatica (PMR)
	Prolapsed Intervertebral Disc (“slipped disc”)
	Psoriatic Arthropathy
	Reiter’s Syndrome (arthritis plus urethritis)
	Rheumatoid Arthritis
	Sciatica
	Scoliosis
	Septic Arthritis
	Sjogren’s Syndrome
	Spinal Cord Compression
	Spinal Stenosis
	Spondylolithesis
	Stress Fracture
	Systemic Lupus Erythematosus (SLE)
	Vasculitis
	Wegener’s Granulomatosis

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Major presentations of disease »show table...

History taking »show table...

	History of the present illness (HPI) - questions about the complaint(s)
	Mood
	How has your mood been lately? Does your mood vary over the course of a day? Can you still enjoy the things you used to enjoy?(anhedonia) Ask about sleep, appetite, memory, concentration, libido
	Self –harm
	How do you feel about the future? Have you ever thought that life was not worth living? Have you had thoughts of ending your life? Have you thought about how you would do it? Have you made any preparations? Have you tried to take your own life or harm yourself?
	Anxiety
	Would you say you were an anxious person? Recently, have you been feeling particularly anxious or on edge? Do any particular situations make you more anxious than others? Have you ever had a panic attack? Do any thoughts or worries keep coming back to your mind even though you try to push them away? Do you ever find yourself spending a lot of time doing the same thing over and over – like checking things, or cleaning? (OCD)
	Abnormal beliefs
	Do you ever feel that people are watching you, following you or trying to harm you in any way? When you watch the TV or read the newspaper do you ever feel that the stories refer to you directly? Do you worry that there is anything wrong with your body or that you have a serious illness?
	Abnormalities of perception
	Have you ever had the sensation that you were unreal – or that the world had become unreal? Have you ever had the experience of hearing noises or voices where there was no-one about to explain it? Have you seen any visions? Do you ever notice smells or tastes that other people aren’t bothered by?

Social/Family/Drug/Past Medical History »show table...

Physical Examination »show table...

	Physical Examination
	General Underweight or signs of weight loss; enlarged parotids, Russell's sign (knuckle callus), lanugo hair Goitre Pupil size, piloerection, gynecomastia Multiple forearm scars
	Cardiovascular pulse
	Abdomen enlarged liver scars of previous surgeries
	Neurological tremor, involuntary movements, abnormal posturing, gait
	Mental State Examination
	Appearance Apparent age Racial origin Style of dress Level of cleanliness General physical condition.
	Behaviour Appropriateness of behaviour Level of motor activity Apparent level of anxiety Eye contact Rapport Abnormal movements or posture Aggression Distractibility
	Speech Rate, rhythm, tone and volume Quantity and fluency Abnormal associations, clang and punning Flight of ideas
	Mood Subjective and objective Variations of mood Congruency Risk: thoughts of suicide or deliberate self-harm. Thoughts of harm to others Anxiety and panic symptoms
	Thought Form: formal thought disorder Content: Delusions Over-valued ideas
	Perception Hallucinations Illusions
	Cognition Orientation Attention and concentration Memory Eg. Can use Mini mental state examination (MMSE) and Frontal assessment battery (FAB)
	Insight

Investigation/Procedure »show table...

Differential Diagnosis – common clinical conditions »show table...

Management of diseases »show table...

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Family history – especially conditions relevant to the patient's chief complaint.		Ask about:
		Family history of hypertension or diabetes
		Family history of heart or vascular disease
		High cholesterol
Social history (medicine) - including living arrangements, occupational history, marital status, number of children, smoking history, alcohol use, drug abuse, foreign travel, exposure to environmental pathogens		Emphasise – smoking, alcohol, poor nutrition, obesity. Recreational drugs causing cardiac disease.
Sexual and reproductive history, as appropriate		Ask about cardiac problems or high blood pressure during pregnancy
Drug history - regular and acute medications (including those prescribed by doctors, and others obtained over-the-counter or alternative medicine)		ACE inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB).
		Non-steroidal anti-inflammatory drugs (NSAID).
		B-blockers (aggravate peripheral vascular disease)
Allergies		medications, food, latex, and other environmental factors

	Investigation / Procedures
	Electrocardiography
	Echocardiography
	Chest X-ray
	Cardiac catheterisation
	Cardiac CT, MRI
	Ambulatory blood pressure monitoring
	Plasma lipids (cholesterol, triglycerides)
	Cardiac enzymes (troponin)

	Differential Diagnosis – common clinical conditions
	Myocardial infarction
	Angina
	Pericarditis
	Aortic dissection
	Heart failure
	Cardiomyopathy
	Pulmonary hypertension
	Valvular disease – aortic stenosis/incompetence, mitral stenosis/incompetence, pulmonary stenosis, tricuspid incompetence
	Arrhythmias – atrial fibrillation, atrial flutter, atrial and ventricular extrasystoles, heart block
	Hypertensive heart disease with left ventricular hypertrophy
	Peripheral atherosclerosis
	Ischaemic or embolic stroke
	Raynaud's syndrome (digital vasospasm

	Key points in anatomy and physiology
	Upper respiratory tract (nasopharynx; oropharynx; laryngopharynx).
	Lower respiratory tract (Left and Right Main Bronchi; Bronchioles; Acini)
	Right lung – upper, middle and lower lobes
	Left lung – upper and lower lobes
	Bronchial arteries and veins; Pulmonary arteries and veins
	The pleura and pleural cavities
	Anatomical landmarks
	Cervical Lymph nodes Intercostal spaces Mid-clavicular Line Cardiac apex Lung bases
	The respiratory tract is lined with ciliated pseudo-stratified columnar epithelium.
	Pulmonary gas exchange – oxygen and carbon dioxide
	Pulmonary ventilation and perfusion

	Investigations
	Peak expiratory flow rate
	Plasma
	White cell count ACE activity (test for sarcoidosis) Immunology screen - including anti-neutrophil cytoplasmic antibodies (ANCA) Arterial blood gases
	Imaging
	The Chest X-Ray (CXR)
	May be Posterio-Anterior (PA), Anterio-Posterior (AP) or Lateral
	Report:
	Patient Demographics/Date + Time of X-ray Lung fields - are they equally translucent? Apices - ?masses ?cavitation ?consolidation Trachea - ?deviated or midline Heart - ?Cardiomegaly ?Cardiophrenic angles Diaphragm ?depressed by hyperinflation Costophrenic Angles - ?well defined Soft Tissues - ?breast shadows ?surgical emphysema Hila - ?masses ?lymphadenopathy Bones - ?fractures - look at ribs, vertebrae, both scapula. ?Bone metastases
	CT scan of thorax
	Isotope scanning
	CT Pulmonary angiography
	Lymph node biopsy
	Bronchoscopy
	Lung biopsy
	Pleural aspiration and biopsy

	Major presentations of disease specific to this system
	Chest pain (angina, myocardial infarction, pericardial pain, aortic dissection)
	Breathlessness
	Palpitation
	Syncope (fainting)
	Oedema
	Hypertension
	Intermittent claudication
	Gangrene

	Major presentations of disease specific to this system
	Breathlessness
	Cough
	Sputum
	Haemoptysis
	Wheeze
	Stridor
	Chest Discomfort – e.g. pleuritic chest pain

	Differential Diagnosis – common clinical conditions
	Asthma
	Chronic Obstructive Pulmonary Disorder (COPD)
	Bronchiectasis
	Pulmonary Embolism (PE)
	Pneumothorax
	Tuberculosis
	Pneumonia
	Lung Cancer
	Small Cell or Oat Cell
	Large Cell
	Squamous cell
	Adenocarcinoma
	Mesothelioma
	Asbestosis
	Coal Worker's Pneumoconiosis
	Sarcoidosis
	Pigeon Fancier's Lung
	Pulmonary Fibrosis/
	Wegner's Granulomatosis
	Goodpasture's Syndrome
	Obstructive Sleep Apnoea Hypopnoea Syndrome (OSAHS)

	Management of Diseases
	Inhalers:
	Short Acting Β2 agonist – salbutamol (Ventolin) – blue inhaler Inhaled Corticosteroid – beclomethasone/budenoside – brown inhaler Long Acting B2 agonist preparation – salmeterol – purple inhaler Sodium Chromoglycate Leukotriene Antagonists – Montelukast
	Oxygen therapy
	Mucolytics – Carbocysteine Tablets
	Cough Suppressions – Codeine Phosphate.
	Oral Corticosteroids
	Chemotherapy, radiotherapy, surgical treatment for cancer.
	Antibiotics
	Anti-tuberculous chemotherapy
	Anti-fungal drugs
	Anticoagulation (heparin, warfarin)
	Chest physiotherapy
	Artificial ventilation

	Key points in anatomy and physiology
	Gland
	Hypothalamus – GnRH (Gonadotrophin Releasing Hormone), TRH (Thyrotropin – Releasing Hormone), Dopamine, GHRH (Growth Hormone Releasing Hormone), Stomatostatin, CRH (Corticotrophin Releasing Hormone)
	Pituitary – GH (Growth Hormone), TSH (Thyroid Stimulating Hormone), Prolactin, FSH (Follicle Stimulating Hormone), LH (Luteinizing Hormone), ACTH (Adrenocorticotrophic Hormone) Posterior Pituitary – Oxytocin, ADH (Antidiuretic Hormone) [Vasopressin]
	Thyroid - Thyroxine
	Parathyroid – Parathyroid Hormone
	Pancreas – Insulin, Glucagon, Somatostatin
	Adrenals – Cortisol, Aldosterone, DHEA (Dihydroepiandosterone)
	Gonads
	Testes - Testosterone
	Ovaries – Oestrogen, Progesterone
	Autocrine
	Paracrine
	Endocrine
	Viatmin D
	Noradrenaline (NA)
	Triiodothyronine

	Major presentations of disease specific to this system
	Alopecia
	Amenorrhoea
	Angina
	Ankle swelling
	Anorexia
	Anxiety
	Apathy
	Bruising
	Carpal Tunnel Syndrome
	Cataracts
	Central Obesity
	Constipation
	Deafness
	Decreased Skin Thickness
	Depression
	Diarrhoea
	Diplopia
	Dry Hair
	Dry Skin
	Excessive Lacrimation
	Fatigue
	Galactorrhoea
	Gynaecomastia
	Hair Thinning
	Heat/Cold Intolerance
	Hypercalcaemia
	Hyperglycaemia
	Hyperkalaemia
	Hypoglycaemia
	Hyponatraemia
	Impotence
	Infertility
	Irritability
	Loss of libido
	Loss of secondary sexual characteristics
	Loss of visual acuity
	Menorrhagia
	Moon Face
	Muscle stiffness
	Muscle weakness
	Palpitations
	Peptic Ulceration
	Pigmentation
	Postural Hypotension
	Primary/Secondary Amenorrhoea
	Pruritis
	Psychosis
	Renal Colic
	Shock
	Steatorrhoea
	Striae
	Sweating
	Tremor
	Vomiting
	Weight loss/gain
	Retinopathy
	Nephropathy (Diabetic)
	Peripheral Neuropathy
	Diabetic Foot Disease

	Investigations
	Blood Glucose (BM)
	Calcium
	CT
	Dexamethasone Suppression Test
	FNA Cytology
	Gonadotrophins
	MRI
	PET
	Radionuclide
	Serum Cortisol
	Sinus ACTH Sampling
	Specific Hormone Testing
	Thyroxine
	TSH
	Ultrasound
	Urinalysis

	Differential Diagnosis – common clinical conditions
	Pituitary	Pituitary Adenoma
		Pituitary Insufficiency (post trauma)
		Acromegally
		Craniopharyngioma
		SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone release)
		Diabetes Insipidus
	Parathyroid	Primary Hyperparathyroidism
		Secondary Hyperparathyroidism
		Tertiary Hyperparathyroidism
		Pseudohyperparathyroidism
	Thyroid	Hypothyroidism
		Hyperthyroidism
		Grave's Disease
		Autoimmune Hypothyroidism
		Multinodular Goitre
		Transient Thyroiditis
		Thyrotoxic Crisis
		Hashimoto's Thyroiditis
	Adrenals	Phaeochromocytoma
		Congenital Adrenal Hyperplasia
		Cushing's Disease
		Addison's Disease
		Conn's Syndrome
	GI Tract	Insulinoma
		Gastrinoma
		Type 1 Diabetes Mellitus
		Type 2 Diabetes Mellitus
		Pancreatic Carcinoma
		Neuroendocrine Tumours
		Carcinoid Tumours
	Reproductive	PCOS (Polycystic Ovarian Syndrome)
		Leydig Cell Tumour
		Teratoma
		Granulosa Cell Tumour
		Menopause
		Hypogonadism
		Turner's Syndrome (45XO)
		Klinefelter's Syndrome (47XXY)
		5 alpha reductase deficiency (guevedoce)

	Major Presentation of Disease
	Dysphagia (difficulty swallowing)
	Haematemesis (vomiting blood)
	Dyspepsia/Heart burn
	Abdominal Pain
	Abdominal Distension
	Altered Bowel Habit (frequency, consistency)
	Constipation
	Diarrhoea
	PR Blood/Melaena
	Wind/Flatulence
	Jaundice
	Other Symptoms
	Anorexia (loss of appetite)
	Weight Loss
	Xerostomia (dry mouth)
	Halitosis (bad breath)
	Dysgeusia (abnormal taste)
	Globus (feeling a lump in the throat)
	Waterbrash (acid in mouth)
	Hiccups
	Steatorrhoea (fatty stools)
	Pruritus (itch)

	Look (inspection):
	Leukonichia Koilonichia Dupuytren's Contracture Palmar Erythema Jaundice Anaemic Pallor Angular Stomatitis Hair Loss Gynaecomastia Ascities/Abdominal Swelling Dullness in the Abdomen Scarring Telangiectasia
	Feel (palpation): Spelomegaly Hepatomegaly Shifting Dullness Enlarged Kidneys/Bladder
	Listen (auscultation): Increased Bowel Sounds Absent Bowel Sounds Renal/Hepatic Bruits
	Pelvic/PR Exam: Hernias Anal Fissures Anal Abcess

	Investigation / Procedures
	Chest X-Ray (CXR)
	Abdominal X-Ray (AXR)
	Upper GI Endoscopy
	Lower GI Endoscopy
	CT Colonography
	MRCP (Magnetic Resonance Cholangiopancreatography)
	ERCP (Endoscopic Retrograde Cholangiopancreatography)
	Laparoscopy
	Abdominal CT
	Barium Meal
	Abdominal/Pelvic Ultrasound Scan
	Guided Aspiration/Cytology
	Abdominal Paracentesis

	Drugs / Medication
	Constipation Magnesium Sulphate Senna Glycerol Ricinoleic Acid
	Diarrhoea Loperamide Morphine
	IBD Infliximab Azathioprine Prednisolone Methotrexate Sulfasalazine
	IBS Loperamide Fluoxitene Imipramine
	Motility Disorders Atropine Hyoscine Metroclopramide Domperidone Gastrin
	Peptic Ulcer Disrease Ranitidine Omeprazole Misoprostol Aluminium Hydroxide Magnesium Sulphate Amoxicillin Metronidazole Clarithromycin
	Viral Hepatitis Apha-Interferon Ribavirin Lamividudine

	Key points in anatomy and physiology
	Size, shape, position of kidneys
	Kidneys lie POSTERIORLY and move DOWN during inspiration.
	Kidneys and ureters are retro-peritoneal.
	Anatomy of bladder, prostate, urethra, male genitalia.
	The nephron – glomerulus, proximal tubule, Loop of Henle, distal tubule, collecting duct.
	Ureters and bladder are lined by a transitional cell epithelium.
	Glomerular filtration
	Tubular reabsorption and secretion
	Renal hormones – the renin-angiotensin system, 1:25-OH Vitamin D3, erythropoetin

	Major presentations of disease
	Renal failure (biochemical diagnosis)
	Pain – from kidneys or ureters (loin pain), bladder or urethra (suprapubic). Dysuria = pain on passing urine.
	Disordered micturition (passing urine) – frequency, urgency, nocturia, hesitancy and dribbling, incontinence.
	Altered urine volume – polyuria, oliguria, anuria.
	Abnormalities in urine – haematuria, proteinuria.

Social history (medicine)		including living arrangements, occupational history, marital status, number of children, smoking history, alcohol use, drug abuse, foreign travel, exposure to environmental pathogens.
Sexual and reproductive history, as appropriate.		Problems during pregnancy - hypertension, urinary infection, proteinuria.
Drug history - regular and acute medications (including those prescribed by doctors, and others obtained over-the-counter or alternative medicine)		ACE inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB).
		Non-steroidal anti-inflammatory drugs (NSAID).
Allergies - to medications, food, latex, and other environmental factors		Allergic drug reactions may cause kidney failure.

	General
	Pallor, breathlessness, scratch marks, state of hydration
	Oedema (ankles, sacrum)
	Fluid retention (raised jugular venous pressure, crackles in lungs)
	Blood pressure (high or low)
	Abdomen
	Look (inspection): for distension due to enlarged kidneys or bladder scars of previous surgery
	Feel (palpation): tenderness over kidneys, bladder enlarged kidneys or bladder
	Percussion: suprapubic dullness due to full bladder
	Listen (auscultation): renal artery or other bruits

	Investigations
	Urinalysis – for blood, protein, glucose
	Urine microscopy – for red cells, white cells, casts, bacteria
	Urine culture and sensitivities (C&S)
	Plasma:
	urea creatinine sodium potassium bicarbonate calcium phosphate albumin haemoglobin Immunology screen - including anti-neutrophil cytoplasmic antibodies (ANCA) Prostate-specific antigen (PSA)
	Glomerular filtration rate (GFR) – used to classify stages of CKD. Measured as creatinine clearance (needs 24 hour urine collection)
	Imaging
	renal tract ultrasound
	CT scan
	renal angiography (direct, CT or MRI)
	renal isotope scan
	Other
	Renal biopsy
	Cystoscopy

	Differential Diagnosis – common clinical conditions
	Chronic Kidney Disease (CKD) – stages 1-5
	Acute renal failure (ARF)
	Glomerulonephritis – many types
	Interstitial nephritis
	Vasculitis
	Diabetic nephropathy
	Hypertensive nephropathy
	Renal vascular disease
	Adult Polycystic Kidney Disease (APKD)
	Vesico-ureteric reflux
	Obstructive uropathy
	Renal stone disease
	Benign Prostatic Hyperplasia
	Prostate cancer
	Renal adenocarcinoma
	Cancer of renal pelvis, ureter, bladder (transitional cell carcinoma)

	Management of Diseases
	Renal replacement therapy (for CKD stage 5)
	haemodialysis (also used in acute renal failure) peritoneal dialysis renal transplantation
	Immunosuppressive drugs (for some forms of glomerulonephritis, vasculitis, and after transplantation)
	prednisolone azathioprine cyclophosphamide tacrolimus cyclosporin mycophenolate mofetil (MMF)
	Recombinant erythropoietin (EPO) for renal anaemia

	Family History
	Do any diseases run in your family?
	Does anyone have a history of
	Alzheimer's? Stroke? Dementia? Multiple Sclerosis? Motor Neurone Disease? Huntington's Disease? Muscular Dystrophy? Wilson's Disease?
	Drug History
	Which medications do you take?
	How long have you been taking them for?
	Specific drugs which may cause neurological problems:
	benzodiazepines (diazepam, temazepam, lorazepam) antieplileptics (phenytoin, carbamazepine) antihistamines aspirin corticosteroids anti-TB drugs (isoniazid) nitrates/vasodialators (GTN/Sildenafil) anti-asthmatic (Salbutamol/Terbutaline)
	Social History
	Do you drink alcohol?
	How much alcohol? How often?
	What is your job?
	Are you exposed to any harmful chemicals through your work?
	How is your sexual health?
	How are you coping with your problems?
	Do you have support at home?
	Are you worried about your problems?
	Do you drive?
	Are you worried about driving?

	Investigations
	Electro-encephalography (EEG)
	Nerve Conduction Studies
	Electromyography
	Imaging:
	CT MRI Ultrasound (Carotid Doppler) X-Ray PET
	Blood Tests:
	FBC (Full Blood Count) Blood Cultures U+Es (Urea and Electrolytes) LFTs (Liver Function Tests) TFTs (Thyroid Function Tests) dsDNA (Lupus Screen) Vitamin B12 levels Syphilis Serology Copper levels Creatine Kinase Auto-antibodies (In Syndenham's Chorea/Gullian-Barré ....etc)
	Lumbar Puncture
	Biopsies

	Disease/Drug Class
	Benzodiazepines
	Diazepam Temazepam Lorazepam
	Antihistamines (for vertigo)
	Cinnarizine
	Anti-epileptics
	Phenytoin Valproate Carbamazepine Leveteracetam
	Anti-parkinsonism
	L-dopa
	Drug/Alcohol dependence
	Disulfram Methadone
	Alzheimer's
	Donezepil Rivastigmine
	Analgesics
	Morphine Diamorphine Amitriptylline Codeine Gabapentin Paracetamol Sumatriptan
	Anti-emetics
	Metoclopramide Prochlorperazine Cyclizine

	Investigations
	Plain X-ray
	MRI (Magnetic Resonance Imaging)
	CT (Computerised Tomography)
	DEXA Scan
	Radioisotope Bone Scan
	USS (Ultrasound)
	U+Es (Urea and Electrolytes)
	FBC (Full Blood Count)
	Uric Acid
	ESR (Erythrocyte Sedimentation Rate)
	Calcium
	PTH (Parathyroid Hormone)
	Alk Phos (Alkaline Phosphatase)
	RF (Rheumatoid Factor)
	ANF/ANA (Antinuclear Factor/Antibody)
	Anti- double stranded DNA
	Joint Aspiration
	Biopsy
	Arthroscopy

	Major presentations of disease
	Abnormalities of mood - depression, elation, suicidal ideation
	Anxiety
	Abnormalities of thinking - stream of thought (eg. pressure of thought, thought blocking)
	form of thought (eg, flight of ideas, loosening of associations) delusions, over-valued ideas
	Abnormalities of perception – hallucinations, illusions
	Abnormalities of memory

Disciplines English

Past Psychiatric History	Ask about:
	Previous psychiatric diagnosis
	Psychiatric inpatient, day hospital and outpatient care
	Any illnesses treated by GP
Past Medical History (PMH) (including major illnesses, any previous surgery/operations, any current ongoing illness, childhood illnesses).	Ask about :
	Carcinoma, infections, neurological disorder, endocrine disorder (cause depression)
	Hyperthyroidism, hyperventilation, hypoglycaemia, drug withdrawal (cause anxiety)
	Anaemia, sleep disorder, chronic infection, hypothyroidism, diabetes, carcinoma, radiotherapy (cause fatigue)
Family history – especially conditions relevant to the patient's chief complaint.	Ask about:
	Psychiatric disorders
	Neurological disorders
Personal History	Childhood Education Employment Relationships Forensic
Social history (medicine)	Ask for living arrangements, occupational history, marital status, number of children, smoking history, alcohol use, drug abuse, foreign travel, exposure to environmental pathogens.
Drug history - regular and acute medications (including those prescribed by doctors, and others obtained over-the-counter or alternative medicine)	Anti-depressants, anti-psychotics
	Benzodiazepines

	Investigations
	Plasma
	Full Blood Count
	Urea and electrolytes (U&Es)
	Liver Function Tests (LFTs)
	Thyroid Function Tests (TFTs)
	Glucose
	When drug/alcohol misuse suspected: MCV, B12/folate and toxicology screening
	EEG
	Imaging: CT, MRI MRI (and SPEC or PET)
	Common assessment instruments
	General Health Questionnaire (GHQ)
	Present State Examination (PSE)
	Schedule for Assessment in Neuropsychiatry (SCAN)
	Diagnostic Interview Schedule (DIS)
	Hamilton Rating Scale for Depression (HAM-D)
	Beck Depression Inventory (BDI)
	Positive and Negative Symptom Scale (PANSS)
	Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)
	Cage Questionnaire

	Differential Diagnosis – common clinical conditions
	Dementia (Alzheimer, vascular, many types)
	Delirium
	Mental and behavioural disorders due to psychoactive substance abuse
	Schizophrenia, schizotypal and delusional disorders
	Mood (Affective) Disorders
	Manic Episode Bipolar Affective Disorder Depressive Episode Recurrent depressive disorder
	Neurotic, stress-related, and somatoform disorders
	Agoraphobia +/-panic disorder Generalised anxiety disorder Obsessive-compulsive disorder (OCD) Post-traumatic stress disorder (PTSD) Dissociative (conversion) disorders
	Eating disorders
	Anorexia nervosa Bulimia nervosa
	Personality disorder (many types)
	paranoid dissocial emotional unstable – impulsive type borderline type
	Autism
	Hyperkinetic disorder
	Conduct disorder
	Learning disability

	Management of Diseases
	Pharmacological
	anti-depressants, anti-psychotics, mood stabilizers
	acetylcholinesterase inhibitors
	benzodiazepines
	Psychological
	psychodynamic psychotherapy
	cognitive behavioural therapy(CBT)
	family therapy
	interpersonal therapy (IPT)
	dialectical behaviour therapy (DBT)
	Social