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    Edited by Adam Feather, MBBS, FRCP, FAcadMEd; David Randall, MA, MRCP; and Mona Waterhouse, MA, MRCP

    Contributors comprise consultants at the top of their fields, paired with younger doctors closer to the exam experience, to ensure authority and relevance.

    Enhanced e-book accompanies the print book, for ease of transportation and use on the move.

    International Advisory Board, led by Professor Janaka de Silva and Professor Senaka Rajapakse, providing guidance for global coverage from across the world.

    Contributions to the e-book by members of the International Advisory Board to amplify areas of clinical importance in their parts of the world.



    Table of Contents:


    1. Diagnosis: The art of being a doctor

    Core Skills and Knowledge

    Diagnosis in the Clinical Consultation

    The medical consultation

    Clinical diagnostic reasoning

    Communicating a diagnosis

    Diagnosis, artificial intelligence and the future of medicine

    2. Human genetics

    Core Skills and Knowledge

    Clinical skills for genetic medicine


    Clinical genetics

    The cellular basis of genetics

    Genetic disorders

    Techniques for studying the genetic code

    Genomic medicine

    The genetic basis of cancer

    3. Immunity

    Core Skills and Knowledge

    Introducing the tissues, cells and molecules of the immune system

    Innate immune system

    Adaptive immune system

    Cell migration

    HLA molecules and antigen presentation

    The immune system in concert

    Laboratory investigations of the immune system

    Clinical immunodeficiency

    Allergic disease (immediate hypersensitivity)

    Autoimmune disease

    Organ rejection in clinical transplantation

    Immune-based therapies

    4. Evidence-based practice

    Core Skills and Knowledge


    Asking Answerable Questions

    Searching for the Evidence

    Appraising the Evidence

    Applying the Evidence

    Section 1: Asking Answerable Questions and Searching for the Evidence

    Section 2: Critical Appraisal

    Section 3: Interpreting Odds Ratios, Confidence Intervals and P-Values

    Section 4: Multiple Choice Questions

    5. Ethical practice and clinical communication

    Core Skills and Knowledge

    Ethics and the law

    Communication in medicine

    6. Malignant disease

    Core Skills and Knowledge

    Clinical skills for malignant disease


    The biology of cancer

    Aetiology and epidemiology

    Screening and investigations

    Principles of cancer treatment

    Acute oncology

    Common solid tumour treatment

    Lung cancer

    Breast cancer

    Upper gastrointestinal cancers

    Lower gastrointestinal cancers

    Hepatobiliary and pancreatic cancers

    Urological cancers

    Gynaecological cancers

    Brain tumours

    Head and neck cancer

    Metastatic cancer of unknown primary

    7. Palliative care and symptom control

    Core Skills and Knowledge

    Introduction and General Aspects

    Symptom Control

    Palliative Care in Non-Malignant Disease

    Care of the Dying

    8. Sepsis and the treatment of bacterial infection

    Core Skills and Knowledge

    clinical skills for infection and sepsis



    recognition of sepsis

    Management of Sepsis

    Antimicrobial Stewardship

    Antibiotic Therapies

    9. Water balance, fluids and electrolytes

    Core skills and knowledge

    Clinical skills for water balance, fluids and electrolytes

    Water and Electrolytes

    Disorders of sodium concentration

    Disorders of potassium concentration

    Disorders of magnesium concentration

    Disorders of phosphate concentration

    Acid–Base Disorders

    10. Critical care medicine

    Core Skills and Knowledge


    Clinical approach to the critically ill patient

    Applied cardiorespiratory physiology

    Disturbances of acid–base balance

    Shock, sepsis and acute disturbances of haemodynamic function

    Respiratory failure

    Acute respiratory distress syndrome

    Acute Kidney injury

    Neurocritical care


    11. Surgery

    Core Skills and Knowledge

    Clinical skills for surgery


    The pathophysiology of surgery

    Management of the perioperative patient

    The patient journey in surgery

    Surgical Ethics, Consent and the Law

    12. Prescribing, therapeutics and toxicology

    Core Skills and Knowledge


    Why do patients need drugs?

    The choice of drug

    The dose

    Prescribing in special populations

    Monitoring drug therapy

    Adverse drug reactions

    Drug interactions

    Information sources


    Clinical approach to the poisoned patient

    Principles of management of poisoning

    Specific poisons

    Poisons in the natural world: additional online content

    13. Global health

    Core Skills and Knowledge


    Millennium and Sustainable Development Goals

    Global Burden of Disease


    Water and Sanitation

    Organizations and the global health agenda


    Maternal and Child Health

    Mental health

    Accidents and Trauma

    Conflict and Catastrophe

    Economics and Politics in Global Health

    Social Determinants of Health

    Human rights and the value of engagement in global health

    14. Public health

    Core Skills and Knowledge


    Key Concepts in Public Health

    Pillars of Public Health

    15. Geriatric medicine, frailty and multimorbidity

    Core Skills and Knowledge



    Investigations in Older Adults

    Taking a History

    Multimorbidity, Sarcopenia and Frailty

    Comprehensive Geriatric Assessment

    Advance Care Planning

    The Most Common Issues in Older People

    Ageing Well and Advantages of Ageing

    16. Haematology

    Core Skills and Knowledge

    Clinical skills for haematology




    The red cell

    Anaemia: an introduction

    Microcytic anaemia

    Normocytic anaemia

    Macrocytic anaemias

    Anaemia due to marrow failure (aplastic anaemia)

    Haemolytic anaemias: an introduction

    Inherited haemolytic anaemia

    Acquired haemolytic anaemia


    The spleen

    Blood transfusion

    Blood groups

    Procedure for blood transfusion in hospitals

    Complications of blood transfusion

    Strategies for the avoidance of unnecessary transfusion

    Blood, blood components and blood products

    The white cell


    Vascular disorders

    Platelet disorders

    Inherited coagulation disorders

    Acquired coagulation disorders

    17. Haematological oncology

    Core Skills and Knowledge

    Clinical skills for haematological oncology




    Clinical features



    MDS/MPN overlap syndromes


    Myeloma and other plasma cell disorders

    18. Rheumatology

    Core Skills and Knowledge

    Clinical skills for rheumatology

    Approach to the patient

    Anatomy and physiology of the normal joint

    Investigation of rheumatic disease

    Clinical conditions in rheumatology

    Common regional musculoskeletal problems

    Chronic pain syndromes

    Analgesic and anti-inflammatory drugs for musculoskeletal problems

    Disorders of collagen


    Inflammatory Arthritis

    Rheumatoid arthritis


    Infections of joints

    Autoimmune rheumatic diseases

    Systemic inflammatory vasculitis

    Arthritis in children

    Rheumatological problems seen in other diseases

    Miscellaneous arthropathies

    19. Bone disease

    Core Skills and Knowledge

    Clinical skills for bone disease

    Anatomy and physiology of bone

    Investigation of bone and calcium disorders



    Paget’s disease of bone

    Rickets and osteomalacia

    Bone infections

    Neoplastic disease of bone

    Scheuermann’s disease

    20. Infectious disease

    Core Skills and Knowledge

    Core content

    Clinical skills for infectious disease


    Clinical approach to the patient with a suspected infection

    Epidemiology and prevention of infections

    Principles and mechanisms of infection

    Viral Infections

    Virus infections of the skin and mucous membranes

    Virus infections of the respiratory tract

    Systemic viral infections

    Virus infections of the nervous system

    Virus infections of the gastrointestinal tract

    Viral hepatitis

    Viruses and malignant disease

    Viral haemorrhagic fevers

    Antiviral drugs

    Transmissible Spongiform Encephalopathies (Prion Diseases)

    Bacterial Infections

    Bacterial infections of the skin and soft tissues

    Bacterial infections of the respiratory tract

    Bacterial infections of the gastrointestinal tract

    Bacterial infections of the cardiovascular system

    Bacterial infections of the nervous system

    Bacterial bone and joint infections

    Bacterial infections of the urinary tract

    Systemic/multisystem bacterial infections

    Bacterial infections seen in developing and tropical countries

    Antibiotic therapies

    Fungal Infections

    Systemic fungal infections

    Subcutaneous fungal infections

    Superficial fungal infections

    Antifungal drugs

    Protozoal Infections

    Blood and tissue protozoa

    Gastrointestinal protozoa

    Helminthic Infections




    Arthropod Ectoparasites

    21. Endocrinology

    Core Skills and Knowledge

    Clinical skills for endocrinology


    The pituitary gland and hypothalamus

    Hypothalamo–Pituitary–adrenal axis

    The thyroid axis

    Hypothalamo–pituitary–gonadal axis

    Growth and puberty

    The Thirst Axis

    Disorders of Calcium Metabolism

    Hypoglycaemia in the non-diabetic patient

    Other endocrine disorders

    22. Dermatology

    Core Skills and Knowledge

    Clinical Skills for Dermatology


    Skin structure and function

    Investigation of Skin Disease

    Principles of Dermatological Therapy

    Erythroderma and Loss of Skin Function (‘Skin Failure’)

    Common rashes

    Skin Infections

    Human Immunodeficiency Virus and the Skin

    Skin Signs of Systemic Disease


    Blistering and Bullous Skin Disease

    Skin Tumours

    Disorders of Pigmentation

    Nail Disorders

    Hair Disorders

    Birth Marks and Neonatal Rashes

    Drug Eruptions

    23. Diabetes mellitus

    Core Skills and Knowledge

    Clinical skills for diabetes mellitus


    Physiology of insulin structure, secretion and action

    Classification of diabetes

    Clinical Approach to the Patient With Diabetes

    Prevention of Type 2 Diabetes

    Management of diabetes

    Diabetic metabolic emergencies

    Complications of diabetes

    Psychosocial Implications of Diabetes

    Diabetes in special situations

    Organization of diabetes care

    24. Lipid and metabolic disorders

    Core Skills and Knowledge





    Disorders of lipid metabolism

    Inherited metabolic diseases

    25. Liaison psychiatry

    Core Skills and Knowledge


    Clinical approach to the patient with a psychiatric disorder

    Classification of psychiatric disorders

    Aetiology of psychiatric disorders

    Psychiatric aspects of physical diseases

    Sick role and illness behaviour

    Functional somatic syndromes

    Somatoform disorders

    Dissociative/conversion disorders

    Sleep difficulties

    Mood (affective) disorders

    Suicide and self-harm

    Anxiety disorders

    Alcohol misuse and dependence

    Drug misuse and dependence


    Organic mental disorders

    Eating disorders

    Sexual disorders

    Personality disorders

    Involuntary Detention

    Mental Capacity Act

    26. Neurology

    Core Skills and Knowledge

    Clinical skills for neurology


    Clinical approach to the patient with neurological disease

    Functional neuroanatomy

    Cranial nerves

    Motor control systems

    Lower motor neurone lesions

    Sensory pathways and pain

    Bladder control and sexual dysfunction

    Investigation of neurological disease

    Unconsciousness and coma


    Intracranial haemorrhage

    Headache, migraine and facial pain

    Epilepsy and loss of consciousness

    Movement disorders

    Neuroinflammatory disorders

    Nervous system infection


    Traumatic brain injury

    Spinal cord disease

    Neurodegenerative diseases

    Congenital disorders

    Neurogenetic disorders

    Paraneoplastic syndromes

    Peripheral nerve disease

    Muscle diseases

    27. Ear, nose and throat and eye disease

    Core Skills and Knowledge

    Introduction to ENT

    Clinical approach to the patient with an ENT complaint

    Disorders of the Ear

    Clinical Approach to the Patient With a Disorder of the Ear

    Common disorders of the ear

    Disorders of the Nose

    Clinical Approach to the Patient With a Disorder of the Nose

    Common disorders of the nose

    Disorders of the Throat

    Clinical Approach to the Patient With a Disorder of the Throat

    Common disorders of the throat

    Disorders of the Eye

    Applied Anatomy and Physiology

    Clinical Approach to the Patient With a Disorder of the Eye

    Common disorders of the eye

    28. Respiratory disease

    Core Skills and Knowledge

    Clinical skills for respiratory medicine

    Function of the respiratory system

    Clinical Approach to the Patient with Respiratory Disease

    Diseases of the Upper Respiratory Tract

    Obstructive Respiratory Disease


    Respiratory Infection

    Pleural Disease

    Tumours of the Respiratory Tract


    Interstitial Lung Diseases

    Lung and Heart–Lung Transplantation

    Occupational Lung Disease

    Miscellaneous Respiratory Disorders

    Disorders of the Diaphragm

    Mediastinal Lesions

    29. Venous thromboembolic disease

    Core Skills and Knowledge


    Pathogenesis of Thrombosis


    Epidemiology and Risk Factors

    Clinical Features




    Investigation of newly diagnosed venous thrombosis


    Anticoagulant agents

    30. Cardiology

    Core Skills and Knowledge

    Clinical skills for cardiology

    ECG interpretation

    Anatomy, physiology and embryology of the heart

    Clinical approach to the patient with heart disease

    Therapeutic procedures

    Cardiac arrhythmias

    Bradycardias and heart block

    Supraventricular tachycardias

    Ventricular tachyarrhythmias

    Heart failure

    Coronary artery disease


    Acute coronary syndromes

    Valvular heart disease

    Aortic valve

    tricuspid valve

    Pulmonary valve

    Prosthetic valves

    Infective endocarditis

    Congenital heart disease

    Marfan’s syndrome

    Pulmonary heart disease

    Myocardial and endocardial disease

    Myocardial disease

    Pericardial disease

    Peripheral vascular disease

    Peripheral venous disease

    31. Hypertension

    Core Skills and Knowledge


    Clinical Approach to the Patient with Hypertension

    Measurement of blood pressure

    Phenotypes of Hypertension

    Causes of raised blood pressure

    Thresholds and Targets In Hypertension

    Hypertensive Target Organ Damage


    Managing blood pressure in hospital

    32. Gastroenterology

    Core Skills and Knowledge

    Clinical Skills for Gastroenterology


    Anatomy and physiology of the gastrointestinal tract

    Investigation of Gastrointestinal Disease

    Functional Gastrointestinal Disorders


    Salivary Glands

    Pharynx and Oesophagus

    Stomach and Duodenum

    Acute and Chronic Gastrointestinal Bleeding

    Small Intestine

    Inflammatory Bowel Disease

    Colon and Rectum

    The Acute Abdomen


    33. Nutrition

    Core Skills and Knowledge


    Water and Electrolyte Balance

    Dietary Requirements

    Protein–Energy Malnutrition


    Fat-soluble vitamins

    Water-soluble vitamins

    Dietary Antioxidants

    Homocysteine, cardiovascular disease and B vitamins


    Nutrition and Ageing


    Nutritional Support

    Food Allergy and Food Intolerance


    34. Liver disease

    Core Skills and Knowledge

    Clinical skills for liver disease


    Anatomy of the liver and biliary system

    Functions of the liver

    Investigations in the patient with liver disease



    Acute hepatic failure

    Autoimmune hepatitis

    Drug-induced chronic hepatitis

    Chronic hepatitis of unknown cause

    Non-alcoholic fatty liver disease


    Alcoholic liver disease

    Budd–chiari syndrome

    Hepatic sinusoidal obstruction syndrome

    Fibropolycystic diseases

    Liver abscess

    Other infections of the liver

    Liver disease in pregnancy

    Liver tumours

    Miscellaneous conditions of the liver

    Drugs and the liver

    35. Biliary tract and pancreatic disease

    Core Skills and Knowledge


    Gall Bladder and Biliary System

    Biliary system

    Miscellaneous conditions of the biliary tract



    Pancreatic cancer

    Pancreatic neuroendocrine tumours

    Clinical syndromes



    36. Kidney and urinary tract disease

    Core Skills and Knowledge

    Clinical Skills for Nephrology



    Anatomy and Physiology of the Kidney and Urinary Tract

    Investigation of Renal and Urinary Tract Disease

    The Glomerulus and Glomerular Disease

    Kidney Involvement in Other Diseases

    Hypertension and the Kidney

    Other Vascular Disorders of the Kidney

    Renal Calculi and Nephrocalcinosis

    Urinary Tract Obstruction

    Drugs and the Kidney

    Urinary Tract Infection

    Tubulointerstitial Nephritis

    Acute Kidney Injury

    Chronic Kidney Disease

    Cystic Renal Disease

    Tumours of the Kidney and Genitourinary Tract

    Diseases of the Prostate Gland

    The Urinary Tract in the Elderly

    37. Sexually transmitted infections and human immunodeficiency virus

    Core Skills and Knowledge

    Clinical skills for STI and HIV care

    Sexually transmitted infections

    Asymptomatic STI screening

    Investigation of STIs

    Management, prevention and control

    Specific infections

    Human immunodeficiency virus and acquired immunodeficiency syndrome

    Clinical features of untreated hiv infection

    Clinical approach to the patient with HIV

    Management of HIV-positive patients

    Specific conditions associated with HIV infection

    Prevention and control of HIV infection

    38. Obstetric medicine

    Core Skills and Knowledge

    Clinical Skills for Obstetric Medicine


    Hypertensive Disorders

    Liver Disease

    Cardiac Disease

    Thromboembolic Disease

    Respiratory Disease

    Neurological Disease

    Endocrine Disease

    Renal Disease

    Skin Disorders


    Prescribing in Pregnancy

    39. Women’s health

    Core Skills and Knowledge

    Clinical skills for women’s health


    The life course approach


    Heavy Menstrual Bleeding

    Abortion/Termination of Pregnancy

    Urinary Incontinence

    Domestic abuse and violence

    Gynaecological cancers

    40. Men’s health

    Core Skills and Knowledge

    Clinical Skills For Men’s Health


    Specific Diseases of Men

    Diseases of the prostate gland

    Diseases of the Penis

    Testicular and Spermatic Cord Disease

    Lack of Libido and Erectile Dysfunction


    The Ageing Male

    41. Environmental medicine

    Core Skills and Knowledge

    Air pollution

    Heat Injury

    Cold injury

    High altitude



    Ionizing radiation

    Electric shock

    Lightning strike

    Inhaled smoke


    Normal Values