Medicine for MRCP PDF
Preview Medicine for MRCP
OXFORD SPECIALTY TRAINING Medicine for MRCP OXFORD SPECIALTY TRAINING Medicine for MRCP SENIOR EDITOR Rupa Bessant MBChB MSc (Dist) FRCP Course Director, PassPACES, UK www.passpaces.co.uk (Formerly Consultant Rheumatologist, Guy’s and St Thomas’ NHS Foundation Trust, London, UK) EDITORS Jonathan Birns BSc MBBS PhD FRCP Consultant in Stroke Medicine, Geriatrics and General Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK Honorary Senior Lecturer, King’s College London, UK Deputy Head of School of Medicine, Health Education England, London, UK Charlotte Ford BSc MBChB MRCP Consultant Gastroenterologist, Western Sussex Hospitals NHS Foundation Trust, UK 1 1 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2020 The moral rights of the authors have been asserted First Edition published in 2020 Impression: All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 98 Madison Avenue, New York, NY 006, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 209939553 ISBN 978– 0– 9– 877950– 6 Printed in Great Britain by Bell & Bain Ltd., Glasgow Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-t o- date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-p regnant adult who is not breast- feeding Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work. For my daughters, Olivia and Serena, who continue to inspire me each and every day, and my parents, Ramola and Amiya, for whose love and guidance I will always be grateful. Rupa Bessant For my sons Cassius, Jonah and Otto who are my answers to everything. Charlotte Ford v Foreword Acquisition of the diploma of Membership of the Royal Colleges of Physicians is a crucial step in a physician’s working life that enables them to pursue a career in one of the thirty medical specialties and two subspecialties that are recognised by the General Medical Council (GMC). The work and training that is required to pass the three parts of the examination should not be underestimated by anyone. Trying to learn the enormous extent of medicine so that the trainee has enough confidence to answer the questions that are posed is daunting and there are many theories about the best way to prepare. The changes that are occurring both in medical training and indeed the MRCP does not obviate the fact that studying medicine will require a sound grounding in knowledge. It is anticipated, however, that the provision of better training will aid in the acquisition of knowledge. The main changes that are occurring in medical training in the UK have been driven by the Shape of Training report which recommended that all new curricula must better serve the patient need, have more generic skills to support the acute unselected take, provide continuity of care, improve care in the com- munity, support credentialing and provide a more flexible approach to training. Furthermore, the GMC mandated that all postgraduate curricula must be based on higher level learning outcomes and incorporate the GMC defined Generic Professional Capabilities (GPCs). In response to this, stage of The Joint Royal Colleges of Physicians Training Board (JRCPTB) designed Internal Medicine Training (IMT) programme was implemented in August 209. This is an indicative three-year programme designed to better prepare doctors to become a medical registrar and provide them with the skills needed to manage patients pre- senting with a wide range of general medical symptoms and conditions. Experience in critical care medicine, geriatric medicine and outpatients is mandated and trainees will receive simulation training throughout the programme. The use of all sources of information can only be assisted if there is an adequacy of time and the intro- duction by JRCPTB of quality standards for registrars in general internal medicine is now being augmented to cover the whole of internal medicine training. The MRCP clinical examination is also changing and 2021 should see the introduction of the updated PACES exam to ensure it remains fair, relevant and fit for purpose. This has been the subject of a great deal of scrutiny, consultation and deliberation reflecting not only the place of the examination, but also the importance of the role of excellent clinical skills. Knowing how a disease presents and how and when to investigate such presentations is at the heart of what physicians do. The editors for this book have enrolled an extensive field of authors who are experts in their fields to provide facts which may be assimilated rapidly and that will be helpful both in revising for the MRCP exam- inations and also in day to day practice. The consistency of editorship means that individual conditions are listed according to clinical features, diagnosis and management - a system that will serve anyone well at the bedside, whether in a clinical or exam setting. It covers aspects of medicine that have been ignored by the statutory definition of specialty but are enormously important in everyday presentations to the acute hospital, including obstetric medicine. The inclusion of critical care as a specific aspect for consideration complements well the ambition within the internal medicine training programme of generating doctors who are more able to manage the acutely ill patient. The editors have also ensured that there are chapters covering topics that traditionally are ‘Cinderella areas’ and yet are defined as being important in the new curriculum – these include Statistics and Medical Law and Ethics. In summary, this work will help you in studying for the MRCP diploma but if used well will stand the reader in good stead for their future career. Michael Jones Medical Director, Training and Development Joint Royal Colleges of Physicians Training Board Federation of Royal Colleges of Physicians of the United Kingdom Consultant Acute Physician GIRFT National Clinical Lead for Acute and General Medicine vii Preface Medicine for MRCP aims to be a comprehensive guide to the MRCP Part and Part 2 written examinations, and to provide the requisite theoretical knowledge in a user-f riendly format. Each chapter has been written by highly experienced MRCP lecturers. The most relevant clinical information for the MRCP (UK) examin- ations is covered, incorporating the appropriate protocols, guidelines and treatment algorithms from NICE, UK, and European and American Colleges. An emphasis has been placed on a UK clinical setting. Latest developments and clinical treatments (e.g. biologic therapy) have been included throughout the text. Can- didates who wish to read in greater depth are directed to relevant publications at the end of each section. Furthermore, the inclusion of links to carefully selected relevant websites (e.g. DVLA guidelines and cur- rent mental health legislation) are intended to provide up- to- date information to benefit doctors within their clinical setting and daily practice. A well- structured and comprehensive approach to clinical medicine has been used to ensure that the text is an invaluable resource for candidates preparing for the MRCP Part and Part 2, and PACES exam- inations, as well as the MRCPI, USMLE and PLAB examinations. Undergraduate students will also find this book beneficial and we believe that it will remain a valuable reference for trainees in acute medicine, acci- dent and emergency medicine, anaesthetics, critical care and general practice. Each chapter integrates the basic science required for the Part written, with more clinically based in- formation, concentrating on subjects that need to be covered for the Part 2 written and providing a solid foundation for candidates as they progress to the PACES examination. Where possible, the clinical impli- cations of the theoretical knowledge covered in Part are emphasised within the clinical context, thereby making this information easier to remember. The text utilises a combination of flowcharts, tables and mnemonics to assist candidates in retaining and recalling the key relevant facts in both an examination setting and clinical practice. Multiple choice ques- tions (MCQs) relevant to Part and Part 2 written papers have been included at the end of each chapter, enabling candidates to build their confidence. The answers to these questions will help to consolidate the medical knowledge relevant to all three parts of the MRCP examination. The editors and chapter authors have combined their extensive clinical knowledge and practical teaching experience to create a book that we believe will help to optimise the chances of examination success. We hope that candidates will both enjoy and benefit from this book during their revision and clinical practice. Good luck to you all! Rupa Bessant ix
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