Clinical Medicine Syllabus

Medicine syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Medicine in Clinical, not a summary of it.

1. 1

   Cardiology

   4 topics

   • Ischemic Heart Disease
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
     • Complications
   • Heart Failure
     • Types
     • Etiology
     • Clinical Features
     • Diagnosis
     • Management
   • Arrhythmias
     • Types
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Hypertension
     • Classification
     • Etiology
     • Clinical Features
     • Diagnosis
     • Management
2. 2

   Pulmonology

   4 topics

   • Chronic Obstructive Pulmonary Disease (COPD)
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Asthma
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Pneumonia
     • Types
     • Etiology
     • Clinical Features
     • Diagnosis
     • Management
   • Pulmonary Embolism
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
3. 3

   Gastroenterology

   4 topics

   • Peptic Ulcer Disease
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Inflammatory Bowel Disease
     • Types
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Liver Cirrhosis
     • Etiology
     • Clinical Features
     • Diagnosis
     • Complications
     • Management
   • Hepatitis
     • Types
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
4. 4

   Neurology

   4 topics

   • Stroke
     • Types
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Epilepsy
     • Types
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Parkinson's Disease
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Multiple Sclerosis
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
5. 5

   Nephrology

   4 topics

   • Acute Kidney Injury
     • Etiology
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Chronic Kidney Disease
     • Etiology
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Glomerulonephritis
     • Types
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Nephrotic Syndrome
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
6. 6

   Endocrinology

   4 topics

   • Diabetes Mellitus
     • Types
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
     • Complications
   • Thyroid Disorders
     • Hyperthyroidism
     • Hypothyroidism
     • Thyroiditis
     • Thyroid Nodules
     • Diagnosis
     • Management
   • Adrenal Disorders
     • Cushing's Syndrome
     • Addison's Disease
     • Adrenal Insufficiency
     • Diagnosis
     • Management
   • Pituitary Disorders
     • Acromegaly
     • Pituitary Adenomas
     • Hypopituitarism
     • Diagnosis
     • Management
7. 7

   Hematology

   4 topics

   • Anemia
     • Types
     • Etiology
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Leukemia
     • Types
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Lymphoma
     • Types
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Coagulation Disorders
     • Hemophilia
     • Von Willebrand Disease
     • Disseminated Intravascular Coagulation
     • Diagnosis
     • Management
8. 8

   Rheumatology

   4 topics

   • Rheumatoid Arthritis
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Systemic Lupus Erythematosus
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Gout
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Scleroderma
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
9. 9

   Infectious Diseases

   4 topics

   • HIV/AIDS
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
     • Complications
   • Tuberculosis
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Malaria
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management
   • Dengue Fever
     • Pathophysiology
     • Clinical Features
     • Diagnosis
     • Management

Medicine flashcards for Clinical

21 of 53 cards from the Medicine deck — real questions with worked answers.

1. In acute coronary syndrome, what ECG and biomarker findings distinguish STEMI from NSTEMI?

   STEMI: persistent ST-elevation (or new LBBB) with elevated troponin, indicating complete coronary occlusion and transmural injury. NSTEMI: no persistent ST-elevation (ST-depression/T-wave inversion may occur) but elevated troponin, indicating partial occlusion/subendocardial infarction. Unstable angina has similar ECG changes to NSTEMI but normal troponin.

2. What is the initial pharmacological management ('MONA-BASH') for a suspected STEMI, and which single component most improves mortality?

   Morphine, Oxygen (only if hypoxic), Nitrates, Aspirin, plus Beta-blocker, ACE-inhibitor, Statin, Heparin/second antiplatelet. Reperfusion (primary PCI within 120 min, or thrombolysis if unavailable) is the key mortality-reducing intervention; aspirin also strongly reduces mortality.

3. Which coronary artery territory corresponds to ST-elevation in leads II, III and aVF?

   The inferior wall of the left ventricle, usually supplied by the right coronary artery (RCA) in a right-dominant circulation.

4. Define heart failure and distinguish HFrEF from HFpEF by ejection fraction.

   Heart failure is a clinical syndrome where the heart cannot pump blood at a rate sufficient to meet metabolic demands (or can only do so at elevated filling pressures). HFrEF (systolic): $LVEF \leq 40\%$. HFpEF (diastolic): $LVEF \geq 50\%$ with signs/symptoms of HF. HFmrEF: $LVEF$ 41–49%.

5. What is the formula for ejection fraction, and what is the normal range?

   $$EF = \frac{SV}{EDV} \times 100\% = \frac{EDV - ESV}{EDV} \times 100\%$$ Normal $LVEF$ is approximately $55$–$70\%$.

6. Which four drug classes form the guideline-directed 'four pillars' of HFrEF therapy that reduce mortality?

   1) ARNI (or ACE-inhibitor/ARB), 2) Beta-blocker, 3) Mineralocorticoid receptor antagonist (MRA, e.g. spironolactone), 4) SGLT2 inhibitor (e.g. dapagliflozin). Diuretics relieve congestion but do not reduce mortality.

7. What is the natriuretic peptide (BNP/NT-proBNP) role in heart failure diagnosis?

   BNP and NT-proBNP are released by ventricular myocytes in response to wall stretch/stress. Elevated levels support a diagnosis of HF; a normal level has a high negative predictive value, effectively ruling out HF. Levels correlate with severity and prognosis.

8. Describe the New York Heart Association (NYHA) functional classification of heart failure.

   Class I: no limitation, ordinary activity causes no symptoms. Class II: slight limitation, symptoms on ordinary activity. Class III: marked limitation, symptoms on less-than-ordinary activity. Class IV: symptoms at rest, unable to carry out any activity without discomfort.

9. On an ECG, how do you differentiate atrial fibrillation from atrial flutter?

   Atrial fibrillation: irregularly irregular rhythm, absent P waves, chaotic fibrillatory baseline. Atrial flutter: regular 'sawtooth' flutter (F) waves (atrial rate ~300/min), typically with a fixed conduction block (e.g. 2:1 giving ventricular rate ~150/min).

10. What are the two main management strategies for atrial fibrillation, and what score guides anticoagulation?

    Rate control (beta-blockers, non-dihydropyridine CCBs, digoxin) and rhythm control (cardioversion, antiarrhythmics, ablation). The CHA₂DS₂-VASc score estimates stroke risk to guide anticoagulation; HAS-BLED estimates bleeding risk.

11. List the components of the CHA₂DS₂-VASc score for stroke risk in atrial fibrillation.

    Congestive HF (1), Hypertension (1), Age $\geq 75$ (2), Diabetes (1), prior Stroke/TIA/thromboembolism (2), Vascular disease (1), Age 65–74 (1), Sex category female (1). Maximum 9; anticoagulation generally recommended at $\geq 2$ (men) or $\geq 3$ (women).

12. What is the immediate management of an unstable patient with a tachyarrhythmia and adverse features (shock, syncope, ischemia, heart failure)?

    Synchronized DC cardioversion. For unstable ventricular tachycardia with a pulse this is also synchronized cardioversion; pulseless VT/VF is treated with immediate unsynchronized defibrillation and CPR.

13. How is blood pressure calculated from cardiac output, and how is cardiac output derived?

    $$MAP \approx CO \times SVR$$ where cardiac output $CO = HR \times SV$ (heart rate × stroke volume). Mean arterial pressure is estimated as $MAP \approx DBP + \frac{1}{3}(SBP - DBP)$.

14. What blood pressure thresholds define hypertension by the office measurement (per common guidelines)?

    Stage 1 (ACC/AHA): $\geq 130/80$ mmHg. Stage 2: $\geq 140/90$ mmHg. ESC/NICE define hypertension as clinic BP $\geq 140/90$ mmHg, confirmed by ambulatory ($\geq 135/85$) or home readings. Normal is $< 120/80$ mmHg.

15. Name the first-line antihypertensive drug classes and a key example of each.

    ACE inhibitors (ramipril), Angiotensin receptor blockers (losartan), Calcium channel blockers (amlodipine), and Thiazide/thiazide-like diuretics (indapamide). Beta-blockers are no longer routine first-line unless a compelling indication exists.

16. What is the most common cause of secondary hypertension, and name three other important causes?

    Primary hyperaldosteronism (Conn's syndrome) is the most common. Others: renal parenchymal disease, renal artery stenosis, phaeochromocytoma, Cushing's syndrome, obstructive sleep apnea, and coarctation of the aorta.

17. State the GOLD definition of COPD and the spirometry criterion for diagnosis.

    COPD is a chronic, progressive airflow limitation that is not fully reversible, caused by airway and alveolar abnormalities from noxious exposure (mainly smoking). Diagnostic spirometry: post-bronchodilator $\frac{FEV_1}{FVC} < 0.70$.

18. How does the GOLD spirometric grading (1–4) stratify COPD severity by FEV₁?

    Based on post-bronchodilator $FEV_1$ % predicted: GOLD 1 (mild) $\geq 80\%$; GOLD 2 (moderate) $50$–$79\%$; GOLD 3 (severe) $30$–$49\%$; GOLD 4 (very severe) $< 30\%$.

19. What is the target oxygen saturation for a COPD patient at risk of CO₂ retention, and why?

    Target $SpO_2$ 88–92%. Excessive oxygen can worsen hypercapnia via loss of hypoxic vasoconstriction (V/Q mismatch), the Haldane effect, and reduced respiratory drive, precipitating type 2 respiratory failure.

20. Contrast asthma and COPD in terms of reversibility, typical onset age, and atopy.

    Asthma: variable/reversible airflow obstruction (bronchodilator reversibility, diurnal variation), onset often in childhood, associated with atopy/eosinophils. COPD: fixed/largely irreversible obstruction, onset usually >40 years, strongly smoking-related, neutrophilic inflammation.

21. What defines a life-threatening acute asthma attack (key clinical/measurement features)?

    $PEF < 33\%$ predicted, $SpO_2 < 92\%$, silent chest, cyanosis, poor respiratory effort, bradycardia/arrhythmia/hypotension, exhaustion, altered consciousness, or a 'normal'/rising $PaCO_2$ (a sign of impending respiratory failure).

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