Membership of the Royal College of General Practitioners (MRCGP) Life-Stage and Population Health Care Syllabus

Life-Stage and Population Health Care syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Life-Stage and Population Health Care in Membership of the Royal College of General Practitioners (MRCGP), not a summary of it.

1. 1

   Maternal, Sexual and Reproductive Health

   6 topics

   • Contraception and family planning
     • Long-acting reversible contraception
     • Emergency contraception
     • UKMEC eligibility criteria
   • Antenatal and postnatal care in primary care
   • Menstrual disorders and menopause management
   • Sexual health and STI management
   • Subfertility assessment and referral
   • Cervical screening and gynaecological cancer referral
2. 2

   Children and Young People

   6 topics

   • Childhood immunisation schedule
   • Developmental assessment and milestones
   • The acutely unwell child and sepsis recognition
     • Fever assessment and traffic-light system
     • Recognising serious illness
   • Common childhood illnesses and rashes
   • Childhood behavioural and neurodevelopmental conditions
     • ADHD and autism spectrum disorder
   • Adolescent health and confidentiality
3. 3

   Older Adults and Care of the Dying

   5 topics

   • Comprehensive geriatric assessment and frailty
   • Falls assessment and bone health
   • Dementia diagnosis and support
     • Cognitive assessment tools
     • Distinguishing dementia, delirium and depression
   • Palliative and end-of-life symptom control
     • Pain management and syringe drivers
     • Anticipatory prescribing
   • Care home medicine and continence
4. 4

   Mental Health and Addiction

   5 topics

   • Depression and anxiety assessment and management
     • Stepped-care model and IAPT
     • Antidepressant prescribing and switching
   • Suicide and self-harm risk assessment
   • Severe mental illness in primary care
     • Psychosis and bipolar disorder shared care
   • Substance misuse and alcohol dependence
   • Eating disorders and perinatal mental health
5. 5

   Health Promotion and Population Health

   5 topics

   • Smoking cessation and brief interventions
   • Immunisation and vaccination programmes
   • NHS Health Checks and cancer screening programmes
   • Health inequalities and social determinants of health
   • Travel health and occupational health

Life-Stage and Population Health Care flashcards for Membership of the Royal College of General Practitioners (MRCGP)

21 of 50 cards from the Life-Stage and Population Health Care deck — real questions with worked answers.

1. What is the UPA (ulipristal acetate) emergency contraception time window, and how does it compare to levonorgestrel and the copper IUD?

   Ulipristal acetate (ellaOne) is effective up to 120 hours (5 days) after unprotected sex. Levonorgestrel 1.5 mg is licensed up to 72 hours. The copper IUD is the most effective method, effective up to 120 hours after UPSI or up to 5 days after the earliest expected ovulation, and is the only one that also provides ongoing contraception.

2. According to UKMEC, what category does the combined oral contraceptive pill fall into for migraine with aura, and why?

   UKMEC category 4 (unacceptable risk / absolute contraindication) at any age, because the oestrogen increases the risk of ischaemic stroke. Progestogen-only methods are acceptable (UKMEC 1-2).

3. What is the recommended minimum interval to wait before starting contraception that makes a missed/late progestogen-only pill (traditional) effective again, and the 'extra precautions' rule for the desogestrel POP?

   For the traditional POP the window is 3 hours (12 hours for desogestrel). If late beyond the window, take the missed pill, continue, and use extra precautions (condoms) or abstain for 48 hours.

4. In UK antenatal care, when is the combined (first-trimester) Down syndrome screening test offered and what does it measure?

   Offered between 11+2 and 14+1 weeks. It combines nuchal translucency ultrasound, maternal serum beta-hCG and PAPP-A, plus maternal age. The quadruple test (AFP, hCG, uE3, inhibin A) is offered at 14-20 weeks if booking is later.

5. What are the two routine antenatal antenatal anomaly/dating ultrasound scans offered in the UK and their timing?

   The dating scan at 11-14 weeks (confirms viability, dates pregnancy by crown-rump length, screens for Down syndrome) and the fetal anomaly scan at 18+0 to 20+6 weeks.

6. What is the first-line treatment for moderate-to-severe postnatal depression, and which screening tool is commonly used?

   First line is a high-intensity psychological intervention (e.g. CBT); an SSRI such as sertraline (preferred in breastfeeding) is used for moderate-to-severe cases or where psychological therapy is declined/ineffective. The Edinburgh Postnatal Depression Scale (EPDS) is the standard screening tool.

7. What is the first-line management for heavy menstrual bleeding in a woman who does not want to conceive and has no structural pathology?

   The levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena) is first line. Alternatives include tranexamic acid or NSAIDs (mefenamic acid) during menses, or the combined oral contraceptive pill.

8. Define menopause and premature ovarian insufficiency (POI) by age and diagnostic criteria.

   Menopause is the permanent cessation of menstruation, diagnosed retrospectively after 12 months of amenorrhoea (average UK age ~51). Premature ovarian insufficiency is menopause before age 40, diagnosed by menopausal symptoms plus elevated FSH (>25-30 IU/L) on two samples 4-6 weeks apart.

9. For a woman with a uterus requiring HRT, why must a progestogen be added to oestrogen, and what is the bleeding pattern of sequential vs continuous combined HRT?

   Progestogen protects against oestrogen-induced endometrial hyperplasia and cancer. Sequential (cyclical) HRT produces a monthly withdrawal bleed and is used in perimenopause; continuous combined HRT is 'bleed-free' and used >12 months after the last period or >1 year of sequential use.

10. What is the UK first-line antibiotic regimen for uncomplicated genital Chlamydia trachomatis infection?

    Doxycycline 100 mg twice daily for 7 days. Azithromycin 1 g stat then 500 mg once daily for 2 days is an alternative (e.g. in pregnancy, where azithromycin or erythromycin/amoxicillin are used as doxycycline is contraindicated).

11. Which organism causes gonorrhoea and what is the current first-line UK treatment given rising resistance?

    Neisseria gonorrhoeae (Gram-negative diplococcus). First line is a single intramuscular dose of ceftriaxone 1 g, due to widespread resistance to ciprofloxacin and azithromycin.

12. What is the recommended HIV post-exposure prophylaxis (PEP) time window and duration of treatment?

    PEP should ideally start within 24 hours and no later than 72 hours after exposure, and is taken for 28 days (typically tenofovir/emtricitabine plus raltegravir or dolutegravir).

13. After how long of regular unprotected intercourse should a couple be referred/investigated for subfertility, and what is the earlier-referral threshold?

    Investigate after 1 year of regular unprotected intercourse (every 2-3 days). Refer/investigate earlier (after 6 months, or immediately) if the woman is over 35, or there is a known cause of infertility or history predisposing to it.

14. Which blood test confirms ovulation in subfertility assessment and when is it taken?

    A mid-luteal phase serum progesterone, taken 7 days before the expected next period (e.g. day 21 of a 28-day cycle). A level >30 nmol/L confirms ovulation.

15. What is the current NHS cervical screening interval for women aged 25-49 and 50-64, and what is the primary test used?

    Ages 25-49: every 3 years; ages 50-64: every 5 years. The primary test is high-risk HPV testing, with reflex cytology only if HPV positive (HPV primary screening).

16. Under the NHS 2-week-wait pathway, name two features that warrant urgent suspected gynaecological cancer referral.

    Postmenopausal bleeding (suspected endometrial cancer), and an abnormal-appearing cervix on examination, or unexplained vaginal discharge/postcoital bleeding in older women. Ascites or a pelvic/abdominal mass not obviously fibroids warrants urgent ovarian cancer referral.

17. List the vaccines given at the UK 8-week (2-month) childhood immunisation visit.

    6-in-1 (DTaP/IPV/Hib/HepB), MenB, and rotavirus (oral). The first 6-in-1, first MenB and first rotavirus doses are given at 8 weeks.

18. When is the first MMR vaccine given in the UK schedule and when is the second (pre-school booster) dose given?

    First MMR at 12 months (1 year); second MMR at 3 years 4 months (with the pre-school booster: 4-in-1 DTaP/IPV).

19. State the expected ages for the gross motor milestones: sitting unsupported, walking unsupported, and the red-flag (refer) age for not walking.

    Sits without support by ~6-8 months; walks unsupported by ~12-18 months. Not walking by 18 months is a red flag requiring referral. Other red flags: no smiling by 8 weeks, hand preference before 12 months (suggests hemiplegia).

20. What is the normal age range for a child to develop a social smile, and by what age is its absence a red flag?

    A social smile normally develops by 6 weeks. Absence of smiling by 8 weeks (2 months) is a developmental red flag warranting assessment.

21. In the NICE traffic-light system for the unwell child, name three 'red' (high-risk) features suggesting serious illness.

    Pale/mottled/blue skin, no response to social cues or appears ill to a professional, weak/high-pitched/continuous cry, grunting, tachypnoea >60/min, moderate-severe chest indrawing, reduced skin turgor, bulging fontanelle, non-blanching rash, neck stiffness, or temperature ≥38°C in an infant under 3 months.

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