Membership of the Royal College of Physicians (MRCP UK) Infectious Diseases, Rheumatology and Immunology Syllabus

Infectious Diseases, Rheumatology and Immunology syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Infectious Diseases, Rheumatology and Immunology in Membership of the Royal College of Physicians (MRCP UK), not a summary of it.

1. 1

   Systemic and Tropical Infections

   5 topics

   • Sepsis and antimicrobial stewardship
     • Sepsis recognition and management bundles
   • HIV infection
     • Antiretroviral therapy and opportunistic infections
   • Tropical and travel-related infection
     • Malaria and enteric fever
   • Healthcare-associated and resistant organisms
     • Clostridioides difficile and MRSA
   • Pyrexia of unknown origin
2. 2

   Connective Tissue and Autoimmune Disease

   4 topics

   • Systemic lupus erythematosus and antiphospholipid syndrome
   • Systemic sclerosis and Raynaud's phenomenon
   • Sjogren's syndrome and inflammatory myopathies
   • Vasculitides
     • ANCA-associated vasculitis
     • Large vessel vasculitis
3. 3

   Inflammatory Arthritis and Spondyloarthropathy

   4 topics

   • Rheumatoid arthritis
     • DMARDs and biologic therapy
   • Seronegative spondyloarthropathies
     • Ankylosing spondylitis and psoriatic arthritis
   • Crystal arthropathies
     • Gout and pseudogout
   • Septic arthritis and osteomyelitis
4. 4

   Bone, Soft Tissue and Immunology

   4 topics

   • Osteoarthritis and regional musculoskeletal disorders
   • Polymyalgia rheumatica and fibromyalgia
   • Primary immunodeficiency and complement disorders
   • Allergy and anaphylaxis
     • Anaphylaxis management

Infectious Diseases, Rheumatology and Immunology flashcards for Membership of the Royal College of Physicians (MRCP UK)

20 of 49 cards from the Infectious Diseases, Rheumatology and Immunology deck — real questions with worked answers.

1. In sepsis, what is the recommended target for initiating broad-spectrum antibiotics, and what mortality consequence is associated with delay?

   Antibiotics should be given within 1 hour of recognition of sepsis/septic shock. Each hour of delay in effective antimicrobials is associated with an approximate 7-8% increase in mortality in septic shock.

2. What are the components of the Sepsis Six bundle to be delivered within the first hour?

   1) Give high-flow oxygen, 2) Take blood cultures (and septic screen), 3) Give IV broad-spectrum antibiotics, 4) Give IV fluid challenge, 5) Measure serum lactate, 6) Measure urine output (consider catheter).

3. What qSOFA criteria identify a patient at higher risk of poor outcome from sepsis outside ICU?

   qSOFA (score $\geq 2$): respiratory rate $\geq 22$/min, altered mentation (GCS < 15), and systolic BP $\leq 100$ mmHg.

4. Define the four core principles of antimicrobial stewardship.

   Right drug, right dose, right duration, right route — choosing the narrowest effective agent, de-escalating based on cultures, limiting duration, and avoiding unnecessary use to reduce resistance and Clostridioides difficile risk.

5. What is the natural history target/diagnostic thresholds for staging HIV by CD4 count, including the AIDS-defining threshold?

   Normal CD4 $\approx 500\text{-}1500$ cells/mm³. AIDS is defined by CD4 $< 200$ cells/mm³ or an AIDS-defining illness. Opportunistic infection risk rises sharply below 200.

6. In HIV, at what CD4 count is Pneumocystis jirovecii pneumonia (PCP) prophylaxis started, and with what agent?

   PCP prophylaxis with co-trimoxazole is started when CD4 $< 200$ cells/mm³ (or CD4 fraction < 14%, or oral candidiasis/AIDS-defining illness).

7. What is the recommended first-line antiretroviral regimen structure for HIV, and when should ART be started?

   ART is started in all patients regardless of CD4 count. Typical regimen: two NRTIs (backbone, e.g. tenofovir + emtricitabine) plus a third agent, usually an integrase strand transfer inhibitor (e.g. dolutegravir or bictegravir).

8. What HIV-associated opportunistic infection causes ring-enhancing cerebral lesions, and what is its main differential?

   Cerebral toxoplasmosis (multiple ring-enhancing lesions in basal ganglia). Main differential is primary CNS lymphoma (often single lesion, EBV-positive on CSF PCR, thallium SPECT positive).

9. What is the classic incubation period and presentation of falciparum malaria, and which species causes the most severe disease?

   Plasmodium falciparum causes the most severe disease, typically presenting within 1-4 weeks of travel with fever, often no classic periodicity. Severe features: cerebral malaria, hypoglycaemia, ARDS, AKI, parasitaemia > 2%.

10. Which malaria species cause relapse from dormant hypnozoites, and what drug eradicates them?

    Plasmodium vivax and Plasmodium ovale form hepatic hypnozoites causing relapse. Primaquine (after checking G6PD status) eradicates the liver stage.

11. What is the classic triad/features and vector of dengue fever, and what defines severe (haemorrhagic) dengue?

    Dengue (Aedes mosquito): high fever, severe myalgia/'breakbone' pain, retro-orbital headache, rash. Severe dengue: plasma leakage, thrombocytopenia, haemorrhage, shock — often during defervescence and worse on second infection (antibody-dependent enhancement).

12. What is the characteristic feature distinguishing typhoid (enteric) fever presentation and its causative organism?

    Salmonella Typhi/Paratyphi: stepwise rising fever, relative bradycardia (Faget sign), rose spots, abdominal pain, constipation then diarrhoea, splenomegaly. Treated with azithromycin or ceftriaxone (rising fluoroquinolone resistance).

13. Define MRSA and the first-line treatment for serious MRSA infection.

    Meticillin-resistant Staphylococcus aureus carries the mecA/mecC gene (altered PBP2a) conferring resistance to all beta-lactams. Serious infection is treated with IV vancomycin (or teicoplanin/linezolid/daptomycin).

14. What enzyme defines ESBL-producing organisms, and which antibiotic class remains reliably effective?

    Extended-spectrum beta-lactamases (ESBLs) hydrolyse penicillins and cephalosporins (often in E. coli/Klebsiella). Carbapenems (e.g. meropenem) remain the treatment of choice.

15. What are the main risk factors and first-line treatment for Clostridioides difficile infection?

    Risk: recent broad-spectrum antibiotics (clindamycin, cephalosporins, fluoroquinolones), PPIs, age, hospitalisation. First-line treatment now: oral vancomycin (or fidaxomicin); stop the offending antibiotic.

16. Define pyrexia of unknown origin (PUO) by the classic Petersdorf/Beeson criteria.

    Temperature $> 38.3^{\circ}\text{C}$ on several occasions, lasting $> 3$ weeks, with no diagnosis after appropriate investigation (originally 1 week in hospital; now 3 outpatient visits/3 days inpatient).

17. What are the broad categories of causes of PUO and their approximate relative frequency?

    Infections (~30%), malignancy (~20%, e.g. lymphoma, RCC), connective tissue/autoimmune disease (~20%, e.g. GCA, adult Still's), miscellaneous (~15%), and undiagnosed (~15%).

18. List the diagnostic autoantibodies and their specificity in SLE.

    ANA: sensitive but not specific (~95% positive). Anti-dsDNA: specific, correlates with disease activity/nephritis. Anti-Smith (anti-Sm): highly specific. Low C3/C4 indicate active disease.

19. State the antibodies and the clinical/laboratory criteria for antiphospholipid syndrome (APS).

    Antibodies: lupus anticoagulant, anti-cardiolipin, anti-beta-2-glycoprotein I (positive on 2 occasions $\geq 12$ weeks apart). Clinical: arterial/venous thrombosis or pregnancy morbidity (recurrent miscarriage). Causes paradoxically prolonged APTT but thrombosis.

20. What is the management of thrombosis in antiphospholipid syndrome, and what is the pregnancy regimen?

    Lifelong warfarin (target INR 2-3, or higher for recurrent/arterial events; avoid DOACs especially in triple-positive). In pregnancy: low-dose aspirin plus LMWH.

See more Infectious Diseases, Rheumatology and Immunology flashcards →

Planning Infectious Diseases, Rheumatology and Immunology for Membership of the Royal College of Physicians (MRCP UK)

Infectious Diseases, Rheumatology and Immunology (Membership of the Royal College of Physicians (MRCP UK)) FAQ