UK Medical Licensing Assessment (UKMLA) Acute and Emergency Medicine Syllabus

Acute and Emergency Medicine syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Acute and Emergency Medicine in UK Medical Licensing Assessment (UKMLA), not a summary of it.

1. 1

   Recognition and Management of the Acutely Unwell Patient

   4 topics

   • Structured assessment and resuscitation
     • ABCDE approach
     • National Early Warning Score (NEWS2)
     • Recognising the deteriorating patient and escalation
   • Sepsis and the septic patient
     • Sepsis recognition and the Sepsis Six
     • Septic shock and source control
     • Antimicrobial stewardship in sepsis
   • Shock
     • Hypovolaemic shock
     • Cardiogenic shock
     • Distributive and obstructive shock
     • Anaphylaxis
   • Fluid and electrolyte management in the acute setting
     • Assessment of fluid status
     • Prescribing intravenous fluids
     • Acute electrolyte derangements
2. 2

   Cardiopulmonary Arrest and Peri-Arrest

   5 topics

   • Adult basic and advanced life support
     • Chest compressions and defibrillation
     • Shockable and non-shockable rhythms
     • Reversible causes (4 Hs and 4 Ts)
   • Peri-arrest arrhythmias
     • Bradycardia management
     • Tachycardia with adverse features
   • Post-resuscitation care
   • Paediatric life support principles
   • Decisions around resuscitation and DNACPR
3. 3

   Common Acute Presentations

   6 topics

   • Acute chest pain
     • Acute coronary syndromes
     • Pulmonary embolism
     • Aortic dissection and life-threatening causes
   • Acute breathlessness
     • Acute asthma and COPD exacerbation
     • Acute pulmonary oedema
     • Pneumothorax
   • Acute abdomen
     • Peritonitis and perforation
     • Bowel obstruction
     • Ruptured abdominal aortic aneurysm
   • Reduced consciousness and coma
     • Glasgow Coma Scale assessment
     • Approach to the unconscious patient
   • The collapsed and syncopal patient
   • Acute headache and the thunderclap headache
4. 4

   Poisoning, Overdose and Environmental Emergencies

   4 topics

   • General approach to poisoning
     • Toxidrome recognition
     • Decontamination and enhanced elimination
     • Use of TOXBASE
   • Common specific poisonings
     • Paracetamol overdose and N-acetylcysteine
     • Opioid and benzodiazepine toxicity
     • Salicylate and tricyclic antidepressant overdose
     • Carbon monoxide poisoning
   • Environmental emergencies
     • Hypothermia and hyperthermia
     • Burns and inhalation injury
     • Drowning and electrocution
   • Alcohol-related emergencies and withdrawal
5. 5

   Trauma and Major Incidents

   4 topics

   • Primary and secondary survey in trauma
   • Head and spinal injury
     • Imaging decision rules
     • Raised intracranial pressure
     • Spinal immobilisation
   • Chest and abdominal trauma
     • Tension pneumothorax and haemothorax
     • Massive haemorrhage and transfusion
   • Major incident and triage principles

Acute and Emergency Medicine flashcards for UK Medical Licensing Assessment (UKMLA)

20 of 60 cards from the Acute and Emergency Medicine deck — real questions with worked answers.

1. In the structured ABCDE assessment of an acutely unwell patient, what does each letter stand for and in what order are they addressed?

   A – Airway, B – Breathing, C – Circulation, D – Disability (neurology), E – Exposure. They are assessed and treated in that strict sequence, with life-threatening problems corrected before moving on.

2. What are the components and score range of the qSOFA score used to identify possible sepsis outside ICU?

   qSOFA awards 1 point each for: respiratory rate $\geq 22$/min, altered mentation (GCS $<15$), and systolic BP $\leq 100$ mmHg. Score range $0$–$3$; a score $\geq 2$ suggests higher risk of poor outcome.

3. State the Sepsis Six bundle to be delivered within 1 hour of recognising sepsis.

   Give 3, take 3: (1) high-flow oxygen, (2) IV fluids, (3) IV broad-spectrum antibiotics; and take (4) blood cultures, (5) serum lactate, (6) measure urine output.

4. Define septic shock according to the Sepsis-3 criteria.

   Sepsis with persisting hypotension requiring vasopressors to maintain mean arterial pressure (MAP) $\geq 65$ mmHg AND a serum lactate $> 2$ mmol/L despite adequate fluid resuscitation.

5. List the four broad categories of shock with a defining mechanism for each.

   Hypovolaemic (loss of intravascular volume), cardiogenic (pump failure), distributive (vasodilation, e.g. septic/anaphylactic/neurogenic), and obstructive (mechanical obstruction to flow, e.g. PE, tamponade, tension pneumothorax).

6. How do cardiac output, systemic vascular resistance (SVR) and JVP/preload typically differ between septic and cardiogenic shock?

   Septic (distributive): high/normal cardiac output, low SVR, low JVP (warm peripheries). Cardiogenic: low cardiac output, high SVR, raised JVP (cold peripheries).

7. Give the four classes of haemorrhagic shock (ATLS) by approximate blood loss percentage and the earliest vital-sign change.

   Class I: $<15\%$; Class II: $15$–$30\%$; Class III: $30$–$40\%$; Class IV: $>40\%$. Tachycardia/raised pulse pressure narrowing appears early (Class II); hypotension is typically a late (Class III–IV) sign.

8. What is the recommended initial IV crystalloid fluid bolus for an adult in shock (non-trauma), and what volume is used in paediatrics?

   Adult: $500$ mL balanced crystalloid over $<15$ min ($250$ mL if heart failure/elderly), reassess and repeat. Paediatric: $10$ mL/kg (often quoted as up to $20$ mL/kg) bolus, then reassess.

9. State the Holliday-Segar '4-2-1' rule for calculating paediatric hourly maintenance fluid rate.

   $4$ mL/kg/h for the first $10$ kg, $+\,2$ mL/kg/h for the next $10$ kg, $+\,1$ mL/kg/h for each kg above $20$ kg.

10. What is the standard adult daily maintenance requirement for water, sodium/potassium/chloride, and glucose (NICE)?

    Water $25$–$30$ mL/kg/day; $\ce{Na+}$, $\ce{K+}$, $\ce{Cl-}$ approximately $1$ mmol/kg/day each; glucose $50$–$100$ g/day (to limit ketosis).

11. What is the maximum safe rate of IV potassium replacement on a general ward and why is it limited?

    Maximum $10$ mmol/h via a peripheral line (no faster than $20$ mmol/h even with cardiac monitoring and central access), because rapid infusion risks fatal cardiac arrhythmia.

12. List the ECG changes seen in progressively worsening hyperkalaemia.

    Tall tented T waves → flattened/absent P waves → prolonged PR → widened QRS → sine-wave pattern → VF/asystole.

13. What is the immediate treatment for hyperkalaemia with ECG changes, and what does each agent do?

    IV calcium gluconate/chloride (cardiac membrane stabilisation, no effect on $\ce{K+}$ level), then insulin with dextrose and nebulised salbutamol (shift $\ce{K+}$ intracellularly). Remove $\ce{K+}$ with dialysis/resins as needed.

14. In adult ALS, what is the compression-to-ventilation ratio, compression depth, and rate for CPR?

    Ratio $30{:}2$ (until advanced airway secured), depth $5$–$6$ cm, rate $100$–$120$ compressions/min.

15. In the adult ALS algorithm, which rhythms are 'shockable' versus 'non-shockable', and how does drug timing differ?

    Shockable: VF and pulseless VT. Non-shockable: PEA and asystole. Adrenaline $1$ mg is given after the 3rd shock in shockable rhythms but immediately (then every $3$–$5$ min) in non-shockable; amiodarone $300$ mg is added after the 3rd shock in shockable rhythms only.

16. List the reversible causes of cardiac arrest (the 4 Hs and 4 Ts).

    4 Hs: Hypoxia, Hypovolaemia, Hyper/hypokalaemia (and other metabolic), Hypothermia. 4 Ts: Thrombosis (coronary/pulmonary), Tension pneumothorax, Tamponade (cardiac), Toxins.

17. What is the recommended energy for the first defibrillation shock using a biphasic defibrillator in an adult?

    $120$–$150$ J (per manufacturer) for the first biphasic shock, escalating for subsequent shocks; if in doubt use the maximum available energy.

18. In the peri-arrest tachycardia algorithm, which adverse features mandate synchronised DC cardioversion?

    Shock (hypotension), Syncope, Myocardial ischaemia (chest pain), and Heart failure. Any of these with a tachyarrhythmia → up to 3 synchronised shocks, then amiodarone.

19. What is the first-line treatment for a regular narrow-complex tachycardia (likely SVT) in a stable patient?

    Vagal manoeuvres first; if unsuccessful, IV adenosine $6$ mg rapid bolus, then $12$ mg, then $18$ mg (or $12$ mg) as needed.

20. In the peri-arrest bradycardia algorithm, what is the first-line drug and dose if adverse features or risk of asystole are present?

    IV atropine $500$ \mu g, repeated every $3$–$5$ min to a maximum of $3$ mg. If inadequate, use transcutaneous pacing or isoprenaline/adrenaline infusion.

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