UK Medical Licensing Assessment (UKMLA) Clinical and Practical Skills, Prescribing and Investigations Syllabus

Clinical and Practical Skills, Prescribing and Investigations syllabus — full chapter and topic list

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

1. 1

   History Taking and Clinical Examination

   3 topics

   • Structured history taking
     • Presenting complaint and systems review
     • Ideas, concerns and expectations
     • Collateral history
   • System-based examination
     • Cardiovascular and respiratory examination
     • Abdominal and neurological examination
     • Musculoskeletal examination
   • Examination in special groups
     • Paediatric examination
     • Mental state examination
     • Examination of the older person
2. 2

   Practical Procedures

   5 topics

   • Vascular access and phlebotomy
     • Venepuncture and cannulation
     • Blood cultures and ABG sampling
   • Airway, breathing and circulation procedures
     • Oxygen delivery and basic airway management
     • Use of the defibrillator
   • Bladder and gastrointestinal procedures
     • Urethral catheterisation
     • Nasogastric tube insertion
   • Aseptic technique and infection prevention
   • Wound care, suturing and local anaesthesia
3. 3

   Prescribing and Therapeutics

   6 topics

   • Safe and rational prescribing
     • Writing a safe prescription
     • Reviewing and reconciling medications
     • Prescribing in renal and hepatic impairment
   • Drug interactions and adverse reactions
     • Common interactions
     • Adverse drug reactions and the Yellow Card scheme
     • Allergy versus intolerance
   • Specific therapeutic areas
     • Anticoagulation and antiplatelets
     • Analgesia and the analgesic ladder
     • Antimicrobial prescribing
     • Insulin and variable rate infusions
   • Therapeutic drug monitoring
     • Drugs requiring monitoring
     • Loading and maintenance dosing
   • Prescribing in special groups
     • Prescribing in pregnancy and breastfeeding
     • Prescribing for children and the elderly
     • Controlled drugs
   • Fluid and electrolyte prescribing
4. 4

   Investigations and Their Interpretation

   4 topics

   • Laboratory investigations
     • Full blood count and blood film
     • Urea, electrolytes and renal function
     • Liver function and bone profile
     • Inflammatory markers and tumour markers
   • Cardiac and respiratory investigations
     • ECG interpretation
     • Arterial blood gas interpretation
     • Spirometry and peak flow
   • Imaging interpretation
     • Chest radiograph
     • Abdominal radiograph
     • Principles of CT, MRI and ultrasound
   • Microbiology and point-of-care testing
     • Urinalysis
     • Culture and sensitivity interpretation
5. 5

   Documentation, Handover and Information Management

   4 topics

   • Clinical record keeping and documentation standards
   • Structured handover (SBAR)
   • Referral letters and discharge summaries
   • Death certification and reporting to the coroner

Clinical and Practical Skills, Prescribing and Investigations flashcards for UK Medical Licensing Assessment (UKMLA)

24 of 53 cards from the Clinical and Practical Skills, Prescribing and Investigations deck — real questions with worked answers.

1. What does the mnemonic 'SOCRATES' stand for when taking a pain history?

   Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/relieving factors, Severity.

2. In a structured history, what are the standard sequential components after the presenting complaint?

   History of presenting complaint, past medical history, drug history (with allergies), family history, social history, and systems review (ICE: ideas, concerns, expectations are explored throughout).

3. What does 'ICE' stand for in patient-centred history taking?

   Ideas, Concerns and Expectations — eliciting the patient's own understanding, worries, and what they hope for from the consultation.

4. What are the four classic components of a system-based physical examination, in order?

   Inspection, palpation, percussion, and auscultation.

5. In the cardiovascular exam, what does the JVP measure and where is the upper limit of normal?

   The jugular venous pressure reflects right atrial pressure; normal is $\leq 3$ cm vertical height above the sternal angle (i.e. $\leq 8$ cmH$_2$O total from the right atrium).

6. When examining a child (special group), why is the abdomen typically palpated last and the chest auscultated when quiet?

   Examination order is adapted to opportunism and cooperation — least distressing/most informative steps are done when the child is calm (e.g. auscultate while settled), and uncomfortable steps (deep abdominal palpation, ENT) are left until last to avoid distress invalidating earlier findings.

7. What gauge and colour of cannula is preferred for rapid fluid resuscitation in an adult?

   A large-bore cannula — grey (16G) or, ideally, orange (14G) — because flow rate is governed by Poiseuille's law and rises steeply with radius.

8. State Poiseuille's law and explain why a short, wide cannula gives the fastest flow.

   $$Q = \frac{\pi r^{4} \Delta P}{8 \eta L}$$ Flow ($Q$) is proportional to radius$^4$ and inversely proportional to length, so a short, wide cannula maximises flow.

9. What is the correct order of draw for blood culture and standard vacutainer tubes?

   Blood cultures first, then coagulation (citrate, blue), then serum (red/gold), then heparin (green), then EDTA (purple/lavender), then fluoride oxalate (grey) — to prevent additive cross-contamination.

10. In adult basic life support, what is the recommended chest compression rate and depth?

    Rate of 100–120 compressions per minute at a depth of 5–6 cm, with a compression:ventilation ratio of 30:2.

11. What does the 'ABCDE' approach stand for in assessment of the acutely ill patient?

    Airway, Breathing, Circulation, Disability, Exposure — assessed and treated in sequence, reassessing after each intervention.

12. What is the formula for estimating the correct nasopharyngeal/oropharyngeal airway size and ET tube size in children?

    Oropharyngeal airway is sized from incisors to angle of mandible; uncuffed ET tube internal diameter (mm) $\approx \frac{\text{age}}{4} + 4$.

13. What are the recognised sites for needle thoracocentesis in tension pneumothorax (adult)?

    2nd intercostal space mid-clavicular line, or (preferred in current guidance) 4th–5th intercostal space anterior to mid-axillary line, inserting just above the rib to avoid the neurovascular bundle.

14. When inserting a urinary catheter, what volume of sterile water is used to inflate the balloon and why is it inflated only after urine flows?

    Typically 10 mL of sterile water; the balloon is inflated only after urine is seen to confirm the tip is in the bladder, avoiding urethral trauma from premature inflation.

15. What is the maximum recommended volume to drain at one time in tense ascites to avoid circulatory dysfunction, and what is given concurrently?

    Large-volume paracentesis (>5 L) should be accompanied by intravenous albumin (about 6–8 g per litre removed) to prevent post-paracentesis circulatory dysfunction.

16. Define the difference between 'sterile' and 'aseptic' technique.

    Sterile technique aims for a completely microorganism-free field (e.g. surgery); aseptic non-touch technique (ANTT) prevents contamination of key parts/sites by not touching them, used for procedures like cannulation and wound care.

17. What are the WHO '5 Moments for Hand Hygiene'?

    Before touching a patient; before a clean/aseptic procedure; after body fluid exposure risk; after touching a patient; after touching patient surroundings.

18. Which hand hygiene method is required for Clostridioides difficile and why?

    Soap and water handwashing (mechanical removal), because alcohol gel does not kill C. difficile spores.

19. What is the maximum safe dose of plain lidocaine and lidocaine with adrenaline for local anaesthesia?

    Lidocaine plain: 3 mg/kg (max ~200 mg); lidocaine with adrenaline: 7 mg/kg (max ~500 mg), as adrenaline-induced vasoconstriction slows systemic absorption.

20. Why must adrenaline-containing local anaesthetic be avoided in digits, nose, ears, and penis (traditional teaching)?

    These are areas supplied by end-arteries, where vasoconstriction was thought to risk ischaemic necrosis (though modern evidence challenges this for fingers).

21. What suture material type is used for skin closure vs deep dermal/absorbable layers?

    Skin: non-absorbable monofilament (e.g. nylon/polypropylene), removed later; deep/dermal: absorbable (e.g. polyglactin/Vicryl or poliglecaprone/Monocryl).

22. Typical suture removal times: face, scalp, limbs/trunk, and joints?

    Face 3–5 days; scalp/neck ~5 days; trunk/upper limb 7–10 days; lower limb/over joints 10–14 days.

23. What are the '5 Rights' (5 Rs) of safe medication administration?

    Right patient, right drug, right dose, right route, right time (often extended to right documentation and right to refuse).

24. What does the prescribing principle 'start low, go slow' apply to, and give one example drug class?

    Initiating drugs cautiously in the elderly/frail or where toxicity risk is high — e.g. opioids, antihypertensives, or psychotropics.

See more Clinical and Practical Skills, Prescribing and Investigations flashcards →

Planning Clinical and Practical Skills, Prescribing and Investigations for UK Medical Licensing Assessment (UKMLA)

Clinical and Practical Skills, Prescribing and Investigations (UK Medical Licensing Assessment (UKMLA)) FAQ