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

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).

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.

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).

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.

Define pharmacodynamic vs pharmacokinetic drug interaction with an example of each.

Pharmacodynamic: drugs with additive/opposing effects at the same target (e.g. warfarin + aspirin → bleeding). Pharmacokinetic: one drug alters another's absorption, distribution, metabolism or excretion (e.g. enzyme inducer reducing warfarin levels).

List the four pharmacokinetic processes summarised by 'ADME'.

Absorption, Distribution, Metabolism, Excretion.

Name two important CYP450 enzyme inducers and two inhibitors.

Inducers ('PC BRAS'): phenytoin, carbamazepine, barbiturates, rifampicin, alcohol (chronic), St John's wort. Inhibitors ('AODEVICES'/'GPACMAN'): grapefruit juice, macrolides, azoles, ciprofloxacin, omeprazole, sodium valproate, isoniazid.

How are adverse drug reactions classified (Rawlins–Thompson)?

Type A (Augmented): dose-related, predictable from pharmacology, common (e.g. bleeding on warfarin). Type B (Bizarre): idiosyncratic, unpredictable, dose-independent (e.g. anaphylaxis). Plus C chronic, D delayed, E end-of-use, F failure.

In the UK, how are suspected adverse drug reactions reported and which agency?

Via the Yellow Card Scheme to the MHRA (Medicines and Healthcare products Regulatory Agency); all suspected ADRs for black-triangle (▼) drugs and all serious ADRs should be reported.

What is the therapeutic INR target range for most indications (e.g. AF, DVT/PE) on warfarin, and for mechanical mitral valves?

Most indications: INR 2.0–3.0 (target 2.5); recurrent VTE or mechanical mitral valve: INR 2.5–3.5 (target 3.0).

Which drugs classically require therapeutic drug monitoring, and what is monitored?

Examples: digoxin (level + K$^+$/renal), lithium (level 12 h post-dose), gentamicin/vancomycin (trough/levels + renal), phenytoin, theophylline, ciclosporin — monitored due to narrow therapeutic index.

What is the therapeutic serum lithium range and when is the sample taken?

0.4–1.0 mmol/L (often 0.6–0.8 for maintenance), measured 12 hours post-dose.

What is the digoxin toxicity threshold concept and one factor that potentiates toxicity?

Narrow therapeutic index (~0.8–2.0 ng/mL); hypokalaemia potentiates toxicity because digoxin and K$^+$ compete at the $\ce{Na+/K+}$-ATPase.

Which antibiotics are contraindicated/cautioned in pregnancy and why?

Tetracyclines (teeth/bone staining), trimethoprim (folate antagonist — 1st trimester), nitrofurantoin (avoid at term — neonatal haemolysis), aminoglycosides (ototoxicity), fluoroquinolones (cartilage), sulfonamides at term (kernicterus).

How is paediatric drug dosing typically calculated and why is body surface area sometimes preferred?

Usually by weight (mg/kg); body surface area (BSA) is used for narrow-margin drugs (e.g. chemotherapy) as it correlates better with metabolic rate and physiological parameters.

What is the Holliday–Segar '4-2-1' rule for paediatric maintenance fluid rate?

100 mL/kg/day for first 10 kg, 50 mL/kg/day for next 10 kg, 20 mL/kg/day thereafter — hourly: 4 mL/kg (first 10 kg) + 2 mL/kg (next 10 kg) + 1 mL/kg (each kg >20).

What are the approximate daily maintenance requirements for water, sodium and potassium in an adult (NICE)?

Water 25–30 mL/kg/day; sodium, potassium and chloride ~1 mmol/kg/day; glucose 50–100 g/day to limit ketosis.

How do you calculate a patient's free water deficit in hypernatraemia?

$$\text{Water deficit} = \text{TBW} \times \left(\frac{[\text{Na}^+]_{\text{measured}}}{[\text{Na}^+]_{\text{normal}}} - 1\right)$$ where TBW $\approx 0.6 \times$ weight (kg) in men, $0.5\times$ in women.

What is the maximum safe rate of potassium replacement via a peripheral line, and why is faster restricted?

Usually $\leq 10$ mmol/hour peripherally (higher rates need central access and cardiac monitoring) because rapid infusion risks fatal arrhythmia.

How is the anion gap calculated and what is the normal range?

$$\text{Anion gap} = (\text{Na}^+ + \text{K}^+) - (\text{Cl}^- + \text{HCO}_3^-)$$ Normal $\approx 8\text{–}16$ mmol/L (varies if K$^+$ included).

How do you estimate corrected calcium for albumin?

$$\text{Corrected Ca} = \text{measured Ca} + 0.02 \times (40 - [\text{albumin in g/L}])$$ (in mmol/L), adjusting for the albumin-bound fraction.

What is the Cockcroft–Gault equation for creatinine clearance?

$$\text{CrCl} = \frac{(140 - \text{age}) \times \text{weight (kg)} \times F}{0.814 \times \text{serum creatinine (}\mu\text{mol/L)}}$$ where $F = 1$ for men and $0.85$ for women.

Interpret a blood gas showing low pH, high $\ce{PaCO2}$, normal/high $\ce{HCO3-}$.

Respiratory acidosis (acute if HCO$_3^-$ normal; with renal compensation/chronic if HCO$_3^-$ raised) — e.g. type 2 respiratory failure.

On an ECG, how is heart rate estimated from a regular rhythm using large squares?

$$\text{Rate} = \frac{300}{\text{number of large squares between R waves}}$$ (each large square = 0.2 s at 25 mm/s).

State the normal PR interval and QRS duration on a standard ECG.

PR interval 120–200 ms (3–5 small squares); QRS duration $<120$ ms ($<3$ small squares).

How is the corrected QT interval (QTc) calculated using Bazett's formula?

$$QTc = \frac{QT}{\sqrt{RR}}$$ where RR is in seconds; prolonged if $>440$ ms (men) or $>460$ ms (women).

In spirometry, how do you distinguish obstructive from restrictive disease using $\frac{\text{FEV}_1}{\text{FVC}}$?

Obstructive: $\frac{\text{FEV}_1}{\text{FVC}} < 0.7$ (e.g. asthma, COPD). Restrictive: ratio normal or increased ($\geq 0.7$) with both FEV$_1$ and FVC reduced (e.g. pulmonary fibrosis).

What is the recommended systematic approach (mnemonic) for reading a chest X-ray?

'ABCDE': Airway/trachea, Breathing (lung fields), Cardiac (heart size/silhouette), Diaphragm (costophrenic angles, under-diaphragm air), Everything else (bones, soft tissues, devices) — after checking RIPE: Rotation, Inspiration, Projection, Exposure.

What is the normal upper limit of the cardiothoracic ratio on a PA chest film?

$\frac{\text{maximal cardiac width}}{\text{maximal thoracic width}} \leq 0.5$; greater than 50% suggests cardiomegaly (only valid on a PA, well-inspired film).

Differentiate Gram-positive from Gram-negative bacteria on the basis of staining and cell wall.

Gram-positive: thick peptidoglycan wall retains crystal violet → purple. Gram-negative: thin peptidoglycan plus outer membrane, loses crystal violet, takes up safranin counterstain → pink/red.

What does the SBAR handover tool stand for?

Situation, Background, Assessment, Recommendation — a structured framework for concise, safe communication and escalation.

State three legal/professional standards for clinical record keeping in the UK.

Entries must be contemporaneous, legible, signed/dated/timed with author identifiable, factual and objective (no unprofessional comments), and never altered retrospectively without a clear, dated amendment trail (GMC Good Medical Practice).

Who can complete a Medical Certificate of Cause of Death (MCCD) in England/Wales and what is the key referral trigger to the coroner?

Now an attending practitioner who can state the cause, with scrutiny by a Medical Examiner. Refer to the coroner if death was violent/unnatural, sudden/unexplained, due to an accident, suicide, neglect, in custody, related to a procedure, industrial disease, or where cause is unknown.