UK Medical Licensing Assessment (UKMLA) Medicine and Long-Term Conditions Syllabus

Medicine and Long-Term Conditions syllabus — full chapter and topic list

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

1. 1

   Cardiovascular and Respiratory Medicine

   6 topics

   • Ischaemic heart disease and heart failure
     • Stable angina and secondary prevention
     • Heart failure diagnosis and management
     • Cardiovascular risk assessment (QRISK)
   • Arrhythmias and hypertension
     • Atrial fibrillation and anticoagulation
     • Conduction disorders and heart block
     • Hypertension diagnosis and stepwise management
   • Valvular, vascular and structural disease
     • Aortic and mitral valve disease
     • Infective endocarditis
     • Peripheral and venous thromboembolic disease
   • Airways disease
     • Asthma diagnosis and stepwise management
     • COPD and long-term oxygen therapy
     • Bronchiectasis
   • Respiratory infection and pleural disease
     • Pneumonia (CURB-65)
     • Tuberculosis
     • Pleural effusion and pneumothorax
   • Lung cancer, interstitial and sleep disorders
     • Lung cancer and pulmonary nodules
     • Interstitial and occupational lung disease
     • Sleep-disordered breathing
2. 2

   Gastroenterology, Hepatology and Renal Medicine

   5 topics

   • Upper and lower GI disorders
     • Peptic ulcer disease and H. pylori
     • Reflux, dyspepsia and alarm symptoms
     • Coeliac disease and irritable bowel syndrome
   • Inflammatory and bleeding GI disease
     • Crohn's disease and ulcerative colitis
     • Upper and lower gastrointestinal bleeding
   • Liver and pancreaticobiliary disease
     • Cirrhosis and its complications
     • Viral, alcohol-related and fatty liver disease
     • Acute and chronic pancreatitis
     • Jaundice and gallstone disease
   • Acute and chronic kidney disease
     • Acute kidney injury and its causes
     • Chronic kidney disease staging and complications
     • Dialysis and transplantation principles
   • Glomerular disease and electrolyte disorders
     • Nephrotic and nephritic syndromes
     • Sodium and potassium disturbances
     • Acid-base disorders
     • Urinary tract infection and renal stones
3. 3

   Endocrinology and Metabolic Medicine

   5 topics

   • Diabetes mellitus
     • Type 1 and type 2 diagnosis and management
     • Diabetic ketoacidosis and hyperosmolar hyperglycaemic state
     • Microvascular and macrovascular complications
     • Hypoglycaemia
   • Thyroid disease
     • Hyperthyroidism and thyroid storm
     • Hypothyroidism and myxoedema
     • Thyroid nodules and cancer
   • Adrenal disorders
     • Addison's disease and adrenal crisis
     • Cushing's syndrome
     • Phaeochromocytoma and Conn's syndrome
   • Pituitary and calcium disorders
     • Hypopituitarism and pituitary tumours
     • Diabetes insipidus and SIADH
     • Hyper- and hypocalcaemia and parathyroid disease
   • Lipid disorders and obesity
4. 4

   Neurology

   6 topics

   • Cerebrovascular disease
     • Acute stroke and thrombolysis/thrombectomy
     • Transient ischaemic attack
     • Intracranial haemorrhage
   • Headache disorders
     • Migraine and tension-type headache
     • Cluster headache
     • Secondary headaches and red flags
   • Seizures and epilepsy
     • Classification and diagnosis
     • Anti-epileptic management
     • Status epilepticus
   • Neurodegenerative and movement disorders
     • Parkinson's disease
     • Dementia subtypes
     • Motor neurone disease
   • Neuromuscular and demyelinating disease
     • Multiple sclerosis
     • Guillain-Barre syndrome and myasthenia gravis
     • Peripheral neuropathies
   • CNS infection and raised intracranial pressure
     • Meningitis and encephalitis
     • Space-occupying lesions
5. 5

   Musculoskeletal, Rheumatology and Immunology

   5 topics

   • Inflammatory arthritis
     • Rheumatoid arthritis
     • Seronegative spondyloarthropathies
     • Crystal arthropathies (gout and pseudogout)
   • Connective tissue disease and vasculitis
     • Systemic lupus erythematosus
     • Giant cell arteritis and polymyalgia rheumatica
     • Systemic sclerosis and Sjogren's syndrome
   • Degenerative and metabolic bone disease
     • Osteoarthritis
     • Osteoporosis and fracture risk
     • Osteomalacia and Paget's disease
   • Soft tissue and regional pain
     • Mechanical back pain and red flags
     • Common joint and tendon disorders
   • Septic arthritis and bone infection
6. 6

   Haematology, Oncology and Infectious Diseases

   5 topics

   • Anaemia and haematological malignancy
     • Iron, B12 and folate deficiency anaemia
     • Haemolytic anaemia
     • Leukaemias, lymphomas and myeloma
   • Haemostasis, thrombosis and transfusion
     • Bleeding disorders and thrombocytopenia
     • Thrombophilia and anticoagulation
     • Blood components and transfusion reactions
   • Principles of oncology
     • Cancer pathways and staging
     • Oncological emergencies
     • Systemic anti-cancer therapy and radiotherapy principles
   • Infection and antimicrobials
     • Antimicrobial stewardship and resistance
     • Healthcare-associated infection and infection control
   • Systemic, viral and travel-related infection
     • HIV and opportunistic infections
     • Viral hepatitis and mononucleosis
     • Malaria and the returning traveller with fever
7. 7

   Dermatology

   4 topics

   • Inflammatory skin disease
     • Eczema and dermatitis
     • Psoriasis
     • Acne and rosacea
   • Skin cancer and lesions
     • Melanoma
     • Basal and squamous cell carcinoma
     • Benign lesions and the urgent referral pathway
   • Skin infection and infestation
     • Cellulitis and erysipelas
     • Fungal and viral skin infection
     • Scabies
   • Dermatological emergencies
     • Stevens-Johnson syndrome and toxic epidermal necrolysis
     • Erythroderma and necrotising fasciitis

Medicine and Long-Term Conditions flashcards for UK Medical Licensing Assessment (UKMLA)

18 of 51 cards from the Medicine and Long-Term Conditions deck — real questions with worked answers.

1. What ECG changes occur in the evolution of an acute ST-elevation myocardial infarction (STEMI), and what is the gold-standard diagnostic biomarker?

   Sequence: hyperacute peaked T waves → ST elevation → pathological Q waves → T-wave inversion → ST normalisation. The gold-standard biomarker is high-sensitivity cardiac troponin (T or I), which rises within 3-6 hours and peaks at ~12-24 hours.

2. State the New York Heart Association (NYHA) functional classification of heart failure.

   Class I: no symptoms with ordinary activity. Class II: slight limitation, symptoms with ordinary activity. Class III: marked limitation, symptoms with less-than-ordinary activity. Class IV: symptoms at rest. Higher class = worse prognosis.

3. Which four drug classes form the prognostic foundation ('four pillars') of guideline-directed therapy for heart failure with reduced ejection fraction (HFrEF)?

   1) ACE inhibitor/ARB or ARNI (sacubitril-valsartan), 2) beta-blocker, 3) mineralocorticoid receptor antagonist (e.g. spironolactone/eplerenone), 4) SGLT2 inhibitor (e.g. dapagliflozin). All reduce mortality.

4. In atrial fibrillation, what does each component of the CHA2DS2-VASc score represent and what does it determine?

   Congestive heart failure (1), Hypertension (1), Age ≥75 (2), Diabetes (1), Stroke/TIA/thromboembolism (2), Vascular disease (1), Age 65-74 (1), Sex category female (1). It estimates stroke risk to guide anticoagulation.

5. What are the thresholds for diagnosing hypertension using clinic and ambulatory (ABPM) blood pressure under NICE staging?

   Stage 1: clinic $\geq 140/90$ mmHg and ABPM $\geq 135/85$. Stage 2: clinic $\geq 160/100$ and ABPM $\geq 150/95$. Severe (stage 3): clinic systolic $\geq 180$ or diastolic $\geq 120$ mmHg.

6. Contrast the murmurs of aortic stenosis and mitral regurgitation, including character, location and radiation.

   Aortic stenosis: ejection systolic murmur, loudest at right upper sternal edge, radiates to the carotids, with a slow-rising pulse. Mitral regurgitation: pansystolic murmur, loudest at the apex, radiates to the axilla.

7. What is the classic clinical triad of severe symptomatic aortic stenosis, and what does it indicate?

   Syncope, Angina, and Dyspnoea (heart failure). Onset of any of these in severe AS indicates poor prognosis and is an indication for valve replacement (surgical or TAVI).

8. Describe the typical presentation of an abdominal aortic aneurysm (AAA) rupture and the screening/threshold for elective repair.

   Ruptured AAA: sudden severe abdominal/back pain, pulsatile expansile mass, hypotension/collapse. UK screens men at age 65. Elective repair is considered when diameter $\geq 5.5$ cm, growth $> 1$ cm/year, or symptomatic.

9. How is the severity of airflow obstruction in COPD graded by spirometry (GOLD/post-bronchodilator FEV1)?

   Diagnosis requires post-bronchodilator $\frac{FEV_1}{FVC} < 0.7$. Severity by FEV1 % predicted: Stage 1 mild $\geq 80\%$; Stage 2 moderate 50-79%; Stage 3 severe 30-49%; Stage 4 very severe $< 30\%$.

10. What is the stepwise pharmacological management of chronic asthma in adults per current BTS/NICE guidance?

    Start with low-dose ICS/formoterol as combined reliever and maintenance (MART). Escalate to low-dose then moderate-dose MART, then add LAMA or refer. Inhaled corticosteroid is the cornerstone anti-inflammatory; SABA-only treatment is no longer recommended.

11. State the CURB-65 score components and how the total guides management of community-acquired pneumonia.

    Confusion, Urea $> 7$ mmol/L, Respiratory rate $\geq 30$, Blood pressure $< 90$ systolic or $\leq 60$ diastolic, age $\geq 65$. Score 0-1: home; 2: consider admission; $\geq 3$: hospital/consider ICU.

12. What pleural fluid biochemistry distinguishes an exudate from a transudate (Light's criteria)?

    Exudate if any: pleural/serum protein $> 0.5$; pleural/serum LDH $> 0.6$; pleural LDH $> \frac{2}{3}$ upper limit of normal serum LDH. Transudates (protein $< 25$ g/L) suggest heart failure, cirrhosis; exudates suggest infection/malignancy.

13. Differentiate small cell lung cancer (SCLC) from non-small cell lung cancer (NSCLC) in terms of behaviour and treatment.

    SCLC: central, highly aggressive, strongly smoking-associated, often metastatic at presentation, causes paraneoplastic syndromes (SIADH, ectopic ACTH, Lambert-Eaton); chemo/radiotherapy is mainstay (rarely surgical). NSCLC (adeno, squamous, large cell): slower, may be resectable if early; targeted therapy for mutations.

14. What are the classic features of idiopathic pulmonary fibrosis (IPF) on examination and imaging?

    Progressive exertional dyspnoea, dry cough, fine bibasal end-inspiratory 'velcro' crackles, and finger clubbing. High-resolution CT shows a usual interstitial pneumonia (UIP) pattern: bibasal subpleural reticulation and honeycombing. Spirometry is restrictive (reduced FVC, preserved/raised $\frac{FEV_1}{FVC}$).

15. Define obstructive sleep apnoea (OSA) and the first-line treatment for moderate-to-severe disease.

    OSA: repetitive upper-airway collapse during sleep causing apnoeas/hypopnoeas, with daytime somnolence (assessed by Epworth Sleepiness Scale) confirmed on polysomnography. First-line for moderate-severe disease is continuous positive airway pressure (CPAP), plus weight loss and avoidance of alcohol/sedatives.

16. What are the alarm ('red flag') symptoms of dyspepsia that warrant urgent upper GI endoscopy (ALARMS)?

    Anaemia (iron deficiency), Loss of weight, Anorexia, Recent onset/progressive symptoms, Melaena/haematemesis, Swallowing difficulty (dysphagia). Also age $> 55$ with new persistent dyspepsia. These raise concern for upper GI malignancy.

17. Compare ulcerative colitis and Crohn's disease in distribution, depth, and histology.

    Ulcerative colitis: continuous inflammation from rectum proximally, limited to colon, mucosal-only, crypt abscesses, no granulomas. Crohn's disease: skip lesions anywhere mouth-to-anus, transmural inflammation, non-caseating granulomas, cobblestoning, fistulae and strictures.

18. What is the eradication therapy for Helicobacter pylori-associated peptic ulcer disease?

    Triple therapy for 7 days: a proton pump inhibitor plus two antibiotics — typically amoxicillin plus either clarithromycin or metronidazole (with clarithromycin + metronidazole if penicillin-allergic). Confirm eradication with urea breath test or stool antigen.

See more Medicine and Long-Term Conditions flashcards →

Planning Medicine and Long-Term Conditions for UK Medical Licensing Assessment (UKMLA)

Medicine and Long-Term Conditions (UK Medical Licensing Assessment (UKMLA)) FAQ