WIXLIB

Phase 4 MedicineIntended Learning Outcomes (ILOs)This Phase 4 document outlines the listed ILOs for Medicine. This will be examined in the Year 4and Year 5 summative written examinations. It is important that we impress upon you thelimitation of any ILOs in their application to a vocational professional course such as medicine.ILOs may be useful in providing a ‘shopping list’ of conditions that you will be expected to describeand anticipate. The depth and extent of your knowledge of each condition will be a joint functionof the condition’s frequency and its gravity. Please use the ILOs to make sure you are familiar withthe common and important presentations and conditions. The list does not comprise of the entirecoda for successful medical practice but will provide you with a solid platform from which to buildupon. More detailed explanations and outlines will be available in the standard textbooks. Anyelucidation or expansion can be obtained there. Even more important is the point that ILOs willpoint you in the correct direction to pass our written exam, but that this is only part of the story.ILOs will point you in the correct direction to pass our written exam, but that this is only part ofthe story. Final exams function as ‘objective proof’ for the general public that you have enoughknowledge to function as a doctor. As you will see during your time on the wards, however, beinga doctor requires much more than knowledge; as well as being able to imitate and build on theactivities you witness in your clinical placements, it is imperative that you acquire skills,behaviours, specific attitudes, and commitment to your patients’ well being. These are welldescribed in GMC documents such as Tomorrow’s Doctors 3, and will be ‘proved’ not by exams,but by our monitoring and the feedback you receive, culminating in the portfolio signed off at theend of the Preparation for Practice module.Good luck and work hard!1

TABLE OF CONTENTSINTENDED LEARNING OUTCOMES: LEVEL DESCRIPTORp3INTENDED LEARNING OUTCOMES: TOP 30 CORE PRESENTATIONSp4INTENDED LEARNING OUTCOMES: CORE HISTORY AND EXAMINATIONp5ILOs: PRESENTATION/CONDITIONS/ISSUESCARDIOLOGYCLINICAL PHARMACOLOGYDERMATOLOGYDIABETES, ENDOCRINOLOGY, CLINICAL BIOCHEMISTRYGASTROENTEROLOGYGERIATRIC MEDICINEHAEMATOLOGYINFECTIOUS DISEASENEPHROLOGYNEUROLOGYPALLIATIVE MEDICINERESPIRATORY 5p16p17p18p192

INTENDED LEARNING OUTCOMES: LEVEL DESCRIPTORThis document sets out the core knowledge expected at the completion of Phase 4.At the completion of Preparation for Practice you will also be expected to describethe steps required to provide immediate care for the conditions designated anasterisk (*) in the tables below. Below you will find descriptors for the levelrequired for all of the common and/or important presentations in medicine. Youwill also find tables outlining the level required for the common and/or importantconditions within a valid a differential diagnosis. These have been graded level A, Bor C to acknowledge the joint function of the conditions frequency and gravity. Yourlevel should continue to improve with time in line with the principles of a spiralcurriculum.Level required for Common/Important presentationsAllInterpret findings from history and examination to recognise thepresentation/sDemonstrate and apply knowledge of the presentation/s to supportinclusion in a differential diagnosisFormulate a plan of investigationLevel required for Common/Important conditionsCInterpret findings from history and examination to recognisecondition/sDemonstrate and apply knowledge of the condition/s to supportinclusion in a differential diagnosisB C Formulate a plan of investigationA B Synthesise a full assessment of the patient’s problemsDefine a likely final diagnosisFormulate a plan for managementRecognise complicationsEstimate prognosis and outline prevention (where relevant)3

INTENDED LEARNING OUTCOMES: TOP 30 CORE PRESENTATIONSThe core common and important presentations for Junior and Senior Medicine havebeen listed below. Please map your portfolio cases and cases of the week to the toppresentations.Year 3 Junior MedicineAnaphylaxis (Emergency)BreathlessnessCardio-respiratory arrest (Emergency)Chest painFeverGastro-intestinal bleedingPolyuria/PolydipsiaShocked patient (Emergency)Unconscious patient (Emergency)Weakness/ParalysisYear 4 Senior MedicineAbdominal PainAcute Back PainAcute Kidney InjuryBruising/Spontaneous arrhoeaFalls/Deterioration in mobilityFits/SeizureHeadacheJaundiceJoint SwellingLimb ashSymptoms requiring palliative care/The dying patientWeight loss4

INTENDED LEARNING OUTCOMES: CORE HISTORY AND EXAMINATIONThe core history and examinations for Medicine:History: Full history relevant to presentationCore tinalNeurologicalNeck/Thyroid Examination5

ILOS: PRESENTATIONS/CONDITIONS/ISSUES BY SYSTEM/SPECIALTYCardiologyCommon and/or Important PresentationsCardio-respiratory Arrest, Shocked Patient, Breathlessness, Chest Pain, Palpitations,Collapse/Blackout, Falls, Acute Back Pain, Pre -syncope/Syncope, Lower Limb Swelling,FatigueCommon and/or Important ConditionsCondition/IssueCoronary ArterydiseaseMyocardial InfarctionPhase 4MedicineAPreparationfor PracticeA*HypertensionATachyarrhythmia’s(AF, SVT, VT, VF)Brady arrhythmias(sinus, heart block)Heart failureA***A*A*Infective EndocarditisPostural HypotensionDyslipidaemiaValvular HeartDisease (Aortic andMitral)CardiomyopathyABBBCongenital HeartDiseasePericardial DiseaseAortic DissectionCCCC6

ILOS: PRESENTATIONS/CONDITIONS/ISSUES BY SYSTEM/SPECIALTYClinical PharmacologyCommon and/or Important PresentationsPoisoning, Drug side-effects, Drug allergyCommon and/or Important ConditionsCondition/IssueAdverse drug reactionsPractice safe and rationalprescribing and medicinesoptimisationUse local and national guidelineson appropriate and safeprescribingPhase 4MedicineAPreparationfor PracticeA**A*7

ILOS: PRESENTATIONS/CONDITIONS/ISSUES BY SYSTEM/SPECIALTYDermatologyCommon and/or Important PresentationsShocked Patient, Fever, Rash, Limb Pain/Swelling, Skin Changes, Skin Blisters,Pigmentation, Purpura, Skin Ulcers, Hair lossCommon and/or Important ConditionsCondition/IssueDermatological Emergencies(Toxic Epidermal NecrolysisErythema Mutiforme, AcuteUrticaria, Drug Reactions,Erythroderma/Skin Failure)Cutaneous Infection/Soft TissueinfectionEczema and DermatitisPhase 4MedicineAPreparationfor PracticeA*A***Leg UlcersAPsoriasisAAcne VulgarisRosceaSkin BlistersUrticariaSkin CancerAlopecia AreataCutaneous Manifestations ofSystemic DiseaseCutaneous VasculitisAAABBBBC8*

ILOS: PRESENTATIONS/CONDITIONS/ISSUES BY SYSTEM/SPECIALTYDiabetes, Endocrinology & Clinical BiochemistryCommon and/or Important PresentationsUnconscious Patient, Shocked Patient, Blackout/Collapse, Confusion, Falls,Fits/Seizure, Headache, Nausea/Vomiting, Weakness/Paralysis, Appetite and WeightChanges, Disturbed Defecation, Sweating, Fatigue, Skin Changes, Pigmentation,Stature, Loss of Libido, Erectile Dysfunction, Galactorrhoea, Menstruation, Polyuria,Polydipsia, Thirst, Blurred Vision, Neck LumpCommon and/or Important ConditionsCondition/IssueDiabetic Emergencies(DKA, HHS,Hypoglycaemia)Type 2 DiabetesPhase 4MedicineAPreparationfor PracticeA***Type 1 DiabetesADiabetes ComplicationsGestational DiabetesSecondary DiabetesMonogenic DiabetesABBCCondition/IssueHypothyroidismPhase 4MedicineAHyperthyroidismAThyroid GoitreThyroid CarcinomaThyroid Eye DiseaseBBCCondition/IssuePhase 4MedicineBBPreparationfor PracticePreparationfor PracticeAdrenal InsufficiencyPhase 4MedicineAHypopituitarismCushing’s tionfor Practice***9

Cushing’sDisease/SyndromePolycystic OvarySyndromePrimary Gonadal FailureKleinfelter’s Condition/IssueILO LevelPreparationfor PracticeObesityILO LevelPhase 4MedicineAHypo or HyperkalaemiaA*Hypo or HypernatraemiaHypo or HypercalcaemiaHypo orHypermagnesaemiaAcid-base BalanceAABBBCCCB10

ILOS: PRESENTATIONS/CONDITIONS/ISSUES BY SYSTEM/SPECIALTYGastroenterologyCommon and/or Important PresentationsAbdominal Pain, Diarrhoea, Nausea/Vomiting, Gastrointestinal Bleeding, Jaundice,Appetite and/or Weight Change, Constipation, Faecal Incontinence, Heartburn/Waterbrash, Dysphagia, Abdominal Swelling/Bloating, Dark Urine, Pale Stools, MouthUlcers, Alcohol/Substance DependenceCommon and/or Important ConditionsCondition/IssuePhase 4MedicineGastro-oesphageal Reflux ADisease and HiatusHerniaUpper GastrointestinalABleedingAcute Liver FailureAPreparationfor Practice**Acute AlcoholWithdrawalInflammatory BowelDisease includingUlcerative Colitis andCrohn’s DiseaseGastritis/DuodenitisA**A*AGastric/Duodenal UlcerDiseaseOesphageal VaricesChronic Liver Diseaseand CirrhosisBarret’s OesphagusMalabsorption includingCoeliac DiseaseIrritable Bowel SyndromeA**AABBC11

ILOS: PRESENTATIONS/CONDITIONS/ISSUES BY SYSTEM/SPECIALTYGeriatric MedicineCommon and/or Important PresentationsChronic pain, Delirium, Dementia, Deterioration in mobility, Falls, Fragility fractures,Frailty, IncontinenceCommon and/or Important ConditionsCondition/IssueDeterioration in mobilityPhase 4MedicineAFallsAContinence – urinary / epressionOsteoporosis / fragilityfracturesPressure ulcersHearing and visual disordersElder abuseCommon conditions in olderpeople (CVA/TIA, COPD, IHD,Heart failure, Hypertension,COPD, Pneumonia, UTI,Diabetes, Renal r Practice******SeeSystem/Subspecialty

ILOS: PRESENTATIONS/CONDITIONS/ISSUES BY SYSTEM/SPECIALTYHaematologyCommon and/or Important PresentationsBreathlessness, Fever, Jaundice, Fatigue, Pre -syncope/Syncope, Easy Bruising andSpontaneous Bleeding, Purpura, Night Sweats, Recurrent Infections, Mouth Ulcers,Appetite and/or Weight Change, Lymph Gland Enlargement, AbdominalSwelling/Hepatosplenomegaly,Common and/or Important ConditionsCondition/IssueAnaemiaPancytopenia and BoneMarrow FailureBleeding Disorders(includingThrombocytopenia)Multiple MyelomaThrombophiliaMyeloid Diseases andLeukaemiasLymphomaPhase 4MedicineAAPreparationfor Practice**AABBB13

ILOS: PRESENTATIONS/CONDITIONS/ISSUES BY SYSTEM/SPECIALTYInfectious DiseasesCommon and/or Important PresentationsShocked Patient, Breathlessness, Fever, Abdominal pain, Diarrhoea,Nausea/Vomiting, Jaundice, Headache, Confusion, Weakness/Paralysis, Rash, LimbPain/Swelling, Neck Pain, Altered Cognition, Frequency, Urgency, Dysuri a,Haematuria, Incontinence, Urinary Retention, Loin pain, Cough, Sputum,Haemoptysis, Genital Discharge and Ulceration, HypothermiaCommon and/or Important ConditionsCondition/IssueILO LevelPreparationfor PracticeSepsisILO LevelPhase 4MedicineAGastroenteritisARespiratory Infections (including Viral)ACellulitis (including indications for surgicalintervention)MRSA InfectionA***Clostridium InfectionAMeningitisAHerpes Virus InfectionsTuberculosisHIV/AIDSStaphylcoccus Aureus BacteraemiaSexually Transmitted InfectionMalariaInfections in the Immunocompromised HostFever in the Returning TravellerAAABBBBBInfectious MononucleosisBPyrexia of Unknown OriginBLess Common Infections (Spirochaetal infectionincluding syphilis, Tetanus, Dysentery, Cholera,Leprosy, Viral haemorrhagic fevers, Enteric fever,Rabies, Roundworm and tapeworm infestation,Toxoplasmosis, Lyme disease, Measles, Mumps)C14A****

ILOS: PRESENTATIONS/CONDITIONS/ISSUES BY SYSTEM/SPECIALTYNephrologyCommon and/or Important PresentationsFever, Abdominal pain, Nausea/Vomiting, Confusion, Frequency, Urgency, Dysuria,Haematuria, Incontinence, Nocturia, Anuria, Urinary Retention, Oliguria, Polyuria,Anorexia, Fatigue, Vomiting, Pruritus, OedemaCommon and/or Important ConditionsCondition/IssueUrinary TractInfection/PyelonephritisAcute Kidney InjuryChronic Kidney Disease(includingprinciples/consequences ofrenal replacement therapyincluding transplantation)GlomerulonephritisCongenital Disease of theKidneySystemic Disease of theKidneyPhase 4MedicineAPreparationfor PracticeA**ABBB15