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ANATOMY ........................................................................................................................................................... 7 SOFT TISSUES , NERVES, BLOOD VESSELS.....................................................................................................

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ANATOMY ........................................................................................................................................................... 7 SOFT TISSUES , NERVES, BLOOD VESSELS.......................................................................................................................... 7 KNEE..................................................................................................................................................................... 7 HIP ....................................................................................................................................................................... 8 ANKLE ................................................................................................................................................................... 9 SHOULDER............................................................................................................................................................ 10 HAND AND W RIST.................................................................................................................................................. 12 ELBOW ................................................................................................................................................................ 13 CERVICAL AND THORACIC SPINE ................................................................................................................................. 14 LUMBAR SPINE ...................................................................................................................................................... 14 COMPARE AND CONTRAST THE ANATOMY OF THE CERVICAL AND THORACIC VERTEBRAE ........................................................... 15 DERMATOMES , MYOTOMES AND SENSORY PATHWAYS ................................................................................................... 16 MECHANISMS BY WHICH JOINT MOVEMENT OCCURS AND ANATOMICAL STRUCTURES THAT RESTRICT MOVEMENT .......................... 18 STRUCTURE OF LIGAMENTS AND TENDONS.................................................................................................................... 18 CARPEL TUNNEL SYNDROME ..................................................................................................................................... 18 BASIC SCIENCES.................................................................................................................................................. 18 G ENETIC CONDITIONS IN THE FOETUS , SCREENING, ORGANIZATION OF GENES ON CHROMOSOME ............................................... 18 POLYMERASE CHAIN REACTION (PCR): HOW IT CAN BE USED TO IDENTIFY, FOR EXAMPLE , CHLAMYDIA. ...................................... 19 ROLE OF ENZYMES AND THE ROLE OF LIVER ENZYMES IN DIAGNOSIS .................................................................................... 20 ONCOGENES : ROLE IN NORMAL CELL PROLIFERATION AND IN CARCINOGENESIS. GRADING AND STAGING OF TUMOURS.................... 20 CELL DEATH DURING THE HUMAN LIFE CYCLE ................................................................................................................. 21 BONE STRUCTURE AND HOW IT IS MAINTAINED .............................................................................................................. 21 MUSCLE: HOW STRUCTURE RELATES TO FUNCTION.......................................................................................................... 21 STRUCTURE AND FUNCTION OF A NEURONE................................................................................................................... 22 PERIPHERAL NERVOUS SYSTEM: COMPONENTS AND HOW ELECTRICAL IMPULSES ARE TRANSMITTED ............................................ 23 NEUROLOGICAL MECHANISMS INVOLVED IN VOLUNTARILY CONTRACTING A MUSCLE ............................................................... 24 BEING A DOCTOR ............................................................................................................................................... 24 DOCTOR’S ROLE OF CERTIFYING A PATIENT AS UNFIT FOR WORK AND PATIENT AUTONOMY ....................................................... 24 HOW DOCTORS ARE REGULATED : GMC ....................................................................................................................... 25 HOW DOCTORS RECOGNISE SIGNS OF PRESSURE AND STRESS ON THEMSELVES AND OTHERS, THE IMPORTANCE OF SELF - CARE , STRESS REDUCTION AND AVOIDANCE OF UNHEALTHY PRACTICES SUCH AS ALCOHOL MISUSE , WHAT TO DO IF CONCERNED .......................... 25

FACTORS (BIASES AND ERRORS IN MEMORY, ATTENTION, CONCENTRATION AND DECISION MAKING ABILITY) THAT CAN INFLUENCE INTERACTIONS WITH PATIENTS AND THE DIAGNOSTIC SKILLS OF THE DOCTOR. FACTORS THAT COULD EXACERBATE OR AMELIORATE THEIR IMPACT................................................................................................................................................................ 26

CHRONIC ILLNESS ............................................................................................................................................... 27 1

FACTORS WHICH MAY PREDISPOSE A PERSON TO DEVELOPING CHRONIC DISABLING PAIN .......................................................... 27 IMPACT OF CHRONIC DISEASE ON PATIENTS’ PSYCHOLOGICAL WELL BEING............................................................................. 27 CONNECTIVE TISSUES (SLE, SJOGRENS, PMR, CREST, DERMATO/POLYMYOSITIS, VASCULITIS) .............................. 27 CLINICAL FEATURES AND INVESTIGATIONS OF CONNECTIVE TISSUE DISORDERS ....................................................................... 27 TENDON INSERTION TO BONE AND THE PRESENTATION OF COMMON CLINIC AL CONDITIONS WHICH ARISE..................................... 32 DIET AND HEALTH .............................................................................................................................................. 33 NUTRITIONAL STATUS ASSESSMENT, CONSTITUENTS OF A HEALTHY DIET AND THE CONSEQUENCES OF AN UNBALANCED DIET, PROLONGED ABNORMAL LIPIDS AND OBESITY................................................................................................................................. 33 DIFFERENCES BETWEEN A HEALTHY AND UNHEALTHY LIFESTYLE AND THE CONSEQUENCES OF EITHER CHANGING OR NOT CHANGING ONES LIFESTYLE WITH REGARD TO SMOKING AND ALCOHOL....................................................................................................... 33 ENVIRONMENTAL RISKS AND HAZARDS: RELATION TO MORTALITY AND MORBIDITY................................................................. 34 IMPORTANCE OF OF DIETARY INTAKE IN CHRONIC ILL HEALTH............................................................................................. 34 LIPID METABOLISM: FACTORS AFFECTING AND MANAGEMENT (PHARMACOLOGICALLY AND LIFESTYLE)......................................... 34 DISABILITY ......................................................................................................................................................... 36 CHRONIC DISABILITY: IMPACT OF LIVING WITH ............................................................................................................... 36 INTERVENTIONS THE MULTIDISCIPLINARY TEAM MAY OFFER A PATIENT WITH A DISABILITY ........................................................ 36 DISABILITY, HANDICAP AND IMPAIRMENT: DEFINITIONS ................................................................................................... 37 DR-PT ................................................................................................................................................................ 37 DOCTOR PATIENT RELATIONSHIP IN PRIMARY CARE: IMPORTANCE OF , FACTORS AFFECTING , HOW IT CAN AFFECT PATIENT OUTCOMES . 37 RISK : DEFINING , EXPLAINING TO PATIENTS .................................................................................................................... 38 IMMUNISATIONS: REASONS WHY PEOPLE CHOOSE FOR OR AGAINST .................................................................................... 38 REASONS WHY PEOPLE TAKE TIME OFF WORK AND SUPPORT THAT IS AVAILABLE..................................................................... 38 DYING AND THE ELDERLY ................................................................................................................................... 39 PRESCRIBING FOR THE ELDERLY: PROBLEMS THAT MAY ARISE............................................................................................. 39 AGEING: NORMAL AND ABNORMAL, HOW GOOD HEALTH CAN BE MAINTAINED IN OLDER PEOPLE , IMPLICATIONS

OF ACUTE AND CHRONIC

ILL HEALTH ............................................................................................................................................................ 39

CONTEXT OF CARE : INFLUENCE ON THE CARE OF THE DYING PATIENT AND THE SUPPORT PROVIDED TO THEIR FAMILY ....................... 39 CULTURAL AND RELIGIOUS PRACTICES ASSOCIATED WITH DEATH AND BEREAVEMENT............................................................... 40 DEATH : DEFINING, CONFIRMING , CERTIFYING AND REPORTING TO CORONER ......................................................................... 40 DEATH : EPIDEMIOLOGY OF THE CAUSES OF AND HOW THIS KNOWLEDGE CAN BE USED TO PREVENT PREMATURE DEATH ................... 41 FALLS ................................................................................................................................................................. 41 W HY THE ELDERLY ARE MORE AT RISK OF FALLING THAN YOUNGER PEOPLE ........................................................................... 41 MDT IN PATIENTS WITH A HISTORY OF FALLS................................................................................................................. 42 ADVICE GIVEN TO A CARER OF A PATIENT WITH REPEATED FALLS , INCLUDING PREVENTION AND WHAT TO DO IN THE EVENT OF A FALL . 43 HOME ASSESSMENT IN A PATIENT WITH FALLS ............................................................................................................... 43 FRACTURES ........................................................................................................................................................ 44 2

FRACTURE HEALING: CELLULAR PROCESS....................................................................................................................... 44 PRINCIPLES BEHIND GENERAL MANAGEMENT OF A FRACTURE ............................................................................................ 45 DESCRIBE THE DIFFERENT TYPES OF FRACTURES .............................................................................................................. 45 RADIOLOGY: PRINCIPLES BEHIND DIAGNOSING FRACTURES................................................................................................ 46 COMPLICATIONS OF FRACTURES ................................................................................................................................. 46 FEMORAL FRACTURES : CLASSIFICATION AND BASIC SURGICAL MANAGEMENT OF..................................................................... 47 W HY FRACTURES IN SOME PATIENTS HEAL MORE SLOWLY................................................................................................. 47 GAIT/LIMP ......................................................................................................................................................... 47 G AIT CYCLE: DESCRIPTION AND CONTROL OF ................................................................................................................. 47 MUSCULOSKELETAL CAUSES OF LIMP: DIFFERENTIAL DIAGNOSIS ......................................................................................... 48 REASONS WHY A CHILD MAY LIMP WITH REFERENCE TO AGE.............................................................................................. 48 IMMUNOLOGY................................................................................................................................................... 49 HOST DEFENCE MECHANISM AGAINST PATHOGENS: INNATE AND ACQUIRED .......................................................................... 49 ACUTE VIRAL INFECTION : SYMPTOMS OF AND HOW TO DIFFERENTIATE FROM MORE SERIOUS ILLNESSES E.G. APPENDICITIS ............... 49 W HY COMMON PATHOGENIC ORGANISMS ARE INFECTIVE................................................................................................. 49 COMMON PATHOGENIC ORGANISMS: CHARACTERISTICS AND HOW THEY CAN BE IDENTIFIED ..................................................... 49 ROLE OF IMMUNE SYSTEM IN INFLAMMATION ............................................................................................................... 50 AUTOIMMUNITY: CONSEQUENCES AND RECOGNITION OF SELF ........................................................................................... 51 INVESTIGATIONS/RADIOLOGY............................................................................................................................ 53 METHODS OF IMAGING BONE: ADVANTAGES AND DISADVANTAGES .................................................................................... 53 INFLAMMATORY DISEASE: BLOOD TESTS....................................................................................................................... 54 RED FLAG SYMPTOMS : HOW THEIR PRESENCE INFLUENCES THE MANAGEMENT OF A PATIENT..................................................... 54 LAW AND ETHICS ............................................................................................................................................... 55 DUTY OF CARE : DOCTORS’ LEGAL DUTY, PRINCIPLES APPLIED IN ASSESSING ALLEGATIONS OF NEGLIGENCE..................................... 55 COMPETENCY: DEFINITION , HOW THIS IMPACTS ON INFORMED CONSENT IN OLDER PEOPLE ....................................................... 55 INFORMED CONSENT AND INDIVIDUAL AUTONOMY ......................................................................................................... 56 EUTHANASIA AND ASSISTED SUICIDE: ETHICAL AND MORAL ISSUES...................................................................................... 56 INFORMED CONSENT............................................................................................................................................... 57 LAW CASES OF NOTE ............................................................................................................................................... 58 UK LEGAL SYSTEM .................................................................................................................................................. 59 MDT .................................................................................................................................................................. 60 SHARED CARE IN PATIENTS WITH INFLAMMATORY ARTHRITIS............................................................................................. 60 SHARED CARE IN CHRONIC ILLNESS , DIFFERING ROLES OF PRIMARY, SECONDARY AND INTERMEDIATE CARE PROFESSIONALS............... 60 MISC. UNIT 2...................................................................................................................................................... 61 OSTEOPOROSIS: EPIDEMIOLOGY AND SOCIETAL COSTS OF OSTEOPOROSIS............................................................................. 61 3

POLYARTICULAR PAIN: DIFFERENTIAL DIAGNOSIS AND CLINICAL FEATURES ............................................................................ 61 INFECTION IN BONE: PRESENTATION AND CAUSATIVE ORGANISMS ...................................................................................... 62 MONOARTICULAR PAIN ..................................................................................................................................... 62 OSTEOARTHRITIS: RISK FACTORS ................................................................................................................................ 62 ACUTE SEPTIC ARTHRITIS AND ACUTE CRYSTAL ARTHRITIS : PRESENTATION, INVESTIGATION, PATHOPHYSIOLOGY............................. 63 NECK/BACK PAIN ............................................................................................................................................... 64 NON- PHARMACOLOGICALADVI CE WHICH MAY HELP A PATIENT WITH CERVICAL PAIN ............................................................... 64 IMAGING TECHNIQUES FOR CERVICAL SPINE: ADVANTAGES AND DISADVANTAGES................................................................... 64 THERAPEUTIC INTERVENTIONS FOR NECK PAIN ............................................................................................................... 65 W ORK RELATED MUSCULOSKELETAL PAIN AND THE INTERVENTIONS AVAILABLE TO REDUCE THESE PROBLEMS................................ 65 MDT ROLE IN TREATING LOW BACK PAIN ..................................................................................................................... 66 DEGENERATIVE AND AGE RELATED CHANGES IN THE SPINE PROLAPSED INTERVERTERBRAL DISC .................................................. 67 CLINICAL HISTORY: MECHANICAL BACK PAIN, INFLAMMATORY BACK PAIN AND METASTATIC BACK PAIN, INCLUDING RED FLAGS ......... 67 LOW BACK PAIN: EPIDEMIOLOGY AND RISK FACTORS ....................................................................................................... 67 LIFTING AND HANDLING PRINCIPLES ............................................................................................................................ 68 PHYSIOLOGY OF PAIN , HOW PAIN IS PERCEIVED.............................................................................................................. 68 HOW PAIN IS EXPERIENCED : INFLUENCE OF PHYSICAL AND PSYCHOLOGYICAL EXTERNAL FACTORS ................................................ 68 PHARMACOLOGICAL TREAT MENTS: HOW THE MODULATE CHRONIC PAIN PATHWAYS ............................................................... 69 NON PHARMACOLOGICAL PAIN TREATMENTS : MECHANISMS BY WHICH THEY MODIFY THE PERCEPTION OF PAIN............................. 70 PSYCHOLOGY OF PAIN ............................................................................................................................................. 70 REFERRED PAIN: MUSULOSKELETAL MECHANISM............................................................................................................ 70 PHARMACOLOGY............................................................................................................................................... 71 IBUPROFEN AND PARACETAMOL: WHY THEY ARE EFFECTIVE IN TREATING PYREXIA................................................................... 71 ANTIBIOTICS: GENERAL MECHANISMS AT MOLECULAR, CELLULAR AND TISSUE LEVEL. DIFFERENT GROUPS ..................................... 71 PROTON PUMP INHIBITORS: MECHANISMS AT A MOLECULAR , CELLULAR , TISSUE, AND ORGAN LEVEL ........................................... 72 PARACAETAMOL: MECHANISM AS ANALGESIC AT A MOLECULAR , CELLULAR , TISSUE, AND ORGAN LEVEL ....................................... 72 NSAIDS: PHARMACOLOGY AND SIDE EFFECTS................................................................................................................ 73 ANALGESICS : HOW THEY WORK , CONTRAINDICATIONS ..................................................................................................... 74 STEROIDS : INDICATIONS AND COMMON SIDE IN PATIENTS WITH MUSCULOSKELETAL DISEASE..................................................... 74 SIDE EFFECTS: HOW TO DISCUSS SIDE EFFECTS OF STEROIDS WITH A PATIENT STARTING NEW TREATMENT ..................................... 75 HORMONES : MECHANISMS OF ACTION INCLUDING THYROXINE, ADRENALINE AND THE COMBINED CONTRACEPTIVE PILL ................... 77 SYNOVIAL FLUID , HOW ITS ANALYSIS MAY BE HELPFUL IN THE MANAGEMENT OF DISEASE ......................................................... 77 PREGNANCY AND CHILDCARE...............................................................................................................