BASIC SCIENCES
ANATOMY
RESPIRATORY SYSTEM
Mouth, nose, pharynx, larynx, trachea, main bronchi, segmental bronchi, structure of bronchial tree: differences in the child
Airway and respiratory tract, blood supply, innervation and lymphatic drainage
Pleura, mediastinum and its contents
Lungs, lobes, microstructure of lungs
Diaphragm, other muscles of respiration, innervation
The thoracic inlet and 1st rib
Skills
Interpretation of a chest x-ray
CARDIOVASCULAR SYSTEM
Heart, chambers, conducting system, blood and nerve supply
Congenital deviations from normal anatomy
Pericardium
Great vessels, main peripheral arteries and veins Foetal and maternal-foetal circulation
NERVOUS SYSTEM:
Brain and its subdivisions
Spinal cord, structure of spinal cord, major ascending and descending pathways
Spinal meninges, subarachnoid and extradural space, contents of extradural space.
Cerebral blood supply CSF and its circulation
Spinal nerves, dermatomes
Brachial plexus, nerves of arm
Intercostal nerves
Nerves of abdominal wall
Nerves of leg and foot
Autonomic nervous system
Sympathetic innervation, sympathetic chain, ganglia and plexuses
Parasympathetic innervation.
Stellate ganglion
Cranial nerves: base of skull: trigeminal ganglion
Innervation of the larynx
Eye and orbit
VERTEBRAL COLUMN:
Cervical, thoracic, and lumbar vertebrae Interpretation of cervical spinal imaging in trauma
Sacrum, sacral hiatus
Ligaments of vertebral column
Surface anatomy of vertebral spaces, length of cord in child and adult
SURFACE ANATOMY:
Structures in antecubital fossa
Structures in axilla: identifying the brachial plexus
Large veins and anterior triangle of neck
Large veins of leg and femoral triangle
Arteries of arm and leg
Landmarks for tracheostomy, cricothyrotomy
Abdominal wall (including the inguinal region): landmarks for suprapubic urinary and peritoneal lavage catheters
Landmarks for intrapleural drains and emergency pleurocentesis
Landmarks for pericardiocentesis
ABDOMEN:
Gross anatomy of intra-abdominal organs
Blood supply to abdominal organs and lower body
PHYSIOLOGY & BIOCHEMISTRY GENERAL
Organisation of the human body and homeostasis
Variations with age
Function of cells; genes and their expression
Mechanisms of cellular and humoral defence
Cell membrane characteristics; receptors: Protective mechanisms of the body
Genetics & disease processes
BIOCHEMISTRY:
Acid base balance and buffers Ions e.g. Na + , K+, Ca++ , Cl-, HCO3-, Mg++, PO4-
Cellular and intermediary metabolism; variations between organs
Enzymes
BODY FLUIDS:
Capillary dynamics and interstitial fluid
Oncotic pressure
Osmolarity: osmolality, partition of fluids across membranes
Lymphatic system
Special fluids: cerebrospinal, pleural, pericardial and peritoneal fluids
HAEMATOLOGY & IMMUNOLOGY:
Red blood cells: haemoglobin and its variants
Blood groups
Haemostasis and coagulation; pathological variations
White blood cells
Inflammation and its disorders
Immunity and allergy
MUSCLE:
Action potential generation and its transmission
Neuromuscular junction and transmission
Muscle types
Skeletal muscle contraction
Motor unit
Muscle wasting
Smooth muscle contraction: sphincters
HEART & CIRCULATION:
Cardiac muscle contraction
The cardiac cycle: pressure and volume relationships
Rhythmicity of the heart
Regulation of cardiac function; general and cellular
Control of cardiac output (including the Starling relationship)
Fluid challenge and heart failure
Neurological and humoral control of systemic blood pressures, blood volume and blood flow (at rest and during physiological disturbances e.g. exercise, haemorrhage and Valsalva manoeuvre)
Peripheral circulation: capillaries, vascular endothelium and arteriolar smooth muscle
Autoregulation and the effects of sepsis and the inflammatory response on the peripheral vasculature
Characteristics of special circulations including pulmonary, coronary, cerebral, renal, portal and foetal
Skills
Electrocardiogram and arrhythmias
RENAL TRACT:
Blood flow, glomerular filtration and plasma clearance
Tubular function and urine formation
Endocrine functions of kidney
Regulation of fluid and electrolyte balance
Regulation of acid-base balance
Micturition
Pathophysiology of acute renal failure
Skills
Assessment of renal function
RESPIRATION:
Gaseous exchange: O2 and CO2 transport, hypoxia and hyper- and hypocapnia, hyper-and hypobaric pressures
Functions of haemoglobin in oxygen carriage and acid-base equilibrium
Pulmonary ventilation: volumes, flows, dead space.
Effect of IPPV and PEEP on lungs and circulation
Mechanics of ventilation: ventilation/perfusion abnormalities
Control of breathing, acute and chronic ventilatory failure, effect of oxygen therapy
Non-respiratory functions of the lungs
Cardio-respiratory interactions in health & disease
NERVOUS SYSTEM:
Functions of nerve cells: action potentials, conduction, synaptic mechanisms and transmitters
The brain: functional divisions
Intracranial pressure: cerebrospinal fluid, blood flow
Maintenance of posture
Autonomic nervous system: functions
Neurological reflexes Motor function: spinal and peripheral receptor: receptors, nociception, special receptor
Pain: afferent nociceptive pathways, dorsal horn, peripheral and central mechanisms, neuromodulatory systems, supraspinal mechanisms, visceral pain, neuropathic pain, influence of therapy on nociceptive mechanisms
Spinal cord: anatomy and blood supply, effects of spinal cord section
LIVER:
Functional anatomy and blood supply
Metabolic functions
Skills
Tests of function
GASTROINTESTINAL:
Gastric function; secretions, nausea and vomiting
Gut motility, sphincters and reflex control
Digestive functions and enzymes
Nutrition: calories, nutritional fuels and sources, trace elements, growth factors
METABOLISM AND NUTRITION:
Nutrients: carbohydrates, fats, proteins, vitamins, minerals and trace elements
Metabolic pathways, energy production and enzymes; metabolic rate
Hormonal control of metabolism: regulation of plasma glucose, response to trauma
Physiological alterations in starvation, obesity, exercise and the stress response
Body temperature and its regulation
ENDOCRINOLOGY:
Mechanisms of hormonal control: feedback mechanisms, effect on membrane and intracellular receptors
Central neuro-endocrine interactions
Adrenocortical hormones
Adrenal medulla: adrenaline (epinephrine) and noradrenaline (norepinephrine)
Pancreas: insulin, glucagon and exocrine function
Thyroid and parathyroid hormones and calcium homeostasis
PREGNANCY:
Physiological changes associated with a normal pregnancy and delivery
Materno-foetal, foetal and neonatal circulation
Functions of the placenta: placental transfer Foetus: changes at birth
PHARMACOLOGY
PRINCIPLES OF PHARMACOLOGY:
Dynamics of drug-receptor interaction
Agonists, antagonists, partial agonists, inverse agonists
Efficacy and potency
Tolerance
Receptor function and regulation
Metabolic pathways; enzymes; drug: enzyme interactions; Michaelis-Menten equation
Enzyme inducers and inhibitors.
Mechanisms of drug action Ion channels: types: relation to receptors.
Gating mechanisms.
Signal transduction: cell membrane/receptors/ion channels to intracellular molecular targets, second messengers
Action of gases and vapours Osmotic effectspH effectsAdsorption and chelation Mechanisms of drug interactions:
Inhibition and promotion of drug uptake.
Competitive protein binding.
Receptor inter-actions.
Effects of metabolites and other degradation products.
PHARMACOKINETICS & PHARMACODYNAMICS
Drug uptake from: gastrointestinal tract, lungs, nasal, transdermal, subcutaneous, IM, IV, epidural and intrathecal routes
Bioavailability
Factors determining the distribution of drugs: perfusion, molecular size, solubility, protein binding.
The influence of drug formulation on disposition
Distribution of drugs to organs and tissues:
Body compartments Influence of specialised membranes: tissue binding and solubility
Materno-foetal distribution
Distribution in CSF and extradural space
Modes of drug elimination:
Direct excretion
Metabolism in organs of excretion: phase I & II mechanisms
Renal excretion and urinary pH Non-organ breakdown of drugs
Pharmacokinetic analysis:
Concept of a pharmacokinetic compartment
Apparent volume of distribution
Orders of kinetics
Clearance concepts applied to whole body and individual organs Simple 1 and 2 compartmental models:
Concepts of wash-in and washout curves
Physiological models based on perfusion and partition coefficients
Effect of organ blood flow: Fick principle
Pharmacokinetic variation: influence of body size, sex, age, disease, pregnancy, anaesthesia, trauma, surgery, smoking, alcohol and other drugs
Effects of acute organ failure (liver, kidney) on drug elimination Influence of renal replacement therapies on clearance of commonly used drugs
Pharmacodynamics: concentration-effect relationships: hysteresis
Pharmacogenetics: familial variation in drug response
Adverse reactions to drugs: hypersensitivity, allergy, anaphylaxis, anaphylactoid reactions
SYSTEMIC PHARMACOLOGY
Hypnotics, sedatives and intravenous anaesthetic agents
Simple analgesics
Opioids and other analgesics; Opioid antagonists Non-steroidal anti-inflammatory drugs
Neuromuscular blocking agents (depolarising and non-depolarising) and anti-cholinesterases
Drugs acting on the autonomic nervous system (including inotropes, vasodilators, vasoconstrictors, antiarrhythmics, diuretics)
Drugs acting on the respiratory system (including respiratory stimulants and bronchodilators)
Antihypertensives
Anticonvulsants Anti-diabetic agents Diuretics
Antibiotics
Corticosteroids and other hormone preparations Antacids. Drugs influencing gastric secretion and motility
Antiemetic agents
Local anaesthetic agents Immunosuppressants
Principles of therapy based on modulation of inflammatory mediators indications, actions and limitations
Plasma volume expanders
Antihistamines Antidepressants Anticoagulants
Vitamins A-E, folate, B12
PHYSICS & CLINICAL MEASUREMENT
MATHEMATICAL CONCEPTS:
Relationships and graphs
Concepts of exponential functions and logarithms: wash-in and washout
Basic measurement concepts: linearity, drift, hysteresis, signal: noise ratio, static and dynamic response
SI units: fundamental and derived units
Other systems of units where relevant to ICM (e.g. mmHg, bar, atmospheres) Simple mechanics: Mass, Force, Work and Power
GASES & VAPOURS:
Absolute and relative pressure.
The gas laws; triple point; critical temperature and pressure
Density and viscosity of gases.
Laminar and turbulent flow; Poiseuille's equation, the Bernoulli principle apour pressure: saturated vapour pressure
Measurement of volume and flow in gases and liquids.
The pneumotachograph and other respirometers.
Principles of surface tension
ELECTRICITY & MAGNETISM:
Basic concepts of electricity and magnetism.
Capacitance, inductance and impedance
Amplifiers: bandwidth, filters Amplification of biological potentials: ECG, EMG, EEG.
Sources of electrical interference
Processing, storage and display of physiological measurements
Bridge circuits
ELECTRICAL SAFETY:
Principles of cardiac pacemakers and defibrillators : Electrical hazards: causes and prevention.
Electrocution, fires and explosions. Diathermy and its safe use
Basic principles and safety of lasers
Basic principles of ultrasound and the Doppler effect
PRESSURE & FLOW MONITORING:
Principles of pressure transducers
Resonance and damping, frequency response
Measurement and units of pressure.
Direct and indirect methods of blood pressure measurement; arterial curve analysis
Principles of pulmonary artery and wedge pressure measurement
Cardiac output: Fick principle, thermodilution
CLINICAL MEASUREMENT:
Measurement of gas and vapour concentrations, (oxygen, carbon dioxide, nitrous oxide, and volatile anaesthetic agents) using infrared, paramagnetic, fuel cell, oxygen electrode and mass spectrometry methods
Measurement of H+, pH, pCO2 , pO2
Measurement CO2 production/ oxygen consumption/ respiratory quotient
Colligative properties: osmometry
Simple tests of pulmonary function e.g. peak flow measurement, spirometry
Capnography Pulse oximetry
Measurement of neuromuscular blockade
Measurement of pain
RESEARCH METHODS
DATA COLLECTION:
Simple aspects of study design (research question, selection of the method of investigation, population, intervention, outcome measures)
Power analysis
Defining the outcome measures and the uncertainty of measuring them
The basic concept of meta-analysis and evidence based medicine
DESCRIPTIVE STATISTICS:
Types of data and their representation
The normal distribution as an example of parametric distribution
Indices of central tendency and variability
DEDUCTIVE & INFERENTIAL STATISTICS:
Simple probability theory and the relation to confidence intervals
The null hypothesis.
Choice of simple statistical tests for different data types
Type I and type II errors
Inappropriate use of statistics