Year 5 - MBChB
Updated: 29/11/2022
Year 5 is designed to co-ordinate your final undergraduate training culminating with entry into the Foundation Year Programme.
The Year 5 aims are threefold, ensuring Students are equipped for professional practice through:
- possession and understanding of a suitable and relevant knowledge base
- clinical competence across a wide range of skills relevant to the Foundation year and beyond
- demonstration of appropriate professional attributes and ongoing professional development
The major component of Year 5 is comprised of 6 integrated clinical placements, each of 4 weeks duration. Students rotate between placements including one placement in Primary Care, one with a musculoskeletal medicine/surgery focus and the remaining four placements covering a range of medical and surgical specialties to provide a balanced overall clinical experience in Year 5. At the end of the year there is a 15 day of Post-Finals Assistantship during the 4-week clinical placement immediately after main Finals exams.
Other teaching includes Infectious Diseases teaching during the first semester, Clinical Skills scenario-based teaching whilst on Primary Care placements, Year 5 RRAPID combined with ILS, and training in ultrasound guided peripheral access (MUST course).
Core Clinical Conditions
The core clinical conditions are categorised into three levels of knowledge.
List I ‘Act/Know About’ Core Clinical Conditions
For each of these conditions students knowledge should incorporate an understanding of the:
- basic scientific principles
- aetiology and epidemiology
- pathology
- presenting clinical features
- appropriate investigations
- differential diagnosis
- principles of management
- complications and outcome
- prevention of disease
For those conditions marked by an * (the ‘Act’ conditions), you should be competent to:
- initiate appropriate action
- prescribe appropriately, with basic knowledge of the doses of COMMON & EMERGENCY drugs
- recognise the limits of your own competence and know, how and to whom to refer
List II ‘Know of’ Core Clinical Conditions
These are conditions for which a less extensive knowledge is required at this stage in the student's education. The list indicates those conditions that students should:
- be aware of or have heard about
- be able to define
- consider in a differential diagnosis (if appropriate)
- know when and where to find out more about if necessary
Examination material can be derived from both List I and List II.
List III Core Clinical Presenting Problems
This list includes common presenting problems that Students will encounter as a newly qualified doctor in their Foundation Years. Students are expected to understand the science (anatomical, physiological, biochemical, psychological and pathological) underlying each of the presenting problems. Students will find this easier if they cross reference this list with the Core Clinical Conditions.
|
System |
List I - ‘Act’ core conditions | List I - Core conditions | List II - Less common “know of” conditions | List III - Core clinical problems for the student and new doctor |
| Blood | Anaemia – iron deficiency
Acute non-haemolytic reactions during transfusion
|
Macrocytic anaemia
Haemolytic anaemias Lymphomas Myeloma |
Disseminated intravascular coagulation
Sickle cell disease Haemophilia Thalassaemia Thrombophilia Thrombocytopenia Pancytopenia Neutropenia Bone marrow replacement Acute leukaemia Chronic myeloid leukaemia Chronic lymphocytic leukaemia
|
|
| Cardiovascular system | Cardiac arrest
Myocardial infarction Acute coronary syndrome Acute left ventricular failure Hypertension Chronic cardiac failure Deep vein thrombosis Acute limb ischaemia Superficial thrombophlebitis Cannula-related phlebitis Complete Heart Block Postural hypotension (not limited to CV causes) |
Stable angina
Atrial flutter Atrial fibrillation Heart block (all degrees) Re-entrant supra-ventricular tachycardia Ventricular tachycardia Mitral regurgitation & stenosis Aortic regurgitation & stenosis Infective endocarditis Pulmonary embolism Aneurysms Varicose veins Chronic lower limb ischaemia Abdominal aortic aneurysm |
Accelerated hypertension
Pericarditis Pericardial effusion Cardiomyopathy Aortic Dissection Mesenteric Ischaemia Superior Vena Cava thrombosis / obstruction Raynaud’s syndrome Lymphoedema
|
Chest pain Palpitations Collapse Painful limb Peripheral oedema |
| Emergency conditions | Anaphylaxis
Septic shock Cardiogenic shock Hypovolaemic shock Acute respiratory failure Cardiac arrest Overdose (paracetamol, salicylate, TCADs and Iron) Falls in the elderly (all causes) Acute and chronic confusion |
Spinal shock
Complications of shock Acute renal failure |
Collapse Coma Respiratory Arrest Cardiac Arrest Haemorrhage – internal and external Hypothermia |
|
| Endocrine system | Hypoglycaemia
Diabetic ketoacidosis
|
Type 1 diabetes
Type 2 diabetes Severe acute diabetic foot infection/ischaemia Graves’s disease Adrenocortical insufficiency (Addison’s Disease) Hypothyroidism Hyperparathyroidism Hypercalcaemia of malignancy Hyperlipidaemia |
Hypoparathyroidism
Thyroid Cancer Multinodular goitre Toxic nodule Simple goitre Thyroiditis Hypopituitarism Pituitary tumours Suppressed hypothalamo-pit-adrenal axis Phaeochromocytoma Cushing’s syndrome Adrenogenital syndrome Hyperaldosteronism Hypoaldosteronism Hirsuitism Hyperosmolar hyperglycaemic non ketotic coma Diabetes insipidus Syndrome of inappropriate ADH secretion |
Gynaecomastia Weight change Urinary frequency Hyponatraemia |
| Gastrointestinal system | Upper GI bleeding
Constipation Diarrhoea |
Malnutrition
Oesophagitis and reflux Oesophageal carcinoma Hiatus hernia Peptic ulcer Gastric carcinoma Carcinoma of pancreas Coeliac disease Acute pancreatitis Peritonitis Inguinal hernia Femoral hernia Incisional hernia Umbilical hernia Gallstones Cholecystitis Portal hypertension Viral hepatitis Cirrhosis Non-alcoholic fatty liver disease Ascites
Inflammatory bowel disease Diverticular disease Appendicitis Intestinal obstruction Ileus Colorectal carcinoma Irritable bowel syndrome Rectal prolapse Haemorrhoids Perianal abscess Anal fissure Sigmoid volvulus |
Achalasia
Gastritis Chronic pancreatitis Chronic hepatitis Subphrenic abscess Liver abscess Primary liver tumours Hepatic failure Epigastric hernia Colonic polyposis Anal Carcinoma Perianal Haematoma Fistula-in-ano Refeeding syndrome
|
Weight Loss
Dysphagia Dyspepsia Haematemesis Constipation Faecal incontinence Rectal bleeding Acute abdominal pain Abdominal swelling Jaundice Vomiting Diarrhoea
|
| Infection (not classified elsewhere) | Infection in surgical patients*
Infectious mononucleosis Severe sepsis Hospital acquired infection including Clostridium difficile enteritis/colitis Pyrexia of unknown origin
|
Pyrexia of undetermined origin
Human immunodeficiency virus (HIV) Influenza Measles Mumps Rubella Chicken-pox Whooping cough Infective gastro-enteritis Malaria Febrile traveller |
Febrile patient | |
| Musculoskeletal | Septic arthritis Temporal arteritis Spinal cord compression | Osteoarthritis
Osteoporosis Rheumatoid arthritis Polymyalgia rheumatica Gout/ Pseudogout Vasculitis Low back pain Fragility fractures Ankylosing Spondylitis Reactive arthritis |
Seronegative arthritis
Pagets and osteomalacia Bone tumours Connective tissue diseases e.g. SLE, scleroderma Soft tissue conditions e.g. rotator cuff tears, lateral epicondylitis
|
Back and /or neck pain Painful swollen and /or stiff joints Peripheral joint /joint region pains Painful limbs Difficulty walking The limping child Limb weakness |
| Nervous system | Stroke
Meningitis Acute confusional state Subarachnoid haemorrhage |
Status epilepticus
Cranial nerve lesions Peripheral nerve lesions Subdural haematoma Extradural haematoma Multiple sclerosis Parkinson’s disease Dementia Epilepsy Tension headache Migraine |
Brain Tumours Encephalitis
Fibromylagia Hydrocephalus Myasthenia Gravis Motor Neurone Disease
|
Pain Headache Fits Faints Collapse Coma Difficulty walking Hemiparesis/ Hemiplegia |
| Ear | Otitis media | Otitis externa
Ear wax Deafness Labyrinthitis (and the causes of dizziness) |
Cholesteatoma
Acoustic neuroma |
Earache Tinnitus Hearing loss Dizziness |
| Eye | Acute glaucoma | Cataracts
Corneal ulcers Stye Conjunctivitis allergic and infective Ocular foreign bodies Ocular trauma Diabetic retinopathy Hypertensive retinopathy |
Acute anterior uveitis
Ectropion Entropion Blepharitis Episcleritis/scleritis |
Acute Red Eye Loss of Vision Visual Failure Squint |
| Nose | Epistaxis
Nose trauma and foreign bodies Rhinitis Sinusitis |
Nasal Polyps | Epistaxis | |
| Skin | Acne
Eczema Psoriasis Warts Basal cell carcinoma Squamous carcinoma Melanoma Leg ulcers |
Solar Keratosis
Keloid scar Ganglion Vascular lesions of the skin Kaposi’s Sarcoma
|
Rash Lump in the groin Lump in the neck Lump in the skin
|
|
| Throat and mouth | Acute tonsillitis
Acute pharyngitis
|
Upper respiratory tract infection
Acute epiglottitis
|
Oral tumours
Trigeminal neuralgia |
Oral Ulceration Hoarseness Cervical Lump Globus Stridor |
| Psychiatry and mental health | Suicide and parasuicide – assessment and management
Dementia (common causes e.g. Alzheimer’s, multi-infarct, alcohol-induced); risk assessment of confused older adults
|
Adjustment disorders (acute and chronic), bereavement
Anxiety/panic attacks (assessment and initial management) Bipolar affective disorders (manic and hypomanic states) Pseudodementia Depressive disorders Eating disorders (bulimia and anorexia nervosa) Mental Health Act – principles of use Obsessional compulsive disorder Schizophrenia and paranoid disorders including drug-induced psychosis Somatisation |
Rarer dementias
Picks disease Creutzfeld Jakob AIDS related dementia Learning disability Post-traumatic stress disorder Phobic anxiety disorders (such as agoraphobia, social phobia, simple phobias) Personality disorders
|
Confusion/Delirium Aggression/Violence Depression Sleep Disturbance |
| Reproductive system | Torsion of the testis
Suspected ectopic pregnancy |
Genital warts
Genital herpes HIV – all manifestations Gonorrhoea Syphilis Prostatitis Male: Balanitis Phimosis/paraphimosis Erectile dysfunction Epididymo-orchitis Urethritis Testicular cancer Female: Breast fibroadenoma Breast cancer Breast abscess Gynaecological causes of abdominal pain Vaginal discharge Vaginal bleeding |
Female:
Fat necrosis of breast Fibrocystic disease
Male: Hypospadias Undescended testis |
Female: Vaginal discharge Discharging nipple Breast lump Male: Testicular swelling / pain Infertility
|
| Respiratory system | Acute asthma exacerbation
Acute exacerbation of COPD Hyperventilation (panic attack) Acute bronchitis Tension pneumothorax Pulmonary embolism Pneumonia
|
Asthma
COPD Non-tension-pneumothorax Pleural effusion Bronchial carcinoma Metastatic cancer – lung Sarcoidosis Cystic fibrosis Inhaled foreign body Tuberculosis Sleep disorders – obstructive sleep apnoea |
Bronchiectasis
Carbon Monoxide Poisoning Idiopathic pulmonary fibrosis Coalworkers’ pneumoconiosis Mesothelioma Asbestosis Lung abscess Empyema |
Chest pain Breathlessness Wheeze Cough Haemoptysis Cyanosis |
| Substance abuse | Paracetamol overdose | Opiate overdose
Aspirin overdose Alcohol Alcohol intoxication Alcohol withdrawal Cigarettes ‘Recreational’ drug abuse Solvent abuse |
Other drug/substance abuse | |
| Trauma | Compartment syndrome | Sprained ankle
Colles’ fracture Long bone fracture Hip fracture Head injury Hand sepsis Multi system trauma Assessing the injured limb |
Facial Injury
Shoulder fractures The injured hand Soft tissue knee injuries Foot and ankle fractures Pelvic and acetabular fractures Ilizarov frame surgery |
The severely injured patient Assessment of the injured limb Spinal cord compression |
| Urinary system | Urinary tract infection
Acute cystitis Acute pyelonephritis Prostatic acute urinary obstruction Severe hyperkalaemia |
Chronic kidney disease
Acute kidney injury Stress/other causes of incontinence Nephrotic syndrome Detrusor instability Bladder cancer Prostatic cancer Hydronephrosis Renal carcinoma Urethritis Urinary stones |
Adult polycystic disease
Urethral stricture Vesico-ureteric reflux Glomerulonephritis Orthostatic proteinuria
|
Loin Pain Dysuria Oliguria/Anuria Acute Retention of Urine Haematuria Incontinence |
Additional Information