Essential Revision Notes for MRCP Fourth Edition Dedication To my wife, Marian, and children, Michael, Gabriella and Alicia, who will always inspire Essential Revision Notes for MRCP Fourth Edition edited by Philip A Kalra MA MB BChir FRCP MD Consultant and Honorary Professor of Nephrology, Salford Royal NHS Foundation Trust and The University of Manchester © PASTEST LTD 1999, 2004, 2009, 2014 Egerton Court Parkgate Estate Knutsford Cheshire WA16 8DX Telephone: 01565 755226 All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permissions of the copyright owner First published 1999 Reprinted 1999 Revised edition 2002 Reprinted 2003 Second edition 2004 Third edition 2009 Reprinted 2009 Fourth edition 2014 ISBN: 905 635 92 978 905635 92 ePub ISBN: 978 909491 97 Mobi ISBN: 978 909491 96 A catalogue record for this book is available from the British Library The information contained within this book was obtained by the authors from reliable sources However, whilst every effort has been made to ensure its accuracy, no responsibility for loss, damage or injury occasioned to any person acting or refraining from action as a result of information contained herein can be accepted by the publishers or authors PasTest Revision Books and Intensive Courses PasTest has been established in the field of postgraduate medical education since 1972, providing revision books and intensive study courses for doctors preparing for their professional examinations Books and courses are available for the following specialties: MRCP Parts and 2, MRCPCH Parts and 2, MRCS, MRCOG Parts and 2, DRCOG, DCH, FRCA, MRCGP, Dentistry For further details contact: PasTest, Freepost, Knutsford, Cheshire WA16 7BR Tel: 01565 752000 www.pastest.co.uk Original design and typesetting by EDITEXT, Derbyshire (01457 857622) Fourth edition text prepared by Keytec Typesetting Ltd, Bridport, Dorset Printed and bound in the UK by Page Bros (Norwich) Ltd Fax: 01565 650264 enquiries@pastest.co.uk Contents Contributors to Fourth Edition Contributors to Third Edition Permissions Preface to the Fourth Edition CHAPTER Cardiology J E R Davies, S Nijjer Clinical Pharmacology, Toxicology and Poisoning S Waring Dermatology H Robertshaw Endocrinology T Kearney, S Giritharan, M Kumar Epidemiology J Ritchie Gastroenterology S Lal, D H Vasant Genetics E Burkitt Wright Genito-urinary Medicine and AIDS B Goorney Haematology K Patterson 10 Immunology J Galloway Infectious Diseases and Tropical Medicine 11 C L van Halsema 12 Maternal Medicine L Byrd 13 Metabolic Diseases S Sinha 14 Molecular Medicine K Siddals 15 Nephrology P Kalra 16 Neurology M Jones, C Kobylecki, D Rog 17 Ophthalmology K Smyth 18 Psychiatry E Sampson 19 Respiratory Medicine H Green 20 Rheumatology M McMahon 21 Statistics E Koutoumanou Index Contributors to Fourth Edition Emma Burkitt Wright MBChB PhD MRCP(UK) Specialist Registrar and Honorary Clinical Research Fellow, Manchester Centre for Genomic Medicine, Central Manchester University Hospitals Foundation Trust and University of Manchester, Chapter Genetics Louise Byrd MBBS, MRCOG, Dip RCR/RCOG Cert Medical Education Consultant in High Risk Obstetrics and Maternal Medicine with special interest in Medical Education, Central Manchester Foundation Trust, Manchester, Chapter 12 Maternal Medicine Justin E R Davies BSc, MBBS, PhD, MRCP Senior Research Fellow and Consultant Cardiologist, Imperial College London, Chapter Cardiology James Galloway MBChB, MRCP, MSc, PhD, CHP Clinical Lecturer / Honorary Consultant Rheumatologist, Department of Rheumatology, King’s College Hospital, London, Chapter 10 Immunology Sumithra Giritharan MBChB MRCP(UK) Specialist Registrar, Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Manchester, Chapter Endocrinology Ben Goorney MBChB FRCP Consultant Genito-Urinary Physician, Department of Genito-Urinary Medicine, Hope Hospital, Salford, Chapter Genito-Urinary Medicine and AIDS Heather Green BSc, MBChB (Hons), MRCP(UK), Certificate in Respiratory Medicine Respiratory Registrar/Research Fellow in Cystic Fibrosis, Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester, Manchester, Chapter 19 Respiratory Medicine Matthew Jones MD MRCP Consultant Neurologist and Clinical Teaching Fellow, Department of Neurology, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, Chapter 16 Neurology Philip A Kalra MA MB BChir FRCP MD Consultant and Honorary Professor of Nephrology, Salford Royal NHS Foundation Trust and University of Manchester, Chapter 15 Nephrology Eirini Koutoumanou BSc MSc Senior Teaching Fellow, UCL Institute of Child Health, Population, Policy, Practice Programme, London, Chapter 21 Statistics Tara Kearney MB BS, BSc(Hons), FRCP, MD Consultant Endocrinologist, Salford Royal Foundation NHS Trust, Manchester, Chapter Endocrinology Mohit Kumar MBChB MRCP Specialist Trainee, Department of Diabetes, Endocrinology and Weight Management, Salford Royal Foundation Trust, Salford Manchester, Chapter Endocrinology Simon Lal BSc MBChB PhD FRCP Consultant Gastroenterologist, Salford Royal NHS Foundation Trust, Salford, Chapter Gastroenterology Michael McMahon BSc MBChB FRCP Consultant Physician and Rheumatologist, Department of Rheumatology, Dumfries and Galloway Royal Infirmary, Dumfries, Chapter 20 Rheumatology Sukhjinder S Nijjer BSc (Hons) MBChB (Hons) MRCP(UK) Cardiology Registrar, Hammersmith Hospital and the International Centre for Circulatory Health, Imperial College London, Chapter Cardiology Keith Patterson FRCP FRCPath Consultant Haematologist, London, Chapter Haematology James Ritchie MBChB, MRCP PhD Clinical Research Fellow, Department of Renal Medicine, Salford Royal Hospital, Salford, Manchester, Chapter Epidemiology Helen Robertshaw BSc(Hons) MBBS FRCP Consultant in Dermatology, Royal Bournemouth and Christchurch Hospitals, Bournemouth, Chapter Dermatology David Rog BMedSci (Hons), BMBS, FRCP, MD Consultant Neurologist and Honorary Lecturer, Department of Neurology, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, Chapter 16 Neurology Liz Sampson MBChB MRCPsych MD MSc Clinical Senior Lecturer In Old Age Psychiatry, Division of Psychiatry, University College London Consultant in Liaison Psychiatry, Barnet Enfield and Haringey Mental Health Trust London, Chapter 18 Psychiatry Kirk W Siddals BSc PhD Research Fellow, Vascular Research, Salford Royal Hospital, Manchester, Chapter 14 Molecular Medicine Smeeta Sinha MBChB PhD MRCP FRCP Consultant and Honorary Senior Lecturer in Nephrology, Salford Royal NHS Foundation Trust, Salford, Chapter 13 Metabolic Diseases Katherine Smyth MBChB MRCP FRCOpth Consultant Ophthalmologist, Royal Bolton Hospital, Bolton, Chapter 17 Ophthalmology Clare L van Halsema MBChB MSc MD MRCP DTM&H Dip HIV Med Specialist Registrar in Infectious Diseases, Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, Manchester, Chapter 11 Infectious Diseases and Tropical Medicine Dipesh H Vasant MB ChB, MRCP(UK) Clinical Research Fellow and Specialist Registrar in Gastroenterology and Medicine, The University of Manchester Clinical Sciences Building, Salford Royal NHS Trust, Chapter Gastroenterology Stephen Waring PhD FRCP (Edin) FRCP FBPharmacolS Consultant in Acute Medicine & Toxicology, Acute Medical Unit, York Teaching Hospital NHS Foundation Trust, York, Chapter Clinical Pharmacology, Toxicology and Poisoning schistosomiasis ref1, ref2, ref3 schizophrenia ref1, ref2 sciatic nerve lesions ref1 sclera ref1 scleritis ref1, ref2 scleroderma ref1, ref2 diffuse ref1, ref2 localised ref1, ref2 renal crisis ref1, ref2 systemic see systemic sclerosis scleromalacia ref1 scrapie ref1 screening tests ref1 scurvy ref1 seborrhoeic dermatitis ref1 second messengers ref1, ref2, ref3 secretin ref1 seizures eclamptic ref1 epileptic ref1 history taking ref1 pregnancy ref1 see also epilepsy selectins ref1 selection bias ref1, ref2 selective noradrenaline re-uptake inhibitors (SNRI) ref1 selective oestrogen receptor modulators (SERMs) ref1 selective serotonin reuptake inhibitors (SSRIs) ref1 anxiety disorders ref1, ref2 depression ref1 obsessive compulsive disorder ref1 side-effects ref1, ref2 selegiline ref1, ref2 selenium-75 homotaurocholic acid (SeHCAT) retention test ref1 self-harm ref1 Sengstaken–Blakemore tube ref1 sensitivity, screening test ref1, ref2 sensorimotor neuropathy, HIV/AIDS ref1 sepsis ref1, ref2 septic shock ref1, ref2, ref3 seronegative (HLA-B27-associated) spondylarthropathies ref1, ref2 serotonin (5-HT) ref1 sertraline ref1, ref2 serum-free light chains (SFLC) ref1, ref2 sevelamer ref1 severe sepsis ref1 sex chromosome aneuploidies ref1 sexually transmitted infections ref1 Sézary syndrome ref1 SGLT-2 inhibitors ref1 Sheehan’s syndrome ref1 Shigella infections ref1, ref2 shingles see herpes zoster short stature ref1 shunt nephritis ref1 sick euthyroidism ref1 sickle cell disease ref1, ref2, ref3 sickle dactylitis ref1 sickle pain crisis ref1 sideroblastic anaemia ref1, ref2, ref3 sight impairment, certificate of ref1 sigmoidoscopy ref1 significance tests, statistical ref1, ref2 sildenafil ref1 silicosis ref1 Simpson’s paradox ref1 simvastatin ref1, ref2, ref3, ref4 single-photon absorptiometry (SPA) ref1, ref2 single ventricular circulation ref1, ref2 sinus node disease ref1 sinus of Valsalva’s aneurysm, ruptured ref1, ref2 sinus venosus defects ref1 sirolimus ref1, ref2 sitagliptin ref1, ref2 sitaxsentan ref1 β-sitosterolaemia ref1 sixth (VI) nerve ref1, 563 palsy ref2, ref3 Sjögren syndrome ref1 laboratory tests ref1, ref2 renal disease ref1 secondary ref1, ref2 skewed distributions ref1, ref2 skin ref1 skin cancer ref1, ref2 skin disorders/lesions ref1 bullous eruptions ref1 connective tissue disorders ref1 drug eruptions ref1 HIV/AIDS ref1, ref2, ref3 infections ref1 internal malignancy ref1 pigmentary ref1 rheumatoid arthritis ref1, ref2 specific dermatoses ref1 systemic disease ref1 terminology ref1 skin-prick tests ref1 skin tumours ref1 SLE see systemic lupus erythematosus sleep apnoea, obstructive ref1 sleep disorders ref1 sleeping sickness ref1 small-bowel enteroscopy ref1 small-cell lung cancer ref1, ref2, ref3 small-for-gestational age (SGA) infants ref1 small intestine ref1 bacterial overgrowth ref1, ref2 disorders ref1 infections ref1 villous atrophy ref1 Smith–Magenis syndrome ref1 smoking asthma and ref1 cardiovascular complications ref1 COPD ref1 lung cancer ref1, ref2 psoriasis and ref1 social interventions depression ref1 schizophrenia ref1 social phobia ref1 sodium renal handling ref1, ref2 see also hyponatraemia sodium bicarbonate ref1, ref2, ref3 sodium cromoglicate ref1 sodium valproate see valproate, sodium soft tissue infections ref1, ref2 SOM230 ref1 somatic cells ref1, ref2 somatisation disorder ref1 somatoform disorders ref1 somatostatin ref1 somatostatin analogues ref1 somatostatinoma ref1 sorbitol ref1 sotalol ref1, ref2, ref3 South American trypanosomiasis ref1 Spearman’s rank correlation ref1 specificity, screening test ref1, ref2 spherocytes ref1 spina bifida ref1 spinal cord anatomy ref1 blood supply ref1 complete transection ref1, ref2 disorders ref1, ref2 hemisection ref1, ref2 spinothalamic tracts ref1 spiramicin ref1 spirochaetes ref1, ref2 spirometry ref1 spironolactone ascites ref1 heart disease ref1, ref2 hyperaldosteronism ref1 mechanism of action ref1, ref2 spleen ref1 splenectomy ref1, ref2, ref3 splenic infarction, sickle cell disease ref1 splenic sequestration crisis ref1 splenic vein thrombosis ref1 splenomegaly ref1, ref2 spondyloarthropathies, seronegative (HLA-B27-associated) ref1, ref2 spontaneous bacterial peritonitis ref1 sputum examination ref1, ref2, ref3 squamous cell carcinoma cutaneous ref1 lung ref1 standard deviation (SD) ref1, ref2, ref3 standard error (SE) ref1 stanols ref1, ref2, ref3 staphylococcal infections endocarditis ref1, ref2 skin ref1 staphylococci, classification ref1 Staphylococcus aureus ref1 cystic fibrosis ref1 gastroenteritis ref1, ref2 pneumonia ref1 soft tissue infections ref1 toxic shock syndrome ref1 Starr–Edwards heart valve ref1 starvation ref1, ref2 statins (HMG-CoA reductase inhibitors) ref1, ref2, ref3 chronic kidney disease ref1 ischaemic heart disease ref1 secondary prevention ref1 side-effects/interactions ref1, ref2 transient ischaemic attack ref1 statistical inference ref1 statistical significance ref1 statistics ref1 steatorrhoea ref1 Steele–Richardson–Olszewski syndrome see progressive supranuclear palsy ST elevation ref1 stem cells ref1 peripheral blood (PBSCs) ref1 stem cell (bone marrow) transplantation ref1 aplastic anaemia ref1 leukaemia ref1, ref2, ref3 lymphoma ref1 myeloma ref1 sterilisation, female ref1 steroid hormones ref1, ref2 receptors ref1, ref2 steroids see corticosteroids steroid sulphatase deficiency ref1 sterols ref1, ref2, ref3 Stevens–Johnson syndrome ref1, ref2 Still’s disease ref1 stomach ref1 disorders ref1 streptococcal infections endocarditis ref1, ref2, ref3 rheumatic fever ref1 skin ref1 soft tissue ref1 streptococci classification ref1, ref2 group A ref1, ref2, ref3 group B ref1 group D ref1 toxic shock syndrome ref1 viridans-type ref1, ref2 Streptococcus pneumoniae (pneumococcal) infections empyema ref1 increased susceptibility ref1, ref2 meningitis ref1 pneumonia ref1, ref2 Streptococcus pyogenes see streptococci, group A streptokinase ref1, ref2, ref3 stress hormones ref1 stress polycythaemia ref1 stroke ref1 atrial fibrillation and ref1, ref2 haemorrhagic ref1, ref2 intravenous thrombolysis ref1 ischaemic ref1 risk factors ref1, ref2 secondary prevention ref1 sickle cell disease ref1 syndromes ref1 vascular dementia ref1 stroke volume index ref1 strongyloidiasis ref1 strontium ref1, ref2 ST segment, abnormalities ref1 Student’s t-test ref1 study designs, epidemiological ref1, ref2 Sturge–Weber syndrome ref1, ref2, ref3 subacute combined degeneration of spinal cord ref1 subarachnoid haemorrhage (SAH) ref1 subcutis ref1 subgroup analyses ref1 sudden cardiac death (SCD) ref1, ref2, ref3 suicide ref1, ref2 sulfadiazine ref1, ref2, ref3 sulfadoxine ref1 sulfamethoxazole ref1 sulfasalazine ref1, ref2, ref3 sulfonamides ref1 sulphinpyrazone ref1 sulphonylureas ref1 sumatriptan ref1, ref2 summary measures, statistical ref1 superiority trials ref1 superior vena caval (SVC) obstruction ref1, ref2, ref3 superoxide dismutases (SOD) ref1 supraventricular tachycardia (SVT) ref1, ref2, ref3, ref4 survival time ref1 sweating, episodic ref1 swimmers’ itch ref1 swinging flashlight test ref1 Synacthen tests ref1, ref2 syncope, neurocardiogenic ref1 syndrome of inappropriate ADH secretion (SIADH) ref1, ref2, ref3 syndrome X ref1 Syntocinon ref1 syphilis ref1, ref2 blood-borne transmission ref1 eye disease ref1 see also neurosyphilis syringomyelia ref1 systematic review ref1 systemic inflammatory response syndrome (SIRS) ref1 systemic lupus erythematosus (SLE) ref1 antiphospholipid antibodies ref1 autoantibodies ref1, ref2, ref3 C1q deficiency ref1, ref2 endocarditis ref1 investigations ref1 mental disorders ref1 nephritis ref1, ref2, ref3 prognosis ref1 pulmonary involvement ref1 skin features ref1 treatment ref1 systemic sclerosis ref1 pulmonary involvement ref1, ref2 renal disease ref1, ref2 skin features ref1, ref2 see also scleroderma systemic vascular resistance (SVR) ref1 T3 ref1, ref2 free (fT3) ref1, ref2, ref3 pregnancy ref1 reverse (rT3) ref1, ref2 T4 see thyroxine tabes dorsalis ref1, ref2, ref3 tachyarrhythmias ref1 tachycardia, broad-complex ref1 tacrolimus ref1 nephrotoxicity ref1, ref2, ref3 renal transplant recipients ref1 Taenia solium ref1 Takayasu arteritis ref1, ref2 Tamm–Horsfall glycoprotein ref1 tamoxifen ref1 Tangier’s disease ref1 tarazotene ref1 tardive dyskinesia ref1 target cells ref1 TATA box ref1 tauopathies ref1, ref2 tau protein ref1 T cells (T lymphocytes) ref1 deficiencies ref1 teicoplanin ref1 telbivudine ref1 temazepam ref1 temporal arteritis see giant-cell arteritis temporal lobe lesions ref1, ref2 tendon xanthomas ref1 tenecteplase ref1 tenofovir ref1, ref2, ref3 Tensilon test ref1 teratogenic agents ref1 teriflunomide ref1 teriparatide ref1, ref2 terlipressin ref1 testicular feminisation syndrome ref1, ref2, ref3 testosterone ref1 tetanus ref1 tetracyclines ref1, ref2, ref3, ref4 tetralogy of Fallot ref1 Th1 cells ref1 Th2 cells ref1 Th17 cells ref1, ref2 thalassaemia ref1 trait ref1, ref2 thalidomide ref1, ref2 thelarche ref1 T-helper cells ref1 see also CD4 (helper) T cells theophylline ref1, ref2 thiamine deficiency ref1, ref2, ref3 therapy ref1, ref2 thiazide diuretics ref1 heart failure ref1 hypercalciuria ref1 liver disease ref1 mechanism of action ref1, ref2 renal calculi ref1 thiazolidinediones ref1 thin basement membrane nephropathy (TBMN) ref1 thiopurine methyl transferase (TPMT) ref1 thioridazine ref1 third (III) nerve ref1, ref2, ref3 palsy ref1, ref2 thought disorder, schizophrenic ref1 thrombin time (TT) ref1 thrombocythaemia, primary (essential) ref1 thrombocytopenia ref1, ref2 thrombocytosis ref1 thrombolysis ref1 contraindications ref1 myocardial infarction ref1, ref2, ref3 pulmonary embolism ref1 stroke ref1 thrombophilia ref1 pregnancy in ref1, ref2 thrombophlebitis, migratory ref1 thrombosis ref1 complications of pregnancy ref1 contraceptive pill users ref1, ref2 see also venous thromboembolism thrombotic microangiopathies ref1 thrombotic thrombocytopenic purpura (TTP) ref1, ref2 renal involvement ref1, ref2 treatment ref1, ref2 thymectomy ref1 thyroid axis in illness ref1, ref2 in pregnancy ref1, ref2 thyroid-binding globulin (TBG) ref1, ref2, ref3, ref4 thyroid-binding prealbumin (TBPA) ref1 thyroid cancer ref1 thyroid disease ref1 autoimmunity ref1 pregnancy and ref1 see also hyperthyroidism; hypothyroidism thyroid eye disease ref1, ref2 thyroid function tests (TFTs) ref1, ref2 pregnancy ref1, ref2 thyroid gland ref1 drugs and ref1 ectopic tissue ref1 thyroid hormones metabolism ref1 therapy, depression ref1 see also T3; thyroxine thyroiditis ref1 post-partum ref1 thyroid nodules ref1 thyroid-stimulating hormone (TSH) ref1, ref2, ref3, ref4, ref5 thyrotoxicosis see hyperthyroidism thyroxine (T4) mechanism of action ref1, ref2 metabolism ref1 pregnancy ref1, ref2 replacement therapy ref1, ref2, ref3 serum free (fT4) ref1, ref2 ticagrelor ref1, ref2, ref3 tics ref1 tidal volume (TV) ref1, ref2 tigecycline ref1 time-varying risk ref1 tinidazole ref1, ref2 tiopronin ref1 tiotropium ref1 tirofiban ref1 tissue damage and repair, molecular mediators ref1, ref2 tissue Doppler imaging ref1 tissue plasminogen activator (tPA; alteplase) bronchiectasis ref1 myocardial infarction ref1, ref2 pulmonary embolism ref1 stroke ref1 tobacco-alcohol amblyopia ref1 tobramycin ref1 tocilizumab ref1, ref2 tocolytic agents ref1 tolvaptan ref1 tongue, disorders ref1 tonic deviation of eyes ref1 tonic pupil ref1 topiramate ref1 Torre–Muir syndrome ref1 torsades de pointes ref1 total lung capacity (TLC) ref1, ref2, ref3 Tourette syndrome ref1 toxic epidermal necrolysis ref1 toxic erythema ref1 toxic nephropathy ref1 toxic neuropathies ref1, ref2 toxicology ref1 toxic shock syndrome ref1 toxoplasmosis ref1 AIDS-related ref1, ref2, ref3 pregnancy ref1, ref2 tPA see tissue plasminogen activator trachoma ref1, ref2 tranexamic acid ref1 transcriptional silencing ref1 transcription factors ref1, ref2, ref3 transcriptome ref1, ref2 transcriptomics ref1 transferrin receptor, serum soluble ref1 transferrin saturation ref1, ref2, ref3 transforming growth factor β (TGF-β) ref1 transient elastography (Fibroscan) ref1 transient ischaemic attacks (TIAs) ref1, ref2, ref3 transjugular intrahepatic porto-systemic shunting (TIPSS) ref1 translocations ref1 malignant disease ref1, ref2 transmissible spongiform encephalopathies (TSEs) ref1, ref2 transoesophageal echocardiography (TOE) ref1, ref2 transplant immunology ref1 transposition of great vessels ref1, ref2 transpulmonary contrast echocardiography ref1 transudates ref1, ref2 transverse myelitis, longitudinally extensive ref1 Traube’s sign ref1 travellers, fever in returning ref1 travellers’ diarrhoea ref1 tremor ref1, ref2 treponemal tests ref1 Trichomonas vaginalis ref1 tricuspid regurgitation (TR) ref1 tricyclic antidepressants ref1, ref2 trientine ref1 trifluoperazine ref1 trigeminal neuralgia ref1 triglycerides ref1, ref2 drugs lowering ref1 triiodothyronine see T3 trimethoprim ref1, ref2 trinucleotide repeat disorders ref1, ref2 tripe palms ref1 triple X syndrome ref1 triploid ref1 triptans ref1 trisomy 13 ref1 trisomy 18 ref1 trisomy 21 (Down syndrome) ref1 trochlear nerve see fourth (IV) nerve tropical infections ref1, ref2 tropical spastic paraparesis ref1 tropical sprue ref1, ref2 troponin assays ref1 Trousseau’s sign ref1 Truvada ref1 trypanosomiasis ref1 T scores ref1 t-test ref1 tuberculin skin test ref1 tuberculosis (TB) ref1 diagnosis ref1, ref2 extremely drug-resistant (XDR-TB) ref1, ref2 gastrointestinal ref1 HIV/AIDS ref1 meningitis ref1, ref2, ref3 miliary ref1 multidrug-resistant (MDR-TB) ref1, ref2 myelitis ref1 pericarditis ref1 post-primary ref1 prevention ref1, ref2 primary ref1 pulmonary ref1 screening for latent ref1 treatment ref1, ref2 urinary tract ref1 tuberous sclerosis ref1 genetics ref1, ref2 ocular features ref1 renal cysts ref1 skin features ref1 tubulointerstitial nephritis (TIN), chronic ref1 tumour lysis syndrome ref1, ref2 tumour necrosis factor (TNF) ref1, ref2, ref3, ref4 tumour necrosis factor-α (TNF-α) ref1 tumour necrosis factor-α (TNF-α) blockers see anti-tumour necrosis factor-α agents tumour necrosis factor (TNF)-receptor gene superfamily ref1 tumour-suppressor genes ref1, ref2 tunnel vision ref1 Turner’s syndrome ref1, ref2, ref3 T wave changes ref1 type I error ref1, ref2 type II error ref1, ref2 typhoid ref1 tyrosine kinase inhibitors ref1, ref2, ref3 tyrosine kinases ref1, ref2, ref3 ulcerative colitis ref1, ref2 ulnar neuropathy ref1 ultrasonography antenatal screening ref1, ref2 endoscopic ref1, ref2 intracardiac ref1 intravascular ref1, ref2 liver ref1, ref2 pre-eclampsia ref1, ref2 renal ref1, ref2, ref3 ultraviolet (UV) radiation ref1, ref2, ref3 uncal herniation ref1 unconsciousness ref1 undifferentiated inflammatory arthritis (UIA) ref1 undulant fever ref1 uniparental disomy ref1 untranslated regions (UTR) ref1, ref2 upper airway disease cystic fibrosis ref1 granulomatosis with polyangiitis ref1 sarcoidosis ref1 upper gastrointestinal endoscopy ref1, ref2, ref3, ref4, ref5 upper gastrointestinal haemorrhage ref1, ref2 upper motor neuron lesions ref1 uraemia acute kidney injury ref1 prerenal ref1 urate oxidase ref1 urea breath test ref1 ureteric diversion, metabolic acidosis ref1 urethral syndrome ref1 uric acid ref1, ref2, ref3 urinalysis ref1 urinary albumin excretion ratio (UAER) ref1 urinary catheter-associated infections ref1 urinary dipsticks ref1 urinary protein selectivity index ref1 urinary tract changes in pregnancy ref1 obstruction ref1, ref2, ref3 tuberculosis ref1 tumours ref1 urinary tract infections (UTI) ref1, ref2 urine discoloration ref1 microscopy ref1 urobilinogen ref1 urography, CT ref1 urolithiasis see renal calculi urothelial tumours ref1 ursodeoxycholic acid ref1, ref2 urticaria ref1, ref2 Usher syndrome ref1 ustekinumab ref1 usual interstitial pneumonia (UIP) ref1 uterine artery waveforms, preeclampsia ref1, ref2 uveal tract ref1 uveitis ref1, ref2, ref3 vaccination ref1, ref2, ref3 hyposplenism/splenectomy ref1, ref2 inflammatory bowel disease ref1 UK schedule ref1, ref2 vaccine types ref1, ref2 valganciclovir ref1, ref2 valproate, sodium ref1, ref2, ref3, ref4 valvular heart disease ref1 vancomycin ref1, ref2, ref3, ref4, ref5 variables ref1 types of ref1 variance ref1 variceal haemorrhage ref1, ref2, ref3 varicella (chickenpox) ref1, ref2 varicella zoster virus (VZV) ref1 varices ref1 vascular access, haemodialysis ref1 vascular dementia (VaD) ref1, ref2, ref3 vascular disorders dialysis patients ref1 major vessels ref1 see also cardiovascular disease vascular endothelial growth factor (VEGF) inhibitors ref1, ref2, ref3 vascular tone, molecular regulation ref1 vasculitis ref1 aetiology ref1 ANCA-positive see ANCA-positive vasculitis classification ref1 clinical features ref1 CNS ref1 drug-induced ref1, ref2 large-vessel ref1, ref2 pulmonary ref1 renal ref1 retinal artery occlusion ref1 rheumatoid arthritis ref1 small-vessel ref1, ref2 vasoactive intestinal peptide (VIP) ref1, ref2 vasodilators ref1 vasopressin see antidiuretic hormone vemurafenib ref1 venesection, therapeutic ref1, ref2 venlafaxine ref1, ref2 venoms, animal ref1 venous thromboembolism (VTE) ref1, ref2 air travel in pregnancy and ref1 pregnancy ref1, ref2 prophylaxis ref1, ref2, ref3 risk factors ref1 ventilation ref1 changes in pregnancy ref1 ventilation/perfusion (V/Q) scanning ref1, ref2 ventilation pneumonitis ref1 ventilatory support ref1 ventricular angiography ref1 ventricular arrhythmias ref1, ref2, ref3 ventricular fibrillation ref1, ref2 ventricular septal defects (VSD) ref1, ref2 ventricular tachycardia (VT) ref1, ref2, ref3, ref4 vertebral artery dissection ref1 vertigo ref1 very-low-density lipoprotein (VLDL) ref1 vesicles ref1 vesicoureteric reflux (VUR) ref1, ref2 vestibular schwannoma ref1 vestibulocochlear nerve lesions ref1 VHL gene ref1 Vibrio cholerae ref1, ref2 vigabatrin ref1, ref2 vinblastine ref1 Vincent’s angina ref1 vincristine ref1 VIPoma ref1 viral infections blood-borne ref1 encephalitis ref1, ref2 haemorrhagic fevers ref1, ref2 hepatitis ref1 meningitis ref1, ref2 myelitis ref1 skin ref1 see also specific infections virilisation ref1, ref2 viruses ref1 visfatin ref1 vismodegib ref1 visual field defects ref1, ref2, ref3 driving standards ref1 visual impairment, certificate of ref1 visual obscurations, transient ref1 vital capacity (VC) ref1, ref2 vitamin A deficiency ref1 vitamin B1 see thiamine vitamin B2 deficiency ref1 vitamin B6 see pyridoxine vitamin B12 ref1 deficiency ref1, ref2, ref3 therapy ref1 vitamin C ref1, ref2 deficiency ref1 iron absorption and ref1, ref2 vitamin D dependent rickets ref1 function ref1, ref2 mechanism of action ref1, ref2 metabolism ref1 resistant rickets ref1 therapy ref1, ref2 vitamin D deficiency ref1 chronic kidney disease ref1 hypocalcaemia ref1, ref2 osteomalacia ref1 vitamin deficiencies ref1, ref2 vitamin E ref1 deficiency ref1 vitamin K ref1, ref2 deficiency ref1 vitiligo ref1 vitrectomy ref1 vitreous ref1 voltage-gated potassium channel complex (VGKC) antibody-mediated encephalitis ref1 volume of distribution (Vd) ref1 vomiting infectious causes ref1 metabolic alkalosis ref1 see also gastroenteritis von Hippel–Lindau syndrome ref1 ocular features ref1 phaeochromocytomas ref1 renal cysts ref1, ref2 skin lesions ref1 von Willebrand’s disease ref1 von Willebrand’s factor (vWF) ref1, ref2 v wave ref1 waist circumference ref1 Waldenström’s macroglobulinaemia ref1 Wallenberg syndrome ref1 warfarin ref1 atrial fibrilllation ref1 liver disease ref1 myocardial infarction ref1 pregnancy ref1, ref2, ref3, ref4 pulmonary embolism ref1 warming methods, hypothermia ref1 water deprivation test ref1 weal ref1 Weber’s test ref1 Wegener’s granulomatosis see granulomatosis with polyangiitis weight, hormonal regulation ref1 weight loss malnutrition ref1 type diabetes ref1 Weil’s disease ref1 Wernicke–Korsakoff syndrome ref1 Wernicke’s area ref1 Wernicke’s encephalopathy ref1, ref2 Whipple’s disease ref1 Whipple’s triad ref1 Whitaker’s test ref1 white cell count, raised ref1, ref2 white cell disorders ref1 Wickham’s striae ref1 Williams’ syndrome ref1, ref2, ref3 Wilms’ tumour ref1 Wilson’s disease ref1, ref2, ref3, ref4 Wiskott–Aldrich syndrome ref1 Wolffian ducts ref1 Wolff–Parkinson–White (WPW) syndrome ref1, ref2, ref3 Wolf–Hirschhorn syndrome ref1 Wuchereria bancrofti ref1 xanthochromia ref1, ref2 xanthogranulomatous pyelonephritis ref1 xanthomas ref1 X-autosome translocation ref1 X-chromosome inactivation ref1, ref2 x descent ref1, ref2 xenograft ref1 xeroderma pigmentosum ref1 xerophthalmia ref1 X-linked conditions ref1 XO karyotype see Turner’s syndrome XXX karyotype ref1 XXY karyotype see Klinefelter’s syndrome xylose absorption test ref1 XYY males ref1 y descent ref1, ref2 yeasts ref1 yellow nail syndrome ref1 Yersinia enterocolitica ref1 Young syndrome ref1 zidovudine ref1, ref2 zinc ref1 Zollinger–Ellison syndrome ref1, ref2 zoonoses ref1 zuclopenthixol ref1 .. .Essential Revision Notes for MRCP Fourth Edition Dedication To my wife, Marian, and children, Michael, Gabriella and Alicia, who will always inspire Essential Revision Notes for MRCP... Preface to the Fourth Edition I am delighted that Essential Revision Notes for MRCP’ has retained it’s place as one of the key texts for preparation for the MRCP over a period now extending beyond... layout within the Essential Revision Notes (ERN) with emphasis upon ‘user-friendliness’ with succinct text, bullet points and tables The doublecolumn format enhances readability and revision The aim