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FCPS Part I Syllabus Endocrinology

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FCPS Part I Syllabus Endocrinology Powered By Docstoc
					SYLLABUS
FOR FCPS ENDOCRINOLOGY AND METABOLISM

Published by : Bangladesh College of Physicians and Surgeons Mohakhali, Dhaka-1212.

Edition : July, 2004

BANGLADESH COLLEGE OF PHYSICIANS & SURGEONS
67, SHAHEED TAJUDDIN AHMED SARANI MOHAKHALI, DHAKA-1212, BANGLADESH

Printed by : Asian Colour Printing 130 DIT Extension Road Fakirerpool, Dhaka-1000 Phone : 8362258, 9357726

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This syllabus is divided in two broad parts. Part-A includes the general rules and regulations of Bangladesh College of Physicians and Surgeons for FCPS in specialty. Part-B includes the course and syllabus for FCPS Endocrinology and Metabolism Part-II (Final) examination.

PART-A
General Rules of Bangladesh College of Physicians and Surgeons for FCPS in Specialties Syllabus for Part-I Examination of FCPS in Specialties of Medicine

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General Rules of Bangladesh College of Physicians and Surgeons for FCPS in Specialties
Introduction Bangladesh College of Physicians and Surgeons has been conducting Fellowship examinations since its inception in a number of disciplines. Examinations in specialties of major disciplines have been introduced only recently. So far, these Fellowship examinations in specialties could only be taken after obtaining a Fellowship in the relevant major discipline. Additional Fellowship examination in specialties without obtaining a Fellowship in the relevant major subjects is also introduced. The course of FCPS in specialities will consist of 2 (two) parts, Part-I and Part-II (or Final part). The general structure of the Fellowship programme in specialties from Bangladesh College of Physicians and Surgeons will be as follows: The general rules for FCPS in specialities will vary according to the following categories of candidates: 1. Medical graduates only 2. Medical graduates with FCPS or MD / MS in relevant major subject (General Medicine, General Surgery, Obst. & Gynae, Paediatrics) 3. Medical graduates with MD / MS in relevant Speciality 1. Medical graduates A medical graduate who obtained full registration with BMDC shall have to undertake the following sequential examinations and training programme for FCPS in a Speciality. a. FCPS Part-I examination. The Part-I examination will consist of 3 papers on Basic medical sciences. Each paper will carry 100 marks with 50 MCQs. The questions in each paper will be 50% general basic type and 50% relevant major subject biased basic type (applied).

b. Successful candidates will then enter into a two years structured training in the relevant major subject after registration with the College. This training will be structured and monitored. A logbook is to be maintained. c. On completion of the training there will be an assessment examination.

d. Successful candidates of the assessment examination will proceed to three to five years (depending on speciality subject) structured training in the Speciality. This training will be structured and monitored. e. During this speciality training period the candidate will have to prepare a dissertation / thesis on a topic of the speciality. The dissertation / thesis must be defended by the candidate and accepted by the BCPS. Candidates completing the training and dissertation / thesis will then appear in the Part -II (Final) Fellowship examination in the speciality. Successful candidates will be declared to have obtained the Fellowship in their speciality.

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2. Medical graduate with FCPS or MD/MS (Dhaka University / BSMMU) in relevant Major subject (General Medicine, General Surgery, Obst. & Gynae, Paediatrics, Ophthalmology and Otolaryngology) A medical graduate who has already done FCPS or MD/MS in the relevant major subject will not be required to undertake Part-I examination and two years training in the relevant major subject. However, he will have to pass through the following sequential events for FCPS in speciality. a. Three to five years (depending on speciality subject) structured training in the speciality. This training will be structured and monitored. A logbook is to be maintained. During this speciality training period the candidate will have to prepare a dissertation / thesis on a topic of the speciality. The dissertation / thesis must be defended by the candidate and accepted by the BCPS.

b.

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c.

Candidates completing the training and dissertation / thesis will then appear in the Part -II (Final) Fellowship examination in the speciality. Successful candidates will be declared to have obtained the Fellowship in their speciality.

3. Medical graduate with MD / MS in relevant Speciality (Dhaka University / BSMMU) A medical graduate who has already done MD/MS in the relevant speciality will not be required to undertake Part-I examination and two years training in the relevant major subject. However, he will have to pass through the following sequential events for FCPS in speciality. a. Three to five years (depending on speciality subject) structured training in the speciality. This training will be structured and monitored. A logbook is to be maintained. During this speciality training period the candidate will have to prepare a dissertation / thesis on a topic of the speciality. The dissertation / thesis must be defended by the candidate and accepted by the BCPS. Candidates completing the training and dissertation / thesis will then appear in the Part -II (Final) Fellowship examination in the speciality. Successful candidates will be declared to have obtained the Fellowship in their speciality.

Training in Relevant Major Subjects Candidates who are successful at the Part-I examination can enter into this training programme. They will need to register their names with the College and obtain a logbook. The training will be of two-years duration in the relevant major discipline (General Medicine, General Surgery, Obst. & Gynae, Paediatrics). Alternatively, one and a half-year training in the major discipline and six months in a relevant speciality of the major discipline (except the speciality for which the candidate has been enrolled) will be acceptable. At least one year of the total training will need to be spent in a unit with emergency intake. Logbooks will need to filled-in appropriately by the candidate, signed by the supervisor, and countersigned by the hospital Director/Superintendent. Logbooks will be available in the College office. At the end of the training period, the completed logbook will need to be submitted. Certificates of successful completion of training/segments of training (not less than six months) from the relevant heads of hospital/institutions must be obtained and copies submitted to the College. After successful completion of two years training and assessment examination in relevant major subject the candidates will be eligible to enter into speciality training for three to five years (depending on speciality subject). Speciality Training After successful completion of two years training and assessment examination in relevant major subject, the candidates will proceed for training in the respective speciality. Candidates having FCPS in relevant major subject or MD/MS (Dhaka University / BSMMU) in relevant major subject or MD/MS (Dhaka University / BSMMU) in relevant speciality will directly enter into speciality training. The objective of the training will be to produce a competent specialist and teacher in that discipline who have an adequate knowledge base and proper training in necessary skills with proper aptitude expected of a specialist and is capable of upgrading his/her knowledge and skills with advances in their disciplines and will have some experience in clinical research.

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FCPS Part-I Examination Candidates with MBBS or an equivalent degree (recognized by BMDC) who have completed the internship programme and obtained full registration with the BMDC will be eligible to appear in the examination. Candidates must specify the speciality for which they wish to appear. They can appear in entry examination for one speciality only. The examination will consist of three written papers each carrying 100 marks and consisting of 50 Multiple-choice questions (MCQs). The questions in each paper will be 50% general basic type and 50% relevant major subject biased basic type (applied). Marks will be awarded as per rules laid down by the College. The examination will be held in January / July each year.

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There will be a course of ten working days duration on research methodology and medical statistics. This course will be organized by the College or will be approved by the College. Candidates will need to go through the course within six months of beginning the training. This in-course training in speciality will be of three to five years duration depending on the speciality subject. Training in clinical aspects of the discipline including assessment and management of outpatient and inpatient cases, acquiring experience in required skills, participating in clinical meetings, case discussions, journal clubs, death reviews, management of emergencies will be structured. A logbook for this training is to be collected from the College office. The logbook will be periodically monitored by the trainer and any shortcomings of the trainee will be corrected in course. Completed logbook and the certificate of completion of the training will need to be submitted before the Part-II examination. The candidate will be required to conduct a piece of supervised research during this period on new aspects of epidemiology, diagnosis or management of a disease in their discipline and will prepare a dissertation/thesis on it. The dissertation/thesis is to be defended by the candidate and accepted by the appropriate authority recognized by BCPS. General Medicine, General Surgery, Obst. & Gynae, Paediatrics, Ophthalmology and Otolaryngology may be taken as speciality and in that case additional two years training in General Medicine, General Surgery, Obst. & Gynae, Paediatrics, Ophthalmology and Otolaryngology will be required. FCPS Part -II Examination The Part- II examination will be held in January and July each year. Candidates will need to submit the following with their application: a. Evidence of 1) passing FCPS Part -I examination in the speciality or 2) having FCPS in relevant major subject or 3) MD/MS (Dhaka University, BSMMU) in relevant major subject or

4) having MD/MS (Dhaka University, BSMMU) in relevant speciality b. Copies of certificates of successful completion of two years training and assessment examination in relevant major subject. c. The completed logbook of speciality training d. Copies of certificates of successful completion of training in the speciality from the heads of hospitals / institutions. e. A dissertation/thesis prepared during the speciality-training period. This dissertation/thesis must be defended by the candidate and accepted by the BCPS. Prescribed fees

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g. Copies of photograph The block of assessment of examination will be equivalent to that of a specialist and member in the relevant discipline. The following will be the components: a. Two written papers consisting of short answer question, problem oriented questions and essay type questions. b. A clinical examination consisting of one long case and several short cases with different boards of examiners. c. An oral examination (one board) of twenty minutes duration. There will be another board for imaging materials, interpretation of laboratory reports, specimen, clinical photographs, problem oriented questions and operative surgery (in case of Surgical specialities).

Institutional requirements For training in relevant Major subjects All institutions that are currently recognized by the BCPS for training in the major disciplines (General Medicine, General Surgery, Obst. & Gynae, Paediatrics) will also be recognized for the training in relevant Major subjects of the specialty. For the recognition of new institution: Any institution that is newly recognized for training in the relevant major discipline by the BCPS will also be recognized for training in relevant Major subjects of the specialty.

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For Speciality Training All institutions/departments that are currently conducting a postgraduate course (MD or MS) in that speciality will be recognized for Speciality training in that speciality by the BCPS. New recognition will be considered after inspection by an expert team constituted by the BCPS. The following points will be taken into consideration. 1) Clinical facilities : Inpatient, outpatient, diagnostic, therapeutic and emergency services in that speciality. 2) Number and quality of teaching staff. 3) Academic activities of regular clinical meeting, journal clubs, seminars etc. 4) Academic facilities library, classrooms, clinical meeting rooms, audiovisual equipments, internet, computer etc. 5) Research background of the department.

Syllabus for Part-I Examination of FCPS in specialties of Medicine

Introduction Bangladesh College of Physicians and Surgeons (BCPS) is formed by President's Order No. 63 of 1972. It is founded as the highest body for conferring postgraduate qualifications in various disciplines of medical science. The ultimate goal is to bring about an improvement in the health and nutritional status of the people in the country. The College runs its Fellowship examinations twice a year. At present, the College runs FCPS exams in 21 disciplines including some specialties. The college aims to expand its programme of training and assessment of specialties so that a bigger number of specialists are included as Fellows of the College. The Fellowship exam is taken at two parts. Although divided into two parts, the FCPS is a single examination. FCPS Part-I Exam is not in itself a diploma, nor does it carry Membership status. The Part-I Exam assesses mainly basic knowledge pertinent to the particular clinical discipline. Three written paper of MCQs will be used as tools for evaluation. A candidate with MBBS or equivalent degree will be eligible to appear in the Part-I Exam after getting full registration from BMDC. After qualifying in the Part-I Exam the candidates will be required to undergo two years of structured training in General Medicine as detailed in appropriate section. After completion of the training the candidate will appear in the assessment examination. Requisites for appearing in the Final Exam are successful crossing of Part-I and assessment examinations, completion of a structured three years training in speciality in accredited centres and production of a dissertation/thesis accepted by BCPS. The final examination comprises written, clinical and oral components.

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The following sections will deal with the syllabus of FCPS (in specialties of Medicine) Part-I Examination. Purpose and Academic Aims The FCPS (in specialties of Medicine) has three main academic aims : To produce specialists in different specialities of Medicine who have adequate background knowledge and experience and necessary technical skills to deal with all problems of his/her specialty. To produce specialists with sound knowledge and experience in General Medicine. To provide a sound basis for continuing medical education. The practice of high quality Medicine necessitates that one has knowledge of important new advances in disease mechanism, an understanding of evidence based Medicine, and an ability to apply this knowledge and understanding in the management of patients. Preparation for the Examination will encourage the examinee to acquire relevant knowledge and understanding. It is important that examinee develops skills and acquire professional habits that will enable him to keep abreast of current medical knowledge and new developments. Preparation for the Examination will help him to develop such skills and professional habits. Hence, reading the medical literature and attending relevant medical meetings should be a normal part of professional life. The Part-I Examination is set at a level that is appropriate for medical graduates. The FCPS (in specialities of Medicine) Part-I Examination is designed to identify physicians who have a broad knowledge and understanding of common or important disorders as well as of basic sciences relevant to medical practice. Content of the Part-I Examination The examination will consist of three written papers each carrying 100 marks and consisting of 50 Multiple-choice questions (MCQs). The questions in each paper will be 50% general basic type and 50% relevant major subject biased basic type (applied).

Marks will be awarded as per rules laid down by the College. Topic-wise Distribution of Questions Topic General Aspects of Medical Practice Genetics Immunology Infections diseases and Tropical Medicine Cardiology Respiratory Medicine Gastroenterology Hepatology Neurology Endocrinology and Metabolic disorders Nephrology Disturbances in Water, Electrolyte and Acid-Base Imbalance Hematology Rheumatology Clinical Nutrition Principles of Medical Oncology Climate and Environmental Factors in Disease Principles of Geriatric Medicine Toxicology Dermatology Psychiatry Medical Statistics 8 5 1 1 1 1 1 2 2 4 Number 3 4 4 10 8 8 6 3 10 10 6 2

The questions on a particular body system should be divided in following three categories: 1. Clinically relevant basic information on the particular system, i.e., Anatomic, Physiological and Pathological basis of diseases pertaining to the system. Some standard textbook of Medicine (for example, Harrison's. Principles of Internal Medicine should be followed for preparing for such questions. Wherever appropriate, 20 to 30% of questions from a particular system

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should belong to this category. For example, out of 15 questions on Neurology 4 to 5 questions should cover Neuroanatomy, Neurophysiology and Neuropathology. Standard textbook of Medicine should also be used as guides for construction questions on Genetics and Immunology. 2. Clinical Assessment related to the particular system. These questions should relate to history taking and principles & procedure of examination. Standard textbooks of Clinical Methods (e.g., Hutchison's or McLeod's ones) should be utilized for developing such questions. 10 to 20% of questions from a particular system should belong to this category. For example, out of 15 questions on Neurology 2 to 3 questions should cover neurological history taking and examination. 3. Cardinal clinical and laboratory features and classification of diseases. Some simple textbook of Medicine (e.g., Davidson's) may be used for developing questions on this aspect. 30 to 50% of questions from a particular system should belong to this category. For example, out of 15 questions on Neurology 5 to 7 questions should cover Clinical and diagnostic Neurology. 4. Clinical Pharmacology of drugs used for treatment of diseases belonging to the particular system. Some standard textbook of Medicine should be followed for preparing such questions. 10 to 20% of questions from a particular system should belong to this category. For example, out of 15 questions on Neurology 2 to 3 questions should cover Neuropharmacology. Syllabus No syllabus can be comprehensive. Hence, this syllabus is indicative of those areas of knowledge with which examinee is expected to be familiar, but is not intended to be exhaustive or to exclude other items of knowledge, which are of similar relevance. The majority of questions will test knowledge in the broad areas specified. 1. Genetics Understanding of the structure and function of chromosomes and genes and knowledge of the principles of inheritance of chromosomal and genetic disorders. Examples of question topics might include: Inherited diseases Chromosome structure

Common chromosome abnormalities 2. Immunology Although a detailed knowledge of basic immunology and immunological diseases in not required, a sound working knowledge of the principles of immunomechanisms is required. Examples of question topic might include: Humoral and cell-mediated immunity Immunodeficiency syndromes Phagocytic dysfunction disease Complement deficiencies Hypersensitivities including allergies and autoimmune diseases Immunology and immunological tests A basic knowledge of the immune system in health and diseases. Examples of question topics might include : Common immunological laboratory tests Evaluation of patients with immune disease Intercellular communication and signal transduction Lymphocyte and phagocytic cell biology Antigen Presentation Humoral, cellular and mucosal immunity including THI and TH2 responses Inflammation Complement system and cytokines Hypersensitivity and autoimmunitys Clinical Conditions Ability to answer questions on the various immunodeficiency syndromes. Examples of question topics might include : Mechanisms of immunoldeficiency Antibody immunodeficiency disorders T-cell immunodeficiency disorders

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Combined antibody and cellular immunodeficiency disorders Phagocytic dysfunction, diseases Complement deficiencies The clinical characteristics and immediate management of acute allergic emergencies. Examples of question topics might include : Anaphylaxis Angio-oedema Urticaria Familiarity with immunology as applied to other medical diseases. Examples of question topics might include: Rheumatic disease (connective tissue diseases) Endocrine diseases (thyroid autoimmune diseases, diabetes mellitus, Addison's disease) Haematological diseases (pernicious anaemia, autoimmune haemolytig anaemai, idiopathic thrombocytopenic purpura) Gastroentestinal diseases (Coeliac disease, inflammatory bowel disease, hepatobiliary disease) Renal diseases (Goodpasture's syndrome, immunecomplex glomerulonephritis) Dermatological disease (discoid lupus, pamphigus, pemphigoid) Neurological diseases (demyelinating diseases, myasthenic syndromes) Management The principles of immunosuppressive therapy including major indications and side effects. Examples of question topics might include. Immunosuppressive drug therapy cytotoxic agents, and eyclosporin) (corticosteroids;

Intravenous immunoglobulin Monoclonal antibodies Bone marrow transplantation Examinee should know about the principles of immunisation and be familiar with vaccines currently in use. 3. General aspects of Medical Practice A sound understanding of attributes of a good physician. Examples of question topics might include : Doctor-patient relationship General aspects of history taking General physical examination Medical ethics Socio-demographic influences on pathogenesis and management of diseases Cost awareness in Medicine 4. Infectious Diseases and Tropical Medicine Microbiology Understanding the major taxonomy of bacteria in terms of Gramstaining and aerobic/anaerobic metabolism. Virus classification is not important except for members and characteristics of the herpes group. Virus replication with reference to retroviruses should be understood. Major pathogenic protozoa and helminths should be known. Examples of question topics might include: Aerobic or anaerobic bacteria Gram-staining characteristics of bacteria Immunology of infectious diseases Understand immune deficiency states linked with types of opportunistic infections. Principles of immunization and knowledge of vaccines currently used should also be known. Examples of question topics might include: Opportunistic infections Immunization policy

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Pathophysiology A basic understanding of : Septic Shock ARDS Epidemiology Knowledge of the principles of epidemiology relevant to infectious diseases. Examples of question topics might include: Mechanisms of transmission of pathogens How epidemics happen Knowledge of carrier states, reservoirs, vectors and zoonoses Elementary concepts of the control of communicable diseases (including immunization isolation, contact tracing, chemoprophylaxis of close contacts) Broad awareness of geographical variation in disease including TB, HIV, Hepatitis B, Malaria. Treatment The board indications for, and major adverse effects of, commonly employed antimicrobial agents. Examples of question topics night include: B-lactamas Tetracyclines Macrolides Aminoglycosides Quinolines Trimethoprim Metronidazole Antituberculous drugs Antimalarial drugs Antiviral agents Specific infection Knowledge of the characteristics, recognition, prevention, eradication and pathological effects of all commonly encountered

bacteria, viruses, rickettsia, fungi, protozoa, parasites. and toxins, including and understanding of the principles of infection control, will be required. Special attention to differential diagnosis, appropriate investigations and awareness of when presumptive therapy is indicated is essential. Examples of question topics might include : Tuberculosis Cholera and other infective diarrheas Pneumococcal infections Meningitis Typhoid fever Sexually transmitted diseases Influenza Mumps Dengue AIDS Malaria Visceral leishmaniasis Amebiasis Candidiasis Tineas Subcutaneous and deep mycoses Scabies 5. Cardiology Anatomy and physiology Knowledge of the basic anatomy and physiology of the heart in health and disease : Examples of question topics might include : Clinically relevant normal anatomy of the heart, coronary arteries great vessels Determinants of heart rate and rhythm Cardiac function Cardiac condition Cardiac output

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Vascular tone Blood pressure Coronary blood flow Genesis of heart sounds Pathophysiology and pathology The mechanisms underlying the main pathological processes Examples of question topics might include : Thrombosis Infarction Atherogenesis Hypertrophy Heart failure Cardiomyopathies Dysrhythmias Hypertension Cell biology Examinee does not need detailed specialized knowledge of cell biology, as only topics of proven clinical relevance will be tested. Examples of question topics might include: Excitation-contraction process Molecular and cellular aspects of hypertrophy of the myocardium and of vascular smooth muscle Clinical pharmacology The indication for drug therapy in cardiac disease and understand the actions, interactions and side effects of the drugs used. The emphasis will often be on new drugs or on novel applications or newly observed side effects of established drugs. Details of drug dosage are asked only rarely. Clinical cardiology The clinical features and management of the cardiac disorders encountered in hospital practice by the general physician, though

detailed specialist knowledge is not expected. Examinee should have knowledge of risk factors. Examples of question topics might include: Clinical features of constrictive pericarditis, cardiac tamponade, endocariditis, valvular heart disease Management of coronary syndromes Management of cardiac failure Management issues in atrial fibrillation Indications for and types of, permanent pacemaker Knowledge of important changes in clinical practice, following the publication of major clinical trials, is likely to be tested. Examples of question topics might include: Use of ACE inhibitors after myocardial infarction Use of HMG CoA reductase inhibitors in primary and secondary prevention of coronary morbidity and mortality Use of beta-adrenoceptor blocking drugs in left ventricular dysfunction Examinee should know the : Indications for invasive and non-invasive cardiac investigation Principles of these investigative methods, their limitation and the clinical relevance of the results Knowledge of the practical aspects of the investigative techniques is not required. Examples of question topics might include: Common ECG abnormalities Basic echocardiographic abnormalities such as hypertrophic obstructive cardiomyopathy or pericardial effusion Indications for coronary angiography

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6.

Respiratory Medicine

Cystic fibrosis Anti-protease deficiency Clinical pharmacology The indication for, and mechanisms of action of, drugs used in respiratory disease together with their interactions and side effects should be known. Important respiratoery complications of other drugs, e.g., NSAIDs and beta blockers should also be understood. Clinical conditions The clinical features, investigation and management of respiratory disease likely to be encountered by a general physician must be known. Examples of question topics might include : Pleural effusion Chest pain Haemoptysis Breathlessness The impact of systemic disease on the respiratory system should be known. Examples of question topics might include : Vasculitis Neuromuscular diseases HIV infection Examinee should know how to assess respiratory malignant conditions and understand the general principles of ontological management including the indication for surgery. The indications for specialized investigations, including bronchoscopy, CT scanning, lung biopsy, lung volumes and exercise testing should be known. Knowledge on the control of Mycobacterium tuberculosis infection.

Anatomy and physiology Understanding clinically relevant anatomy of the upper and lower respiratory tract and thorax including radioloeical anatomy. Knowledge of the principles of respiratory physiology including : How respiration is controlled Principal of gas exchange and oxygen transport Ventilation - perfusion relationship Lung volumes and transfer factor Respiratory aspects of sleep and exercise physiology Examinee should understand the: Physical, humoral and cellular aspects of respiratory defence mechanisms Physiology of the proteinase inhibitors and pulmonary surfactant Pathophysiology and pathology Understanding the effects of disease on pulmonary physiology and anatomy including: The pulmonary and bronchial circulations and gas exchange Adaptations to chronic hypoxemia Pleural fluid production and reabsorption The application of the basic immunological process to pulmonary pathology including : Asthma Tuberculosis Examinee should possess knowledge of humoral and cellular immunodeficiency states and sequelae. The microbiology of acute and chronic respiratory infections should be known. Cell biology and genetics Examinee should have knowledge of Lung inflammation and repair Vasculitis

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Exclusions Knowledge of detailed pulmonary mechanics, oncology drug regimens, drug therapy of environmental mycobacterial infection, inhalation drug kinetics and detailed histological descriptions is not required. 7. Gastroenterology Clinical science Structure and function of the gastrointestinal and hepatobilary tract Neurohormonal control of gut motility Secretory and absorptive functions of the gastrointestinal tract and liver Symptoms and signs of gastrointestinal, hepatobiliary and pancreatic disease Genetics of the more common gastrointestinal and liver disorders Clinical pharmacology of drugs used in gastrointestinal disorders including their actions, interactions and adverse effects Examples of question topic might include: Control of gastric acid secretion Autonomic control of gut function Effects of cholinergic, adrenergic and serotonergic agents on gut function Disorders of the mouth, tongue and salivary glands An understanding of : Mouth ulcers, periodontal and salivary disorders Oral manifestation of systemic and dermatological disorders Examples of question topic might include: Causes of mouth ulcers and their management Skin disorders commonly involving the buccal Mucosa

Disorders of the esophagus and stomach Familiarity with the following disorders: Achalasia Carcinomas Dyspepsia Peptic ulceration Gastrointestinal hemorrhage Examples of question topic might include : Control of HCL secretion by the parietal cells Role of Helicobacter-associated gastritis in peptic ulcer disease Management of acute upper gastrointestinal bleeding Functional disorders Functional chest pain and functional dyspepsia Irritable bowl syndrome and functional abdominal pain Functional constipation and diarrhoea Neural control of viseral nociceprtion and gut motility Role of emotional and psychosocial factors in illness Management of chronic pain and the use of painmodifying drug therapy Disorders of the small intestine Malabsorption syndromes Examples of question topic might include : Investigations commonly used in the assessment of suspected malabsorption Disorders of the liver, biliary tree and pancreas Bilirubin metabolism and the enterohepatic circulation of bile acids Causes of jaundice and cholestasis Common pancreatic disorders including carcinoma Fulminant liver failure Acute and chronic hepatitis Drugs, toxins, alcohol and the liver

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Examples of question topic might include : Aetiology, clinical and histopathological features of acute and chronic parenchymal disorders of the liver Aetiology, presentation and management of acute and chronic pancreatitis Inflammatory bowel diseases and gut infections Familiarity with : Infective gastroenteritis Parasitic and protozoal gut infections Ulcerative colitis Examples of question topic might include : Causes, investigation and management of acute and chronic enteric disorders Colorectal disorders Examinee should have knowledge of Polyps Carcinomas Anorectal disorders 8. Neurology Neuroanatomy Examines is not expected to have detailed knowledge of neuroanatomy. Questions with an anatomical bias will be confined to circumstances where and understanding of anatomical structure is of critical importance in appreciating the localization of a particular neurological problem. Examples of question topic might include: The clinical features of a lesion in different parts of the brain The manifestations of a particular nerve root or peripheral nerve disorder The organization of pathways within the spinal cord.

Neurophysiology Detailed knowledge of neurophysiology is not expected but, as with neuroanatomy, certain aspects of the subject are particularly relevant to the understanding of neurological disease and may be tested. Examples of question topic might include: The formation, circulation, absorption and content of the cerebrospinal fluid Aspects of cerebral blood flow Functions of basal ganglia, hypothalamus, cerebellum Muscle tone, reflexes Cell biology Questions in this area will relate to advances in the cellular mechanisms of certain neurological disease process which have provided better understanding of disease mechanisms and which might, in the future, lead to more rational therapy. Examples of question topic might include : The role of the dopaminergic and cholinergic systems in various disorders The role of other neurotransmitters in certain diseases, for example, in Alzheimer's disease Neuropharmacology Examinee is expected to have some knowledge of new drug developments in neurology, as well as the established drug therapies. Examples of question topic might include : The role of some recently introduction anticonvulsants The present status of immunosuppressant therapy in multiple sclerosis Neuropathology Although it not expected to have a detailed knowledge of neuropathology, examinee will be expected to have outline knowledge of the pathological aspects of some common diseases,

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for example, multiple sclerosis, Parkinson's disease and Alzheimer's disease. Clinical neurology Questions in the field of clinical neurology will test knowledge of the more common disorders. There will be emphasis on clinical features, which have been shown to be of diagnostic value. The choice of subject matter will be influenced by areas of recent advance, particularly those which have either led to better definition of disease entities, or have led to their improved management. In the field of cerebrovascular Medicine, examples of question topic might include: Epidemiological aspects, in particular the risk factors for stroke The evidence for the role of anti-platelet agents in transient ischetmic attacks. 9. Clinical Haematology Knowledge of the following Physiology, control and function of formed blood elements Bone marrow structure and function Applications of biochemistry, genetics, immunology, and virology blood disorders Effects of age and pregnancy on blood disease Splenomegaly, lymphadenopathy, and their causes Principles and hazards of blood and blood product replacement therapy Principles of marrow transplantation Adverse effects of drugs on the bloods Iron metabolism An understanding of : Physiology of iron, including its absorption Iron overload Iron deficiency states including diagnosis, causes and treatment

Iron metabolism, including anaemias of chronic disorders and sideroblastic anaemias Megaloblastic anaemias Examinee should understand the physiology of vitamin B12 and folic acid and the mechanisms and investigation of deficiencies and their management. Examples of question topics might include : B12 deficiency Folate deficiency Haemolytic anaemias Understanding the: Mechanisms of shortened red cell survival Features and management of congenital and acquired haemolytic states Molecular pathology of thalassaemia and common haemoglobinopathies Examples of question topics might include: Causes of haemolysis Diagnosis of haemolytic anaemia Other anaemias Anaemias complicating systemic disease Aplastic anaemia Myelodysplastic syndromes Polycythaemia and myeloproliferative disorders The causes, investigation and management of polycythaemia and myeloproliferative disorders. White cell disorders Examinee should understand the: Physiology of leucocytes Leucocytosis and leucopenia Acute and chronic leukaemias, including diagnosis, management and prognosis

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Lymphoproliferative diseases including Hodgkin's disease, non-Hodgkin's lymphomas, and plasma cell dyscrasias Disorders of haemostasis Knowledge of : Platelet function and coagulation Thrombocytopenia and impaired platelet function Thrombocytosis Common congenital and acquired disorders of coagulation (especially anticoagulant therapy and disseminated intravascular coagulation) 10. Endocrinology Although examinee is not expected to have a detailed knowledge of biochemistry, it is anticipated that he will have an insight into the mechanisms of hormone action and the importance of receptors and substances involved in control of intracellular metabolism. Examinee should have knowledge of the clinically relevant anatomical aspects of this specialty. Examples of question topic might include: Factors involved in cell signaling Anatomical relationships of the pituitary gland The cell types in the pancreatic islets A broad understanding of the pathways of carbohydrate, protein and fat metabolism Endocrine tests in routine clinical use Hypothalamus / pituitary Detailed knowledge of the structure of the pituitary and hypothalamic hormones is unnecessary. However, knowledge of the endocrine system will be required. Examples of question topic might include : The physiology and pathophysiology of control of pituitary hormone secretion The mechanisms of maintaining plasma osmolality Tests of pituitary hormone secretion

Pituitary diseases such as acromegaly, prolactinoma and Cushing's syndrome Drugs used in the treatment of pituitary disease Pituitary replacement therapy Thyroid Since thyroid disease is common examinee is expected to have a broad knowledge of the mechanisms of thyroid disease, its clinical presentation and treatment. Examples of questions topic might include: Thyroid hormone biosynthesis and its control Important drugs interfering with thyroid function Indications for use of various types of thyroid function tests Autoimmunity and the thyroid Clinical features of thyrotoxicosis and hypothyroidism Goiter and its management Thyroid neoplasia Adrenal A detailed knowledge of mechanisms of steroid biosynthesis is not required, but it is expected to have some knowledge of those parts, which are clinically important. knowledge of those parts, which are clinically important. Examples of question topic might include : Tests for adrenocortical function Endocrine causes of hypertension and their differential diagnosis Clinical features and management of adrenal hyper-and hypodunction Complication of steroid therapy

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Testis It is not expected to have a detailed knowledge of the urological investigation of infertility but some concept or relevant investigations and of the endocrine aspects of testicular function is required. Examples of question topic might include : The aetiology of hypogonadism both primary and secondary Causes of male infertility related to general medical diseases and its treatment Causes of erectile dysfunction and its investigation Androgen replacement therapy Parathyroid/bone Detailed knowledge of the anatomy and physiology of bone metabolism is not required. Examinee is expected however to have some broad concept of the control of bone turnover and the disorders which can result in its failure. Examples of question topic might include : Control of calcium metabolism Laboratory tests of parathyroid function The causes of hypercalcaemia The mechanisms of osteomalacia Hyperpatathyroidism, both primary and secondary The prophylaxis and treatment of osteoporosis Diabetes mellitus It is expected to have detailed knowledge of this very common condition. Examples of question topic might include: Control of carbohydrate metabolism Aetiology of type 1 diabetes and type 2 diabetes Insulin resistance Management of diabetic emergencies

Disorders of lipid metabolism Although a detailed knowledge of lipid metabolism is not required, it is expected to have an understanding of the importance of this group of disorders. Examples of question topic might include : Control of cholesterol metabolism Etiology of different types of hyperlipidemias including both cholesterol and triglyceride disorders Indications for complications 11. Nephrology Physiology Knowledge of : Discrete functions of glomerular ultrafiltration and tubular function Proximal and distal parts of the nephron, with particular reference to control of water and electrolyte balance. Renal tubular acidosis Fluid, Electrolyte, and acid-balance disturbances Glomerular and tubular disorders It is expected to have some knowledge of glomerular ultrastructure based upon techniques of light microscopy, electron microscopy and immunofluorescence as applied to renal biopsy. These techniques form the basis of current understanding of primary glomerular disorder as in idiopathic glomerulonephritis, and nephropathies of systemic diseases. Examples ofquestion topic might include : Primary glomerular disorders Diabetic nephropathy SLE Hypertensive nephrosclerosis lipid lowering agents and their

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Examinee should be acquainted with the metabolic sequelae of acute nephritis and nephrtic syndromes. He should be aware of the investigation and assessment of glomerular and tubular disorders, including ultrasonic studies and nuclear Medicine. He should have and understanding of disturbed renal and metabolic functions in nephritic syndrome from a variety of causes. Knowledge of intestinal nephritis (especially those cases with reversible etiology such as drugs, heavy metals and analgesics) is expected. Infection of the kidney Examinee should be familiar with the management of urinary tract infections including their detection, predisposing factors, prevention and treatment. A knowledge of anatomical abnormalities leading to repeated urinary tract infection is expected. Examples of questions topic might include : ULTs Examinee should be aware of other infections that could affect the kidney by direct invasion or by immune complex deposition. Examples of question topic might include infection of the urinary tract with : Mycobacteria HIV CMV HBV HCV Acute and chronic renal failure Knowledge of the management of acute and chronic renal failure of the disturbed physiolgy involved is expected. You should be familiar with pathophysiological changes and non-dialytic treatment in different stages of progressive renal failure. Knowledge of the principles of nutritional requirement and dietary intervention for patients with chronic renal failure is required. Other therapeutic means to slow down the progression of renal failure should be understood.

Hypertension and renal problems in pregnancy It is expected to be familiar with renal adaptation to pregnancy, the management and prophylaxis of renal disease and hypertension in pregnancy. Drugs and the kidney Knowledge of the role of the kidney in the normal elimination of drugs is expected and you should understand the mechanisms by which drugs cause nephrotoxic damage. The principles of dose adjustment according to residual renal function should be known. Renal replacement therapy Knowledge of different dialysis modalities and their complications is expected. Examinee should know the complications related to immunosuppressive therapy following renal transplantation. 12. Fluid Electrolyte and Acid-Base Imbalance Knowledge of physiology of Fluid, Electrolyte and Acid-Base balance and pathophysiology of its imbalances. Examples of question topics might include : Hypo-or hyper - kalemia Hypo-or hyper-natremia Acidosis and alkalosis SIADH 13. Rheumatology Detailed knowledge of all the rheumatic conditions is not required. However, examinee should have a sound working knowledge of the basic principles of the common musculoskeletal conditions. Examples of question topics might include : Inflammatory arthritis Back pain Periarticular disorder Osteoarticular disorder Osteoarthritis

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Connective tissue disease Bone diseases Clinical Science Basic physiology, biochemistry, anatomy and pathology relating to musculoskeletal disease should be known. Examples of question topics might include : Physiology of pain Physiology of inflammation Urate metabolism Bone metabolism Applied anatomy, particularly of cervical and lumbar nerve roots, and of peripheral nerves commonly involved in disease The pathology of the common rheumatic condition should be known. Examples of questions topic might include pathological findings in : Rheumatoid arthritis Osteoarthritis Connective tissue diseases Bone diseases Clinical Conditions : The relative prevalence and major associations of the common rheumatological conditions. Examples of questions topic might include the relationship to: Age Gender Genetic influences Environmental influences Occupational influences Able to answer question on the symptoms and signs of the rheumatic diseases.

Examples of question topic might include : Rheumatoid arthritis and associated syndromes Seronegative spondyloarthirits (ankylosing aspondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis) Osteoarthritis Crystal arthritis (gout, pyrophosphate arthritis) Connective tissue disease (systemic lupus erythematosus, sjogren's syndrome, scleroderma, polymyositis/ dermatomyositis) Polymyalgia rheumatica and giant-cell artheritis Systemic vasculitic syndromes Bone disorders (Osteoporosis, osteomalacia) Familiarity with arthritis associated with other medical conditions. Examples of question topic might include : Sarcoidosis Erythema nodosum Infections and arthritis (e.g. Parvovirus B 19) Investigations Knowledge of the investigations relevant to the diagnosis and assessment of rheumatic diseases. Examples of the question topic might include: Acute phase proteins Immunological tests relating to the connective tissue diseases (rheumatoid factor, ANA, anti-dsDNA, ANCAs, etc.) Contemporary imaging techniques in rheumatology (xray, ultrasound, MR imaging)

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Management Examinee should be able to answer questions on the management of rheumatic disease. Examples of question topics might include : Drug related therapies (indications and contraindications, adverse effects, drug interactions. Simple analgesics Non-steroidal anti-inflammatory drugs Corticosteroids Allopurinol Disease modifying anti-rheumatic drugs Immunosuppressive drugs 14. Clinical Nutrition Familiarity with : Nutritional requirements in health Assessment of nutritional status Nutritional deficiency states Primary nutritional disorders Examples of question topic might include : Calorific requirements Body water distribution Derivation of the body mass index Protein caloric malnutrition Essential dietary constituents Vitamin requirements Pathogenesis and management of obesity 15. Principles of Medical Oncology Examinee should have a good understanding of pathogenesis of neoplasia, behavior of the cancer cells and principles of management of neoplastic disorders.

Examples of question topic might include : Etiology of neoplasms Staging of neoplasms Paraneoplastic syndromes Principles of chemotherapy Principles of endocrine therapy Management of cancer pain 16. Clinical Toxicology Examinee should understand the principles of management of patients who have been poisoned with drugs or other toxic substances. This should include assessment, recognition of common symptom patterns, principles of removal of toxic substances, and their antidotes where these approaches may be appropriate. Examples of question topic might include : Organophosphorus poisoning Atropine/datura poisoning Ethanol poisoning Methanol poisoning Benzodiazepine poisoning Tetrodotoain poisoning Snake bite 17. Principles of Geriatric Medicine Awareness of anatomic and physiological changes with aging, common age-related disorders and drug pharmacokineties in the elderly. Examinee should have Knowledge of Physiological effects of aging Immobility Falls Stroke rehabilitation Drug treatment in the elderly

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18. Psychiatry Mental state Understanding the conduct and scope of a mental state examination. It is expected to be familiar with features of abnormal mental states and particularly those that present commonly to physicians and to Accident and Emergency Department. Etiological factors in psychiatric illness Understanding the primary etiological factors in psychiatric areas including Genetic factors Environmental factors Life events Investigations Familiarity with the potential value of, and indications for common laboratory procedures used in psychiatric illness including: Psychometric testing EEG Brain imaging Syndromes of psychiatric disorders and their treatment Knowledge of Organic brain syndromes (delirium, dementia, focal brain syndromes, head injury) Schizophrenia and related syndromes Paranoid disorders and related syndromes Affective disorders (anxiety states, phobic disorders, bipolar affective disorers) Grief and bereavement Self-harm, attempted suicide, suicide Substance misuse (including alcohol dependence)

Eating disorders Obsessive compulsive disorder Abnormal illness behavior Syndromes associated with medically explained physical symptoms (including somatization and somatoform disorders) Psychiatric aspects of physical disease Awareness of the psychiatric presentations of physical disease including : Endocrine and metabolic disorders Toxic states AIDS Neurological disease Epilepsy Pain Mental retardation Features of the commoner syndromes. 19. Dermatology Basic science It is expected to have a working knowledge of the structure and, function of the epidermis and dermis Clinical dermatology Knowledge of the clinical features of the following skin diseases is required : Psoriasis Eczema Urticaria Superficial fungal infection (dermatophytjsis, pithyriasis versicolor) Common skin cancers such melanoma Vitiligo and alopecia areata

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Pemphigus and pemphigold Cutaneous herpes virus infections (herpes simplex, varicella zoster) Cutaneous staphylococcal and streptococcal infections Leprosy Many diseases affecting internal organs will present with skin signs or symptoms. Examinee should know the differential diagnosis and plan of investigation of patients who present with the following cutaneous signs or sym toms which may indicate internal disease: Itch Hyperpigmentation Generalized erythema Loss of hair Increased hair growth Common patterns of nail dystrophy such as clubbing Erythema nodusum Erythema multiforme Purpura Ulceration Vasculitis It is expected to be able to recognize the cutaneous symptoms -and signs of systemic diseases. Examples of question topic might include: Collagen vascular disease such as SLE, systemic sclerosis Metabolic and endocrine disorders Infections diseases Cancers Leukaemias Respiratory and cardiovascular diseases Common inherited diseases such as neurofibromatosis

Examinee should have knowledge of the main dermatological complication of therapeutic immunosuppression (for example, systemic corticosteroid therapy, cyclosporin etc.) or of diseases such as HIV which cause immunosuppression. Investigation Examinee should know the principles but not details of dermatological investigation such as patch testing somatoform disorders) 20. Medical Statistics Randomization Placebo-controlled trial Open trial Single-blind trial Double-blind trial Intention-to-treat Bias Evidence-based Medicine Examinee is expected to have an understanding of evidence-based Medicine and an ability to apply this understanding in the management of patients.

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Course for FCPS Endocrinology and Metabolism Part-II
Training All candidates must complete three years of full time training in an Endocrinology and Metabolism department, including inpatient and out-patient care. The training must take place in an institution recognized for this purpose by the relevant authority. Any facility in which the training takes place must fulfill the following criteria: a) A sufficient number of in-patients and out-patients to provide a broad exposure to all aspects of Endocrinology and Metabolism. This includes adult endocrinology, paediatric endocrinology, reproductive endocrinology, bone and mineral disorders. b) Adequate supervision c) Adequate diagnostic and therapeutic facilities

PART-B
Course for FCPS Endocrinology and Metabolism Part-II

d) A well stocked library with internet access The entire training must be done after enrollment in the `FCPS in Endocrinology and Metabolism' course. The training program must give the candidate adequate opportunity to observe laboratory methodology. At the end of the training program, certification must be.given by the supervisor of the program of the competence of the trainee in both in-patient and out-patient management. Case Book A case book of 30 cases relevant to the field of Endocrinology and Metabolism, in which the trainee has been actively involved, must be submitted at the end of the training period. This must include 10 patients with diabetes mellitus as their primary illness, and 5 patients with a variety of thyroid diseases. Each case must have the hospital identification number for verification purposes. The diagnosis and management of each case must be thoroughly discussed. There must be a variety of cases. The supervisor of the program will be responsible for checking and approving the case book.

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The case book must also contain a list of 10 fine needle aspirations of the thyroid done by the trainee. The cytology findings in the individual cases must be discussed and interpreted in light of each separate case, and a management plan must be given. A candidate with an incomplete case book will not be allowed to appear in the examination. Evaluation of Competence This will include all of the following: professionalism, clinical competence, knowledge in the chosen field. Syllabus for FCPS, Endocrinology and Metabolism A) General 1) Anatomy and Development of Endocrine organs 2) History taking and physical examination in Endocrine disorders 3) General principles of peptide and steroid hormones 4) General principles of nutrition and disorders of nutrition 5) lmmunological basis of Endocrine disease B) Diagnostic tests in endocrinology 1) Histology and cyto-pathology in Endocrinology 2) Principles of hormone assay 3) DNA diagnosis; of Endocrine disease 4) Diagnostic imaging in endocrinology and Metabolism 5) Dynamic procedures in endocrinology C) Endocrime Pancreas 1) Diabetes Mellitus Definition, diagnosis, classification, aetiology, patho-physiology, complications, management, emergencies, treatment of associated disorders 2) Homones of the pancreas D) Hypoglyeucmia

Actiology, physiology, diagnosis, management physiology, E) Endocrine hypertension F) Lipids 1) Normal lipid metabolism and it's disorders 2) Hyperlipaedemia - types, causes, management G) Neuro-endocrinology 1) The anterior and posterior pituitary 2) The pineal gland 3) Endocrinology of the hypothalamus H) Thyroidology 1) Normal anatomy and physiology, diseases, role of trace elements 2) Hyperthyroidism, hypothyroidism 3) Thyroid nodules 4) Thyroid malignancy 5) Thyroid function tests in non-thyroidal illness 6) Interpretation of thyroid function tests and radio-nuclide thyroid imaging I) The parathyroid glands II) Hypo- and hyper- parathyroidism II) Parathyroid hormone resistance J) Disorders of calcium and magnesium metabolism K)Disorders of bone metabolism 1) Osteoporosis 2) Osteomalacia 3) Paget's disease 4) Developmental disorders of bone 5) Fibrous dysplasia 6) Sclerosing bone disorders

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7) Metastatic bone disease L) The adrenal gland and it's disorders 1) Functioning tumours of the adrenal gland 2) Non functioning tumours of the adrenal gland 3) Adrenal insuffiency 4) Adrenal Hypertension 5) Involvement of the adrenal glands by systemic diseases M) Normal and abnormal growth and development N) Reproductive endocrinology 1) Normal and abnormal sexual development 2) Endocrine aspects of pregnancy 3) Male and female contraception 4) Endocrinology of the ovary and endometrium 5) Male and female sexual function 6) Male and female infertility 7) Testicular endocrine disorders 8) Hormone replacement therapy O) Hormonal manipulation of non-endocrine diseases 1) Breast cancer 2) Prostatic disease P) Endocrinology of non-endocrine organs 1) Heart 2) Gut and liver 3) Kidney and uro-genital system 4) Skin 5) Eye Q) Endocrine tumours 1) Pancreatic endocrine tumours - insulinoma, glueagonoma, gastrinoma, VlPoma

2) Thyroid neoplasms 3) Sellar and extra-scl lar tumours R) Miscellaneous 1) Inborn errors of Metabolism 2) Hereditary disorders in Endocrinology and Metabolism 3) Acid-base disorders 4) Fluid and electrolyte disorders 5) Endocrine and metabolic effects of toxic agents 6) latrogenic endocrine disorders 7) Endocrine emergencies 8) Endocrine pharmacology 9) Surgery in endocrinology 10) Radiation therapy in endocrinology 11) Future prospects in endocrinology

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