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Abdominal aortic aneurysm (AAA, termed 'triple A') is a swelling in the aorta (the main artery from the heart) that can grow over time and can rupture, which is a medical emergency.
There is AAA screening in the UK.
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The ankle-brachial pressure index (ABPI) is the ratio of the systolic blood pressure at the ankle (highest of the dorsalis pedis and posterior tibial artery pressures) to the systolic blood pressure in the upper arm (brachial artery pressure).
ABPI is measured on the same side of the body (left ankle compared with left upper arm).
Lower blood pressure in the leg than the arm (a low ABPI, less than 1) suggests blocked arteries due to PAD.
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Attention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness.
Atrial fibrillation (AF) is a type of cardiac arrhythmia characterised by rapid and irregular beating of the heart's atria, due to aberrant electrical activity.
Artificial intelligence (AI) is intelligence demonstrated by machines.
Autoimmune hepatitis (AIH) is a chronic, autoimmune, inflammatory liver disease.
Without immunosuppressive treatment, AIH may lead to cirrhosis.
AKI / CKD
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Acute lymphoblastic leukaemia (ALL) is a rapidly-developing blood cancer where an abundance of immature lymphocytes are produced.
ALL is the most common type of leukaemia to affect children but can also affect adults.
Chemotherapy is the mainstay of treatment.
Allergy / Immunology
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Advanced life support (ALS) expands on BLS with the addition of airway equipment, cardiac monitoring, manual defibrillation, and medications used in cardiac arrest, with increased focus on working in a multi-disciplinary team.
Acute myeloid leukaemia (AML) is an aggressive blood cancer of myeloid cells.
Risk increases with age, and AML is most common in people over 65.
Chemotherapy is the mainstay of treatment, but bone marrow or stem cell transplants may also be considered.
Antimicrobial resistance (AMR) includes resistance of infectious microorganisms to antibiotics, antivirals, antiprotozoals, antimalarials, and antifungals.
AMR makes these treatments ineffective, meaning infections persist and are more likely to cause harm and be spread to others.
The Abbreviated Mental Test (AMT, or Abbreviated Mental Test Score, AMTS) is a quick screening test produced in 1972 to detect cognitive impairment in the elderly.
It may not be culturally appropriate to continue using this test, and its validity has been questioned.
Anaesthetics / Intensive Care
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Acute respiratory distress syndrome (ARDS) is characterised by rapid onset of widespread inflammation in the lungs.
Autism spectrum disorder (ASD) is a condition that affects social interaction, communication, interests and behaviour.
AVPU is a responsiveness scale: Alert, responds to Voice, responds to Pain, Unresponsive
Abdominal X-ray (AXR, more accurately abdominal radiograph) may be used to confirm diagnoses such as bowel obstruction, toxic megacolon and renal colic (using a KUB AXR, Kidneys-Ureters-Bladder).
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Blackout / Collapse
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Basic life support (BLS) includes CPR and may include use of an AED, but does not include advanced monitoring or interventions such as use of airway equipment.
More advanced support is provided by ALS.
The British Medical Association (BMA) is the trade union and professional association for doctors and medical students in the UK.
Bone mineral density (BMD) is the amount of bone mineral in bone tissue, and can be measured using DEXA.
Body mass index (BMI) is defined as the body mass divided by the square of the body height (kg/m²).
BMI classifies people as underweight (BMI less than 18.5), healthy weight (18.5-24.9), overweight (25-29.9) and obese (30-39.9).
The British National Formulary (BNF) is a UK pharmaceutical reference source (publication/App) that contains information and advice on prescribing and pharmacology for medicines available on the NHS.
Benign prostatic hyperplasia/hypertrophy (BPH) is an enlargement of the prostate gland (benign prostate enlargement, BPE) common in elderly men. BPH can cause a number of LUTS (lower urinary tract symptoms), such as increased frequency and poor stream.
Beats per minute
Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder.
BPPV causes repeated, brief periods of vertigo with movements such as turning in bed or changing position. N&V are common.
Diagnosis can be made with the Dix–Hallpike test and BPPV can be treated with the Epley manoeuvre.
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Bovine spongiform encephalopathy (BSE, or "mad cow" disease) causes variant CJD.
A coronary artery bypass graft (CABG), commonly termed heart bypass surgery, involves creating an alternative channel to improve blood flow to the heart when a coronary artery is blocked.
Community-acquired pneumonia (CAP) is a pneumonia developed by a person with little contact with the healthcare system - in contrast with HAP.
Continuous ambulatory peritoneal dialysis (CAPD) is a form of dialysis which happens throughout the day/night, in which the person drains and exchanges their own fluid.
During CAPD, dialysis fluid is left in the peritoneal cavity for 4-6 hours to allow waste products from the blood to accumulate. The fluid is then drained out. Fluid can be left overnight.
The other form of peritoneal dialysis is APD.
CAPD is an example of RRT.
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Cognitive behavioral therapy (CBT) is a psycho-social 'talking therapy' focussing on how your thoughts, beliefs and attitudes affect your feelings and behaviour. CBT teaches coping strategies.
Congestive cardiac failure (CCF, or congestive heart failure, CHF) refers to combined left and right heart failure.
Clinical Commissioning Groups (CCGs) organise the local delivery of NHS services in England.
CCGs consist of groups of (nearby) GP practices which come together to commission the best services for the patients and population in their local area.
CCGs commission services (including mental health services, urgent and emergency care, elective hospital services, and community care) for their local community from any service provider that meets NHS standards and costs (including NHS hospitals, social enterprises, voluntary organisations or private sector providers).
The Centers for Disease Control and Prevention (CDC) is a public health institute of the United States.
Cystic fibrosis (CF) is an autosomal recessive genetic disorder that mostly affects the lungs, but also the pancreas, liver, kidneys, and GI tract.
CF typically leads to frequent lung infections, sinus infections, poor growth, fatty stool, and infertility in males due to congenital absence of the vas deferens.
There is no cure. CF is managed with pulmonary rehabilitation, antibiotics, mucolytics (drugs that loosen and thin mucus) and pancreatic enzyme replacement; lung transplantation may be considered. Ivacaftor may also be considered.
Coronary heart disease (CHD), previously called ischaemic heart disease (IHD), occurs when the coronary arteries are narrowed by a build-up of fatty material within their walls, limiting oxygen delivery to the heart.
NB: CHD may also refer to congenital heart disease.
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Capabilities in Practice (CiPs) are learning outcomes for internal medicine training (IMT) that cover the key professional activities expected of a fully-trained physician.
Creutzfeldt–Jakob disease (CJD) is a rare and fatal degenerative brain disorder. CJD is a prion disease and there are four main types:
Creatinine kinase (CK) is an enzyme expressed by various tissues, particularly in muscles.
CK is measured as a marker of damage of CK-rich tissue such as in rhabdomyolysis (severe muscle breakdown) and muscular dystrophy. CK used to be used to diagnose MI but has been replaced by troponin.
Chronic lymphocytic leukaemia (CLL) is a type of blood cancer that affects B lymphocytes and tends to progress slowly over many years.
CLL mostly affects people over the age of 60.
CLL is often asymptomatic and found on routine blood tests.
Chemotherapy is the mainstay of treatment, if needed.
Chronic myeloid leukaemia (CML) is a type of blood cancer where too many myeloid cells are produced – immature white blood cells that are not fully developed and do not work properly.
CML tends to progress slowly over many years.
CML can occur at any age, but is most common in older adults around 60-65 years of age.
The main treatment for CML are tyrosine kinase inhibitors, such as imatinib.
CML is classically associated with the Philadelphia chromosome.
Cytomegalovirus (CMV) is a common virus that is usually harmless (but poses a risk to developing babies and people with immunodeficiency). CMV persists for life.
CNS refers to the central nervous system , consisting of the brain and spinal cord (in contrast to the PNS, the peripheral nervous system).
Chronic obstructive pulmonary disease (COPD) is the name for a group of lung conditions that cause breathing difficulties.
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Continuing professional development (CPD), colloquially termed 'lifelong learning', is an important part of every physicianly career.
NB: You can claim up to five external (category 1) CPD credits for watching our archived talks on the Education Portal (1 hour = 1 CPD credit). Additional learning can be categorised as personal (category 3) credits. Claim your CPD in the CPD Diary using ‘Add Self-Certified Entry’.
Cardio-pulmonary resuscitation (CPR) is a life-saving intervention for cardiac arrest.
Cerebrospinal fluid (CSF) is a clear, colourless fluid found in the brain and spinal cord.
CSF can be obtained by lumbar puncture (LP). LP can determine intracranial pressure and CSF analysis (colour, cell contents, chemical composition, presence of pathogens) can help to diagnose a number of neurological conditions.
Computerised tomography (CT, as in CT/CAT scan) uses several X-ray images and computer processing to create cross-sectional images of the body.
Carcinoma of unknown primary (CUP) is a diagnosis for a metastatic cancer (a cancer that has spread) with an unclear site of origin (the original 'primary' cancer is unknown).
Cerebrovascular accident (CVA) is synonymous with stroke.
The Chest X-ray (CXR, more accurately chest radiograph) is a common radiological investigation used to diagnose conditions affecting the lungs and chest.
An erect CXR (a CXR taken when the patient is standing) may be used to confirm diagnosis of bowel perforation.
D&V refers to Diarrhoea and Vomiting.
Deep brain stimulation (DBS) is a neurosurgical procedure involving the placement of electrodes and a neurostimulator (colloquially termed a brain pacemaker) in order to deliver electrical impulses to specific brain (nuclei) targets.
DBS is used in the management of movement disorders (such as PD) and epilepsy.
Ductal carcinoma in situ (DCIS) is an early, non-invasive form of breast cancer.
In DCIS, the cancer cells are completely contained in the ducts and lobules and have not invaded into surrounding breast tissue. However, DCIS can transform into invasive breast cancer. DCIS is therefore surgically managed; hormone therapy or radiotherapy may be considered.
Differential diagnosis (DDx) is the process of distinguishing a particular disease from others that present with similar clinical features.
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DI is a rare condition characterised by the production of large amounts of dilute urine (polyuria) and greatly increased thirst (polydipsia).
DI is caused by a problem with either the production or action of the hormone arginine vasopressin (AVP; also known as anti-diuretic hormone, ADH). Lack/inaction of AVP means the kidneys are unable to retain water.
There are two main forms: central DI (also known as cranial or neurogenic DI), caused by a deficiency of AVP and nephrogenic DI, caused by resistance to AVP in the kidneys (the kidneys do not respond to AVP). DI can also be related to pregnancy (gestational DI) or a problem with the body's thirst mechanism (dipsogenic DI).
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Drug-induced liver injury (DILI) is a challenging disorder faced by hepatologists.
Liver injury can result from a vast number of drugs used in clinical practice, and from a number of herbs and dietary supplements.
Diabetes ketoacidosis (DKA) is an acute metabolic complication of diabetes (triad of hyperglycaemia, ketonaemia and acidaemia), characterised by absolute insulin deficiency. DKA is potentially fatal and is a medical emergency, and it is the most common acute hyperglycaemic complication of type 1 diabetes.
DMARDs are disease-modifying antirheumatic drugs.
Direct-acting oral anticoagulants (DOACs) are direct-acting oral anticoagulants (first called 'novel' oral anticoagulants, NOACs).
A digital rectal examination (DRE) is an internal examination of the rectum.
DRE is also known as a PR (per rectum/rectal) examination.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare reaction to certain medications causing widespread rash, fever, swollen lymph nodes, and characteristic blood abnormalities including eosinophilia.
Management consists of stopping the offending medication and supportive care. Systemic corticosteroids are commonly used.
The Driver and Vehicle Licensing Agency (DVLA) maintains the registration and licensing of drivers in Great Britain, and responsibilities include recording driver medical conditions.
Deep vein thrombosis (DVT) is a blood clot in a deep vein, typically in the leg.
The electrocardiogram (ECG or EKG) measures electrical activity of the heart to detect cardiac problems.
Electroconclusive therapy (ECT, previously termed electroshock therapy) involves the intentional induction of seizures by applying electricity to one (unilateral ECT) or both brain hemispheres (bilateral ECT), and is used in the management of a number of psychiatric conditions.
The electro-encephalogram (EEG) measures electrical activity of the brain and can be used to diagnose epilepsy, sleep disorders and other conditions.
Estimated glomerular filtration rate (eGFR) is a measure of kidney function, calculated using creatinine and patient charateristics: age, sex and ethnicity.
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Ears, nose and throat (ENT), formally otorhinolaryngology, is a surgical specialty.
Endoscopic retrograde cholangiopancreatography (ERCP) can be used to help diagnose conditions of the liver, bile ducts, pancreas or gallbladder, although non-invasive magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound are preferred, unless there is therapeutic intent.
Through the endoscope, the inside of the stomach and duodenum can be visualised. Contrast (dye) can be injected into the ducts in the biliary tree and pancreas so they can be assessed using X-rays. Biopsies can also be taken.
Stents can be inserted during ERCP to relieve ductal blockage.
The erythrocyte sedimentation rate (ESR) is a non-specific measure of inflammation.
There is no statutory definition of fair dealing and, in a court of law, use would be judged on a case-by-case basis.
‘Fair dealing’ includes the use of works for illustration for instruction and quotation. Works made available to the public can be used for criticism and review.
In essence, ‘fair dealing’ means use is limited to only the minimum necessary amount of content for its purpose (reasonable and appropriate to the context) and use does not negatively impact on the market for the original works. Copying should not harm the copyright holder, financially or otherwise.
The Full Blood Count (FBC, also termed Complete Blood Count, CBC) provides information on the cellular contents of the blood: red blood cells, white blood cells (e.g. WBC) and platelets.
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Fresh frozen plasma (FFP) is made from the liquid portion of whole blood.
FFP is used to replace low blood clotting factors or low levels of other blood proteins, and can be used to treat TTP.
The Faecal Immunochemical Test (FIT), also termed Quantitative Faecal Immunochemical Test (qFIT), is used in bowel cancer screening.
qFIT uses antibodies that specifically recognise human haemoglobin and is therefore more sensitive and specific than the older guaiac-based FOB test.
Fits / Seizure
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The two foundation years (FY1 and FY2) form the initial post-graduate training for doctors in the UK.
Generalised anxiety disorder (GAD) is a long-term condition that causes anxiety about a wide range of situations and issues, rather than one specific event.
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Guillain–Barré Syndrome (GBS) is an autoimmune disease affecting the peripheral nerves, which causes rapid-onset muscle weakness.
The main treatments are IVIG and plasma exchange (plasmapheresis).
Giant cell arteritis (GCA) is a vasculitis of arteries, typically those in the head and neck.
GCA is a medical emergency.
Symptoms typically include headache, severe pain and tenderness over the temples (hence GCA is also called temporal arteritis) and the scalp, jaw pain while eating (jaw claudication), and flu-like symptoms.
Visual disturbance (double vision or visual loss) and jaw claudication demands urgent medical attention, with high-dose steroid as management.
GCA is frequently associated with PMR.
The Glasgow Coma Scale (GCS) is a neurological scale which aims to give a reliable and objective way of recording the state of a person's consciousness for initial as well as subsequent assessment. A person is assessed against the criteria of the scale, and the resulting points give a person's score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (more widely used, modified or revised scale).
GCS Resources and FAQs
Gestational diabetes mellitus (GDM) is diabetes (high blood glucose) that develops during pregnancy. GDM is usually diagnosed from a blood test 24 to 28 weeks into pregnancy. Women with GDM don’t have diabetes before their pregnancy, and it usually goes away after giving birth.
In the UK, roughly 16 out of every 100 women will develop GDM.
The most common problem associated with GDM is a large baby (macrosomia), which can make vaginal delivery more difficult and may mean caesarean section is required.
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Gamma-glutamyl transferase (GGT) is an enzyme found mainly in the liver.
GGT has three key uses beyond revealing liver disease:
GI refers to the gastrointestinal system, the focus of the gastroenterology specialism.
Getting It Right First Time (GIRFT) is an NHS improvement programme.
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Gastro-oesophageal reflux disease (GORD) is a common condition, where acid from the stomach leaks up into the oesophagus.
GORD causes heartburn, acid regurgitation and may cause oesophagitis.
Left untreated, GORD may lead to stricture formation or Barrett's oesophagus, which may develop into cancer.
Management focusses on lifestyle change (such as weight loss) and acid-lowering medications (such as PPIs). Surgery may be considered.
'General Practitioner' (GP) is UK-terminology for a primary care physician ('family doctor').
GP can also refer to General Practice, the remit of a General Practitioner.
Glyceryl trinitrate (GTN) is a medication used in the prophylaxis and treatment of angina and the management of anal fissures, amongst other indications.
Haematemesis / Melaena
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Healthcare-associated infection (HAI) is an infection acquired in the hospital or other healthcare setting.
Examples include catheter-associated infections and HAP.
Hospital-acquired pneumonia (HAP) is an example of a nosocomial infection. HAP is a new pneumonia arising two or more days after admission to hospital.
Hospital-Based Complex Clinical Care (HBCCC) provides hospital care (nursing and medical input) for patients who cannot be looked after anywhere else due to their frailty and complexity. The medical input should involve consultant geriatrician input as well as day to day input which varies between facilities (some GP, some specialty or junior doctor).
Criterion for eligibility is "cannot be looked after anywhere else" as assessed by consultant geriatrician. Eligibility should be reviewed every three months, and patients who no longer meet the criterion should be moved on (usually nursing home).
The high-dependency unit (HDU) offers a level of care (Level 2) between ward-level (Level 1) and ICU-level (Level 3).
A HDU is for "patients needing single organ support (excluding mechanical ventilation) such as renal haemofiltration or ionotropes and invasive BP monitoring. They are staffed with one nurse to two patients." (reference).
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HFpEF is heart failure with preserved ejection fraction.
Hereditary haemorrhagic telangiectasia (HHT), also known as Osler–Weber–Rendu syndrome, is a rare autosomal dominant genetic disorder that leads to abnormal blood vessel formation:
Management may include iron supplementation, blood transfusion, laser treatment for telangiectasia and embolisation or surgery for AVMs.
Human immunodeficiency virus (HIV) damages cells in the immune system. Once acquired, HIV persists for life. There is no cure, but antiretroviral drugs can control infection and stop transmission to others. HIV can be transmitted in a number of ways, all of which are preventable.
HIV can lead to acquired immune deficiency syndrome (AIDS).
The hypothalamic–pituitary–adrenal (HPA) axis is a hormone-based system that regulates the body’s reaction to stress.
Hormone replacement therapy (HRT) is a form of hormone therapy used to treat symptoms associated with menopause, including hot flushes and night sweats, vaginal dryness, reduced sex drive, and bone loss.
The Health and Safety Executive (HSE) is Great Britain's independent regulator for work-related health, safety and illness. HSE also researches occupational risks, producing statistics, and enforces the law surrounding health and safety at work.
Haemolytic-Uraemic Syndrome (HUS) is a group of blood disorders mainly affecting infants and children.
HUS is characterised by low red blood cells, AKI, and low platelets. Bloody diarrhoea is a common early symptom - kidney problems and low platelets then occur as the diarrhoea is improving.
Most cases occur after infectious diarrhoea due to E. coli O157:H7.
Irritable bowel syndrome (IBS) is a common condition affecting the digestive system.
Intracerebral haemorrhage (ICH) occurs when a blood vessel in the brain ruptures, causing bleeding in the brain.
Intracranial pressure (ICP) is the pressure inside the skull: in brain tissue and CSF.
Raised ICP signs/symptoms include headache (particularly morning headache - the headache is worse with coughing, sneezing and bending, and progressively worsens over time), vomiting, altered level of consciousness, and papilloedema.
Intensive Care Unit (ICU) and Intensive Therapy Unit (ITU) are synonymous.
An ICU offers 'Level 3' care, for "Patients requiring two or more organ support (or needing mechanical ventilation alone). Staffed with one nurse per patient and usually with a doctor present in the unit 24 hours per day." (reference)
An ICU is therefore used for patients with severe or life-threatening illnesses (particularly multi-organ failure) and injuries, requiring constant care and specialist equipment, monitoring, medications and interventions.
Iron deficiency anaemia (IDA) is the most common form of microcytic anaemia.
IDA can be caused by chronic blood loss (including menstruation in pre-menopausal women or from the GI tract, such as in the case of bowel cancer), malabsorption of iron, or dietary deficiency of iron.
Infective endocarditis (IE) is an infection of the heart's inner lining (the endocardial surface), which may include valves and chordae tendineae.
Like IFG, IGT is a form of 'prediabetes'.
The current WHO diagnostic criteria for IGT are: a fasting plasma glucose of less than 7.0 mmol/L and a 2-hour venous plasma glucose (after ingestion of 75 g oral glucose load) of 7.8 mmol/L or greater, and less than 11.1 mmol/L. (source: NICE)
IGT is a strong risk factor for developing diabetes and cardiovascular disease, and therefore IGT is managed using lifestyle change ± medication.
Interstitial lung disease (ILD) refers to a group of diseases affecting the lung interstitium (the tissue and space around the alveoli).
Internal Medicine Training (IMT) replaced Core Medical Training (CMT) in August 2019. This new curriculum was introduced in response to the recommendations set out in the Shape of Training Report, and other drivers.
IMT forms the first three years of post-foundation training and, for the main specialties supporting acute hospital care, an indicative 12 months of further internal medicine training will be integrated flexibly with specialty training in a dual programme.
IMT aims to prepare doctors for the management of the acutely unwell patient, with an increased focus on chronic disease management, comorbidity and complexity. Generic professional capabilities (GPCs) as set out in the GMC's framework will be embedded in all curricula to emphasise the importance of these professional qualities as well as helping to promote flexibility in postgraduate training.
Source: JRCPTB - More information on IMT
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The international normalised ratio (INR) is a laboratory measurement of how long it takes blood to clot, used to monitor individuals taking the anticoagulant warfarin.
INR is derived from the prothrombin time, which evaluates the extrinsic pathway and common pathway of coagulation.
Idiopathic pulmonary fibrosis (IPF) is a progressive condition causing lung scarring, making breathing increasingly difficult.
IPF is the most common type of pulmonary fibrosis.
The clinical course of IPF can be unpredictable, but its five-year survival from diagnosis is comparable to, or even worse than, a number of common cancers.
Intravenous (IV) means existing within or administered into a vein or veins.
The inferior vena cava (IVC) is a large vein that returns deoxygenated blood from the lower and mid body to the right atrium of the heart. Valves prevent backflow due to gravity.
Intravenous immunoglobulin (IVIG) is a therapy for autoimmune disease, including GBS.
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The Journal of the Royal College of Physicians of Edinburgh (JRCPE) is the College’s quarterly, peer-reviewed journal, with an international circulation of 8,000. It has three main emphases – clinical medicine, education and medical history and humanities.
The Joint Royal Colleges of Physicians Training Board (JRCPTB) sets and maintains standards for physician training in the UK on behalf of the Royal College of Physicians of London, Royal College of Physicians of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow.
JRCPTB are involved in curriculum design and implementation, recruitment and certification of trainees, and support the GMC in quality management.
The jugular venous pulse (JVP) provides an indirect measure of central venous pressure.
Liver function tests (LFTs) assess the functioning of the liver, by measuring levels of proteins, enzymes, blood clotting ability, and waste products in the blood.
LMWH is derived from unfractionated heparin (UFH), but does not require APTT monitoring and has more predictable pharmacokinetics (with a longer half-life) and anticoagulant effect. LMWH less commonly causes heparin-induced thrombocytopenia than UFH.
LMWH is cleared renally.
Lumbar puncture (LP, colloquially termed spinal tap) obtains a CSF sample for analysis and is also used in the management of conditions such as idiopathic intracranial hypertension.
LP is a sterile procedure, performed by inserting a needle into the subarachnoid space, usually between the third and fourth lumbar vertebrae.
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Mild cognitive impairment (MCI) refers to minor difficulties with cognition (mental abilities such as memory or thinking) that are worse than would normally be expected for a healthy person of that age.
Symptoms are not severe enough to interfere significantly with daily life.
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The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for protecting and promoting public health and patient safety by ensuring that medicines, medical devices and blood components for transfusion meet appropriate standards of safety, quality and efficacy.
Myocardial infarction (MI, commonly termed heart attack) describes necrosis (death) of myocardial tissue (heart muscle) due to ischaemia (an inadequate supply of blood to the affected tissue) - typically due to sudden blockage by a blood clot.
CHD is a leading cause of MI.
The Mini Mental State Examination (MMSE), not to be confused with the MSE, measures cognitive impairment and is used to assess severity and progression of cognitive impairment. The MMSE can be used to help diagnose and monitor dementia. It takes 5-10 minutes to administer.
The MMSE tests a number of mental abilities, including memory, attention and language.
Motor neurone disease (MND) is a group of rare neurodegenerative conditions that progressively damage the motor neurones. Messages from the motor neurones gradually stop reaching voluntary muscles, leading to muscle weakness and wasting.
Amyotrophic lateral sclerosis (ALS) is the most common form of MND.
MND is life-limiting and there is no cure.
Maturity onset diabetes of the young (MODY) is a rare genetic form of diabetes caused by a mutation in an autosomal dominant gene disrupting insulin production. MODY is also known as monogenic diabetes. There are many forms of MODY, depending on the gene affected.
MODY affects around 1-2% of people with diabetes.
The charity Diabetes UK lists the key features of MODY as: being diagnosed with diabetes under the age of 25; having a parent with diabetes, with diabetes in two or more generations; not necessarily needing insulin.
Magnetic resonance imaging (MRI) is an imaging modality, particularly useful for soft tissues, which does not involve ionising radiation.
Multiple sclerosis (MS) is an autoimmune demyelinating disease: the insulating cover of nerve cells in the brain and spinal cord (myelin) is attacked by the body's immune system.
There are three main types of MS:
Signs/symptoms are unpredictable, but can include fatigue, optic neuritis and other visual disturbance, weakness of limbs, pain, bowel and bladder problems, and sexual problems.
The Mental State Examination (MSE) is used to assess a patient's emotions, thoughts, and behaviour. Present mental state informs differential diagnosis and can allow risk assessment.
Mid-stream specimen of urine
MTI / IMTF
The Medical Training Initiative (MTI) and International Medical Training Fellowship Programme (IMTF) are ran by the College and allow international (non-EU) junior and middle-grade doctors to train and work in the UK for up to two years, whilst enabling NHS Boards and Trusts to fill rota gaps with high quality staff.
Minimum unit pricing (MUP) is a policy aimed at improving public health by reducing alcohol consumption and thus alcohol-related harm, disease and death.
SHAAP champions MUP in Scotland (introduced in May 2018).
N&V refers to Nausea and Vomiting.
NAD means 'no abnormality detected'.
Non-alcoholic fatty liver disease (NAFLD) is caused by a build-up of fat in the liver, typically seen in people who are overweight or obese.
NAFLD is a progressive disease: starting from simple fatty liver (steatosis), NAFLD progresses to non-alcoholic steatohepatitis (NASH), to fibrosis, and ultimately to cirrhosis.
NBM means 'nil by mouth', that is, no food, drink, or medications should be taken orally.
NBM is typically done pre-operatively to avoid aspiration risk.
Maintenance IV fluids should be prescribed.
A neuroendocrine tumour (NET) is a tumour that develops from cells of the neuroendocrine system. These cells are similar to nerve cells, but make hormones.
NETs can be benign or malignant, and functioning (hormone-producing) or non-functioning.
NETs typically affect the GI system or lungs.
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The National Early Warning Score (NEWS)
The National Health Service (NHS) encompasses the four separate and independent public healthcare providers in the United Kingdom: the National Health Service in England, NHS Scotland, NHS Wales, and Health and Social Care in Northern Ireland.
The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care in the United Kingdom.
Non-invasive ventilation (NIV) involves ventilatory support without an invasive artificial airway (endotracheal tube or tracheostomy tube), using a face or nasal mask or similar device.
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NPIS and TOXBASE
NSAIDs are non-steroidal anti-inflammatory drugs.
NSTEMI is non-ST-elevation MI.
Osteoarthritis (OA) is the most common type of arthritis. OA tends to occur in middle age or due to an injury or obesity.
OA can affect any joint, but it typically occurs in the hands, knees, hips, lower back and neck.
Obsessive-compulsive disorder (OCD) is an anxiety disorder where a person has obsessive thoughts and/or compulsive activity (commonly both).
'Overdose' can be abbreviated to 'OD'.
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Obstructive sleep apnoea (OSA) occurs when the walls of the throat relax and narrow or close during sleep, interrupting normal breathing. This disturbs sleep.
When asleep, OSA may cause snoring and snorting alongside interrupted breathing. When awake, OSA causes excessive daytime sleepiness (hypersomnia). Hypersomnia poses a danger to driving and should be reported by patients and explored by doctors - the driving licencing/regulatory agency (such as the DVLA) should be informed.
Occupational therapy (OT) is an AHP.
OT provides support to people whose health prevents them from doing activities or the occupation they wish to do.
Practical Assessment of Clinical Examination Skills (PACES) is an exam designed to test the clinical knowledge and skills of trainee doctors who hope to enter higher specialty training.
Peripheral arterial disease (PAD) occurs where a build-up of fatty deposits in the peripheral arteries causes narrowing or blockage, restricting blood supply to the lower limbs, particularly the leg muscles.
PAD classically causes intermittent claudication, leg pain when walking which resolves with rest.
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Pulmonary arterial hypertension (PAH) is a rare, progressive disorder characterised by high blood pressure in the arteries of the lungs, due to thickening and stiffening of the walls of the smaller branches of the pulmonary arteries. Over time, PAH damages the heart, which has to work harder to overcome this arterial resistance.
PAH can be associated with a number of conditions, including connective tissue diseases (such as scleroderma), portal hypertension, HIV, and certain medications/drugs. The cause may be unknown (idiopathic PAH).
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Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are a new type of cholesterol-lowering drug.
Parkinson's disease (PD) is a chronic, progressive neurodegenerative condition caused by lack of dopamine in the brain, due to loss of the dopamine-containing cells of the substantia nigra.
PD is a movement disorder with four core features: tremor (shaking), bradykinesia (slowness of movement), rigidity (muscle stiffness) and postural instability (difficulty with balance and coordination).
Pulmonary embolism/emboli (PE) occurs when a blood vessel in the lung(s) is blocked by a blood clot.
PERLA means pupils equal and reactive to light and accommodation.
PEARL means pupils equal and reactive to light; PERRLA means pupils equal, round and reactive to light and accommodation.
Patent foramen ovale (PFO) occurs if the foramen ovale, a hole between the heart's atria made in normal foetal development, does not close after birth as it should.
PFO is common, affecting about 1 in 4 people.
PFO can increase risk of ischaemic stroke, because thrombi (blood clots) can pass from the right to the left side of the circulation and more easily reach the brain - normally small thrombi are filtered out by the lungs.
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Public Health England (PHE) exists to protect and improve the nation's health and wellbeing, and reduce health inequalities.
PHE is an executive agency of the Department of Health and Social Care, which provides the government, the NHS, Parliament, industry and the public with evidence-based professional, scientific expertise and support.
Pelvic inflammatory disease/disorder (PID) is an infection of the female upper genital tract, including the uterus, Fallopian tubes and ovaries. In about 1 in 4 cases, STI is the cause.
PID can lead to a number of complications including infertility and ectopic pregnancy.
Prompt and effective treatment with antibiotics is important (after STI screening), of both the affected female ± recent sexual partner(s).
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Personal protective equipment
Psychiatry / Psychological
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Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by very stressful or distressing events.
People with PTSD often relive the traumatic event through nightmares and intrusive thoughts or images when awake (flashbacks). Symptoms last for at least one month after the traumatic event.
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PUD is peptic ulcer disease.
PUO is pyrexia (fever) of unknown origin.
The Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for all GP practices in England, detailing practice achievement results.
QOF consists of a number of achievement measures (indicators) against which GP practices score points according to their level of achievement. The higher the score, the higher the financial reward for the practice.
QOF helps standardise improvements in the delivery of primary care.
Quality Governance Collaborative
The Quality Governance Collaborative (QGC) is an independent, neutral, non-governmental body committed to a new approach to governance in health and social care.
Rheumatoid arthritis (RA) is a common, long-term autoimmune inflammatory disease that causes pain, swelling and stiffness in the joints (typically affecting the hands, feet and wrists).
Radiology / Nuclear
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RCPCH works on a range of programmes, including research, to improve child health in the UK and across the world.
The Royal College of Psychiatrists (RCPsych) is the professional body responsible for education and training, and setting and raising standards in psychiatry.
Remote + Rural
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Return of spontaneous circulation (ROSC) is resumption of sustained perfusing cardiac activity associated with significant respiratory effort after cardiac arrest.
Resuscitation Council (UK) - Post-resuscitation care
Renal replacement therapy (RRT) includes dialysis and transplantation.
Subarachnoid haemorrhage (SAH) is an uncommon type of stroke caused by bleeding into the space around the brain (the subarachnoid space, found between the arachnoid and pia mater).
SAH classically produces a thunderclap headache - patients report a sudden-onset headache that is the worst headache of their life.
SAH can be traumatic (the most common cause), caused by head injury, or be spontaneous, typically due to a ruptured berry aneurysm.
Speech and Language Therapy (SALT or SLT) is an AHP.
SALT involves the support and treatment for people who have speech, language, communication or swallowing difficulties.
SAS Doctors are not in training grades and nor are they consultants or GPs.
Doctors who have knowledge, skills and experience in a specialty that is approved for the award of a CCT by the GMC but have gained these outside of an approved training programme (including as a SAS Doctor) may apply for entry onto the Specialist Register with a CESR in a CCT specialty.
Subacute bacterial endocarditis (SBE) is a slowly-developing IE, typically caused by the Streptococcus species S. viridans.
SBE is an infection of the inner lining of the heart (the endocardium) and is associated with vegetations on heart valve surfaces with eventual valve destruction if the infection is not treated effectively.
Spontaneous coronary artery disease (SCAD) occurs when a tear appears in the wall of a coronary artery.
SCAD presents similarly to angina or a heart attack, and may cause an MI or even cardiac arrest.
SCAD typically affects young to middle-aged women, many of whom have no/few risk factors for CHD.
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Scottish Health Action on Alcohol Problems (SHAAP) was set up in 2006 by the Medical Royal Colleges in Scotland and is based within the RCPE. Clinicians had become increasingly concerned at the escalation in alcohol-related health damage in Scotland - both in its acute effects seen in admissions to EDs and in chronic conditions such as liver disease and brain damage.
The Scottish Intercollegiate Guidelines Network (SIGN) develops evidence-based clinical practice guidelines for the NHS in Scotland.
Systemic lupus erythematosus (SLE, known as lupus) is an autoimmune disease where the body mistakenly attacks healthy tissue.
Lupus can affect many systems of the body, including the skin, heart, lungs, kidneys and brain.
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The Scottish Medicines Consortium (SMC) is the national source of advice on the clinical and cost-effectiveness of all new medicines for NHS Scotland.
Shortness of breath (SOB) is termed dyspnoea.
SPECT provides metabolic and functional information.
Sport / Exercise
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STEMI is ST-elevation MI
STI is a sexually-transmitted infection (also termed STD, sexually-transmitted disease).
STIs are passed through unprotected sex or genital contact.
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The superior vena cava (SVC) is a large valveless vein that returns deoxygenated blood from the upper body to the right atrium of the heart.
The Trainees and Members’ Committee (T&MC) is a representative Committee of elected Trainees and Members of the College (RCPE). The Committee provides support for trainees and to ensure that the views of trainees are represented in all College discussions and to represent trainees in our external discussions, such as within the Joint Royal Colleges of Physicians Training Board (JRCPTB).
Type 1 diabetes mellitus (T1DM) is caused by absolute insulin deficiency due to destruction (most commonly autoimmune destruction) of pancreatic beta-cells.
Type 2 diabetes mellitus (T2DM) is caused by insulin resistance and a relative insulin deficiency.
Tri-iodothyronine (T3) is active thyroid hormone, and regulates the body's metabolism.
Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis, and typically affects the lungs (pulmonary TB) but can also affect other organs and sites (extrapulmonary TB), such as the meninges, lymph nodes and bones/joints.
TB infection can be 'active' (symptomatic and transmissible) or 'latent' (asymptomatic and non-transmissible).
TBI is traumatic brain injury.
Transcutaneous electrical nerve stimulation (TENS) uses a mild electrical current to help manage pain or muscle spasm.
TENS can be used in a number of painful conditions including joint pain, pelvic pain (such as in endometriosis) and during labour.
TFTs can be used to diagnose thyroid disease and to monitor treatment (thyroid suppression or thyroid hormone replacement).
Thyroid antibodies may also be tested.
A transient ischaemic attack (TIA, also known as 'mini-stroke') is a "transient (less than 24 hours) neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without evidence of acute infarction".
TIAs are associated with increased risk of ischaemic stroke (particularly in the short-term), highlighting higher risk patients who should be assessed for aggressive management of stroke risk factors.
A transjugular intrahepatic portosystemic shunt (TIPS or TIPSS) is an artificial channel within the liver connecting the portal vein with the hepatic vein, allowing (a proportion of) blood draining from the bowel to bypass the liver's portal venous circulation.
TIPS is used to treat portal hypertension and is a life-saving procedure in oesophageal/gastric variceal bleeding.
TLoC is transient loss of consciousness - also known as 'blackout'.
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Tropical / Travel
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Thrombotic thrombocytopaenic purpura (TTP) is a rare blood disorder that results in blood clots forming in small blood vessels throughout the body (disseminated microvascular platelet rich-thrombi).
TTP results in a low platelet count, low red blood cells (microangiopathic haemolytic anaemia), and often kidney, heart, and brain dysfunction due to reduced oxygen-rich blood flow.
TTP is managed with plasma therapy (plasma exchange for acquired TTP; FFP for inherited TTP) and immunosuppression.
Urea and Electrolytes (U&E) is a common blood test to assess kidney function and electrolyte balance.
U&E typically includes sodium, potassium, urea, creatinine and eGFR.
The UK is the United Kingdom of Great Britain and Northern Ireland, and includes England, Scotland (the home of RCPE), Wales and Northern Ireland.
ULN means 'upper limit of normal'.
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USA and US refers to the United States (of America).
NB: for ultrasound, see USS.
An ultrasound scan, or ultrasound (USS) uses ultrasonography: non-ionising, high-frequency sound waves to characterise tissue.
USS is used for diagnosis and investigation (including in pregnant women, obstetric ultrasound) and to guide intervention (such as USS-guided FNA).
PoCUS is a specific example of USS.
NB: To avoid confusion, USS is used in place of US, which refers to the United States (of America).
Urinary tract infection (UTI) is an infection in any part of the urinary system. Lower UTI affects the bladder (cystitis); upper UTI affects the ureters or kidneys (pyelonephritis).
UTI is more common in females.
Complicated UTI occurs when the urinary tract is abnormal, if a patient has a catheter (catheter-associated UTI), if the causative organisms are atypical, or if there are predisposing co-morbidities such as poorly controlled diabetes. Uncomplicated UTI is caused by typical organisms in people with a normal urinary tract and kidney function. Complicated UTI increases risk of persistent infection, treatment failure and recurrent infection (recurrent UTI).
Most UTIs can be easily treated with antibiotics, although recurrence is possible, particularly in women.
Ventilation (V, air reaching the lung alveoli) / Perfusion (Q, blood reaching lung alveoli via capillaries) is an important concept in respiratory physiology.
The V/Q ratio refers to the ratio of the amount of air reaching the alveoli per minute to the amount of blood reaching the alveoli per minute. V and Q are the main determinants of blood oxygen and carbon dioxide concentration.
V/Q mismatch occurs when one or more areas of the lung receive oxygen but no/little blood flow, or they receive blood flow but no/little oxygen.
V/Q ratio can be determined using a V/Q lung scan, medical imaging using scintigraphy and medical isotopes to evaluate the circulation of air and blood within the lungs. The V/Q scan is used in preference to a CTPA for the investigation of PE in patients with kidney failure or in pregnancy, to avoid significant radiation exposure.
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Ventricular fibrillation (VF) is a type of cardiac arrhythmia where the heart's ventricles twitch randomly rather than contracting in a co-ordinated fashion, due to aberrant electrical activity in the ventricles.
VF results in cardiac arrest with loss of consciousness and no pulse, as the ventricles fail to pump blood around the body.
Prompt CPR and defibrillation are needed to survive VF.
Ventricular septal defect (VSD) is a form of congenital heart disease where there is a hole in the ventricular septum, between the ventricles of the heart. This hole allows blood to flow from the left side of the heart to the right, meaning a large volume of blood flows to the lungs.
A large VSD causes high blood pressure in the pulmonary arteries (pulmonary hypertension) and means the left heart has to work harder than normal. This may lead to heart failure.
VSDs may close over time and not need treatment. Alternatively, surgery may be required. Pulmonary artery banding may be performed, allowing surgery to take place at a later date.
White Blood Cell Count (WBC) or White Cell Count (WCC)
Weakness / Paralysis
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The World Health Organization (WHO) is a United Nations agency, headquartered in Geneva, Switzerland, concerned with international public health.