GMC Domains

• THE DOCTOR AS A SCHOLAR
  • TD 8: APPLICATION OF BIOMEDICAL SCIENTIFIC PRINCIPLES, METHOD AND KNOWLEDGE
    • Medical knowledge: ANATOMY (TD 8.1)
    • Medical knowledge: PHYSIOLOGY (TD 8.2)
    • Medical knowledge: BIOCHEMISTRY (inc. Metabolism) (TD 8.3)
    • Medical knowledge: CELL BIOLOGY (TD 8.4)
    • Medical knowledge: MOLECULAR BIOLOGY and GENETICS (TD 8.5, 8.6)
    • Medical knowledge: PATHOLOGY (TD 8.7)
    • Medical knowledge: CANCER
    • Medical knowledge: IMMUNOLOGY and INFLAMMATION (TD 8.8)
    • Medical knowledge: MICROBIOLOGY and INFECTION (TD 8.9)
    • Medical knowledge: PHARMACOLOGY (TD 8.10)
    • Medical knowledge: NUTRITION (TD 8.11)
    • Medical knowledge: CLINICAL FEATURES of DISEASE (TD 8 b)
  • TD 9: APPLICATION OF PSYCHOLOGICAL PRINCIPLES, METHOD AND KNOWLEDGE
    • Medical knowledge: PSYCHOLOGY (TD 9 a-g)
  • TD 10: APPLICATION OF SOCIAL SCIENCE PRINCIPLES, METHOD AND KNOWLEDGE
    • Medical knowledge: SOCIOLOGY (TD 10 a-e)
  • TD 11. PRINCIPLES, METHODS AND KNOWLEDGE OF POPULATION HEALTH
    • Medical knowledge: PUBLIC HEALTH and GLOBAL HEALTH (TD 11 a-j)
  • TD 12; APPLICATION OF SCIENTIFIC METHOD AND APPROACHES TO MEDICAL RESEARCH
    • Medical knowledge: EPIDEMIOLOGY
    • Medical Knowledge: SCIENTIFIC METHOD & RESEARCH
• THE DOCTOR AS A PRACTITIONER
  • TD 13: CARRY OUT A CONSULTATION WITH A PATIENT
    • Clinical skills: HISTORY (TD 13 a-b)
    • Clinical skills: PHYSICAL EXAMINATION (TD 13 c)
    • Clinical skills: MENTAL STATE EXAMINATION (TD 13 d)
  • TD 14: DIAGNOSE AND MANAGE CLINICAL PRESENTATIONS
    • Clinical skills: INTERPRETING FINDINGS AND INITIAL ASSESSMENT (TD 14 a-b)
    • Clinical skills: PLANNING AND INTERPRETING INVESTIGATIONS (TD 14 c-d)
    • Clinical skills: MAKING A DIAGNOSIS and CLINICAL JUDGEMENT (TD 14 e-f)
    • Clinical skills: FORMULATING A TREATMENT PLAN (TD 14 g)
    • Clinical skills: SURGERY and ANAESTHETICS (TD 14 g)
    • Clinical skills: SUPPORTING PATIENTS and IDENTIFYING ABUSE and NEGLECT (TD 14 h-i)
    • Clinical Skills: CARE OF PATIENTS AND RELATIVES AT END OF LIFE (TD 14 j)
  • TD 15: COMMUNICATE EFFECTIVELY WITH PATIENTS AND COLLEAGUES
    • Clinical skills: INTERACTION WITH PATIENTS (TD 15 a-b)
    • Clinical skills: MANAGING INFORMATION (TD 15 c)
  • TD 16: PROVIDE IMMEDIATE CARE IN MEDICAL EMERGENCIES
    • Emergency Management of Patients (TD 16 b-e)
  • TD 17: PRESCRIBE DRUGS SAFELY, EFFECTIVELY AND ECONOMICALLY
    • Clinical skills: PRESCRIBING DRUGS SAFELY AND EFFECTIVELY (TD 17 a-h)
  • TD 18: CARRY OUT PRACTICAL PROCEDURES SAFELY AND EFFECTIVELY
    • Clinical skills: DIAGNOSTIC PROCEDURES (TD 18 a)
    • Clinical skills: THERAPEUTIC PROCEDURES (TD 18 b)
  • TD 19: USE INFORMATION EFFECTIVELY IN A MEDICAL CONTEXT
    • Clinical skills: EVIDENCE BASED MEDICINE
• THE DOCTOR AS A PROFESSIONAL
  • TD 20: BEHAVE ACCORDING TO ETHICAL AND LEGAL PRINCIPLES
    • Professional issues: ETHICS and LAW (TD 20 a-g)
  • TD 21: REFLECT, LEARN AND TEACH OTHERS
    • Professional Issues: PERSONAL LIMITS OF CARE (TD 21e)
    • Professional issues: LEARNING (TD 21 a-d)
    • Professional issues: TEACHING AND MENTORING (TD 21 f)
  • TD 22: LEARN AND WORK EFFECTIVELY WITHIN A MULT-PROFESSIONAL TEAM
    • Professional issues: WORKING IN TEAMS (TD 22 a-c)
  • TD 23: PROTECT PATIENTS AND IMPROVE CARE
    • Professional issues: DUTIES OF A DOCTOR (TD 23 a-b)
    • Professional issues: MEDICAL FRAMEWORK IN THE UK (TD 23 c)
    • Professional issues: RISK MANAGEMENT and PATIENT SAFETY (TD 23 d)
    • Professional issues: GOVERNANCE, QUALITY MATTERS and AUDIT (TD 23 e)
    • Professional issues: PERSONAL ATTITUDES and SELF CARE (TD 23 f-j)

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TD 8: APPLICATION OF BIOMEDICAL SCIENTIFIC PRINCIPLES, METHOD AND KNOWLEDGE: Medical knowledge: IMMUNOLOGY and INFLAMMATION (TD 8.8)

Index

• Immunology
• Inflammation

• Immunology
  • Immunology - General Outcomes
    1. Indicate the development of the immune system, including the function of lymphocytes. (GEP/HD, HD1)
    2. To understand how the immune system can sometimes do more harm than good
    3. Indicate the development of the immune system, including the function of lymphocytes
    4. 1. To understand that immunology is related to disease including infections, autoimmunity and allergy (hypersensitivity). (FM1)
    5. Understand cytokines and their function (FM1)
    6. Identify patients at risk of immunodeficiency (CSP3)
    7. Appreciate that the gut is a highly vulnerable tissue, susceptible to infections.
    8. Identify clinical features suggestive of deficiency of Non-specific defences; Neutrophils; Antibody; T-Lymphocytes ('combined') deficiencies (CSP3)
    9. Appreciate the key concept that cytokines are very beneficial molecules in small localised controlled doses, but are extremely harmful molecules in high prolonged and systemic doses (FM1)
    10. Be aware of the main players in the immune system including lymphocytes (T-cells, B cells and NK cells), myeloid cells (macrophages and granulocytes), dendritic cells and antibodies (FM1)
    11. Realise that only a single layer of epithelium separates the gut lumen from the tissues.
    12. To understand that the immune response normally can tell the difference between ‘self’ and ‘non-self’
    13. Appreciate that the gut contains the majority of the immune system in the body
    14. Know that the immune system is an agent of harm in the modern age (FM1)
    15. Appreciate that communication between cells is critical (FM1)
    16. To give examples in which this ability to discriminate breaks down - autoimmunity
    17. Understand principles of management of immune deficient patients (CSP3)
    18. Realise the importance of long term immunological memory (FM1)
    19. Explain the immunological processes enabling protection against disease to take place. (GEP/HD, HD1)
    20. IgA is the secretory immunoglobulin
    21. To understand that an appropriate immune response is sometimes undesirable, such as in transplantation
    22. Distinguish the features of the following conditions: conjunctivitis/rhinitis/sinusitis, asthma, atopic dermatitis, aspirin sensitivity, oral allergy syndrome, other food allergy, latex allergy, drug allergy, erythema multiforme and Stevens-Johnson syndrome (CSP3)
    23. List features of the following primary immunodeficiency syndromes: Common variable immune deficiency, X-linked agammaglobulinaemia, Di George syndrome, Severe combined immune deficiency, chronic granulomatous disease, Classical complement pathway deficiency, Lytic sequence deficiencies, Chediak-Higashi syndrome, Wiskott-Aldrich syndrome. (CSP3)
    24. While the gut epithelium is absorbing nutrients, it is also transporting large amounts of IgA into the gut lumen
    25. To be aware of the basic therapeutic mechanisms by which we deliberately suppress the immune system in auto-immunity and transplantation.
    26. List the features of the following secondary immunodeficiency syndromes: neutropenia, Chronic lymphocytic leukaemia, splenectomy, AIDS, Immunodeficiency due to immunosuppression. (CSP3)
    27. Match these tests to their diagnostic indications: total IgE, specific IgE, tryptase, C3, C4, C1q, C2, anti-C1q antibodies, D-dimers, C1 esterase inhibitor, cryoglobulins, skin-prick tests, patch tests (CSP3)
    28. Absence of T cells in the gut leads to chronic low grade infections
    29. That mucosal protective immune responses are generated in Peyer's patches and expressed in lamina propria
  • The Immune Response in Health
    1. Know that many pathogens invade the spaces between cells eg extra-cellular bacteria (FM1)
    2. List the physical defence barrier components of the innate immune system (skin etc), and link them with the mechanisms by which they are breached (CSP3)
    3. To understand the basic immunology processes that affect the joint in disease
    4. To understand the basic immunology processes that affect the joint in disease (LOC2)
    5. To understand the basic inflammatory processes that affect the joint in disease (GEP/M&P)
    6. Know how bacteria are eliminated using the humoral immune response (FM1)
    7. To understand the basic inflammatory processes that affect the joint in disease (LOC2)
    8. To appreciate the different types of inflammation in the skin - mast cell mediated, immune complex mediated, delayed-type hypersensitivity, granuloma formation. (LOC2)
    9. Know what an antibody is (FM1)
    10. Know how phagocytes (eg neutrophils) interplay with antibodies (FM1)
    11. Understand complement and know its function (FM1)
  • Recognition and Response to Antigens
    1. Understand that some pathogens live inside cells - this includes all viruses, or bacteria such as TB
    2. List the cellular components of the innate immune system: macrophages / monocytes; neutrophils; eosinophils; basophils / mast cells; and link them with their antigen T receptors (where known: TLRs, NOD) (CSP3)
    3. How are these eliminated by the cell-mediated immune response including macrophages, cytotoxic T cells, NK cells and yd cells
    4. Know the meaning of the term antigen (FM1)
    5. Know how the immune system recognises antigens (FM1)
    6. Appreciate that innate immune cells recognise a limited array of microbial structures using pattern recognition receptors. (FM1)
    7. What is the MHC and its role in presenting antigens in a form that T cells can see.
    8. Introduce the idea that TCRs and BCRs are made with random antigen recognition capacities (FM1)
    9. Understand the importance of distinguishing self from non-self (FM1)
    10. State how phagocytes move and kill (together with defects), and state the structures and molecules that they interact with: endothelial cells, adhesion molecules, matrix (CSP3)
    11. Understand how T and B cells recognise antigens and how the diversity of antigen recognition receptors on these cells is generated. (FM1)
    12. List the cells of the adaptive immune system (B-cells, different kinds of T-cells etc), and state the roles they play. List the different classes of antibody (CSP3)
    13. Be familiar with the basic structure of an antibody molecule. (FM1)
    14. Distinguish between Th1 and Th2 responses and list the cytokines involved in each stating the cells that secrete them (CSP3)
    15. Delineate the mechanism of septic shock (CSP3)
    16. Understand the role of antigen presentation and the structure and function of major histocompatability complex (MHC) molecules. (FM1)
    17. Correlate the changes in the immune system at a cellular level with the clinical consequences for the patient with HIV infection (I&I 4)
  • Communication between Immune Cells and Tissues
    1. Know that Th1 cells drive cell-mediated immunity (FM1)
    2. Know that Th2 cells drive humoral immunity (FM1)
    3. Know that Th17 cells drive responses to extracellular bacteria (FM1)
    4. Know that T-reg cells retrain immune responses (FM1)
    5. Know that memory T-cells remember our infection history (FM1)
    6. Appreciate that CD4 or helper T-cells orchestrate adaptive immun responses (FM1)
  • Hypersensitivity and Allergy
    1. Mostly revision: definitions of allergy, atopy, types of hypersensitivity, activation of mast cells, anaphylaxis, anaphylactoid reactions, scromboid and the antigens that provoke them (CSP3)
    2. Urticaria: description, and the different causes (allergic, infections, autoimmune, cold, cholinergic/adrenergic, physical, exercise, hormonal, haematinic deficiency) and treatment (CSP3)
    3. Angioedema: description, causes (allergic, inherited, acquired C1 esterase deficiency, ACE inhibitors, idiopathic) and treatment (CSP3)
  • Autoimmunity
  • Transplantation and Immunosupressive Therapy
    1. List the meanings of autograft, isograft, allograft and xenograft. (CSP3)
    2. Understand the role of Class 1 and Class II HLA molecules in presenting antigen to CD8 and CD4 T-lymphocytes respectively, and the ability of foreign Class I and II HLA (or xenogeneic equivalent) to directly activate some CD8 and CD4 T-lymphocytes. (CSP3)
    3. Understand and know the timing of the terms: Hyperacute rejection (mediated by antibodies against Graft HLA molecules + complement), Accelerated rejection (mediated by presensitised T-lymphocytes), Acute rejection mediated by T-lymphcytes, and chronic rejection (uncertain mechanisms). (CSP3)
    4. Know the role of IL2 and IFNy in promoting T-lymphocyte reactivity, and of IL4 and 6 in producing anti-graft antibodies. (CSP3)
    5. Understand the role of recipient antibody screening, and of cross matching in prevention of hyper-acute rejection. (CSP3)
    6. Understand that bone marrow transplant carries the additional risk of Graft-versus-Host. (CSP3)
  • Immunology - Neurological Diseases
    1. Describe the neuroimmunological aspects of multiple sclerosis
  • Immunology - Respiratory Disease
    1. Explain the two phases of asthma and how bronchial hyper-responsiveness is documented (CSP3)
    2. Explain the role of mast cells, eosinophils, dendritic cells, B lymphocytes and CD4 Th1 and CD4 Th2 T-lymphocytes in asthma (CSP3)
    3. Explain the role of IgE, Fcel1, FceRII, IL2, IL3, IL4, IL5, IL13, GMCSF gamma interferon, histamine, leukotrienes, cytokines, adhesion molecules and the Th1/Th2 paradigm (CSP3)
    4. List environmental and genetic factors predisposing to or protecting from asthma (CSP3)
  • Immunology - Renal Diseases
    1. Describe the MHC / HLA system and its role in the immune response
    2. Describe the role of T-cells and B-cells in the immune response
    3. Describe the complications associated with anti-rejection therapy
    4. Be aware of the concept of rapidly progressive glomerulonephritis and the relevant autoantibodies ie anti-GBM and ANCA and their association with pulmonary haemorrhage
  • Immunology - Dermatological Disease
    1. Appreciate the differences between Th1 and Th2 responses and the pathogenesis of allergic contact dermatitis.
    2. To appreciate the differences between Th1 and Th2 responses and the pathogenesis of allergic contact dermatitis. (LOC2)
• Inflammation
  • Acute Inflammation
    1. To appreciate the patho-physiology underlying the signs of inflammation in the skin redness, swelling and pain. (LOC2)
    2. To appreciate the different types of inflammation in the skin - mast cell mediated, immune complex mediated, delayed-type hypersensitivity, granuloma formation. (LOC2)
  • Chronic Inflammation

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