GEM 302 — Alimentary and Renal System I

• MLO1 Describe the gross and surface anatomy of the abdominal wall, inguinal region, peritoneum, abdominal viscera, great vessels, diaphragm and posterior abdominal wall, and apply it to hernias, incisions, portal hypertension and referred pain. not yet covered
• MLO2 Relate the microscopic structure of the alimentary tract and its associated glands to their functions. not yet covered
• MLO3 Describe the development of the alimentary tract and associated organs and explain the basis of their congenital anomalies. not yet covered
• MLO4 Explain the mechanisms and control of gastrointestinal secretion, motility, digestion and absorption, and the pathophysiology of vomiting, peptic ulcer disease and jaundice. not yet covered
• MLO5 Explain nutrient metabolism, energy balance, appetite and body composition, and the basis of malnutrition, malabsorption and diet-related disease; estimate energy intake, expenditure and body composition. not yet covered
• MLO6 Describe the gross anatomy, histology and development of the kidneys and urinary tract, including congenital anomalies, pain localisation and radiological anatomy. not yet covered
• MLO7 Explain renal function (urine formation, body fluid and electrolyte regulation, acid–base balance, blood pressure control), the biochemistry of urine and body fluids, and the principles of dialysis; interpret urinalysis and calculate renal clearance. not yet covered
• MLO8 Explain the links between psychological stress, kidney function and body fluids, and the relation of elimination disorders to emotional upset. not yet covered

Anatomy (Gross Anatomy)

1.1 Anterior abdominal wall (Gross Anatomy)

• 1.1.1 Identify on a living subject the surface landmarks and planes (mid-inguinal lines, subcostal and transpyloric planes, anterior superior iliac spine, pubic tubercle) and the nine regions of the abdomen, and project the main abdominal organs onto them. 18 questions
• 1.1.2 Describe the attachments, nerve supply and actions of external oblique, internal oblique, transversus abdominis and rectus abdominis, and explain their roles in respiration, micturition and defecation. 26 questions
• 1.1.3 Draw and describe the structure of the rectus sheath above and below the arcuate line. 12 questions
• 1.1.4 Describe the arterial supply, venous drainage and segmental innervation of the anterior abdominal wall, and predict the sensory and motor effects of injury to the lower intercostal nerves in the midaxillary line and at their entry to the rectus sheath. 18 questions
• 1.1.5 Explain the anatomical principles underlying common abdominal incisions (midline, paramedian, subcostal, gridiron, Pfannenstiel). 12 questions
• 1.1.6 List the information gained from inspection and palpation of the intact abdomen and the factors that contribute to normal variation in the position of abdominal organs. 15 questions

1.2 External genitalia: inguinal region, spermatic cord and testis (Gross Anatomy)

• 1.2.1 Describe the inguinal canal (walls, deep and superficial rings, inguinal ligament, conjoint tendon, transversalis fascia) and its contents in each sex (spermatic cord, round ligament of the uterus). 16 questions
• 1.2.2 Distinguish direct from indirect inguinal hernias by their relation to the inferior epigastric vessels and the inguinal (Hesselbach’s) triangle, and explain the mechanisms that normally prevent herniation. 10 questions
• 1.2.3 List the components and coverings of the spermatic cord (external spermatic, cremasteric and internal spermatic fascia) and state their functions. 12 questions
• 1.2.4 Describe the arterial supply, venous drainage (pampiniform plexus) and lymphatic drainage (para-aortic nodes) of the testis and explain their clinical significance. 14 questions
• 1.2.5 Describe the layers of the scrotum and the structure of the penis and of the female external genitalia. 20 questions

1.3 Peritoneum (Gross Anatomy)

• 1.3.1 Define parietal and visceral peritoneum, dorsal and ventral mesentery, and foregut, midgut and hindgut, and distinguish intraperitoneal from retroperitoneal organs. 18 questions
• 1.3.2 Explain the developmental origin and attachments of the falciform ligament, lesser and greater omentum, gastrosplenic and lienorenal ligaments. 25 questions
• 1.3.3 Describe the lesser sac, the boundaries of the epiploic foramen and the subphrenic and hepatorenal spaces, and explain their significance in the spread of infection and fluid. 21 questions
• 1.3.4 Explain the different nerve supplies of parietal and visceral peritoneum and their relevance to localised versus poorly localised abdominal pain. 16 questions

1.4 Stomach and duodenum (Gross Anatomy)

• 1.4.1 Identify the parts of the stomach (cardia, fundus, body, pyloric antrum, pylorus, greater and lesser curvatures) and the four parts of the duodenum. 21 questions
• 1.4.2 Describe the relations of the stomach, including the stomach bed (pancreas, left kidney, spleen, splenic artery, transverse colon, greater and lesser omentum, lesser sac). 18 questions
• 1.4.3 Describe the relations of each part of the duodenum, including the head of the pancreas, bile duct, major duodenal papilla, aorta, superior mesenteric vessels, portal vein and right kidney. 19 questions
• 1.4.4 Describe the arterial supply of the stomach and duodenum from the coeliac trunk and superior mesenteric artery, and explain why a posterior duodenal ulcer can erode the gastroduodenal artery. 14 questions
• 1.4.5 Explain the lymphatic routes by which gastric cancer spreads and name the main groups of lymph nodes involved. 11 questions

1.5 Intestines: small and large (Gross Anatomy)

• 1.5.1 Distinguish the jejunum from the ileum by wall thickness, vasa recta, arterial arcades, mesenteric fat and Peyer’s patches. 22 questions
• 1.5.2 Describe the distinguishing features of the large intestine (taeniae coli, haustra, appendices epiploicae) and the position, relations and peritoneal attachments of the caecum, appendix, colon and rectum. 22 questions
• 1.5.3 Sketch the ileocaecocolic region and label the terminal ileum, caecum, appendix, mesoappendix and the ileocolic, caecal and appendicular arteries. 11 questions
• 1.5.4 Describe the positions of the appendix and the surface marking of its base (McBurney’s point). 14 questions
• 1.5.5 Describe the anatomy of the anal canal and the significance of the pectinate line for its blood supply, lymphatic drainage and innervation. 26 questions

1.6 Blood vessels, lymphatics and nerves of the gut (Gross Anatomy)

• 1.6.1 Describe the origin, course and branches of the coeliac trunk, superior mesenteric and inferior mesenteric arteries and the foregut, midgut and hindgut territories they supply. 21 questions
• 1.6.2 Define the portal venous system, describe its formation, course and relations (duodenum, head of pancreas, epiploic foramen, hepatic artery, bile duct) and explain its function. 16 questions
• 1.6.3 Define portosystemic anastomoses, list their main sites (oesophageal, rectal, paraumbilical, retroperitoneal) and explain their clinical significance in portal hypertension. 10 questions
• 1.6.4 Describe the lymphatic drainage of the abdominal gut (pre-aortic nodes, cisterna chyli) and outline its autonomic innervation. 12 questions

1.7 Spleen, liver and pancreas (Gross Anatomy)

• 1.7.1 Describe the position, relations, blood supply, peritoneal attachments and surface marking of the spleen. 12 questions
• 1.7.2 Sketch the inferior surface of the liver and label its lobes, porta hepatis, portal vein, hepatic artery, IVC, gallbladder, cystic and bile ducts, ligamentum teres and ligamentum venosum; describe its peritoneal relations (falciform and triangular ligaments, bare area). 26 questions
• 1.7.3 Describe the extrahepatic biliary tree (hepatic, cystic and common bile ducts; cystohepatic triangle) and the surface marking of the gallbladder. 19 questions
• 1.7.4 Describe the parts, relations, ducts and blood supply of the pancreas. 15 questions
• 1.7.5 Describe the functional (Couinaud) segments of the liver and their basis in the portal and hepatic venous anatomy. 10 questions

1.8 Suprarenal glands (Gross Anatomy)

• 1.8.1 Describe the position, relations, arterial supply, venous drainage (right to IVC, left to left renal vein) and nerve supply of the suprarenal glands. 9 questions
• 1.8.2 Explain the innervation of the adrenal medulla by preganglionic sympathetic fibres and why the medulla is regarded as a modified sympathetic ganglion. 14 questions
• 1.8.3 Describe the diffuse neuroendocrine (chromaffin) system. 14 questions

1.9 Abdominal aorta and inferior vena cava (Gross Anatomy)

• 1.9.1 Describe the origin, course, relations and termination of the abdominal aorta and list its anterior unpaired, lateral paired and posterior branches with their vertebral levels. 17 questions
• 1.9.2 Describe the formation, course, relations, termination and tributaries of the inferior vena cava. 8 questions
• 1.9.3 Explain the anatomical basis of the supine hypotensive syndrome of pregnancy. 13 questions

1.10 Diaphragm (Gross Anatomy)

• 1.10.1 Describe the attachments, parts (central tendon, crura, arcuate ligaments), nerve supply (phrenic nerve, C3–C5) and actions of the diaphragm. 17 questions
• 1.10.2 Describe the main openings of the diaphragm, their vertebral levels (T8, T10, T12) and the structures that pass through them. 13 questions
• 1.10.3 Explain referred shoulder-tip pain from diaphragmatic irritation and the anatomical basis of hiatus hernia. 17 questions

1.11 Posterior abdominal wall (Gross Anatomy)

• 1.11.1 Describe the attachments, innervation and actions of psoas major, psoas minor, iliacus and quadratus lumborum. 20 questions
• 1.11.2 Explain the clinical importance of the psoas fascia (for example psoas abscess from spinal tuberculosis) and the thoracolumbar fascia. 19 questions
• 1.11.3 Describe the formation and branches of the lumbar plexus (iliohypogastric, ilioinguinal, genitofemoral, lateral cutaneous nerve of the thigh, femoral and obturator nerves) and their relation to psoas. 17 questions

1.12 Autonomic innervation of the abdomen and referred pain (second “posterior abdominal wall” slot) (Gross Anatomy)

• 1.12.1 Discriminate between sympathetic and parasympathetic nerves by origin, organisation and function. 16 questions
• 1.12.2 Distinguish preganglionic from postganglionic autonomic neurones and describe the pathways (splanchnic nerves, coeliac and mesenteric ganglia, vagus, pelvic splanchnic nerves) by which autonomic fibres reach the abdominal viscera and wall. 10 questions
• 1.12.3 Define referred pain and explain its mechanism using appendicitis (periumbilical then right iliac fossa pain) and gallbladder disease (epigastric and right shoulder pain) as examples. 12 questions

Histology)

2.1 Histology of the oral cavity and pharynx (Histology)

• 2.1.1 Describe the histology of the lip (skin, vermilion border, oral mucosa), the tongue (filiform, fungiform, circumvallate and foliate papillae; taste buds; intrinsic muscle), the hard and soft palate and the pharynx. 22 questions
• 2.1.2 Describe the structure of a tooth (enamel, dentine, pulp, cementum, periodontal ligament). 15 questions
• 2.1.3 Compare the parotid, submandibular and sublingual glands by acinar type (serous, mucous, mixed with serous demilunes) and duct system. 16 questions
• 2.1.4 Describe the transition zones between keratinised and non-keratinised epithelium in the oral cavity and pharynx. 15 questions

2.2 Histology of the oesophagus (Histology)

• 2.2.1 Describe the general four-layered plan of the gut wall (mucosa, submucosa, muscularis externa, adventitia or serosa) and the enteric plexuses. 14 questions
• 2.2.2 Describe the oesophageal epithelium (non-keratinised stratified squamous), its glands (oesophageal and oesophageal cardiac glands) and the change in its muscularis externa from skeletal to smooth muscle. 17 questions
• 2.2.3 Relate the structure of the oesophagus to its function, including the significance of the squamocolumnar junction in Barrett’s metaplasia. 12 questions

2.3 Histology of the stomach (Histology)

• 2.3.1 Describe the gastric mucosa (gastric pits and glands) and the differences between the cardiac, fundic (body) and pyloric regions. 21 questions
• 2.3.2 Identify parietal, chief, mucous neck and enteroendocrine (including G) cells and state their secretions. 18 questions
• 2.3.3 Describe the histology of the gastro-oesophageal and gastroduodenal junctions. 16 questions

2.4 Histology of the small intestine (Histology)

• 2.4.1 Describe the structures that increase absorptive surface area: plicae circulares, villi and microvilli. 17 questions
• 2.4.2 Describe the cells of the villi and crypts (enterocytes, goblet cells, Paneth cells, enteroendocrine cells, stem cells) and the lacteal. 12 questions
• 2.4.3 Distinguish the duodenum (Brunner’s glands), jejunum and ileum (Peyer’s patches) histologically, and describe the ileocaecal junction. 12 questions

2.5 Histology of the large intestine (Histology)

• 2.5.1 Describe the histology of the colon (no villi, straight crypts rich in goblet cells, taeniae coli) and relate it to water absorption and lubrication. 15 questions
• 2.5.2 Describe the histology of the appendix (lymphoid follicles), rectum and anal canal, and the epithelial transition at the anorectal junction. 16 questions

2.6 Histology of the liver, pancreas and gallbladder (Histology)

• 2.6.1 Describe the organisation of the liver as classic lobule, portal lobule and acinus (zones 1–3), including the portal triad, sinusoids, Kupffer cells, space of Disse, stellate cells and bile canaliculi. 19 questions
• 2.6.2 Describe the exocrine pancreas (acini, centroacinar cells, ducts) and the endocrine islets (alpha, beta and delta cells). 14 questions
• 2.6.3 Describe the wall of the gallbladder (simple columnar epithelium, absence of submucosa, Rokitansky–Aschoff sinuses) and relate it to concentration of bile. 11 questions

2.7 Development of the tongue, thyroid gland, salivary glands and pharynx (Developmental Anatomy)

• 2.7.1 Describe the contributions of the pharyngeal arches and pouches to the oral cavity and pharynx. 19 questions
• 2.7.2 Describe the development of the tongue (lateral lingual swellings, tuberculum impar, hypobranchial eminence) and explain its pattern of innervation. 8 questions
• 2.7.3 Describe the development and descent of the thyroid gland (foramen caecum, thyroglossal duct) and the basis of thyroglossal cyst and ectopic thyroid. 13 questions
• 2.7.4 Describe the development of the salivary glands. 18 questions

2.8 Development of the foregut: oesophagus, stomach and duodenum (Developmental

• 2.8.1 Describe the formation of the primitive gut by embryonic folding and its division into foregut, midgut and hindgut, each with its own artery. 13 questions
• 2.8.2 Describe the development of the oesophagus (tracheo-oesophageal septum) and of the stomach (rotation, formation of the curvatures and lesser sac). 17 questions
• 2.8.3 Describe the development of the duodenum, including its temporary occlusion and recanalisation. 13 questions

2.9 Development of the midgut (Developmental Anatomy)

• 2.9.1 Describe the primary intestinal loop, physiological umbilical herniation, 270° anticlockwise rotation around the superior mesenteric artery and retraction of the loop. 9 questions
• 2.9.2 Explain the fixation of the mesenteries and the origin of the secondarily retroperitoneal parts of the gut. 7 questions
• 2.9.3 Explain the basis of malrotation and midgut volvulus. 9 questions

2.10 Development of the hindgut (Developmental Anatomy)

• 2.10.1 List the derivatives of the hindgut (distal transverse colon to upper anal canal). 12 questions
• 2.10.2 Describe the partitioning of the cloaca by the urorectal septum and the dual origin of the anal canal. 12 questions

2.11 Development of the liver, gallbladder and pancreas (Developmental Anatomy)

• 2.11.1 Describe the development of the liver from the hepatic diverticulum and septum transversum, and of the gallbladder and bile ducts. 7 questions
• 2.11.2 Describe the development of the pancreas from dorsal and ventral buds, their rotation and fusion, and the formation of the main and accessory pancreatic ducts. 16 questions
• 2.11.3 Explain the haematopoietic function of the fetal liver. 11 questions

2.12 Congenital anomalies of the gastrointestinal tract (Developmental Anatomy)

• 2.12.1 Explain the embryological basis and presentation of oesophageal atresia with tracheo-oesophageal fistula and congenital hiatal hernia. 13 questions
• 2.12.2 Explain infantile hypertrophic pyloric stenosis, gut atresias and stenoses (failed recanalisation or vascular accident) and annular pancreas. 14 questions
• 2.12.3 Explain Meckel’s diverticulum, vitelline cysts and fistulae, omphalocele versus gastroschisis and situs inversus. 16 questions
• 2.12.4 Explain Hirschsprung’s disease (failed neural crest migration), extrahepatic biliary atresia and anorectal malformations (imperforate anus, rectourethral and rectovaginal fistulae). 17 questions

5.6 Microscopic features and function of the kidney

• 5.6.1 Describe the capsule, cortex, medulla (pyramids, medullary rays), renal lobe and lobule, minor and major calyces and hilum. 13 questions
• 5.6.2 Describe the renal corpuscle and the glomerular filtration barrier (fenestrated endothelium, basement membrane, podocyte slit diaphragms) and mesangial cells. 19 questions
• 5.6.3 Describe the epithelium of the proximal tubule, loop of Henle, distal tubule and collecting duct (principal and intercalated cells) and relate each to its function. 20 questions
• 5.6.4 Describe the juxtaglomerular apparatus (macula densa, juxtaglomerular cells, extraglomerular mesangial cells) and its function. 14 questions
• 5.6.5 Describe the renal circulation (interlobar, arcuate, interlobular arteries; afferent and efferent arterioles; peritubular capillaries; vasa recta) and relate it to urine production. 11 questions

5.7 Microscopic features and function of the ureter, urinary bladder and urethra

• 5.7.1 Describe the urothelium (umbrella cells, uroplakins) and explain how it accommodates distension. 10 questions
• 5.7.2 Describe the wall of the ureter and of the bladder, including the detrusor muscle. 13 questions
• 5.7.3 Describe the histology of the male (prostatic, membranous, spongy) and female urethra. 16 questions

Physiology

3.1 Mouth: mastication, oral absorption and salivary secretion (Physiology)

• 3.1.1 State the primary functions of the GIT and describe its functional organisation: enteric nervous system, extrinsic innervation and the main gastrointestinal hormones. 21 questions
• 3.1.2 Describe the mechanism and value of mastication. 16 questions
• 3.1.3 Explain the mechanism, advantages and clinical applications of oral (sublingual and buccal) absorption, including avoidance of first-pass metabolism. 5 questions
• 3.1.4 Describe the composition, two-stage secretion (isotonic acinar fluid modified by the ducts), functions and control of saliva. 19 questions

3.2 Swallowing and vomiting (Physiology)

• 3.2.1 Describe the oral, pharyngeal and oesophageal stages of swallowing and the swallowing reflex. 20 questions
• 3.2.2 Explain the functions of the upper and lower oesophageal sphincters and the factors that affect them. 13 questions
• 3.2.3 Describe the causes and basic mechanism of vomiting (vomiting centre, chemoreceptor trigger zone) and its metabolic consequences. 11 questions

3.3 Gastric secretion and motility (Physiology)

• 3.3.1 List the major functions of the stomach and describe the composition and functions of gastric secretions (acid, pepsinogen, intrinsic factor, mucus, gastrin). 18 questions
• 3.3.2 Describe the mechanism of acid secretion by the parietal cell (H⁺/K⁺-ATPase, carbonic anhydrase, alkaline tide). 12 questions
• 3.3.3 Explain the control of gastric secretion in the cephalic, gastric and intestinal phases (acetylcholine, gastrin, histamine, somatostatin, secretin). 21 questions
• 3.3.4 Explain the protection of the gastric mucosa against luminal contents and describe the pathophysiology of peptic ulcer disease (H. pylori, NSAIDs, acid). 15 questions
• 3.3.5 Describe gastric motility: receptive relaxation, tone, peristaltic contractions and the role of the pyloric sphincter in storage, mixing and emptying. 19 questions

3.4 Small intestinal secretions (Physiology)

• 3.4.1 Describe the secretion, function and control of Brunner’s glands. 12 questions
• 3.4.2 Describe the secretion of the intestinal crypts, the brush-border enzymes, and their functions and control. 12 questions
• 3.4.3 Explain intestinal chloride secretion through CFTR and its role in secretory diarrhoea (for example cholera toxin). 18 questions

3.5 Small intestinal motility (Physiology)

• 3.5.1 Describe mixing (segmentation), peristaltic and villous movements and the role of slow waves and the interstitial cells of Cajal. 15 questions
• 3.5.2 Describe the migrating motor complex. 12 questions
• 3.5.3 Describe the ileocaecal junction and its control. 10 questions

3.6 Pancreatic secretion (Physiology)

• 3.6.1 Describe the composition of pancreatic juice: enzymes (trypsinogen, chymotrypsinogen, amylase, lipase, colipase) and the alkaline bicarbonate-rich fluid. 14 questions
• 3.6.2 Explain the mechanisms that prevent enzyme activation within the pancreas and the consequence of their failure (acute pancreatitis). 15 questions
• 3.6.3 Explain the control of pancreatic secretion by the vagus, secretin and cholecystokinin. 9 questions

3.7 Liver functions, bile and jaundice (Physiology)

• 3.7.1 List the major functions of the liver. 18 questions
• 3.7.2 Describe the composition, secretion, functions and control of bile. 15 questions
• 3.7.3 Explain the enterohepatic circulation of bile acids and its significance. 10 questions
• 3.7.4 Describe the concentrating ability and motility of the gallbladder and the role of cholecystokinin. 8 questions
• 3.7.5 Explain bilirubin metabolism and classify jaundice as pre-hepatic, hepatic or post-hepatic, with the characteristic findings in blood, urine and stool. 25 questions

3.8 Terminal digestion and absorption; large intestine (Physiology)

• 3.8.1 Describe membrane digestion of carbohydrates and sodium-dependent (SGLT1) and sodium-independent (GLUT5, GLUT2) sugar transport, and relate them to oral rehydration solution. 15 questions
• 3.8.2 Describe the absorption of peptides and amino acids, proton-dependent peptide absorption (PepT1) and the absorption of macromolecules. 10 questions
• 3.8.3 Describe lipid absorption: micelle formation, the unstirred water layer, chylomicron formation and lymphatic transport. 15 questions
• 3.8.4 Describe water and electrolyte absorption along the intestine. 16 questions
• 3.8.5 Describe colonic motility (haustral contractions, mass movements), absorption and secretion, colonic flora and the defecation reflex. 24 questions

Medical Biochemistry

4.1 The role of the liver in nutrient metabolism (Medical Biochemistry)

• 4.1.1 Describe hepatic carbohydrate metabolism (glycogenesis, glycogenolysis, gluconeogenesis) in the fed and fasting states. 17 questions
• 4.1.2 Describe hepatic lipid metabolism (fatty acid oxidation, ketogenesis, VLDL and cholesterol synthesis) and protein metabolism (plasma protein synthesis, transamination, urea cycle). 20 questions
• 4.1.3 Explain how liver metabolism changes between the fed state, fasting and starvation. 8 questions

4.2 Nutrient absorption in the intestines: biochemical aspects (Medical Biochemistry)

• 4.2.1 Describe the digestive enzymes acting on carbohydrates, proteins and lipids and their sites of action. 17 questions
• 4.2.2 Describe the absorption of iron (haem and non-haem, DMT1, ferroportin, hepcidin), calcium, vitamin B12 (intrinsic factor, terminal ileum) and the fat-soluble vitamins. 26 questions
• 4.2.3 Explain the metabolic fate of absorbed nutrients by the portal and lymphatic routes. 11 questions

4.3 Nutrient malabsorption (Medical Biochemistry)

• 4.3.1 Classify malabsorption as luminal (pancreatic insufficiency, bile salt deficiency), mucosal (coeliac disease, tropical sprue) or post-mucosal. 14 questions
• 4.3.2 Describe the clinical and biochemical consequences of malabsorption: steatorrhoea and deficiencies of iron, folate, vitamin B12 and the fat-soluble vitamins. 16 questions
• 4.3.3 Describe laboratory tests for malabsorption: faecal fat, D-xylose absorption, breath tests and faecal elastase. 13 questions

4.4 Malnutrition and optimal nutrition (Medical Biochemistry)

• 4.4.1 Define malnutrition (undernutrition, overnutrition, micronutrient deficiency) and the double burden of malnutrition. 19 questions
• 4.4.2 Compare kwashiorkor and marasmus by aetiology, biochemical features and clinical signs. 12 questions
• 4.4.3 Describe the anthropometric and biochemical assessment of nutritional status (weight-for-height, mid-upper arm circumference, BMI, albumin). 15 questions
• 4.4.4 Explain the concept of optimal nutrition: a balanced diet, macronutrient distribution, dietary reference values and key micronutrients. 29 questions
• 4.4.5 Explain the biochemical basis of refeeding syndrome. 19 questions

4.5 Lactose intolerance (Medical Biochemistry)

• 4.5.1 Explain the function of lactase and the causes of lactose intolerance: primary (lactase non-persistence), secondary (mucosal injury) and congenital. 6 questions
• 4.5.2 Explain the mechanism of symptoms (osmotic diarrhoea, colonic fermentation, gas). 12 questions
• 4.5.3 Describe the diagnosis (hydrogen breath test, lactose tolerance test, stool reducing substances) and dietary management. 20 questions

4.6 Diabetes mellitus: metabolic and nutritional aspects (Medical Biochemistry)

• 4.6.1 Describe the roles of insulin and glucagon in fuel metabolism and the metabolic consequences of insulin deficiency and resistance, including ketogenesis. 18 questions
• 4.6.2 Classify diabetes mellitus and state the diagnostic criteria (fasting glucose, OGTT, HbA1c). 17 questions
• 4.6.3 Explain the glycaemic index and the principles of dietary management of diabetes. 16 questions

4.7 Cardiovascular diseases: nutritional aspects (Medical Biochemistry)

• 4.7.1 Describe the lipoprotein classes (chylomicrons, VLDL, LDL, HDL), their metabolism and their role in atherogenesis. 22 questions
• 4.7.2 Explain dietary influences on cardiovascular risk: saturated and trans fats, omega-3 fatty acids, salt, fibre. 15 questions
• 4.7.3 Interpret a lipid profile in relation to cardiovascular risk and outline dietary management. 14 questions

4.8 Hunger, appetite and satiety (Medical Biochemistry)

• 4.8.1 Distinguish hunger, appetite and satiety. 8 questions
• 4.8.2 Describe the hypothalamic control of food intake (arcuate nucleus NPY/AgRP and POMC/CART neurones) and the peripheral signals (ghrelin, leptin, insulin, CCK, PYY, GLP-1). 15 questions
• 4.8.3 Explain the disturbances of appetite regulation in obesity (leptin resistance) and in illness (anorexia, cachexia). 10 questions

4.9 Body composition (Medical Biochemistry)

• 4.9.1 Describe compartment models of body composition (fat mass and fat-free mass; total body water). 17 questions
• 4.9.2 Describe the methods of measuring body composition (anthropometry and skinfolds, bioelectrical impedance, densitometry, DXA) and their limitations. 18 questions
• 4.9.3 Calculate and interpret BMI, waist circumference and waist-to-hip ratio using standard cut-offs. 19 questions

4.10 Energy balance and body weight regulation (Medical Biochemistry)

• 4.10.1 Define energy balance and its components: energy intake, basal metabolic rate, thermic effect of food and physical activity. 18 questions
• 4.10.2 Explain body weight regulation and the consequences of positive and negative energy balance. 14 questions
• 4.10.3 Describe the factors that affect basal metabolic rate (body size, lean mass, age, sex, thyroid hormones, fever). 8 questions

4.11 Estimation of energy intake and energy expenditure (Medical Biochemistry)

• 4.11.1 Describe the methods of estimating energy intake (24-hour recall, food diary, food frequency questionnaire) and their limitations. 12 questions
• 4.11.2 Calculate the energy content of food from its macronutrient composition (4, 9, 4 and 7 kcal/g for carbohydrate, fat, protein and alcohol). 10 questions
• 4.11.3 Describe the methods of estimating energy expenditure (direct and indirect calorimetry, respiratory quotient, doubly labelled water, predictive equations) and calculate total energy expenditure from BMR and physical activity level. 16 questions

Anatomy (Histology

5.1 Kidneys and ureters (Gross Anatomy)

• 5.1.1 Describe the coverings of the kidneys (fibrous capsule, perirenal fat, renal fascia, pararenal fat) and their external and internal features (hilum, cortex, medulla, pyramids, calyces, pelvis). 19 questions
• 5.1.2 Compare the positions and relations of the left and right kidneys and explain the significance of their relation to the diaphragm in clinical examination. 18 questions
• 5.1.3 Describe the blood supply, venous and lymphatic drainage and innervation of the kidneys, and explain the arterial segments of the kidney. 16 questions
• 5.1.4 Describe the course and relations of the ureters from the renal hilum to the bladder, their sites of narrowing, and the significance of their relation to the cervix and uterine artery in females. 16 questions
• 5.1.5 Explain the anatomical basis for the localisation of pain from the urinary tract (loin-to-groin renal colic; T11–L2). 11 questions

5.2 Urinary bladder and urethra (Gross Anatomy)

• 5.2.1 Describe the shape, parts, trigone, position and peritoneal relations of the empty and full bladder. 17 questions
• 5.2.2 Describe the relations of the male bladder to the ureters, ductus deferentes, seminal vesicles, prostate and urethra, and of the female bladder. 17 questions
• 5.2.3 Describe the anatomical and histological features that allow the bladder to expand as it fills. 13 questions
• 5.2.4 Describe the origin and course of the superior and inferior vesical arteries, the significance of the umbilical ligaments, and the venous and lymphatic drainage of the bladder and prostate. 19 questions
• 5.2.5 Describe the innervation of the bladder (pelvic splanchnic, sympathetic and pudendal nerves) and the parts of the male and female urethra. 19 questions

5.3 Posterior abdominal wall: relations of the kidneys and ureters (Gross Anatomy)

• 5.3.1 Describe the morphology of the posterior abdominal wall and identify the structures related posteriorly to the kidneys and ureters (diaphragm, 12th rib, psoas, quadratus lumborum, transversus abdominis, subcostal, iliohypogastric and ilioinguinal nerves). 13 questions
• 5.3.2 Describe the surface projection of the kidneys and ureters on the posterior abdominal wall and the posterior approach to the kidney. 15 questions
• 5.3.3 Explain the spread of perinephric and psoas abscesses along the renal and psoas fascia. 9 questions

5.4 Development and anomalies of the kidney and ureter (Developmental Anatomy)

• 5.4.1 Describe the pronephros, mesonephros and metanephros and the fate of each. 15 questions
• 5.4.2 Describe the reciprocal induction of the ureteric bud (collecting system) and metanephric blastema (nephrons), and the ascent of the kidney with its changing blood supply. 18 questions
• 5.4.3 Explain renal agenesis and its consequences (oligohydramnios), horseshoe kidney, ectopic (pelvic) kidney and duplex ureter. 16 questions

5.5 Development and anomalies of the urinary bladder and urethra (Developmental

• 5.5.1 Describe the partitioning of the cloaca, the urogenital sinus and the development of the bladder, trigone and urethra in both sexes. 23 questions
• 5.5.2 Describe the allantois and urachus and their fate (median umbilical ligament). 5 questions
• 5.5.3 Explain urachal cyst, sinus and fistula, exstrophy of the bladder and megacystis. 15 questions

Renal Physiology, Biochemistry of Urine and Body Fluids, and Psychological Aspects

6.1 Functions of the kidney (Physiology)

• 6.1.1 Explain the functions of the kidney: excretion of metabolic wastes and foreign chemicals; regulation of water and electrolyte balance, osmolarity, arterial pressure and acid–base balance; hormone secretion and metabolism; gluconeogenesis. 21 questions
• 6.1.2 Describe the functional anatomy of cortical and juxtamedullary nephrons and the magnitude of renal blood flow. 15 questions
• 6.1.3 Explain renal clearance and calculate the clearance of a substance from its urine and plasma concentrations and the urine flow rate. 16 questions

6.2 Glomerular filtration and renal blood flow (Physiology)

• 6.2.1 Explain the determinants of the glomerular filtration rate (Starling forces, filtration coefficient) and calculate net filtration pressure. 18 questions
• 6.2.2 Describe the physiological control of GFR and renal blood flow (sympathetic nerves, angiotensin II, prostaglandins, nitric oxide). 14 questions
• 6.2.3 Explain autoregulation of GFR and renal blood flow by the myogenic mechanism and tubuloglomerular feedback. 19 questions
• 6.2.4 Calculate GFR from inulin or creatinine clearance and calculate the filtration fraction. 17 questions

6.3 Tubular reabsorption and secretion; concentrating the urine (Physiology)

• 6.3.1 Describe the mechanisms of tubular transport (primary and secondary active transport) and the main renal transporters by segment (SGLT2, NKCC2, NCC, ENaC, aquaporins). 17 questions
• 6.3.2 Explain tubular secretion and the transport maximum, using the renal threshold for glucose as an example. 14 questions
• 6.3.3 Explain the requirements for excreting a concentrated urine: countercurrent multiplication, urea recycling, the vasa recta and ADH. 19 questions
• 6.3.4 Relate the renal transporters to the sites of action of loop and thiazide diuretics and SGLT2 inhibitors. 16 questions

6.4 Body fluid compartments, fluid therapy and oedema (Physiology)

• 6.4.1 Describe the body fluid compartments, their volumes and composition, and their measurement by indicator dilution. 19 questions
• 6.4.2 Explain the distribution of fluid between plasma and interstitium (Starling forces) and between extracellular and intracellular compartments (osmosis), and calculate plasma osmolality. 12 questions
• 6.4.3 Predict the effects of isotonic, hypotonic and hypertonic fluids on the compartments and explain the principles of fluid therapy. 17 questions
• 6.4.4 Explain the mechanisms of oedema and relate them to heart failure, nephrotic syndrome and cirrhosis. 14 questions

6.5 Principles of the circulation and control of blood flow (Physiology)

• 6.5.1 Describe the functional parts of the circulation, the distribution of blood volumes and pressures, and the relationship between flow, pressure and resistance. 26 questions
• 6.5.2 Explain local (metabolic, myogenic, endothelial) and humoral (angiotensin II, ADH, ANP, bradykinin) control of blood flow. 18 questions
• 6.5.3 Explain short-term control of arterial pressure by the nervous system (baroreceptor and chemoreceptor reflexes). 22 questions

6.6 Long-term control of arterial pressure by the kidneys; hypertension (Physiology)

• 6.6.1 Explain long-term control of arterial pressure by the kidneys (pressure natriuresis and the renal function curve). 12 questions
• 6.6.2 Describe the renin–angiotensin–aldosterone system and its role in blood pressure and volume regulation. 11 questions
• 6.6.3 Explain the pathophysiology of essential, neurogenic and renin-dependent hypertension and of hypertension in pre-eclampsia. 17 questions
• 6.6.4 Explain renal control of body fluid volume in heart failure and its contribution to oedema. 12 questions

6.7 Urine as a body fluid (Medical Biochemistry)

• 6.7.1 Describe the normal composition of urine (urea, creatinine, uric acid, electrolytes) and its abnormal constituents (glucose, protein, ketones, blood, bilirubin). 15 questions
• 6.7.2 Explain the hormonal regulation of urine formation and composition: ADH (pituitary and diuresis), aldosterone, ANP and PTH. 16 questions
• 6.7.3 Describe the kidney hormones (erythropoietin, renin, calcitriol) and their actions. 13 questions
• 6.7.4 Explain the function of channel proteins, especially aquaporin-2 insertion in response to ADH, and the basis of diabetes insipidus. 14 questions
• 6.7.5 Explain the factors that regulate the acidity of urine. 14 questions

6.8 Fluid, electrolyte and acid–base regulation; bone mineral and calcium metabolism (Medical Biochemistry)

• 6.8.1 Explain the renal regulation of acid–base balance: bicarbonate reabsorption, generation of new bicarbonate, and excretion of titratable acid and ammonium. 22 questions
• 6.8.2 Explain the influence of fatty acid and amino acid metabolism on acid–base balance (ketoacids, sulphuric acid from sulphur-containing amino acids, renal ammoniagenesis from glutamine). 11 questions
• 6.8.3 Describe the renal handling of sodium, potassium, calcium, phosphate and magnesium, and the role of the kidney in calcium homeostasis (1-alpha-hydroxylase, PTH, FGF23). 18 questions
• 6.8.4 Interpret basic acid–base and electrolyte results, including calculation of the anion gap. 21 questions

6.9 Fluid and electrolyte disturbances after relief of urinary obstruction (Medical

• 6.9.1 Describe normal daily fluid and electrolyte balance (intake and losses). 15 questions
• 6.9.2 Explain the mechanisms of post-obstructive diuresis (solute diuresis from retained urea, impaired concentrating ability) and the disturbances that follow (hypovolaemia, sodium and potassium disturbances, hypomagnesaemia). 13 questions
• 6.9.3 Outline the principles of monitoring and replacing fluid and electrolytes after relief of obstruction. 6 questions

6.10 Principles of dialysis and its use in kidney disease (Medical Biochemistry)

• 6.10.1 Explain the principles of dialysis: diffusion, ultrafiltration, convection, the semipermeable membrane and the composition of dialysate. 15 questions
• 6.10.2 Compare haemodialysis and peritoneal dialysis. 7 questions
• 6.10.3 State the biochemical indications for dialysis and the substances it removes. 10 questions

6.11 Composition and significance of body fluids (Medical Biochemistry)

• 6.11.1 Compare the composition and functions of saliva, blood plasma, urine, sweat, semen, tears, lymph and synovial fluid. 18 questions
• 6.11.2 Explain the diagnostic use of body fluids, for example sweat chloride, synovial fluid analysis, salivary cortisol and semen analysis. 14 questions

6.12 Stress, the kidney and body fluids (Psychological Medicine)

• 6.12.1 Define stress and describe the physiology of stress (hypothalamic–pituitary–adrenal axis, sympatho-adrenal medullary system). 11 questions
• 6.12.2 Explain how chronic stress harms the body (allostatic load, cardiovascular and immune effects). 12 questions
• 6.12.3 Explain the link between stress, high blood pressure and kidney damage. 13 questions
• 6.12.4 Explain the effects of stress on body fluids, such as saliva, urine output and blood clotting, and describe where body fluids are located. 13 questions
• 6.12.5 Describe the elimination disorders (enuresis, encopresis) and their relation to emotional upset. 6 questions