Basic and Clinical Sciences Applied to Family Medicine
Core concepts
Anatomy, physiology, pathology, pharmacology, and microbiology are tested in their clinical application. Focus on mechanisms that explain bedside findings: acid-base physiology, fluid compartments, drug mechanisms and interactions, and common pathogens.
Question traps
- Acid-base interpretation. Use the systematic approach: pH, then PaCO2, then bicarbonate. Compensatory responses never fully correct the pH; if pH is normal with abnormal CO2 and bicarbonate, consider a mixed disorder.
- Fluid compartments. Intracellular vs extracellular distribution, and the effect of osmoles (e.g. mannitol, hypertonic saline) on water shifts. Isotonic vs hypotonic fluids have different indications.
- Pharmacology. Know mechanisms and key adverse effects of common drug classes: ACE inhibitors (cough, hyperkalaemia), statins (myopathy), metformin (GI upset, lactic acidosis), NSAIDs (renal, GI).
- Microbiology. Distinguish Gram-positive from Gram-negative, and know the classic pathogens for common infections (e.g. Streptococcus pneumoniae for community-acquired pneumonia).
- Genetics. Know autosomal dominant vs recessive inheritance patterns and the meaning of penetrance and carrier status.
Worked rule of thumb
For acid-base questions, use the "expected compensation" check. If the measured compensation differs from the expected value, a mixed disorder is present. This resolves most ABG stems.
Applied physiology
Link the mechanism to the clinical sign: e.g. hyperkalaemia causes peaked T waves; hypocalcaemia causes tetany and prolonged QT.
Professionalism, Ethics, Communication and Health Systems
Core concepts
Ethical principles (autonomy, beneficence, non-maleficence, justice), informed consent, confidentiality, capacity assessment, and communication skills are tested. Also know health system structure and resource allocation.
Question traps
- Capacity vs competence. Capacity is decision-specific and assessed clinically: the patient must understand, retain, weigh, and communicate a decision. A patient who refuses treatment may still have capacity.
- Confidentiality. Breach is justified only in specific circumstances (e.g. risk to life, statutory reporting). Know the limits and the duty to warn where applicable.
- Informed consent. Requires capacity, adequate information, and voluntariness. In emergencies, treat under the principle of necessity.
- Autonomy vs paternalism. The correct answer usually respects the informed choice of a capacitated patient, even if it seems unwise.
- Resource allocation. Justice and equity questions test whether you can justify rationing transparently and fairly.
Worked rule of thumb
When an ethical dilemma appears, apply the four-principles framework in order: identify the conflict between autonomy and beneficence, then check capacity, then consider the least restrictive option. The answer that respects a capacitated patient's informed choice is usually correct.
Communication
Use open questions, summarise, and check understanding (teach-back). Breaking bad news follows a structured approach (e.g. SPIKES).