Infectious disease, haematology, rheumatology, neurology and oncology is 10% of our bank, about 15 items on a 150-item paper. It is where the Gulf shows most: MERS-CoV, brucellosis, thalassaemia, sickle cell disease and G6PD deficiency. The SMLE rates tuberculosis, iron deficiency anaemia, thrombotic disorders, sickle cell disease, SLE and ischaemic stroke at mastery level 3, and brucellosis and MERS-CoV at lower levels.
Weight and where it sits
This is the third medicine domain. In our planning mix it carries about 15 items on a 150-item paper, a figure that is ours and not a regulator's. The domain spans twenty subtopics, so depth per topic has to be modest. The way to cover it is through patterns: the infection you must not miss, the blood disease you must recognise, the neurological emergency with a time window.
What is tested
| Group | Subtopics |
|---|---|
| Infection | Tuberculosis (pulmonary, latent, drug-resistant concepts), MERS-CoV and COVID-19, brucellosis, STIs and HIV, malaria, dengue and travel fever, UTI and pyelonephritis, meningitis and encephalitis, antimicrobial stewardship |
| Blood | Iron deficiency and other microcytic anaemias, beta and alpha thalassaemia (trait versus major), sickle cell disease, G6PD deficiency, thrombocytopenia (ITP, TTP, HIT), bleeding disorders, venous thromboembolism and anticoagulants, haematological malignancy red flags and oncological emergencies |
| Rheumatology | Rheumatoid arthritis, gout, osteoarthritis, SLE and vasculitis |
| Neurology | Ischaemic stroke, TIA and thrombolysis, seizures and status epilepticus, headache, multiple sclerosis, Parkinson disease |
Gulf-specific points
MERS-CoV
Dromedary camels are the primary reservoir. Humans are infected by direct contact with dromedaries or raw camel products. Human-to-human spread is mostly in households and health-care settings. WHO gives about 37% of reported cases dying (probably overestimated) and more than 2,600 laboratory-confirmed cases, about 84% from the Arabian Peninsula. Severe disease risk factors are age over 65, immunosuppression, renal disease, cancer, chronic lung disease, hypertension, cardiovascular disease and diabetes. There is no licensed vaccine or specific treatment; care is supportive; cases are reported to WHO under the International Health Regulations.
Brucellosis
Exposure is unpasteurised milk or cheese from infected goats or sheep, or contact with animal blood, placenta or uterine secretions. Human-to-human spread is very rare. Incubation is one week to two months, usually two to four weeks. Treatment per WHO is doxycycline 100 mg twice daily for 45 days with streptomycin 1 g daily for 15 days, or with rifampicin 15 mg/kg/day (600 to 900 mg) for 45 days. Gentamicin 5 mg/kg/day for 7 to 10 days can replace streptomycin. Children under 8 receive co-trimoxazole with an aminoglycoside or rifampicin. Optimal treatment in pregnancy and neonates is not established. Know the complications: sacroiliitis or spondylitis, epididymo-orchitis, endocarditis and neurobrucellosis.
Thalassaemia, sickle cell disease and G6PD
- Beta-thalassaemia trait: microcytic hypochromic indices with a normal or raised red-cell count, Mentzer index (MCV/RBC) below 13, HbA2 above 3.5%, normal ferritin. Do not give iron without iron deficiency.
- Both parents carriers: 25% risk of thalassaemia major in each pregnancy, with prenatal diagnosis offered.
- Thalassaemia major: regular transfusion, iron chelation, ferritin and cardiac and liver iron monitoring.
- Sickle cell disease: avoid dehydration, hypoxia and cold; prompt strong analgesia in a vaso-occlusive crisis; oxygen only if hypoxic; acute chest syndrome needs oxygen, antibiotics, analgesia and sometimes exchange transfusion. Prevention is penicillin prophylaxis, pneumococcal and Haemophilus b vaccination, and hydroxycarbamide.
- G6PD deficiency: X-linked; haemolysis follows oxidant drugs and fava beans, including primaquine, dapsone, rasburicase, high-dose sulfonamides, nitrofurantoin and methylene blue, and infection.
Other fixed points
Drug-susceptible tuberculosis is treated with 2 months of isoniazid, rifampicin, pyrazinamide and ethambutol, then 4 months of isoniazid and rifampicin (2HRZE/4HR), with pyridoxine for risk groups. Ischaemic stroke: IV thrombolysis within 4.5 hours of onset after excluding haemorrhage, and thrombectomy for large-vessel occlusion within 6 hours, extending to 24 hours with favourable imaging. WHO's iron deficiency cut-off is a ferritin below 15 micrograms/L in adults without inflammation.
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Antibiotic choices and stewardship
Stewardship items ask you to match the drug to the syndrome, the likely organism and the patient's constraints, such as pregnancy, allergy, renal function and local resistance. They reward a short list of first-line choices for common infections, the habit of reviewing early, and a bias towards narrow spectrum once cultures return. Where the stem says a drug is contraindicated or unavailable, choose the next-best guideline option, not the strongest drug. Use the NICE guidelines and BNF as the tie-breaker for UK-style prescribing, and avoid brand names.
Three typical traps
- Iron for every microcytic anaemia. Thalassaemia trait looks like iron deficiency on a blood film. The ferritin, Mentzer index and HbA2 separate them, and iron in trait is the wrong answer.
- Oxidant drugs in a boy with jaundice or haemolysis. A drug on the G6PD list is the hidden cause. Scan every drug in the stem before choosing the diagnosis.
- Quoting a prevalence or a MERS statistic from memory. The bank does not depend on prevalence figures, and neither should your answers. Rely on transmission route, risk factors and management, which are stable.
How to revise it
- Learn the Gulf block first, using the WHO fact sheets for MERS-CoV and brucellosis. Each takes about 30 minutes to read.
- Make a haemoglobinopathy table of trait, major, sickle disease and G6PD with the diagnostic clue and the one drug or action to avoid.
- Do neurology as time windows, especially stroke and status epilepticus, where the number is the point.
- Treat rheumatology and oncology as red-flag recognition: the emergency, not the textbook.
- Link to the child versions in paediatrics and the pregnancy versions in obstetrics. The same diseases return there.
See high-yield topics and the study plan for scheduling.
Frequently asked questions
Is MERS-CoV likely to be on the paper?
The SMLE blueprint includes MERS-CoV and COVID-19 at a low mastery level for adults and a higher one for children. Learn the reservoir, transmission, risk factors and the absence of specific treatment.
What is the WHO brucellosis regimen?
Doxycycline 100 mg twice daily for 45 days with either streptomycin 1 g daily for 15 days or rifampicin 15 mg/kg/day for 45 days. Gentamicin 5 mg/kg/day for 7 to 10 days can replace streptomycin.
How do I tell thalassaemia trait from iron deficiency?
Trait gives microcytosis with a normal or raised red-cell count, a Mentzer index below 13, raised HbA2 and normal ferritin. Iron deficiency gives a low ferritin.
Which drugs trigger haemolysis in G6PD deficiency?
Primaquine, dapsone, rasburicase, high-dose sulfonamides, nitrofurantoin and methylene blue, along with fava beans and infections.
What stroke time windows should I know?
IV thrombolysis within 4.5 hours after excluding haemorrhage, and thrombectomy for large-vessel occlusion within 6 hours, extending to 24 hours with favourable imaging selection.