RDA: Concept Checklist

Concepts covered across the module lectures, grouped by lecture. Tick each once you can explain it from memory.

L1 Intro to the RDA Block Module and Germ cells (15 Jul) L1 RDA Intro to the RDA Block Module and Germ cells

• Compare testicular and ovarian reproductive function (gamete output, replication, hormone production, tract role)
• Testis and seminiferous tubule anatomy, germ cell layers, Leydig and Sertoli cells
• Structure of the spermatozoon: head with acrosome, midpiece and tail
• Blood-testis barrier: junctions, basal vs adluminal compartments and which germ cells lie in each
• Spermatocytogenesis: spermatogonial stem cells, clonal divisions and cytoplasmic bridges
• Meiotic division in spermatogenesis and its functions
• Spermiogenesis: acrosome formation, flagellum development, chromatin condensation, loss of cytoplasm; testosterone requirement
• Spermatogenic cycle and wave: timing, overlapping generations, human mosaic vs rat spiral arrangement
• Spermiation and epididymal maturation
• Factors affecting sperm production: testicular temperature and decline in sperm concentration from 1973 to 2011
• Migration of primordial germ cells to the genital ridge
• Ovarian reserve: peak germ cell number, perinatal and lifelong attrition, proportion ovulated, and depletion causing menopause
• Folliculogenesis: stages from primordial to preovulatory follicle, hormone dependence, theca and granulosa steroidogenesis
• Oogenesis and meiotic arrest; components of oocyte maturation and the zona pellucida
• Maternal-to-zygotic transition and preimplantation development stages
• Ovulation, corpus luteum formation and the corpus albicans; ovarian histology landmarks
• Sperm transport through the female tract and the obstacles at each level
• Capacitation, hyperactivation and the acrosome reaction at fertilisation in the ampulla

L2 Child development (23 Jul) L2 RDA Child development

• Why development matters in paediatric practice, and the information hierarchy (history, observation, examination, labs)
• Distinguish developmental milestones, surveillance, screening and assessment
• The five developmental domains
• Milestones at the sample ages 6 months, 12 months, 2 years, 3 years and 5 years across all five domains
• Three-step approach to developmental assessment
• Developmental regression: definition and why it points to medical pathology

L3 Growth (24 Jul) L3 RDA Growth

• Determinants of normal growth and the homeostatic, endocrine and nutritional requirements for it
• Growth hormone axis: hypothalamic control, pulsatile GH release and its relation to sleep, IGF-1 and binding proteins, GH insensitivity (Laron syndrome)
• Structure and zones of the growth plate
• Four phases of growth (intrauterine, infancy, childhood, puberty) and their main drivers; reference heights and growth velocities
• Measurement of growth: length vs height, head circumference, technique and precision
• Using growth charts: longitudinal plotting, centile/SD bands, mid-parental height, bone age, BMI, puberty staging
• Short stature: why it is not necessarily abnormal, and disproportionate vs proportionate causes
• Clinical assessment of short stature: history, examination and investigations to consider
• Achondroplasia: inheritance, FGFR3 gain-of-function mechanism, complications and growth pattern
• Emerging therapies for achondroplasia, including vosoritide and the CNP/NPR-B pathway

L4 Gross anatomy of male and female reproductive systems (31 Jul) L4 RDA Gross anatomy of male and female reproductive systems

• Functions of the reproductive system and anatomical definitions of the pelvic region (pelvic girdle, perineum, LMP, embryo vs foetus)
• Male perineal triangles and the pelvic floor muscles
• Components of the male reproductive tract and the accessory sex glands with their contributions to seminal fluid
• Testicular descent, the gubernaculum, cryptorchidism, and the layers covering the testes
• Testis and epididymis structure; testicular torsion and the cremasteric reflex
• Scrotum and spermatic cord contents
• Ductus deferens, ejaculatory duct, prostate gland and prostatic urethra
• Anatomy of the penis
• Organs of the female pelvis; uterus and ovary with their ligaments, parts, fallopian tubes, position and peritoneal pouches
• Structure of the ovary
• Vagina, fornices and cervix
• Female pelvic floor, perineum and vulva
• Breast anatomy

L5 Testicular endocrinology system (3 Aug) L5 RDA Testicular endocrinology system

• HPG axis in the male: pulsatile GnRH, LH action on Leydig cells and FSH action on Sertoli cells
• Negative feedback by testosterone (GnRH, LH, FSH) vs inhibin (FSH only), and the diurnal testosterone rhythm
• Distinguish primary from secondary (hypogonadotrophic) hypogonadism by LH/FSH levels
• Kallmann syndrome: absent GnRH neurons, anosmia and absent or delayed puberty
• Steroidogenesis classes from cholesterol via pregnenolone; Δ4 vs Δ5 pathways; roles of aromatase and 5α-reductase
• Steroid transport by albumin, SHBG and ABP; free steroid fraction and dissociation for tissue entry
• Intracellular androgen receptor mechanism of action of testosterone
• Sources and roles of testosterone, DHT and oestradiol in the male, including aromatisation and sexual behaviour
• 5α-reductase deficiency: normal testosterone, absent DHT, and presentation in XY individuals
• Four testicular compartments and the Sertoli cell junctions forming the blood-testis barrier, with its two functions
• FSH, inhibin and testosterone control of spermatogenesis stages; Sertoli paracrine factors (GDNF) and Leydig oxytocin
• Duct pathway from seminiferous tubule to vas deferens; efferent duct fluid absorption
• Regional functions of the epididymis (head, body, tail) and androgen dependence of sperm maturation
• Androgen-dependent accessory glands, their contribution to seminal fluid, and the basis of benign prostatic hyperplasia

L6 Ovarian and menstrual endocrinology (3 Aug) L6 RDA Ovarian and menstrual endocrinology

• Distinguish the ovarian cycle (pituitary-driven) from the menstrual cycle (ovarian hormone-driven)
• FSH, LH, oestrogen, progesterone and inhibin profiles across a 28-day cycle and alignment with uterine phases
• Stages of folliculogenesis: gonadotropin-independent, FSH-sensitive, FSH-dependent and LH-dependent, with timescales
• Atresia and FSH dependence of follicles above 4-6 mm; antral follicle count by transvaginal ultrasound
• Selection of a single dominant follicle by falling FSH under oestradiol and inhibin negative feedback
• Hypothalamic interpretation of circulating hormone patterns across the cycle
• Two-cell, two-gonadotropin model of ovarian steroidogenesis (theca and granulosa)
• HPG feedback in follicular vs luteal phases, GnRH pulse patterns, and kisspeptin in the switch to positive feedback and the LH surge
• Ovulation, formation and function of the corpus luteum, and rescue by hCG in pregnancy
• Ovarian stimulation for fertility treatment and ovarian hyperstimulation syndrome
• Ovarian reserve definitions; AMH and AFC as markers, and why AMH does not predict natural fertility
• Polyendocrine metabolic ovary syndrome (PCOS): diagnostic criteria, pathophysiology and treatment
• Endometrial changes under oestradiol and progesterone, and progesterone withdrawal causing menses
• Cervical mucus G-type vs E-type across the cycle and effects on sperm
• Endometriosis: definition and clinical features

L7 Puberty (7 Aug) L7 RDA Puberty

• Definitions of puberty, adrenarche, pubarche, thelarche and menarche
• Adrenarche: adrenal androgens (DHEA/S, androstenedione) and their effects, independent of GnRH
• Control of puberty: higher centres, rising GnRH pulse amplitude, pulsatile LH/FSH and gonadal sex steroids
• Three-phase lifetime pattern of gonadotropins and sex steroids, including male mini-puberty in infancy
• Normal timing and sequence of pubertal changes in girls and boys, and the sex difference in peak height velocity
• Tanner staging of breast and pubic hair, and orchidometer assessment of testicular volume
• Precocious puberty definition; distinguish central (gonadotropin-dependent) from peripheral (gonadotropin-independent)
• Causes of central and peripheral precocious puberty, and sex differences in idiopathic vs CNS aetiology
• History and examination in precocious puberty: androgen vs oestrogen symptoms, CNS symptoms, café-au-lait spots
• Work-up of precocious breast development using height velocity, bone age and GnRH test response (FSH vs LH dominant)
• Normal variants: premature thelarche and premature adrenarche
• Delayed puberty definitions by sex and constitutional delay of growth and development
• Work-up of delayed puberty: hypergonadotropic vs hypogonadotropic hypogonadism, growth velocity and bone age
• Approach to primary amenorrhoea by breast development and genital anatomy; menstrual variant definitions
• Pubertal gynaecomastia: frequency, when to evaluate, and causes
• Turner syndrome as hypergonadotropic hypogonadism with short stature

L8 Fertilisation and Implantation (7 Aug) L8 RDA Fertilisation and Implantation

• Site of fertilisation and survival and features of the spermatozoon and secondary oocyte
• Four stages of fertilisation: capacitation, acrosomal reaction, cortical reaction and zonal reaction
• Mechanism of the polyspermy block via the calcium wave, cortical granules and ZP3 hydrolysis
• Outcomes of fertilisation: diploid restoration, completion of meiosis II, sex determination and cleavage
• Cleavage, compaction, morula and blastocyst formation within the zona pellucida
• Hatching and the timing and usual site of implantation
• Ectopic pregnancy: implantation site frequencies, with the ampulla as the commonest location
• Embryoblast vs trophoblast, and cytotrophoblast vs syncytiotrophoblast (hCG secretion)
• Sequence of structures during implantation: amniotic cavity, epiblast/hypoblast, lacunae, yolk sac, extraembryonic coelom and chorionic cavity
• Nutrition of the early embryo: from microvilli fluid transfer to trophoblastic lacunae and primary villi

L9 Contraception (14 Aug) L9 RDA Contraception

• Endometrial and cervical mucus actions of oestrogen vs progesterone, and cycle feedback relevant to contraception
• Mechanism of combined and high-dose progesterone methods (suppression of FSH/LH and ovulation) vs low-dose progesterone (cervical mucus, endometrium)
• Which step of reproduction each contraceptive class blocks
• Perfect vs typical use failure rates and the three efficacy tiers
• Medical eligibility criteria (MEC) categories 1 to 4
• Tier 1 LARCs: Jadelle implant, hormonal IUS and copper IUD, with duration, mechanism and failure rates
• Depo-Provera injection: dosing interval, mechanism and effects
• Progesterone-only pill vs combined oral contraceptive: mechanism, regimen and pill windows
• Absolute (MEC 4) contraindications to the combined oral contraceptive
• Tier 3 methods: condoms, withdrawal and fertility awareness
• Emergency contraception: copper IUD vs levonorgestrel ECP, timing and efficacy
• Permanent contraception: vasectomy vs tubal ligation
• Gillick competency and the Fraser guidelines for contraception in young people
• Contraceptive consultation: history, factors influencing choice, and applying MEC to a scenario

L10 Assessment and treatment of fertility (changed 7_7) (17 Aug) L10 RDA Assessment and treatment of fertility (changed 7_7)

• Definition and prevalence of infertility, and the effect of female age on monthly pregnancy rate
• Four aetiological categories of infertility and their relative frequencies
• Ovulatory causes of infertility, with PCOS as the dominant cause
• Uterine, peritoneal and tubal causes: fibroids, Mullerian anomalies, Asherman’s syndrome, endometriosis and PID
• Mechanisms by which endometriosis reduces fertility
• Pre-testicular, testicular and post-testicular causes of male factor infertility
• Standard infertility investigations, including hysterosalpingogram and semen analysis reference values
• Principles of fertility treatment and CPAC scoring for public funding in New Zealand
• Fertility treatment ladder from fertile window advice to donor options
• Indications and procedure for intrauterine insemination
• Steps of IVF and ICSI, and the decline in IVF success with maternal age
• Donor options and regulation of third-party reproduction in New Zealand (HART Act, altruistic donation)
• PGT-M vs PGT-A indications
• Medical and social indications for fertility preservation

L11 Placenta (9 Sep) L11 RDA Placenta

• Decidual reaction: decidual cell contents and secretions, and the basal, capsular and parietal decidua
• Formation of the amniotic cavity, yolk sac, extraembryonic mesoderm, coelom and chorionic cavity after implantation
• The four extraembryonic membranes: amnion, chorion, yolk sac and allantois
• Formation of the intervillous space and primary, secondary and tertiary chorionic villi
• Structure of the placenta: maternal vs fetal surfaces, cotyledons and septa
• Placental functions: exchange, transfer of antibodies, drugs and pathogens, and endocrine output
• Chorion frondosum vs smooth chorion
• Placental anomalies: accessory placenta, placental abruption and placenta previa
• Sources, volume changes and functions of amniotic fluid; oligohydramnios and polyhydramnios
• Structure of the umbilical cord and its vessels
• Dizygotic vs monozygotic twinning: dichorionic-diamnionic, monochorionic-diamnionic and monochorionic-monoamnionic
• Twin-to-twin transfusion via placental vascular anastomoses, and risks of monoamnionic twins
• Amniocentesis vs chorionic villus sampling: timing and approach

L12 Abortion (11 Sep) L12 RDA Abortion

• Abortion terminology in Aotearoa after law reform, including Whakatahe
• Legal framework under the Abortion Legislation Act 2020: health procedure classification, self-referral and counselling requirements
• Requirements for abortion after 20 weeks gestation
• Obligations of a practitioner with a conscientious objection
• Categories of abortion and their gestational limits: early and later medical, early and later surgical
• Early medical abortion regimen and mechanisms of mifepristone and misoprostol
• Early surgical (aspiration) abortion: cervical priming, anaesthesia and suction
• Factors favouring medical vs surgical early abortion
• Later surgical abortion by dilatation and evacuation
• Later medical abortion by induction, and the role of feticide beyond 22 weeks
• Distinguish stillbirth from miscarriage by the 20-week threshold

L13 Intro to human prenatal development and teratology (11 Sep) L13 RDA Intro to human prenatal development and teratology

• Stage terminology: conceptus, embryo and fetus by gestational week; definition of a teratogen
• Trimester developmental milestones
• Pre-implantation development: cleavage, blastomeres, morula, blastocyst, hatching and implantation timeline
• Why IVF favours day 5 blastocyst transfer
• Blastocyst structure and trophoblast differentiation into cytotrophoblast and syncytiotrophoblast
• Bilaminar disc (epiblast, hypoblast) and embryonic vs extraembryonic structures
• Mechanism of gastrulation: primitive streak and node, early involution forming endoderm, late involution forming mesoderm
• Consequences of impaired epiblast cell migration during gastrulation
• Subdivision of mesoderm: notochord, somites, intermediate mesoderm and somatic vs splanchnic lateral plate
• Derivatives of ectoderm (neural and non-neural), mesoderm subdivisions and endoderm
• Teratogenesis principle: peak susceptibility during major developmental events of each organ
• Organ-specific windows of teratogen sensitivity in the embryonic period, and reduced fetal sensitivity except for the brain
• Thalidomide: mechanism (arrested cell division in limb outgrowth) and timing-dependent limb defects

L14 Heart development (11 Sep) L14 RDA Heart development

• Origin of the heart from splanchnic lateral plate mesoderm and formation of the coelom by embryonic folding
• Formation of the primitive heart tube: cardiogenic mesoderm, bilateral endocardial primordia and midline fusion, with timeline
• Regions of the straight heart tube from sinus venosus to outflow tract, and paired inflow and outflow vessels
• Heart looping (days 24 to 28) into the S-shaped heart
• Mechanism of left-right asymmetry: nodal cilia, leftward flow and left-sided gene expression (Nodal, Lefty-2)
• Early malformations: acardia, dextrocardia and situs inversus
• Septation timeline, weeks 5 to 10
• Atrial septation: septum primum, ostium primum, ostium secundum, septum secundum and foramen ovale as a one-way flap valve
• Atrioventricular septation by endocardial cushion fusion into the septum intermedium; persistent AV canal and its associations
• Ventricular septation and its coordination with outflow tract septation
• Outflow tract septation by spiralling truncoconal septae of cardiac neural crest origin
• Atrial septal defects: postnatal shunting causes and genes (TBX5, GATA4, NKX2.5) vs premature closure of the foramen ovale before birth
• Ventricular septal defect, persistent truncus arteriosus and transposition of the great vessels: developmental basis
• Tetralogy of Fallot: four features arising from anterior displacement of the conotruncal septum

L15 Respiratory and GI development (14 Sep) L15 RDA Respiratory and GI development

• Origin of the gut tube from endoderm formed at gastrulation, and folding into foregut, midgut and hindgut
• Buds of the gut tube giving rise to lung, liver and pancreas
• Anteroposterior regionalisation of the gut tube by endoderm-mesoderm interactions and combinatorial gene codes (Hox, Barx-1)
• Timeline of gut elongation, physiological herniation, rotation and return
• Mechanism of midgut rotation around the superior mesenteric artery axis
• Malrotation anomalies: nonrotation, reversed rotation, subhepatic cecum and omphalocele
• Cloacal partitioning by the urorectal septum and anorectal fistulae from its failure
• Development of the liver and gallbladder from the hepatic diverticulum
• Pancreas development from dorsal and ventral buds, and annular pancreas
• Respiratory diverticulum, trachea and asymmetric branching of bronchi
• Four phases of prenatal lung development and their key events
• Why birth before 26 weeks causes respiratory insufficiency: surfactant and alveolar development

L16 Urogenital development (14 Sep) L16 RDA Urogenital development

• Three stages of kidney development from intermediate mesoderm: pronephros, mesonephros and metanephros
• Reciprocal induction between metanephrogenic mesenchyme and ureteric bud, and the adult derivatives of each
• Molecular control of metanephros formation (WT1, GDNF, C-Ret, Wnt4, Pax2)
• Renal anomalies: agenesis, duplication, Wilms’ tumour (WT1) and renal-coloboma syndrome (Pax2)
• Ascent and rotation of the kidneys, and pelvic kidney, crossed ectopia and horseshoe kidney
• Collecting duct formation by sequential ureteric bud bifurcation
• Bladder development from the cloaca, separation of ureter and mesonephric duct, and formation of the trigone
• Bladder malformations: abnormal ureteric attachment, trigonitis and urachal fistula, sinus and cyst
• Differentiation of the bipotential gonad into testis or ovary
• Fate of mesonephric (Wolffian) and paramesonephric (Mullerian) ducts under testosterone and AMH
• Descent of the testis via the processus vaginalis and gubernaculum; hydrocele and indirect inguinal hernia
• Development and male-female homologues of the external genitalia
• Hypospadias: definition and forms

L17 Physiological adaptation of pregnancy (16 Sep) L17 RDA Physiological adaptation of pregnancy

• Uterine growth in pregnancy: hyperplasia and hypertrophy under oestrogens, capacity change, dextro-rotation and the lower segment
• Myometrial gap junctions and Braxton Hicks vs labour contractions
• Ferguson reflex as a positive feedback loop driving oxytocin release, and oestrogen-driven upregulation of oxytocin receptors
• Uterine involution postpartum and its promotion by breastfeeding
• Stages of mammary gland development and their hormonal drivers
• Maternal cardiovascular changes: blood volume, cardiac output and redistribution of blood flow
• Fetal circulatory shunts: ductus venosus, foramen ovale and ductus arteriosus
• Spiral artery remodelling by trophoblast invasion and its failure in preeclampsia
• Coagulation changes in pregnancy (platelet aggregation, clotting factors, fibrinolysis) and their purpose
• Respiratory adaptation: progesterone-driven hyperventilation, lower pCO2, and renal compensation of respiratory alkalosis
• Energy cost and weight gain of pregnancy
• Placental lactogen-induced insulin resistance and increased fetal glucose supply
• Gestational diabetes: insulin and OGTT patterns and fetal macrosomia
• Leptin resistance in pregnancy and proposed mechanisms
• Cervical remodelling: mucus plug, ectropion, relaxin-mediated softening and preterm birth risk

L18 Transition at birth (16 Sep) L18 RDA Transition at birth

• Domains and key requirements of neonatal transition, and the proportion of infants needing intervention
• Endocrine priming: roles of the cortisol and catecholamine surges around birth
• Foetal lung fluid production and its switch to sodium-driven resorption; transient tachypnoea of the newborn
• Initiation of breathing, mechanics of the first breaths, and the role of surfactant; respiratory distress syndrome
• Circulatory switch at birth: cord clamping, fall in PVR, rise in SVR and closure of the ductus arteriosus and foramen ovale
• Foetal oxygen delivery: preferential streaming and properties of HbF vs HbA (oxygen affinity, 2,3-BPG)
• Neonatal thermoregulation: mechanisms of heat loss, link to hypoglycaemia, and practical measures
• Apgar score components and interpretation
• Neonatal Life Support pathway: initial three questions, heart rate thresholds, PPV as the key intervention, compressions and adrenaline
• Risk factors for difficult transition by maternal, foetal, pregnancy and birth category
• Birth hypoxia phases: primary apnoea, gasping and secondary (terminal) apnoea
• Airway obstruction and impaired lung function (mechanical vs intrinsic) as causes of difficult transition
• Persistent pulmonary hypertension of the newborn: mechanisms via Poiseuille’s law, meconium aspiration, pulmonary hypoplasia and treatment
• Congenital heart disease: critical vs non-critical, cyanotic and ductal dependent lesions and their classification
• Neonatal infection: risk factors, early vs late onset presentation and management
• Neonatal jaundice: physiological causes, causes of unconjugated hyperbilirubinaemia, bilirubin encephalopathy and kernicterus
• Neonatal hypoglycaemia: risk factors, mechanism in the infant of a diabetic mother, symptoms and treatment
• Prematurity: definitions by gestation and birthweight, risk factors, complications and viability guidelines in New Zealand

L19 Physiology of parturition (18 Sep) L19 RDA Physiology of parturition

• Onset of labour: prostaglandin synthesis, myometrial gap junctions and oxytocin receptor upregulation
• Positive feedback loop of oestrogen, oxytocin and prostaglandins driving contractions
• The 3 Ps framework: passage, passenger and power
• Gynecoid vs android pelvis, and fetal station relative to the ischial spines
• Cervical effacement and dilation
• Stages and phases of labour with their contraction patterns, durations and dilation
• Fetal head flexion and presentation: vertex, military, brow and face
• Fetal position described by the occiput, and the most favourable position
• Cardinal movements of labour
• Third stage of labour: delivery of the placenta

L20 Lactation (18 Sep) L20 RDA Lactation

• Structure of the mammary gland: lobes, lobules, alveoli, myoepithelial cells and duct system
• Secretion of milk protein (exocytosis) vs fat (membrane entrapment) by alveolar cells
• Stages of mammary development and roles of oestradiol, progesterone and prolactin
• Why copious milk production is blocked during pregnancy and begins after parturition
• Changes in milk composition from colostrum to transitional and mature milk
• Prolactin milk production reflex: suckling inhibits tuberoinfundibular dopamine, supporting the next feed
• Effect of D2 agonists (bromocriptine, cabergoline) on milk production
• Oxytocin milk ejection (let-down) reflex, conditioned let-down and inhibition by stress
• Lactation failure: causes, treatment, and reliable vs unreliable indicators of milk supply
• Acute vs chronic stress effects on lactation
• Lactational contraception: suckling-dependent suppression of GnRH and proposed mechanisms
• Weaning and involution of the mammary gland after cessation of suckling

L22 Normal aging and problems of mobility (28 Sep) L22 RDA Normal aging and problems of mobility

• Population ageing trends globally and in New Zealand, life expectancy vs healthy life expectancy, and growing ethnic diversity of older people
• Effects of negative attitudes to ageing and the prevalence of ageism
• Compression of morbidity hypothesis vs present morbidity and life extension patterns
• Primordial, primary, secondary and tertiary prevention as strategies to compress morbidity
• Life-course model of modifiable dementia risk factors
• Normal ageing vs disease, and chronological, functional and subjective age
• Physiological changes with age: unchanged, lower, higher, slower and longer parameters
• Sarcopenia: definition, fibre-type shift from type II to type I, and myosteatosis influenced by activity
• Life-course pattern of bone mass; osteoporosis vs osteopenia
• Physical inactivity as a modifiable NCD risk factor and its global cost burden
• Definitions of leisure-time physical activity, sport and exercise; New Zealand activity levels
• Principles of exercise prescription: overload, progression and specificity, and the dose-response threshold
• Health benefits of physical activity and specific benefits of resistance training in older adults

L23 Menopause (2 Oct) L23 RDA Menopause

• Definitions of menopause and perimenopause
• Mechanisms of loss of ovarian function: oocyte depletion, desynchronised GnRH secretion, and decline in inhibin B and AMH
• Breakdown of HPO feedback loops with follicle demise and resulting FSH/LH and oestrogen patterns across pre-, peri- and postmenopause
• Mechanism of postmenopausal osteoporosis: uncoupled remodelling via RANKL and OPG
• Cardiometabolic and cardiovascular effects of oestrogen deficiency
• Effects of oestrogen deficiency on cognition
• Menopausal symptoms by body system
• Premature, early and normal menopause by age of onset, and the course of perimenopause
• Primary ovarian insufficiency: diagnostic criteria, investigations, mechanism and long-term consequences
• Treatment options: lifestyle, complementary, non-hormonal medical and hormonal
• Women’s Health Initiative: design, findings and limitations affecting interpretation
• Risks and benefits of MHT in women under 60 or within 10 years of menopause, by regimen and route
• Absolute contraindications to MHT and prescribing principles (oestrogen alone vs with progestogen) and follow-up
• Genital syndrome of menopause and vaginal oestrogen
• Key elements of a menopause consultation

L24 Stroke recovery (5 Oct) L24 RDA Stroke recovery

• Components of stroke recovery: restitution, substitution and compensation
• Aims of stroke rehabilitation and their mapping onto the ICF framework
• Distribution of stroke types and the OCSP classification (TACI, PACI, LACI, POCI) with mortality, functional outcome and recurrence
• Time course of spontaneous recovery, the 70% proportional recovery rule, and the role of neuroplasticity
• Variables influencing stroke recovery, and good vs poor outcome predictors
• Stroke teams, stroke units and early supported discharge, and the evidence for stroke unit care
• Functional outcome measures: FIM structure and scoring, modified Rankin Scale, and AROC
• PREP2 algorithm for upper limb recovery: SAFE score, TMS motor evoked potentials and MRI asymmetry index
• TWIST tool for predicting time to independent walking
• Motor, sensory, pain, vision and hearing challenges after stroke and appropriate referrals
• Emotional barriers, dyspraxia and agnosias after stroke
• Dysphagia, nutrition and speech disorders (dysarthria, dysphasia) after stroke, and the role of SALT
• Physical activity after stroke: AHA recommendations and pre-exercise evaluation
• Supported self-management after stroke: Bridges and Take Charge programmes, and issues on returning home

L27 Iatrogenic Disease (changed 7_7) (9 Oct) L27 RDA Iatrogenic Disease (changed 7_7)

• Definition and scope of iatrogenic disease, including non-physician causes
• Normal age-related changes by body system and conditions that increase with age
• Frailty as loss of homeostatic reserve, the frailty trajectory, and Comprehensive Geriatric Assessment
• Prescribing cascade illustrated by the Mr B case, and the factors that caused it
• Falls: intrinsic, extrinsic and precipitating factors, and medication classes associated with falls
• Distinguish delirium from dementia; precipitating and predisposing factors for delirium; dementia subtypes
• Polypharmacy: definition, associated risks and prevalence in older people
• Adverse drug reactions in older people: admission data and the four main implicated drug classes
• Type A vs Type B adverse drug reactions, and the profile of a patient liable to an ADR
• Causes of iatrogenic harm in older people: inadequate assessment, multimorbidity and excessive prescribing
• Altered pharmacokinetics with age: absorption, volume of distribution, hepatic metabolism and renal clearance
• Altered pharmacodynamics with age: anticoagulants and CNS depressants
• Medication compliance: patient, prescriber and medication factors, identifying non-compliance, and measures to improve it
• Reducing ADRs: the RIGHT principles, start low go slow, Beers and STOPP-START criteria
• Deprescribing and medication reconciliation