MRCP last minute facts

This is a list of commonly tested facts, if you have corrections or you have some of your own, please add themTOP 50 MRCP facts 1.. Occulomotor nuclei intact, supranuclearpathology 47 Pe

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LAST MINUTE MRCP CRAMMING FACTS: please add your own

too

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This is a list of commonly tested facts, if you have corrections or you have some

of your own, please add themTOP 50 MRCP facts

1 Acromegaly – Diagnosis: OGTT followed by GH conc

2 Cushings – Diagnosis: 24hr urinary free cortisol Addisons > shortsynacthen

3 Rash on buttocks – Dermatitis herpetiformis (coeliac dx)

4 AF with TIA > Warfarin

5 Herpes encephalitis > temporal lobe calicification

6 Obese woman, papilloedema/headache > Benign Intercanial Hypertention

7 Drug induced pneumonitis > methotrexate or amiodarone

8 chest discomfort and dysphagia > achalasia

9 foreign travel, macpap rash/flu like illnes > HIV acute

10 cause of gout > dec urinary excretion

11 bullae on hands and fragule skin torn by minor trauma > porphyriacutanea tarda

12 Splenectomy > need pneumococcal vaccine 2 weeks pre-op and for life

13 primary hrperparathyroidism > high Ca, normal/low PO4, normal/highPTH (in elderly)

14 middle aged man with KNEE arthritis > gonococcal sepsis (older people ->Staph)

15 sarcoidosis, erythema nodosum, arthropathy > Loffgrens syndromebenign, no Rx needed

16 tremor postural,slow progression,titubation, relieved by OH->benignessential tremor AutD

17 electrolytes disturbance causing confusion – low/high Na

18 contraindications lung surgery > FEV <1.5, MALIGNANT effusion, mets

Forums UK Medical Zone MRCP Forum

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outside lung

19 prevent further renal deterioration/proteinuria > dec bp 130/90, Aceinhibitors

20 headache with many analgesics at once -> analgesic induced headache

21 1.5 cm difference btwn kidneys -> Renal artery stenosis > Magneticresonance angiogram

22 temporal tenderness > temporal arteritis -> steroids > 90% ischaemicneuropathy, 10% retinal art occlusion

23 severe retroorbital, daily headache, lacrimation > cluster headache

24 pemigus – involves mouth (mucus membranes), pemphigoid – less seriousNOT mucosa

25 diagnosis of polyuria -> water deprivation test, then DDAVP

26 insulinoma -> 24 hr supervised fasting hypoglycaemia

27 Diabetes Random >7 or if >6 OGTT -> >11.1 also seen in HCT

28 causes of villousd atrophy: coeliac, Whipples, dec Ig, lymphoma, trop sprue(rx tetracycline)

29 diarrhoea, bronchospasm, flushing, tricuspid stenosis -> gut carcinoid c livermets

30 hepatitis B with general deterioration -> hepaocellular carcinoma

31 albumin normal, total protein high -> myeloma (hypercalcaemia,electrophoresis)

32 HBSag positive, HB DNA not detectable > chornic carier

33 Inf MI, artery invlived -> Right coronary artert

34 Aut dom conditions: Achondroplasia, Ehler Danlos, FAP, familialhyperchol,Gilbert, Huntington's, Marfans's, NFT I/II, Most porphyrias,tuberous sclerosis, vWD, PeutzJeghers

35 X linked: Beck/Duch musc dyst, alports, Fragile X, G6PD, Haemophilia A/B

36 Loud S1: MS, hyperdynamic, short PR Soft S1: immobile MS, MR

37 Loud S2: hypertension, AS Fixed split: ASD Opening snap: MOBILE MS,severe near S2

38 HOCM/MVP - inc by standing, dec by squating (inc all others) HOCM inc

by valsalva, decs all others Sudden death athlete, FH, Rx Amiodarone, ICD

39 MVP sudden worsening post MI Harsh systolic murmur radites to axilla

40 Dilated Cardiomyopathy: OH, bp, thiamine/selenium deficiency, MD,cocksackie/HIV, preg, doxorubicin, infiltration (HCT, sarcoid), tachycardia

41 Restrictive Cardiomyopathy: sclerodermma, amyloid, sarcoid, HCT, glycogenstorage, Gauchers, fibrosis, hypereosinophilia Lofflers, caracinoid, malignancy,radiotherapy, toxins

42 Tumor compressing Respiratory tract > investigation: flow volume loop

43 Guillan Barre syndrome: check VITAL CAPACITYHorners – sweating lost in upper face only – lesion proximal to common carotidartery

Internuclear opthalmoplegia: medial longitudinal fasciculus connects CN

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nucleus 3-4 TRIES TO Y ANK THE ipsilateral BAD EY E ACROSS THE NOSE.Convergence is normal Causes: MS, SLE, Miller fisher, overdose(barb,

phenytoin, TCA), Wernicke46.Progressive Supranuclear palsy: Steel Richardson Absent voluntarydownward gaze, normal dolls eye i.e Occulomotor nuclei intact, supranuclearpathology

47 Perinauds syndrome: dorsal midbrain syndrome, damaged midrain andsuperior colliculus: impaired upgaze (cf PSNP), lid retraction, convergencepreserved Causes: pineal tumor, stroke, hydrocephalus, MS

48 demetia, gait abnormaily, urinary incontinence Absent

papilloedema >Normal pressure hydrocephalus

49 acute red eye -> acute closed angle glaucoma >> less common (ant uveitis,scleritis, episcleritis, subconjuntival haemmorrhage)

50 wheeles, urticaria, drug induced -> aspirin

51 sweats and weight gain -> insulinoma

52 diagnostic test for asthma -> morning dip in PEFR >20%

53 causes of SIADH: Lithium, chlorpropamide, carbamepine

54 bisphosphonates:inhibit osteoclast activity, prevent steroid incducedosteoperosis (vit Dalso)

55 returned from airline flight, TIA-> paradoxical embolus do TOE

55 alcoholic, given glucose develops nystagmus -> B1 deficiency (wernickes).Confabulation->korsakoff

56 mono-artropathy with thiazide -> gout (neg birefringence) NOALLOPURINOL for acute

High Y ield Topics

1 Anorexia Nervosa

2 Reiters Syndrome – arthritis, uveitis, urethritis – Chlymidia, campylobacter,

Y ersinia, Salmonella, Shigella Balanisits

3 PKD – aut dom Chr 16/4 assoc berry aneurysm, mitral/aortic regurg

4 Porphyria – photosensitivity, blisters, scars with millia, hypertrichosis

5 Heart sounds: Aortic Stenosis s2 paradoxical split, length proportional toseverity

6 Vitiligo – commonest assoctions pernicious anaemia >>> type 1 dm,autoimmune addisons, autoimmune thyoid dx

ALMOST Pathognomic for the exam1.fatiguability -> myasthrnia gravis2.fasciculations -> Motor neurone diease3.silvery white scale -> psoriasis

4.hypopigmented -> vitiligo/pityriasis versicolorplease ONLY ADD COMMONLY TESTED FACTS THAT Y OU HAVE SEEN

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53 Causes of SIADH : chest/cerebral/pancreas pathology, porphyriaDrugs: carbamazepine, chlorpropamide, clofibrate, atipsychotics, NSAIDs

Causes of Diabetes Insipidus: Lithium, amphoteracin, prologedhypercalcaemia/hypornatraemia, familial X linked type, pituitary damage

-> Convergence should be defective Isn't it?

re 47 parinauds

from Kalra pg 563 -Parinauds syndrome :-

impaired upgaze and accomodationretraction of the eyelids

loss of light reflex with preserved convergence reflexconvergent retraction nystagmus

relative midriasis -

?presumably convergant retraction nystagmus means when eyes are returning

to neutral from convergence when it happens ?

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Guest, May 15, 2005 #5

re list reposted

see the main forum, i reposted the list made correction to nummber 53 (nownumber 43)

Passed MRCP Part 1 on first attempt Mark not yet available

To all those who did not pass - I think this has nothing to do with ability as adoctor - do not feel bad, just try again, study differently It is really a very sillyexam but a hurdle we must get through

this is ho I did it -

Background: Honours medical student from UK, recently sat USMLe Step 1 and

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drsujitvasanth10, Jun 15, 2005 #8

2 I read some of Kalra when I was a medical student

Exam Preparation: I studied what other people with very high scores did and Idid likewise, hoping to pass I only had 3 weeks to prepare and during this time Iwasn't working

1) Did all onexamination past questions and made notes on the ones I gotwrong

2) Looked up common topics in Kalra3) Read entire chapters of Kalra, taking brief notes

Y OU DO NOT NOT NEED TO READ BIG BOOKS TO PASS THIS EXAM!!

Please dont waste time reading Kumar and Clarke and Davidsons

I also had the MRCP Masterclass but did not use it - It was too heavy going

I had a borderline score on my fist attempt at onexamination

My score was in the 70's on the second attempt

What got me through?

-1) onexamination teaches the common topics and the correct way of thinking2) I followed the advice of people who did well - so even if I did 50% the same asthem, I would probably pass

Comment

-1 Other candidated during the exam seemed to be very pleased to finish with alot of time to spare - I think tis reflects the unwholesome culture in the nhs -this as everything else is not a race - take your time in the exam- as long as youfinish all the questions

2 The english deliberately put barriers in the way - emphasising subtle language

in the mcq's - which has nothing to do with being a good doctor As far as I cansee this is only to keep foreign doctors out Their latest ploy appears to be addinglots basic science questions in e.g genetics to put a bias on their local gradates,

Conclusion

to pass the exam onexamination (past papers), Kalra

PS my 100 commomly tested facts list was very high yield for the exam Pleasecheck for factual innacuracies

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re high scoring tactics

hi there the best way to find successful tactics these days is to scour the nlinwforums This helps no end and has worked for me for USMLE Step 1 and 2 andMRCP part 1

try a few forms and do some searches i.e mcqs.com etc

what it boils down to for mrcp part 1 is

1) do onexamination.com2) read round commonly tested factsgood luck!

mock test

is there any tools or mock test available?

Hi Shyam,mock tests are available on this very website in the mrcp section

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Drug induced SLE (DILE)

Antihistone antibodies rare but specificAnti-dsDNA present

Complement C3/C4 levels decreaseCutaneous findings in >75%

Raynaud phenomenon in 50%

Hydralazine-induced DILE has association with HLA-DR4

Antiarrhythmics - Procainamide and quinidineAntibiotics - Minocycline, isoniazid, and griseofulvinAnticonvulsants - Valproate, ethosuximide, carbamazepine, and hydantoinsHormonal therapy - Leuprolide acetate

Antihypertensives - Hydralazine, methyldopa, and captoprilAnti-inflammatories - D-penicillamine and sulfasalazineAntipsychotics - Chlorpromazine

Cholesterol-lowering agents - Lovastatin, simvastatin, and gemfibrozil

Polyglandular Autoimmune Syndrome

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Guest, Sep 7, 2005 #15

Polyglandular Autoimmune SyndromePGA syndrome type I (PGA-I), (APECED or Whitaker syndrome) is:

candidiasis, hypoparathyroidism, and adrenal failure

PGA syndrome type II:

Addison disease plus type 1 DM + hypogonadism, pernicious anemia, celiacdisease

PGA syndrome type III: 2 of the following:

thyroid deficiency, pernicious anemia, insulin-requiring diabetes, vitiligo, andalopecia

MEN

MEN 1 affects the parathyroid glands, the pancreatic islets and the anterior pituitary

MEN 2 (MEN 2A)medullary thyroid carcinoma (MTC), pheochromocytoma and parathyroidtumours

MEN 3(MEN 2B)resembling MEN 2, except that parathyroid hyperplasia is rare

re mrcp commonly tested facts

Thanks everyone for your contributions I think a summary of MEn syndromesshould be added to thus list but i dont have time right now and the version Isee posted has no mention of mucosal neuromas

OK I UPDATED MY LIST OF 50 AND ADDED CORRECTIONS PLEASE GIVE CORRECTIONS AND ADDITIONS ONLY ONLY INCLUDE FACTS THAT HAVE FREQUENTLY APPEARED ON

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OFFICIAL PAST MRCP QUESTIONS

4 AF with TIA > Warfarin Just TIA's with no AF > Aspirin

5 Herpes encephalitis > temporal lobe calicification OR temporoparietalattentuation – subacute onset i.e Several days

12 Splenectomy > need pneumococcal vaccine AT LEAST 2 weeks pre-op andfor life

14 middle aged man with KNEE arthritis > gonococcal sepsis (older people ->Staph)

15 sarcoidosis, erythema nodosum, arthropathy > Loffgrens syndromebenign, no Rx needed

16 tremor postural,slow progression,titubation, relieved by OH->benignessential tremor AutDom (MS – titbation, PD – no titubation)

18 contraindications lung surgery > FEV <1.5, MALIGNANT effusion, metsoutside lung

19 prevent further renal deterioration/proteinuria > dec bp 130/90, Aceinhibitors (if proteinuria <3g/24hrs)

24 pemphigus – involves mouth (mucus membranes), pemphigoid – lessserious NOT mucosa

27 Diabetes Random >7 or if >6 OGTT (75g) -> >11.1 also seen in HCT

28 causes of villous atrophy: coeliac (lymphocytic infiltrate), Whipples , dec Ig,

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lymphoma, trop sprue (rx tetracycline)

34 Aut dom conditions: Achondroplasia, Ehler Danlos, FAP, familialhyperchol,Gilberts, Huntington's, Marfans's, NFT I/II, Most porphyrias,tuberous sclerosis, vWD, PeutzJeghers

41 Restrictive Cardiomyopathy: sclerodermma, amyloid, sarcoid, HCT,glycogen storage, Gauchers, fibrosis, hypereosinophilia Lofflers, caracinoid,malignancy, radiotherapy, toxins

43 Guillan Barre syndrome: check VITAL CAPACITY

44 Horners – sweating lost in upper face only – lesion proximal to commoncarotid artery

45 Internuclear opthalmoplegia: medial longitudinal fasciculus connects CNnucleus 3-4 Ipsilateral adduction palsy, contralateral nystagmus Aide memoire(TRIES TO Y ANK THE ipsilateral BAD EY E ACROSS THE NOSE)

Convergence retraction nystagmus, but convergence reflex is normal Causes:

MS, SLE, Miller fisher, overdose(barb, phenytoin, TCA), Wernicke

46 Progressive Supranuclear palsy: Steel Richardson Absent voluntarydownward gaze, normal dolls eye i.e Occulomotor nuclei intact, supranuclearpathology

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53 Causes of SIADH : chest/cerebral/pancreas pathology, porphyria,malignancy, Drugs (carbamazepine, chlorpropamide, clofibrate, atipsychotics,NSAIDs, rifampicin, opiates)

54 Causes of Diabetes Insipidus: Cranial: tumor, infiltration, traumaNephrogenic: Lithium, amphoteracin, domeclocycline, prologedhypercalcaemia/hypornatraemia, familial X linked type

55 bisphosphonates:inhibit osteoclast activity, prevent steroid incducedosteoperosis (vitamin D also)

56.returned from airline flight, TIA-> paradoxical embolus do TOE

59 painful 3rd nerve palsy -> posterior communicating artery aneurysm tillproven otherwise

60 late complication of scleroderma > pumonaryhypertention plus/minusfibrosis

61 causes of erythema mutliforme: lamotrigine

62 vomiting, abdominal pain, hypothyroidism -> Addisonian crisis (TFTtypically abnormal in this setting DO NOT give thyroxine)

63 mouth/genital ulcers and oligarthritis -> behcets (also eye/skin lesions,DVT)

64 mixed drug overdose most important step -> Nacetylcysteine (timedependent prognosis)

65 cavernous sinus syndrome - 3rd nerve palsy, proptosis, periorbital swlling,conj injectn

66 asymetric parkinsons -> likely to be idiopathic

67 Obese, NIDDM female with abnormal LFT's -> NASH (non-alcoholicsteatotic hepatitis)

68 fluctuating level of conciousness in elderly plus/minus deterioration >

chronic subdural Can last even longer than 6 months

69 Sensitivity > TP/(TP plus FN) e.g For SLE - ANA highly sens,dsDNA:highly specific

70 RR is 8% NNT is > 100/8 > 50/4 > 25/2 > 13.5

71 ipsilateral ataxia, Horners, contralateral loss pain/temp > PICA stroke(lateral medulary syndrome of Wallenburg)

72 renal stones (80% calcium, 10% uric acid, 5% ammonium (proteus), 3%

other) Uric acid and cyteine stone are radioluscent

73 hyperprolactinaemia (allactorrohea, amenorrohea, low FSH/LH) -> Daantags (metoclopramide, chlorpromazine, cimetidine NOT TCA's), pregnancy,PCOS, pit tumor/microadenoma, stress

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74 Distal, asymetric arthropathy -> psoriasis

75 episodic headache with tachycardia -> phaeochromocytoma

76 very raised WCC -> ALWAY S think of leukaemia

77 Diagnosis of CLL > immunophenotyping NOT cytogenetics, NOT bonemarrow

78 Prognostic factors for AML -> bm karyotype (good/poor/standard) >> WCC

at diagnosis

79 pancytopenia with raised MCV > check B12/folate first (other causespossble, but do this FIRST) Often associayed with phenytoin use > decreasedfolate

80 miscariage, DVT, stroke > lupus anticoagulant > lifelong anticoagulation

81 Hb elevated, dec ESR -> polycythaemua (2ndry if paO2 low)

82 anosmia, delayed puberty -> Kallmans syndrome (hypogonadotrophichypogonadism)

83 diag of PKD -> renal US even if <30, linkage analysis BUT requires serumfrom 2 relatives with dx

84 Y oung female -> think anorexia nervosa

85 commonest finding in G6PD hamolysis -> haumoglobinuria

86 mitral stenosis: loud S1 (soft s1 if severe), opening snap Immobile valve ->

no snap

87 Flank pain, urinalysis:blood, protein -> renal vein thrombosis Causes:

nephrotic syndrome, RCC, amyloid, acute pyelonephritis, SLE (atiphospholipidsyndrome which is recurrent thrombosis, fetal loss, dec plt Usual cause of cnsmanifestations assoc with lupus ancoagulant, anticardiolipin ab)

88 anaemia in the elderly assume GI malignancy

89 hypothermia, acute renal failure -> rhabdomyolysis (collapse assumed)

90 pain, numbness lateral upper thigh > meralgia paraesthesia (lat cutaneousnerve compression usally by by ing ligament)

91 diagnosis of haemochromatosis: screen with Ferritin, confirm by tranferrinsaturation, genotyping If nondiagnostic do liver biopsy 0.3% mortality

92 40 mg hidrocortisone divided doses (bd) > 10 mg prednisolone (ie

Prednislone is x4 stronger)

93 BTS: TB guidlines – close contacts -> Heaf test -> positive CXR, negative

> repeat Heaf in 6 weeks Isolation not required

94 Diptheria -> exudative pharyngitis, lymphadenopathy, cardio and neurotoxicity

95 Indurated plaques on cheeks, scarring alopecia, hyperkeratosis over hairfollicles ->>Discoid lupus

96 wt loss, malabsoption, inc ALP -> pancreatic cancer

97 foreign travel, tender RUQ, raised ALP > liver abscess do U/S

98 wt loss, anaemia (macro/micro), no obvious cause -> coeliac (diarrhoeadoes NOT have to be present)

99 haematuria, proteinuria, best investigation > if glomerulonephritis

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suspected > renal biopsy

100 venous ulcer treatment > exclude arteriopathy (eg ABPI), controloedema, prevent infection, compression bandaging

101 Malaria, incubation within 3/12 can be relapsing /remitting Vivax andOvale (West Africa) longer imcubation

102 Fever, lymphadenopathy, lymphocytosis, pharygitis ->EBV ->

heterophile antibodies

103 GI bleed after endovascular AAA surgery > aortoenteric fistula

High Y ield Topics

1 Y oung girl – suspect Anorexia Nervosa – linugo hair, finctionalhypogonadotrophic hypogonadism -> amennorhea LH and FSH both low Allother hormones are usually normal Ferritin low

7 Gout – blood urate high/low/normal, joint aspirate pos birif, ppt thiazides,

NO allopurinol/aspirin in acute phase

8 Peripheral neuropathy – a) B12 – rapid, dorsal columns (joint pos, vibration),sensory ataxia, pseudoathetosis of upperlimbs b) diabetic – slow, spinothalamic(pain, temp?) c)alcohol – slow progressive, spinothalamic d) Pb – motor upperlimbs

9 CNS abnormalities in HIV: toxoplaasmosis (ring enhancing), lymphoma(solitary lesion) HIV encephalopathy, progressive multifocal

leucoencephalopathy (PML – demylination in advanced HIV, low attenuationlesions)

10 Travellers diarrohea: chronic (>2 WEEKS) giardia (incidious onset rx

Metronidazole), salmonella (serious systemic illness), E.coli (rx Ciprofloxacin) ,Shigella

11 Renal syndrome – minimal change disease, membanous, IgA nephropathy,post-streptococcal

12 If you see blood on urinalysis forget about RAS

13 Thyroid Malignancy – tend to be non-functional, anaplastic has worseprognosis, local infiltration -> dysphagia, vocal cord paralysis

ALMOST Pathognomic for the exam fatiguability -> myasthenia gravis fasciculations -> Motor neurone diease

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drsujitvasanth10, Sep 9, 2005 #17

silvery white scale -> psoriasis hypopigmented -> vitiligo/pityriasis versicolor pretibial myxoedema > Graves (NOT lid lag, NOT exopthalmus) PLEASE GIVE CORRECTIONS AND ADDITIONS

ONLY INCLUDE FACTS THAT HAVE FREQUENTLY APPEARED ONOFFICIAL PAST MRCP QUESTIONS

re mrcp commonly tested facts

Thanks everyone for your contributions I think a summary of MEn syndromesshould be added to thus list but i dont have time right now and the version Isee posted has no mention of mucosal neuromas

OK I UPDATED MY LIST OF 50 AND ADDED CORRECTIONS PLEASE GIVE CORRECTIONS AND ADDITIONS ONLY

4 AF with TIA > Warfarin Just TIA's with no AF > Aspirin

5 Herpes encephalitis > temporal lobe calicification OR temporoparietalattentuation – subacute onset i.e Several days

12 Splenectomy > need pneumococcal vaccine AT LEAST 2 weeks pre-op andfor life

14 middle aged man with KNEE arthritis > gonococcal sepsis (older people ->

drsujitvasanth11

Guest

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18 contraindications lung surgery > FEV <1.5, MALIGNANT effusion, metsoutside lung

19 prevent further renal deterioration/proteinuria > dec bp 130/90, Aceinhibitors (if proteinuria <3g/24hrs)

24 pemphigus – involves mouth (mucus membranes), pemphigoid – lessserious NOT mucosa

27 Diabetes Random >7 or if >6 OGTT (75g) -> >11.1 also seen in HCT

28 causes of villous atrophy: coeliac (lymphocytic infiltrate), Whipples , dec Ig,lymphoma, trop sprue (rx tetracycline)

34 Aut dom conditions: Achondroplasia, Ehler Danlos, FAP, familialhyperchol,Gilberts, Huntington's, Marfans's, NFT I/II, Most porphyrias,tuberous sclerosis, vWD, PeutzJeghers

41 Restrictive Cardiomyopathy: sclerodermma, amyloid, sarcoid, HCT,

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glycogen storage, Gauchers, fibrosis, hypereosinophilia Lofflers, caracinoid,malignancy, radiotherapy, toxins