Here is a list of commonly tested facts in hte MRCP Part 1 exam.

They
are listed in order of importance - highest first.

1. Acromegaly – Diagnosis: OGTT followed by GH conc.

2. Cushings – Diagnosis: 24hr urinary free cortisol. Addisons --> short
synacthen.
3. Rash on buttocks – Dermatitis herpetiformis (coeliac dx).
4. AF with TIA --> Warfarin. Just TIA's with no AF --> Aspirin
5. Herpes encephalitis --> temporal lobe calicification OR
temporoparietal attentuation – subacute onset i.e. Several days.
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 fragile SKIN torn by minor trauma --> porphyria
cutanea tarda.
12. Splenectomy --> need pneumococcal vaccine AT LEAST 2 weeks
pre-op and for life.
13. primary hrperparathyroidism --> high Ca, normal/low PO4,
normal/high PTH (in elderly).
14. middle aged man with KNEE arthritis --> gonococcal sepsis (older
people -> Staph).
15. sarcoidosis, erythema nodosum, arthropathy --> Loffgrens syndrome
benign, no Rx needed.
16. TREMOR postural,slow progression,titubation, relieved by OH-
>benign essential TREMOR AutDom. (MS – titbation, PD – no
titubation)
17. electrolytes disturbance causing confusion – low/high Na.
18. contraindications lung Surgery --> FEV dec bp 130/90, Ace inhibitors
(if proteinuria analgesic induced headache.
21. 1.5 cm difference btwn kidneys -> Renal artery stenosis --> Magnetic
resonance angiogram.
22. temporal tenderness--> temporal arteritis -> steroids > 90% ischaemic
neuropathy, 10% retinal art occlusion.
23. severe retroorbital, daily headache, lacrimation --> cluster headache.
24. pemphigus – involves mouth (mucus membranes), pemphigoid – less
serious NOT 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 (75g) -> >11.1 also seen in
HCT.
28. causes of villous atrophy: coeliac (lymphocytic infiltrate), Whipples ,
dec Ig, lymphoma, trop sprue (rx tetracycline).
29. diarrhoea, bronchospasm, flushing, tricuspid stenosis -> gut carcinoid
c liver mets.
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, FAMILIAL
hyperchol,Gilberts, 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,
glycogen storage, Gauchers, fibrosis, hypereosinophilia Lofflers,
caracinoid, malignancy, radiotherapy, toxins.
42. Tumor compressing Respiratory tract --> investigation: flow volume
loop.
43. Guillan Barre syndrome: check VITAL CAPACITY.
44. Horners – sweating lost in upper face only – lesion proximal to
common carotid artery.
45. Internuclear opthalmoplegia: medial longitudinal fasciculus connects
CN nucleus 3-4. Ipsilateral adduction palsy, contralateral nystagmus.
Aide memoire (TRIES TO YANK THE ipsilateral BAD eye 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 voluntary
downward gaze, normal dolls eye . i.e. Occulomotor nuclei intact,
supranuclear Pathology .
47. Perinauds syndrome: dorsal midbrain syndrome, damaged midrain
and superior colliculus: impaired upgaze (cf PSNP), lid retraction,
convergence preserved. 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 : chest/cerebral/pancreas Pathology , porphyria,
malignancy, Drugs (carbamazepine, chlorpropamide, clofibrate,
atipsychotics, NSAIDs, rifampicin, opiates)
54. Causes of Diabetes Insipidus: Cranial: tumor, infiltration, trauma
Nephrogenic: Lithium, amphoteracin, domeclocycline, prologed
hypercalcaemia/hypornatraemia, FAMILIAL X linked type
55. bisphosphonates:inhibit osteoclast activity, prevent steroid incduced
osteoperosis (vitamin D also).
56.returned from airline flight, TIA-> paradoxical embolus do TOE.
57. alcoholic, given glucose develops nystagmus -> B1 deficiency
(wernickes). Confabulation->korsakoff.
58. mono-artropathy with thiazide -> gout (neg birefringence). NO
ALLOPURINOL for acute.
59. painful 3rd nerve palsy -> posterior communicating artery aneurysm
till proven otherwise
60 late complication of scleroderma --> pumonaryhypertention
plus/minus fibrosis.
61. causes of erythema mutliforme: lamotrigine
62. vomiting, abdominal pain, hypothyroidism -> Addisonian crisis (TFT
typically 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 (time
dependent 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-
alcoholic steatotic 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) ->
Da antags (metoclopramide, chlorpromazine, cimetidine NOT TCA's),
pregnancy, PCOS, pit tumor/microadenoma, stress.
74. Distal, asymetric arthropathy -> PSORIASIS
75. episodic headache with tachycardia -> phaeochromocytoma
76. very raised WCC -> ALWAYS think of leukaemia.
77. Diagnosis of CLL --> immunophenotyping NOT cytogenetics, NOT
bone marrow
78. Prognostic factors for AML -> bm karyotype (good/poor/standard) >>
WCC at diagnosis.
79. pancytopenia with raised MCV --> check B12/folate first (other
causes possble, but do this FIRST). Often associayed with phenytoin use
--> decreased folate
80. miscariage, DVT, stroke --> LUPUS anticoagulant --> lifelong
anticoagulation
81. Hb elevated, dec ESR -> polycythaemua (2ndry if paO2 low)
82. anosmia, delayed puberty -> Kallmans syndrome (hypogonadotrophic
hypogonadism)
83. diag of PKD -> renal US even if 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
(atiphospholipid syndrome which is recurrent thrombosis, fetal loss, dec
plt. Usual cause of cns manifestations 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
cutaneous nerve compression usally by by ing ligament)
91. diagnosis of haemochromatosis: screen with Ferritin, confirm by
tranferrin saturation, 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
neuro toxicity.
95. Indurated plaques on cheeks, scarring alopecia, hyperkeratosis over
hair follicles ->>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
(diarrhoea does NOT have to be present)
99. haematuria, proteinuria, best investigation --> if glomerulonephritis
suspected --> renal biopsy
100. venous ulcer treatment --> exclude arteriopathy (eg ABPI), control
oedema, prevent infection, compression bandaging.
101. Malaria, incubation within 3/12. can be relapsing /remitting. Vivax
and Ovale (West Africa) longer imcubation.
102. Fever, lymphadenopathy, lymphocytosis, pharygitis --->EBV --->
heterophile antibodies
103. GI bleed after endovascular AAA Surgery --> aortoenteric fistula

OTHER IMPORTANT POINTS

Young girl – suspect Anorexia Nervosa – linugo hair, finctional .1

hypogonadotrophic hypogonadism -> amennorhea. LH and FSH both
.low. All other hormones are usually normal. Ferritin low

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

.campylobacter, Yersinia, SALMONELLA , Shigella. Balanisits

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

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

heart sounds: Aortic Stenosis s2 paradoxical split, length proportional .5

to severity

Vitiligo – commonest assoctions pernicious anaemia >>> type 1 DM , .6

autoimmune addisons, autoimmune thyoid dx

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

thiazides, NO allopurinol/aspirin in acute phase

Peripheral neuropathy – a) B12 – rapid, dorsal columns (joint pos, .8

vibration), sensory ataxia, pseudoathetosis of upperlimbs b) diabetic –
slow, spinothalamic (pain, temp?) c)alcohol – slow progressive,
spinothalamic d) Pb – motor upper limbs

CNS abnormalities in HIV: toxoplaasmosis (ring enhancing), .9

lymphoma (solitary lesion). HIV encephalopathy, progressive multifocal
leucoencephalopathy (PML – demylination in advanced HIV, low
attenuation lesions)
 Travellers diarrohea: chronic (>2 WEEKS) giardia (incidious onset .10
rx. Metronidazole), SALMONELLA (serious systemic illness), E.coli (rx.
Ciprofloxacin) , Shigella

Renal syndrome – minimal change disease, membanous, IgA .11

.nephropathy, post-streptococcal

If you see blood on urinalysis forget about RAS .12

Thyroid Malignancy – tend to be non-functional, anaplastic has worse .13

prognosis, local infiltration -> dysphagia, vocal cord paralysis

ALMOST Pathognomic for the exam

fatiguability -> myasthenia gravis

fasciculations -> Motor neurone diease

silvery white scale -> PSORIASIS

hypopigmented -> vitiligo/pityriasis versicolor

pretibial myxoedema --> Graves (NOT lid lag, NOT exopthalmus)

Source: rxpg.com