MRCP Part 1

400 BOFs

MRCP Part 1
400 BOFs
Imran Mannan BSc (Hons) MBBS MRCP

Core Medical Trainee, Barts Health NHS Trust, London, UK

Vincent Cheung MA (Cantab) MBBS MRCP

Core Medical Trainee, Barts Health NHS Trust, London, UK

Claire Grout MA (Cantab) MB BChir MRCP

Core Medical Trainee, Barts Health NHS Trust, London, UK

Benjamin Mullish MA (Cantab) MB BChir MRCP

Core Medical Trainee, Barts Health NHS Trust, London, UK

Edited by
Aruna Dias BSc MBBS MRCP

Consultant Gastroenterologist,
Newham University Hospital, UK

Eric Beck BSc (Hons) MBBS FRCP FRCPG FRCPE

Former Chairman of MRCP(UK) Part 2 Board

and former Member of the MRCP(UK) Part 1 Board
University College London, UK

London St Louis Panama City New Delhi

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Preface
Passing the MRCP(UK) exam is internationally recognised as a significant achievement, reflecting
the acquisition of the knowledge, skills and attributes required by trainee physicians to progress
to higher specialist training. However, it is not an achievement that comes easily. Having recently
taken the exam ourselves, we know first hand the difficulties of trying to balance revision with
working in a busy job with demanding on-calls, whilst at the same time attempting to keep some
semblance of a normal social and family life.
Another difficulty in preparing for MRCP(UK) (and particularly for Part 1) is that it is not clear
how and what to study. Does every available guideline need to be scrutinised in exquisite detail?
Should huge lists of rare complications be memorised for every disease encountered? Clearly
there is no single, sure-fire correct way of preparing for the exam all of us have met very
knowledgeable doctors who have taken several attempts to pass.
With this book we highlight the key areas of how and what to study, so that candidates can use
it to revise and prepare for the exam as effectively as possible. We have attempted to do this in a
number of different ways.
Firstly, the questions are in the same style as the exam and, like the exam, include normal values.
They reflect the breadth of knowledge and level of difficulty of the exam. This will help candidates
to appreciate what to expect on the actual day. It will quickly become obvious that some questions
are more difficult than others this again is a reflection of the exam itself.
Secondly, based on our own experiences of the exam, in the answers we have tried to put an
emphasis on and simplify the most difficult topics, sharing key memory aids that we have found
useful ourselves including tables, mnemonics and illustrations.
Thirdly, we have tried to provide thorough but not overly-detailed explanations, with answers
that not only explain why one option is correct but also justify why other options are not.
Fourthly, many questions have an accompanying reference, to direct further reading around the
topic.
Whilst this book is principally aimed at those preparing for the MRCP(UK) Part 1, we hope it will
also be of interest to junior doctors more generally. We have written questions that reflect typical
challenging situations that might be encountered on a typical acute medical take, or dilemmas
that might be faced in the clinic.
We hope that you find this book useful and, hopefully, enjoyable to use. Best of luck for the
exam!
Imran Mannan
Vincent Cheung
Claire Grout
Benjamin Mullish
December 2012

Contents
Preface
Exam revision advice
Acknowledgements and Dedication

v
ix
xi

Chapter 1 Cardiology 1

Questions
Answers

1
9

Chapter 2 Clinical pharmacology, therapeutics

and toxicology

25

25
35

Questions
Answers

Chapter 3 Clinical sciences

59

59
70

Questions
Answers

Chapter 4 Dermatology 93

Questions
Answers

93
98

Chapter 5 Endocrinology 105

Questions
Answers

105
114

Chapter 6 Gastroenterology 129

Questions
Answers

129
141

Chapter 7 Haematology and oncology

159

159
171

Questions
Answers

Chapter 8 Neurology 195

Questions
Answers

195
203

vii

Contents

Chapter 9 Ophthalmology 225

Questions
Answers

225
228

Chapter 10 Psychiatry 235

Questions
Answers

235
241

Chapter 11 Renal medicine

251

Questions
Answers

251
265

Chapter 12 Respiratory medicine

283

283
291

Questions
Answers

Chapter 13 Rheumatology 311

Questions
Answers

Chapter 14 Tropical, infectious and sexually

transmitted diseases

345

345
354

Questions
Answers

Index

viii

311
322

371

Exam revision advice

Format
The MRCP(UK) exam consists of three parts. Part 1 is a written exam, whilst Part 2 is split into a
written and a clinical exam (PACES).
The MRCP(UK) Part 1 exam has a two-paper format. Each paper lasts 3 hours and consists of 100
multiple choice questions. All questions take a best of five (BOF) approach, where the single most
appropriate answer must be selected from a list of five options. Questions cover the full range of
medical specialties and include clinical science. The composition of the papers is shown in Table 1.
There is no specific syllabus for the MRCP(UK) Part 1 exam, but the Royal Colleges recommend

Table 1
Specialty

Number of questions*

Cardiology

15

Clinical pharmacology, therapeutics and toxicology

20

Clinical sciences**

25

Dermatology

Endocrinology

15

Gastroenterology

15

Haematology and oncology

15

Neurology

15

Ophthalmology

Psychiatry

Renal medicine

15

Respiratory medicine

15

Rheumatology

15

Tropical medicine, infectious and sexually transmitted diseases

15

Total

200

*This should be taken as an indication of the likely number of questions the actual number may vary slightly.
**Clinical sciences comprise:
Cell, molecular and membrane biology
Clinical anatomy
Clinical biochemistry and metabolism
Clinical physiology
Genetics
Immunology
Statistics, epidemiology and evidence-based medicine

2
3
4
4
3
4
5

Table 1 Composition of the MRCP Part 1 exam.

ix

Exam revision advice

that candidates refer to the Specialty Training Curriculum for General Internal Medicine, prepared
by the Joint Royal Colleges of Physicians Training Board.
The MRCP(UK) Part 1 exam is now marked using a process called equating. Using the equating
system means that rather than being given an overall percentage score, candidates will instead be
given an overall scaled score. This score is a number between 0 and 999, which is calculated from
the number of questions a candidate has answered correctly (out of the maximum possible) and
takes into account the relative difficulty of the exam. Since no two exams contain the same
questions, it is inevitable that some papers may be slightly harder (or easier) than others, and
equating is a statistical process that addresses this. At present, the equated score required to pass
MRCP(UK) Part 1 is 521.
Candidates are strongly advised to visit the MRCP(UK) website for further details of the exam.
How to use this book to prepare for MRCP(UK) Part 1
The book has been set out in chapters that reflect the specialties covered by the MRCP(UK) Part 1
exam. The number of questions per specialty is directly proportional to the weight each specialty
area will carry in the actual exam. Each chapter contains questions covering a broad range of
topics within each specialty, and questions range in difficulty between relatively easy and very
difficult, as in the exam itself. Each question is followed by an explanation to explain why that
answer is the most appropriate and why the other options are not correct. Where illustrations
enhance the explanations these have been included (though interpretation of images is not a requirement for the Part 1 exam). As in the exam, when a question includes a list of laboratory values
we have included the normal values in parentheses.
Having recently sat the exam ourselves, our advice is to approach revision specialty by specialty.
Remember to think laterally when revising, e.g. a question on vasculitis could appear in the renal,
rheumatology, respiratory, neurology or dermatology sections. Tackle the questions as you would
in the exam, by reading the rubric carefully and thinking about what the correct answer might
be before reading the AE options. Next, select which of the options best fits the answer that you
were thinking of. There are no trick questions, but there are definitely questions that are not as
straightforward as they may initially appear. Use the information in the answer to confirm and expand upon what you already know, or to help understand and remember why a certain answer is
more appropriate than others. The references are provided throughout to enable you to clarify any
uncertainties or to expand upon your knowledge if the topic particularly interests you. Remember,
the key to success is practice, practice, practice!
Useful websites
MRCP(UK): http://www.mrcpuk.org/Pages/Home.aspx
Specialty Training Curriculum for General Internal Medicine from the Joint Royal Colleges of
Physicians Training Board: http://www.jrcptb.org.uk/specialties/ST3-SpR/Documents/2009%20
GIM%20curriculum.PDF

Acknowledgements
Header
We are very grateful to Dr Aruna Dias, Consultant Gastroenterologist and Physician, Newham
University Hospital, for his constant help and support throughout all stages of writing and editing
this book. We would like to thank Dr Eric Beck for giving his time to provide helpful editorial input.
We are very appreciative of the dedication and commitment of Hannah Applin at JP Medical
Publishing.
We would also like to thank a number of people for their helpful comments and providing
images for this book:
Dr Steve Ellis, Consultant Radiologist, Barts Health NHS Trust.
Dr Wendy Mills, Consultant Haematologist and James Butler, Section Head of Haematology,
Pathology Department, Barts Health NHS Trust.
Dr Sam Khandhadia, Clinical Research Fellow, Eye Unit, University Hospitals Southampton.
IM, VC, CG, BM

Dedication
In memory of my mother, and for my father and brother.

Imran Mannan

For my mother, father, brother and girlfriend for their endless love and support.

Vincent Cheung
For my mum, dad and husband for their constant support and faith in me.

Claire Grout
For my mother for always being there, and in memory of my father.

Benjamin Mullish

xi