100 commonly tested facts for MRCP Part 1

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. [bleep] on hands and fragule 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 <1.5, MALIGNANT effusion, mets outside
lung.
19. prevent further renal deterioration/proteinuria--> dec bp 130/90, Ace inhibitors (if
proteinuria <3g/24hrs)
20. headache with many analgesics at once -> 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 <30, linkage analysis BUT requires serum from 2
relatives with dx
84. Young 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 (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
[snip]. 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

High Yield Topics

1. Young girl suspect Anorexia Nervosa linugo hair, finctional hypogonadotrophic
hypogonadism -> amennorhea. LH and FSH both low. All other hormones are usually
normal. Ferritin low.
2. Reiters Syndrome arthritis, uveitis, urethritis Chlymidia, campylobacter, Yersinia,
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 to severity
6. Vitiligo commonest assoctions pernicious anaemia >>> type 1 DM , autoimmune
addisons, autoimmune thyoid dx
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 upper limbs
9. CNS abnormalities in HIV: toxoplaasmosis (ring enhancing), lymphoma (solitary
lesion). HIV encephalopathy, progressive multifocal leucoencephalopathy (PML
demylination in advanced HIV, low attenuation lesions)
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, poststreptococcal.
12. If you see blood on urinalysis forget about RAS
13. Thyroid Malignancy tend to be non-functional, anaplastic has worse 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)
PLEASE GIVE CORRECTIONS AND ADDITIONS
ONLY INCLUDE FACTS THAT HAVE FREQUENTLY APPEARED ON OFFICIAL
PAST MRCP QUESTIONS