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‫الحمد هلل والصالة والسالم على رسول هللا‬

My Study Plan For MRCP II:


→ Not less than 4 months.
→ I solved On Examination nearly 2 times.
→ I had a 3 weeks Vacation before exam (during them I studied most of the pat papers from 2011 to
2018). half Exam /day (I was not so fast ☺)
→ In the Last week, I had a rapid review of X-rays, ECGs, fundoscopies, GIT radiology, derma, neuro
radiology, very quickly.
→ In the last week, do not solve Questions, only Re-read, Re-read.
→ These notes are recorded also, so you can study them by reading or by listening.
→ I readied these notes & listened to them nearly 3 times.
→ Past papers are uploaded on my telegram channel.
→ The Images, are also uploaded on my telegram channel.
→ It is also useful to read some documents in telegram channel from MRCP I , I called them
“Extras of Pastest” , do not worry , they are short notes.

There are 150sample Qs on the website of MRCP Exam, you will find 3 or 4 of them in the real exam

https://www.mrcpuk.org/mrcpuk-examinations/part-2/part-2-sample-questions

These notes are open source, collected from Onexamination, past papers, spread freely, if any concern, you
can find the “Microsoft Word copy of this PDF document” on my channel on telegram, you can download the
Microsoft word document & add or remove or edit any part , according to your need.

https://t.me/mrcp_collection

Take chocolate with you in the exam: eat 1 bar of chocolate after 1 hour of the exam (Total of 6 bars in the 2
papers ☺ , I did so).

☺ .‫وال تنسوني من صالح دعائكم بالمغفرة والرحمة وحسن الخاتمة‬

Dr. Khaled Nabeel Elgohary


If any concern, just mail me: dr.khaled.elgohary@gmail.com
1. Hereditary angioedema TTT
➢ Acute attack : C1 esterase inhibitor replacement.
➢ Prophylaxis: Danazol / aminocaproic acid
2. Noonan $ is associated with short stature ‫نونة‬

3. A direct antiglobulin test (Coomb) is positive in the following situations:

➢ Warm AIHA (SLE, Evan’s syndrome, idiopathic)


➢ Hemolytic disease of the newborn
➢ Alloimmune reactions to recently transfused cells, and
➢ Drug-induced hemolysis (alpha methyldopa, levodopa, quinidine or high dose of
penicillin etc).

4. Warm antibody AIHA is highly responsive to corticosteroids and these are the initial
therapy of choice.
5. There is no role for oral or IV iron chelation in hereditary haemochromatosis, but TTT is
by removal of body iron by regular venesection aiming for ferritin <50 ng/ml.
6. AntiTPO antibodies are present in 10% females without thyroid pathology.
7. XLD:
➢ An affected female will pass the disease to 50% of her daughters and 50% of her
sons
➢ An affected male will pass the disease to 100% of his daughters and none of his
sons.

8. Osteoporosis?

➢ T scores greater than −1 are normal


➢ T scores between −1 to −2.5 reflect osteopenia and
➢ T scores less than −2.5 reflect osteoporosis.

9. Bisphosphonate is not preventive for fracture, but only reduces the risk.
10.Raloxifene & HRT >>>DVT.
11. Hypotension not responding to fluid resuscitation is an indicator of septic shock.
12.Septic shock is defined by persisting hypotension requiring vasopressors to maintain a
mean arterial pressure of 65 mm Hg or higher and a serum lactate level greater than 2
mmol/L (18 mg/dL) despite adequate volume resuscitation.
13.Proper placement of tip of CVL in CXR is the lower part of SVC = 2nd ICS posteriorly
=at level of Carina.
14.The most common clinical signs prior to a cardiac arrest are respiratory distress (RR
>25/min) and altered mental state.
15.Base excess has been shown to be superior to PH in evaluating metabolic acidosis and in
predicting subsequent complications.
16.Norfloxacin is recommended for short term prophylaxis in hepatic encephalopathy.
17.Hyperthermia → Hypokalemia →then rhabdomyolysis& hyperkalemia →then metabolic
acidosis with compensatory respiratory alkalosis (&↑serum lactate). Serum osmolality
decreases (as body withholds the water) & urine osmolality increases.
18.CV line impregnation in chlorhexidine →↓ risk of CVL blood stream infection and
catheter colonisation.
19.IgA deficiency → Respiratory tract infections and GI infections.
20.In Wernick’s , with Hypoglycemia start thiamine 1st or glucose? EXAM 2012,2014
If the glucose < 3.5 correct 1st with 10% dextrose and then start the thiamine.
21.EXAM 2012

 Three layer compression bandaging is used in the


management of venous ulcers, it is contra-
indicated where there is arterial insufficiency ‫الرباط‬
‫الضاغط‬

 Anti-embolism compression stockings improve


venous return and reverse some of the postural
hypotension. Fludrocortisone can be added if
symptoms don’t resolve completely, midodrine
(VC/antihypotensive) then added as a 2nd line.
‫شراب ضاغط‬
22.EXAM 2012

Foam dressing: useful to contain


exudate to prevent damage to
surrounding skin

Jelonet: used in dry wounds. Tegaderm Alginate used in wounds


with a much greater burden of
exudate.

23.Hydrocolloid dressings are in more advanced ulcers.


24.Hyperbaric oxygen is used as a therapy in some patients for sensorineural hearing loss.
25.Isolated elevation of liver enzymes only without any other S/S may be the initial
presentation of Wilson’s. EXAM2012
26.O-ve is a universal donor, AB +ve is a universal recipient. EXAM2012, EXAM 2013
RBCs. ‫اللي فوق دا بالنسبة للـ‬

AB +ve is the universal plasma donor. ‫بالنسبة للبالزما‬

Unless in life threatening Hg, do not transfere O blood


to another group,for example: AB +ve can receive from
A+ve or O +ve , better to give him A +ve.

We reserve the –ve blood group for the –ve peoples.

AB+ve ‫ فصيلة دمه‬elective ‫بمعنى ان لو مريض مثال هيعمل عملية‬


A+ve, O-ve ‫والمتاح عندك في بنك الدم‬

. –ve ‫ لحد تاني يكون‬O –ve ‫خلي الـ‬

A+ve ‫وتقدر تدي لمريضك‬

B ‫ أو‬A+ve ‫ تقدر تدي المتاح عندك سواءا‬emergency ‫إنما لو في‬


‫الجدول دا سهل جدا وهاته بالترتيب من فوق لتحت هيسهل لك الموضوع‬ O -ve+‫ أو‬+ve
27.Anaphylactic reaction during blood transfusion is due to ? IgA deficiency. EXAM2013
28.Alkaptonuria →darkening of urine due to homogentisic acid oxidation on standing,
29. Venous ulcer, seen above medial malleolus, ABI, before applying compression bandages.
Normal ABPI (0.9 - 1.2).
30.Take care: 5th finger is the little finger, not the thumb.
31.Feeding in acute pancreatitis:
TPN ‫ ويمشي‬NPO ‫زمان كانوا بيقولوا‬
....‫دلوقتي أل‬
Start oral feeding (if consciuos). NGT feeding if low GCS important in maintaining the
integrity of mucosal barrier against bacterial incursion& have a good outcome on
mortality compared with NPO/TPN. EXAM 2013
32.Irradiating the blood → removes the T-lymphocytes →↓ risk of transfusion related graft
versus host disease (T-GVHD). T-GVHD is seen in immunecompromised ptns.
(Symptoms include fever, rash, abdominal pain, diarrhea and vomiting). EXAM 2013
33.LL myotomes: EXAM 2013 ‫مهمة جدا جدا وسهلة علشان تعرف الـ‬reflexes
 L2 - hip flexion
 L3 - knee extension
 L4 - ankle flexion = dorsi-flexion
 L5 - great toe extension
 S1 - ankle extension = planter flexion
 S2 - knee flexion

NB: Absent ankle jerks may also be seen in peripheral neuropathy.

34.Some bladder problems: EXAM2013


✓ MS with residual volume TTT is →Intermittent self-catheterisation .
Neurostimulation treatment, a so-called”bladder pacemaker” may be of value in
patients who are unable to do self catheterise.
✓ Urge incontinence → Botulinum toxin is useful.
✓ Stress incontinence → pelvic floor exercises.
35.Gold standard for osteomyelitis is MRI. EXAM2013
36.Patient with amyloidosis , 2ry to CRF, what is the best site to take a biopsy from it to
confirm Amyloidosis?
Ans: Bone. EXAM2013 Dialysis related amyloidosis leads to deposition of beta-2
microglobulin, which occurs predominantly in bone. In contrast to other forms of
amyloidosis, visceral deposition is rare, and symptoms of visceral involvement usually
only occur in patients who have been dialysed for 10 years or more. For this reason
traditional sites for tissue confirmation of amyloidosis such as rectal or subcutaneous fat
biopsy are not useful here.
37.INR >1.7 or Seizure at onset of stroke are contraindications to thrombolysis EXAM2013
38.
Massive fibroid:

The bladder is inferior to the large midline


mass arising out of the pelvis. There are
separate planes of cleavage from the
bladder and the anterior abdominal wall,
which have normal appearances.
This mass is contiguous with the uterus as
it wraps around the bladder.

39.1stone=14 pounds=6.3 Kg
40.In HHS start with Saline 0.9%. 5% dextrose or 0.45% saline should only be considered
where osmolality is not declining despite adequate 0.9% saline replacement.
41.After out of hospital cardiac arrest +neurological impairment(Low GCS): Doing
Therapeutic hypothermia (reduction in temperature to between 32 and 34°C for 12-24hrs
is recommended, accompanied by gradual re-warming). EXAM2014
42.Steven Johnson $ is associated with HLA?
EXAM2012 HAL B 1502/1508 ‫ يبقى‬:‫لو حد صيني‬
TEN ‫ وزيها‬... HLA B 3101 ‫لو حد ياباني أو أوروبي‬
43.HLA B 5701 : associated with hypersensitivity to Abacavir
44. How will you cover this ulcer? EXAM2017
Alignate (Tegaderm)
45.Vitamin D↓ in CKD is treated by Alfacalcidol , not ergocalciferol (used for Rickets)
46.Patient’s with Wagner’s (or generally ANCA +ve vasculitis) → nephritic $ within few
months (that is why it is called rapidly progressive GN)
47.MRI is more sensitive than bone scintigraphy in detecting vertebral mets.
48.Intention to treat analysis= Includes all patients analyzed by treatment allocation at study
start.
49.In Hgic stroke, If there is significant mass effect/edema, Mannitol and Dexamethasone can
buy time whilst surgical intervention are considered.
50.Children < 16 are presumed to lack capacity for consent, but they can consent to their own
treatment if it is thought that they are intelligent.
51.Resistent Hypokalemia or Resistent hypocalcemia. What to do? Give IV magnesium
52. Osteomalacia may be presented with: EXAM2017
→ Initially: Proximal myopathy. Then
→ Frank bone pain.
53.TTT: Calcium & vit. D.
54.Again: sun exposure (e.g person in a holiday) → mild hypercalcemia , in this situation ,
no intervention is needed , just observe & retest Ca level within few days (even if there is
mild symptoms of hypercalcemia).
55.Recurrent sino-pulmonary infections (IBC) ‫ من أغنية الـ‬1ry immune deficiency.

‫ زي مثال الـ‬autoimmune features ‫ أو‬BHL of sarcoid ‫ زي مثال‬evidence of granuloma ‫لو فيه معاها‬
EXAM2017 common variable immune defeceincy ‫تبقى دي‬vitiligo

56.Free lambda light chains in AL amyloid


57. In Refeeding $: Feeding triggers
→ Cellular uptake of phosphate.
→ Lack of phosphorylated intermediates →tissue hypoxia.
58.
59.
60.