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100 commonly tested facts for MRCP Part 1

Here is a list of commonly tested facts in the 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)