Commonly Tested Facts for the MRCP Part 1 Exam
Use our list of Commonly Tested Facts identified from forum discussions and a list published by the Royal College of Physicians to determine any gaps in your knowledge. We ensure our MRCP Part 1 revision resource has questions covering the themes and topics which you will encounter in the exam.
1) Acromegaly diagnosis – the role of an oral glucose tolerance test in addition to serum growth hormone.
2) The value of a 24hr urinary free cortisol in the diagnosis Cushing’s syndrome, and the role of the short synacthen test in the diagnosis of Addison’s disease.
3) The classical presentation of Dermatitis herpetiformis (and its strong association with coeliac disease).
4) Risk stratifying atrial fibrillation to guide choice of anticoagulation in stroke prevention.
5) Clinical presentation and radiological findings of herpes encephalitis – classically a subacute onset, initially with subtle low density of the temporal lobes on CT and oedema on T1 weighted MRI.
6) The classical presentation of idiopathic intracranial hypertension (headache and papilloedema in a woman with raised BMI).
7) Drug causes of pneumonitis (in particular methotrexate and amiodarone).
8) Achalasia as a part of the differential diagnosis for patients presenting with chest pain and dysphagia.
9) The presentation of acute HIV infection – a maculopapular rash with a flu-like illness, and possibly travel to an area with high HIV prevalence.
10) The causes of and diagnostic investigations required for gout.
The list above shows some of the commonly tested topics in the MRCP, which candidates often find tricky during the initial stages of their revision.
The value of a 24hr urinary free cortisol in the diagnosis Cushing’s syndrome, and the role of the short synacthen test in the diagnosis of Addison’s disease.
When you see an obese patient with diabetes and hypertension, they probably don’t have Cushing’s syndrome but one day you will encounter a patient with these symptoms who also has a supraclavicular fat pad and striae and the underlying diagnosis may well be Cushing’s. We will teach you that there is no single investigation which you should do in this situation, but that the recommended diagnostic tests are a 24-hour urinary free cortisol (which will be high) and a 1mg overnight dexamethasone suppression test (where the cortisol will remain inappropriately high). As 24-hour collection of urine is often inaccurate, a 1mg overnight dexamethasone suppression test is the best option if you are given both in the exam.
The presentation of acute HIV infection – a maculopapular rash with a flu-like illness, and possibly travel to an area with high HIV prevalence.
What would your differentials be for a 24-year old man presenting with fever, fatigue, maculopapular rash and pharyngitis? You’re probably thinking it’s a viral URTI, and you would probably be right in the majority of cases. But this gentleman has recently travelled to South Africa, and he looks more unwell that you would expect with an URTI. We will teach you that you should consider acute HIV as the diagnosis in this scenario, and that an HIV test can be negative for 5-90 days (depending on the patient and the test used). What about if he had travelled to Brazil recently, and also had arthralgia and conjunctivitis with retro-orbital pain? He might have Zika virus, and whilst it is typically self-limiting you need to ensure he has not had contact with a pregnant woman and that he uses barrier contraception.
Risk stratifying atrial fibrillation to guide choice of anticoagulation in stroke prevention.
A 69-year old patient presents on the medical take with atrial fibrillation. You see him and prescribe rate control, but what about anticoagulation? Should you give aspirin, or warfarin, or even dabigatran or rivaroxaban? Using our question bank you will appreciate the need to calculate the CHA2DS2-VASc score (using age, sex, congestive heart failure history, hypertension history, stroke/TIA/thromboembolism history, vascular disease history and diabetes history) and prescribe anticoagulation if the score is 2 or more. Aspirin is no longer recommended for stroke prevention in this setting, and NICE states that apixaban, dabigatran, rivaroxaban or a vitamin K antagonist can be used as long as the bleeding risk is not too high (assessed using the HAS-BLED score).
Achalasia as a part of the differential diagnosis for patients presenting with chest pain and dysphagia.
How would you approach the investigation of a patient who presents with heartburn and some dysphagia to solids? What are your differentials? You should be considering gastro-oesophageal reflux disease (possibly with a benign stricture) and oesophageal carcinoma, but did you include achalasia? By the end of your revision with us you should know that this is an oesophageal motility disorder, classically presenting with dysphagia to solids and regurgitation, with a bird’s beak appearance on barium swallow and treated with myotomy or dilatation. These less common conditions, such as achalasia or drug-induced pneumonitis, are included to ensure you become confident with their presentation, investigation and management.
Overall, we hope our question bank will increase your chances of success at the MRCP Part 1 and will increase your confidence with regard to the management of your patients in your clinical practice.
Top Tips on How to Pass your Medical Exams
Get the right mind-set
The exams are challenging and represent an important stage in your career. The key is to commit to trying them, make the time, and be consistent in your effort.
Have the right knowledge
Think of your memory as a kitchen shelf. You can only put so much in your exam-prep memory at any one time. Time your memory to make sure you have the most useful stuff and don’t try and cram it with a load of other things. Make sure it's the right time in your career. Are you on a busy rotation? You don’t want these things taking over space in your mind and overloading it. You want an even distribution of knowledge and not just lots of one subject such as cardiology. Just like a kitchen shelf make sure your exam shelf has the right ingredients.
Think like an examiner what would they do?
They are just a few years ahead in their career and they are all around you, consultants in NHS hospitals across the UK and internationally. Every hospital has a senior doctor keen to teach. Talk to them and understand how to prepare for the exam.
Practice basic science questions
It’s most important to practice, practice for basic science questions. They generally don’t change and there will be a good section of them in the exam and will be based on the same sorts of topics.
Know the guidelines
Many exam topics will be based on guidelines. Make sure you get to know where the guidelines for your specialty can be found.
Spot patterns in the questions
The language that is used in the exam papers is something that you can become familiar with. The more you practice the more you will notice they will ask questions in certain ways and they use particular words more often than you would use in other writing.
Common question lead ins
The words ‘may, might and always’ have particular meaning in these exams. If you practice them you will be able to see how you should interpret them when you come across them in the exam. ‘What's the appropriate next step’, comes up often and it's not necessarily a test of knowledge but is asking you to make a judgement as to what may be the safest or most cost effective answer. Certain types of phrases and patterns in questions can help you answer them correctly.
Know your enemy
Think of your College as your enemy and plan your attack accordingly. You should know them. Read their exam reports, read about the exam on the College website and read through the exam syllabus.
Stuck with a question
If you are really stuck with a question and about to give up think of these tips;
- As you would when you are on the ward go back over the history, read through the question stem again.
- Try hiding the options and just answer the question.
- Try and get into the examiner’s head. Is the diagnosis actually given (in which case they are asking for management) or hidden (in which case you need to work it out first then answer the question).
- Try analysing the options. Is there something there that gives you a clue to the area of medicine you are being tested on? You can try and exclude the answers that are definitely wrong rather than definitely right.
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