50 Last Minute Cramming Facts for MRCP Part 2 Exam (UK)

I have summarised what I think to be the 50 most commonly asked non-picture

topics in the Part 2 exam. This list is completely different to the one I previously
posted - which is meant for MRCP Part 1 (see RxPG MRCP part 1 section) . This list is
JUST for MRCP Part 2.

1. Renal deterioration is most often due to NSAID's: NSAID' --> renal deterioration,
ATN, interstitial nephritis, renal papillary necrosis, chronic tubulo interstitial nephritis.
If asked most LIKELY cause of renal failure NSAIDs are likely to be the answer.

2. wt loss, bronchorrohea --> bronchioalveolar carcinoma

3. diabetic patient maximum reduction in CVS risk bp (esp ACE i >>> tight
glycaemic control, weight reduction unproven.

4. antipsychotic + fever, rigidity, confusion, ANS dysfunction --> NMS. can be pptd
by anticholinergics, lithium and benztropine. Rx. withdraw agent, antipyretics,
dantrolene, bromocriptine, levodopa. Can occur at any time since starting
antipsychotics.

5. MS --> 2 neuro lesions seperated in time and location.

6.blood gases: Normal values: pH 7.36-7.44, O2 11.3-12.6, co2 4.7-6.0, hc03 20-28

interpretation rules:
i) pH defines primary disturbance
ii) pO2, pCO2: can be type 1/type 2 resp failure or hypreventilation
iii) hco3: metabolic component
iv) consider lab error if pH is not proportional to HC03:Co2 ratio.
v) anion gap in poisoning (methanol, ethylene glycol), ketoacidosis
trap: alkal, hi HCO3, tp1 failure->should be tp2 if compnstry->mixed metalk+resp
acd

7.carbimazole and sore throat --> if WCC normal and neutrophils OK then reassure
and continue. rate of leuco/neutropenia is only 1%. Stop if neut stop carbimazole,
give antibiotics, consider GCSF

8.occupational asthma: improves away from workplace, worsens markedly on return

9.trivial trauma in young people --> stroke...think vertebral artery dissection. head
and neck pain + stroke --> think of dissection. usually under 40 yrs, trivial trauma
with some neck distrotion.stroke is often brainstem/cerebeller.

10.inversion of biceps and supinator jerks ---> cervical myelopathy C5,6

11.malabsorption --> hyper oxalataemia --> oxolate renal stones (radiopaque)-->

Rx increase fluids, calcium carbonate

12.alcoholic liver disease and neurological deterioration: nystagmus--> Wernicke's. If

decreased GCS only and on opitaes --> opiate overdose. eg. alcoholic, drowsy on
cocodamol --> give naloxone!
13.legionella pneumonia (systemic upset, non porductive cough, inc wcc,
lympohopenia, low Na--> Rx. azithromycin or levofloxacin. Legionaires disease -->
flu-like prodrome, fever, non-productive cough, confusion, neutrophilia, lymphopenia,
HYPONATRAEMIA, non specific liver derangement, proteinuria/myoglobinurua, lobar
or bilateral consolidation, macrolides (azithromycin) or quinolones (levofloxacin)
(both superior to erythromycin). combination therapy of erythromycin and rifampicin
is second line. doxycyclline, cotramoxazole and tetracycline can also be used.

14.arrythmia + amiodarone leading to hyperthyroidism ---> Start carbimazole. If

indication mild, stop amiodarone - carbimazole will often be required if the AF would
lead to compromise - as the half life of amiodarone is long and stopping amiodarone
alone would have a DELAYED affect.

15.foreign travel (esp Africa businessman), rash, lyphadenopathy -> HIV conversion
illness

16.>1g/day proteinuria before ANY other treatment ---> ACE inhibitor. indications for
ACEi in renal failure: hypertension -->and/or>> glycaemic control. Antibiotics not to
be given prophylactically in this case. Low protein diet beficifal in overt proteinuria
not microabluminurea.

17.CRF + Fe PO + anaemia --> give Fe iv to replenish stores PLUS EPO. keep Hb

>11 to prevent LVH. If patient symptomatic i.e. angina then transfuse.

18.obese female, headache, papilloedema --> BIH --> Rx is peritoneal shunt. Benign
intercranial hypertension -- obese lady, pappilloedema, headaches worse in morning.
1. CT to exclude SOL. 2. LP. 3. MRI venogram to exclude venous thrombosis, Space
occupying lesion, hydrocephalus (better than CT). causes of BIH --> vitamin A,
tetracycline, OCP

19.metformin contraindicated if creatinine >150. Overweight Diabetics on metformin

do better on metformin than on insulin, even if HbA1c improves (mortality dec by
40% in UKPDS)

20.coeliac disease --> IgA deficiency, dec Ca, Fe anaemia, aphous ulcers,
antiendomesial IgA may be negative--> test transglutaminase IgG. hypocalcaemia is
seen in Coeliac disease. hypocalcaemia, iron deficiency anaemia, normal
inflammatory markers, GI symptoms --> coeliac disease. raised MCV --> tropical
sprue.

21.osteoperosis with hypopituitrism --> correct testosterone deficiency, then other

things. GH improves symptoms not bone. after testosterone, bisphosphonates are
the treatment of choice especially if steroids are used. HRT is controversial and will
not be the right answer. T-score TCA overdose likely --> Rx. sodium bicarbonate
(alkalinises, and alters memb potetial)

23. DM , impotence, normal LFT --> 1. MRI pituitry (pituitry tumor compressing
stalk). 2. abnormal LFT ---> check ferritin (Haemochromatosis)

24.erythema nodusum --> need CXR to exclude sarcoid/TB. erythema nodosum:

sarcoid, TB (NB. ALWAYS first do CXR), infection (strep), drugs (sulphonamides,
OCP), inflamatory bowel disease, behcets disease. Lesions last 6-8 weeks. other
tests: asot titre, throat swab, Mantoux test. Rx underlying cause, NSAIDs, bed rest.
not associated with DM or PSORIASIS .

25.catheters pressures/sats: Left side of heart : LA, LV, Aorta are all 98%. Right Side
heart : RA, RV, Pulm A all 74%, (IVC 70%, SVC 74%). Mean pressures (mmHg). PA
10, Aorta 100, PCWP 1-10. From this info you can calculate where is the lesion.

26.Guillan Barre syndrome - lower back pain, unconfirmed subjective sensory

symptoms (e.g. tingling), CN lesions, absent reflexes, motor weakness, preceding
resp illness

27.adverse risks with aortic stenosis ---> symptomatic LV failure, EF Rx. Oxygen or
sc sumitriptan. prophylaxis: verapamil, Lithium or valproate. cf.. mirgaine
propranolol cf. Trigeminal neuralgia --> carbamazepine

29.blisters on dorsum of hand --> porphyria cutanea tarda

30.epilepsy in pregnancy --> continue antiepileptics..safer than a fit.

31.Relative of an epileptic patient with diplopia and ataxia --> phenytoin toxicity

32.steroid responsive nephrotic syndrome --> likely to be minimal change NOT

membranous. Childhood recurrent nephrotic syndrome --> likely minimal change
disease therefore steroids, biopsy if not responsive, cyclophosphamis if >2
episodes/6 months, >4/year or steroid dependent. Add ACEi if prolonged protenuria.
DISTINGUISH FROM post streptococcal GN --> invariably complete recovery.

33. new hypertensive guidelines: 55yrs/black (Ca antag or Diuretic) as first line. If
hypertension in urinary incontinance --> Ca ch blocker NOT alpha blocker. isolated
systolic hypertension in elderly --> thiazides or Ca antagonists. with diastolic
hypertension --> ACEi (????not sure about this)

34.myxoedema coma due to thyoxine non compliance --> 1. iv thyoxine, 2.

thyroxine, 3. thyroxine, 4. thyroxine, 5. thyroxine!!! i.e. thyroxine is most important
NOT steroids. COMPARE with 35.
35.slightly hypothyroid patient --> started on thyroxine --> deterioration. Patient
has Addison's
disease with sick euthyroid syndrome and the thyroxine has caused acute Addisonian
crisis. --> Rx. steroids iv COMPARE with 34.

36.total t3/4 up, TSH and free t3/4 normal ---> pregnancy. Compare this with:-
normal T3/4, raised TSH --> non compliance e.g. patient took thyoxine just before
clinic appointment!

37.CN 10, 11, 12 palsy, pulsatile tinnitus ---> glomus jugulare tumor

38.smoker, proximal muscle weakness, dry mouth --> Eaton Lambert syndrome.
Eaton Lambert - dec reflexes, proximal weakness, ANS dysfunction.

39. Schmitt's disease: autoimmune diabetes and Addison's which can be associated
with primary ovarian failure and primary hypothyroidism. In this combination think of
Schmitt's before pituitry dysfunction.

40.AF: flecainide contraindicated in ischaemic heart disease. sotalol can be used for
PAF to maintain sinus rythm. Adenosine (used in SVT) contraindicated in asthma.

41.preg: raised oestrodiol, anorexia - mildly elevated prolactin, ammenorrhea. low

BMI, hyperprolatinaemia, excessive exercise --> anorexia nervosa. (prolactin not
raised in coeliac disease).

42.endocrine abnormalities:
1. PCOS - ostradiol normal, inc LH:FSH ratio, mildly inc prolactin and androgens.
Obesity, huruitism, oligomennorhea.
2. CAH --> elevated 17-hydroxyprogesterone
3. adrenal testostrn tumor--> testosterone >7, switches off LH/FSH --> low
oestrgens
4. preg --> v high osetrgn and progestrn, normal testostrn. inc TotT4 normal freT4

43.entrapment palsies: common peroneal --> lost dorsiflexion and eversion, ulnar
nerve at elbow. Especially after prolonged bedrest.

44.3 dementias + 1 parkinsons plus

1.Pick's disease - frontal lobe dimentia with gradual peronality changes. i.e.
hypersexualiy, hyperphagia, impulsiveness. Pick's disease makes you think with your
pick!!
2.Lewy body degeneration --> visual hallucinations, dimentia and parkinsonism
(lewy body like LSD!!). recent onset parkinsons + visual halluinations + normal CT
--> diffuse Lewy body disease.
3.CADASIL --> migraine, lacunar strokes, dementia. notch 3 gene mutation , no
cure.
4.multisystem atrophy --> cerebellar dysfunction, AND parkinsonian fearures

45. Lung function tests

TLCO=transfer factor = CO diffusing capacity i.e. alveola permeability
KCO=gas transfer coefficient = CO uptake in 1 maximum 10 sec breath
FVC FEV1 RV FEV1/FVC TlCO KCO
COPD dec dec inc 0.8 norm variable
Asthma dec dec >15% improvement follwing b2ag or steroid trial

46.PSC is diagnosed by ERCP, assoc UC.AMA is associated PBC (seen in Crohns).

47.pacemakers: exertional problems or a patient who is fit and active --> always
better to give a rate dependent pacemaker .eg XXX-R

48.hyperthyroidism: -
1.DeQuevern's thyroiditis: tender thyroid, wt loss, malaise, fever, ESR >50 or 100.
2.solitary toxic nodule commonest cause
3.thyroid autoantibodies: think of Grave's or Hashitoxicosis. If these absent solitary
thyroid nodule is likely. Drug induced typically is amiodarone.
4.transient post partum thyrotoxicois lasts 2-6months, occurs in 5% of women
5.pregnancy with hyperthyroidism --> carbimazole NOT radioidine, NOT thyroxine
plus carmbimazole. Surgery increases risk of miscarriage.
6.thyroid disease on OCP --> check free T4 to exclude hyperproteinaemia falsely
elevating T4 and TSH. raised ALP is likely due to thyrotixcoisis.

49.gut carcinoid: diarrhoea, flushing, wheeze, valvular heart disease, raised 5HIAA.
worse prognosis is with cardiac lesions (irrevesible and often require Surgery )
50.decreasing insulin requirements in diabetic, hypos, wt loss and lethargy -->
consider Addisson's.

51.child with hyperkalaemia, metabolic alkalosis and normal blood pressure --->
Barters syndrome (polyuric enuesis, failure to thrive assoc hyperplasia of JGA).
hypokalaemic alkalosis --> vomiting e.g. pyloric stenosis

52.Felty's syndrome is associated with LONSDTANDING Rhematoid arthritis

53.AML:- M2 t(8;21), M4 t(16;16), M3 t(15;17) promyelocytic assoc DIC, Rx. All

trans retinoic acid, Auer rods. acute promyelocytic leukaemia t(15;17) DIC, Rx: all
trans retinoic acid (ATRA). Auer rods.

54.B12 deficiency is associated with other autoimmune conditions e.g. DM , thyroid

disease, alopecia areata, vitiligo.

55.patient looking tired --> think myasthenia gravis, ask to count to 100.

56.culture negative Bacterial endocarditis --> take 4 cultures at any time before
empiricle treatment with benzylpenicillin and gentamycin

57.hyperkalaemia in heart failure: step 1: monitor, step 2: add a K loosing diuretic

step 3: consider stopping amiloride/spirinolactone

58.botulism: CN dysfunction, ANS dysfunction, later limb/resp paralysis, normal

CSF , cholinergic blockade.