Following are the topics/concept you can't avoid for MRCP 1
1. Stroke and TIA is big time favorite ( for MRCP)
There may be question based on area of territory involved such as in Anterior stroke ,posterior etc.
Remember the area supplied by MCA.
Remember what happens in Posterior inferior cerebellum ssyndrome( it's inevitable qs for part1).
Complete sensory stroke
Upto what time you can give tPA in ischemic stroke, immediate next step in managment after stroke(ct scan to rule out hemorrhage) ,
If pt can't remember the exact time of onset of symptoms ,assume as out of window period and treat as such.
Remember to give warfarin in a patient with AF and with risk factors such as inc age,DM,HTN etc.as prophylaxis.
Clopidogrel is drug of prophylaxis in TIA and stroke,Asp plus dipyridamole is outa seen now( in OHCM 9 they say taht clopidogrel is not licensed for TIA ,well check new NICE guideline, now they recommend it-reference NICE 2014 Guideline)
2. Infectious disease in Neurology:
.Rest assure that you are gonna get a HSV encephalitis ,they will tell you the classic temporal lobe lesion on a patient who has recently developed behavioral changes,aggressive,feverish,they may say pt doesn't have nuchal rigidity ( you don't have to have nuchal rigidity in encephalitis but often seen in meningitis)
.Venous sinus thrombosis is also quite important: young patient with recent sinusitis ,was treated with Abx now he has developed CN.4,5,6 symptoms as well fever and headache , they may ask next step in management : do MRV and start lmwh.
.neurosarcoidosis can also be featured in exam
.tertiary syphilis /tabes dorsalis might appear in your exam.they may say a war veteran who fought in Vietnam or Gulf now present with neurological symptoms and then give you TPHA OR RPR positive serology .
.learn the visual pathway very well.
.tubercular meningitis is popular room.patient from India or Pakistan emigrate to UK now he has cough ,wt loss,fever etc .LP shows characteristic finding of TB meningitis ,they may ask diagnosis or treatment.
.HIV PT with meningitis is virtually always cryptococcal or tubercular ( Offcourse in MRCP )
.Progressive multi focal leucoencephelopathy syndrome(PMLS) cause by John Cunningham Virus(JC virus ) is also imp.
.Either you like it or not but GBS is gonna appear in your test and they will ask you to what parameter to monitor (FVC)
.iv drug abuser with diplopia and diaphragmatic paralysis and downward weakness :Botulism is sure qs in your exam don't confuse it with GBS coz in exam they often give you mixed scenerio and people fall for MRCP traps.
3. Neurodegenerative diseases:
Alzheimer's : yes there will be one qs ,and most likely they would like to test you about available treatment options and how familiar you are with it such as memantine,enatacapone etc.
Parkinson often appeared in exams and usually they ask about when to begin the treatment ,and want to know the different approach we use in relatively young patient vs old patient.
Parkinson qs are also appeared where they only asked about diagnosis.
Dementia of Lewy bodies: old patient who was treated with traditional neuroleptic so for hallucination and his symptoms got worsen ,diagnosis??? Virtually asked in every diet of mrcp1.
Charles Bonnet syndrome( macular degeneration ,pt is partial or severe blind and he claims that he can see people around I. e hallucinations).
Huntington's disease : you may be asked about diagnosis of Huntingtons or they can ask the name of trinucleotide repeat sequence ( genetics ehh:(
CJD : prion disease ,pt with myoclonus as well rapid onset of dementia.
MS : either you'll have diagnosis or they may as which drug to use to stop (not really ,you can't stop all you can do is delay) the progression.they won't ask you the criteria of B interferon use( that's part 2 stuff)
B12 deficiency and subacute combined degeneration will be in exam.
Some times HSMN aka Charcot marrie tooth disease is featured.
Fredriech ataxia is big time MRCP qs.
Misclllaneous:-
Some other topics such as
Absence seizure and drug of choice,
DVLA guideline for provoked and unprovoked seizures ,
Patient and GBM tumor and he has undergone resection,when can he drive?
Get yourself familiar with Status epilepticus treatment protocol: they may ask when to use phenytoin,when use anesthetic agent etc.
Differentiate conversion disorder with TIA .
Transient global amnesia is important: they usually ask what are the chances of recurrence: very rare to recur.
Paraneoplastic transverse myelitis
Benign essential tremor and treatment: propranolol ( I know !!!it's very easy;-)
Bell's palsy
Weber's syndrome
Pseudo tumor cerebri(idiopathic intracranial HTN) - in exam they have already done mri and now they are asking what to do next --- do MRV to rule out venous sinus thrombosis).
Either subdural hematoma or epidural hematoma will be in your exam and if you missed these two some how then probably you'll see subarachnoid hemorrhage .
:- they usually ask culprit vessel I.e. Bridging vein,middle meningeal arteryn,communicating artery etc)
Cerebrllar tumors are also featured some times.
Arnold chiari malformation is also important .
Remember the spinocerebral as well corticospinal pathways coz they test your anatomy knowledge by asking brown sequeard syndrome or anterior or central cord dissection syndromes .( I know it's tedious to learn ,but if you could read this once or twice you may not miss the easy 2 or 3 questions)
P.S.- this is entirely my opinion and I don't claim that these are the concepts you are going to see in exam but chances are quite high that you may stumble upon very similar qs in your exam.
Thank you for reading:) any suggestion would be appreciated!
To be continued.....................................................
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