Neurology 1: For Part 2 MRCP

1.Impaired Upgaze is a normal phenomenon while downward gaze impairment with Parkinsonism indicates Progressive supra nuclear palsy(PSP)

2.DVLA Advocates for 6 months off from driving if patient had solitart unprovoked seizure.
This period extends to 3 years in case of multiple unprovoked seizure while asleep.

3.an adolescent patient  presents with cerebellar signs such as gait disturbances,  dysarthria ,nystagmus and her history reveals that her parent is epileptic --- MCC Of symptoms are phenytoin toxicity , patient has easy access to her parents epileptic medication and she is abusing it.

4.in comparatively younger patient who has early Parkinson's disease , always use Dopamine agonist such as Pramipexole over Levo Dopa.

5. Classical scenerio of a badminton or squash player who has suddenly fallen during game and complaints of aching pain in back of his head and neck( in some cases patient present with horner's and other neurological symptoms and in some with simply neck pain)------Carotid artery dissection.

6.even though if the level of total cholesterol is subnormal in  TIA patient
Always put him on 40 mg simvastatin for secondary prevention of vascular events.

7.Painful third nerve palsies are a feature of aneurysms of posterior communicating artery. Other possible conditions which can cause are caroto-cavernous fistula and ischemic diabetic lesion ,however pain is less prominent feature in these two conditions .

8.Anterior inferior cerebellar artery occlusion causes Lateral inferior pontine infarction which present as vertigo ,vomiting, horizontal and vertical nystagmus ,and ipsilateral nystagmus.ipsilaterallu LMN facial weakness ,paresis of conjugate lateral gaze ,cerebellar ataxia , horners and sometime deafness.

9.RIGHT INFERIOR DIVISION OF MIDDLE CEREBRAL ARTERY  occlusion lead to apractagnosia , anosgnosia ,unilateral neglect ,agnosia for the left half of external space , dressing apraxia and constructional apraxia.

10. An adolescent female presents with spells of ' staring and stuperness', fluttering of eyelids .episodes last for few minutes. Also complains of sudden shock like contractions of limbs.EEG reveals 4-6 hz irregular polyspike activity :- Juvenile Myoclonic Epilepsy. Treat with Valproic acid Indefinitely.

11.Stiff Person syndrome:-
Persistent spasm particularly of the proximal lower limbs and lumbar paraspinals lead to exaggerated lumbar lordosis.it has middle age ,insidious onset.muscle spasm usualy dosaapear while sleep and there is normal EMG.Absence  of trismus differentiate it from Tetanus.

Last 7 days of MRCP(UK) part 1 Prep:-

What to do in last 7 days ?this is one of the question I am often being asked. My answer is do any thing but don't try anything new.whatever you have learned,through whichever source ,should be enough to sail through this monstrous examination . Yet if you ask for my specific opinion then ,kindly follow the protocol below.
 A. Keep doing questions you marked wrong on Passmedicine /Onexamination/pastest .

 B. You don't need to read explanation extensively( in this phase) but try to skim through important details. 

C.Don't forget to revise your notes in last 3 days(Kalra or Only MRCP notes you ever need)

 D.avoid digging through extensive details of commonly asked topics.


 E.Relax! It's just another exam.

Good luck!

Pastest Vs.Onexamination Vs.Passmedicine

One big question ,while we study for MRCP always haunt us and that is which online subscription to follow .
Reasons are pretty clear ,first is having little time on the board and second (most obvious ) is limited financial sources! So what we can do when we have no idea and there is no consensus on what to use ?
Well I would like to put my thoughts and comparison between these three most important resources available at the moment .

Pros and cons:

Pastest- 

Pros:

it's a good online qbank and the strong feature of this qbank is previous MRCP qs(based on memory of test takers) and infact previous years questions forms a bulk of this qbank  .another feature if this qbank is, it's concise.you can use it as assessment tool(considering you have read OHCM very well)

Cons : if you are planning to do MRCP part1 with limited resources and time is constraint then PASTEST is not something which will fit in your plan.

Explanation are not elaborated ,and usually they explain why it's correct answer ,they usually neglect other wrong options(it's very important to know ,if wrong then why). But again it's not true for every question in pastest but for majority of qs.

OnExamination.com-

Pros and cons-

It's also a good qbank and  very important feature of this qbank is good explanations and I would infact rank it number two in terms of explanation ,they do explain why a wrong option is wrong and right is right,

Cons: it's quite expensive( minimum is around 80 pounds for a couple of month subscription ) but in terms of expense it's on par with pastest.

Passmedicine.com-

Pros and cons-

Here is present the most important online subscription for MRCP part 1, it's so powerful and accurate that you can pass your Part one solely on the basis of this qbank.

It has very lucid explanation ,though sometimes they go in excessive minute details but considering sooner or later you are gonna take your part 2 hence it's a good resource to build your foundations and master the art of NICE guidelines.

It's cheap as dirt ,something around 25 pounds for 4 weeks and you also get a beta version of MRCP 2 qbank which has around 450 qs at present (I did those questions and I could barely score 58%while on pastest I always score over 65% so that shows the quality of question.)

Another important feature of Passmedicine is a collection of notes (which is basically based on the explanation of question) in alphabetical order ,such as if you wana read about management of acute coronary syndrome you just type ACS management in search browser and it leads to the related page.this note section can be very helpful while you are revising .

The only drawback of Passmedicine is ,excessive concentration on guideline based question .i do undertsand MRCP ask many question based on NICE but still for part 1 they (MRCP)don't ask beyond 15 -20% of total questions  but as I said before ,this tactics will help you for part 2 exam because in part 2 it's all about data interpretation and guidelines).

In summary,considering price and effectiveness Passmedicine is a clear winner and Onexam and pastest are distant runner ups.

Rare diseases :1

Madelung disease aka Benign symmetric lipomatosis :
It is a rare condition which   is characterized by growth of fatty symmetric masses around neck ,upper arms and facial area.
This disease can cause the  disfigurement of face .
The disease itself has a high male  predilection and can be  associated with serious respiratory conditions such as severe obstructive sleep apnea.

Photo Courtsey of : Google images

Percentage of Success in MRCP on first attempt

What not to do for MRCP Part 1

It's always very important to know "what not to do"  and when we talk about MRCP(UK) it become utmost important . There are few important things you must avoid doing while preparing for Part 1 examination.

1. Don't try to read 'Big Books ' such as 'Kumar &clark','Harrison ', 'Cecil's ' .my statement here may seem not very appropriate by some 'Nerds' but you must know when you are studying for MRCP you only study MRCP not Medicine because there is a possibility that you may lost in the piles of information given in text books and it will eat up your precious time and when you are doing questions you are still struggling .

2. you must be aware that UK has it's own guidelines and doctors outside of UK rely heavily on USA based guidelines so please try to avoid that ,I personally feel USA guidelines are more evidence based and backed by major clinical trials but again for the purpose of MRCP exam you must stick with NICE/SIGN/RCP guidelines.

3.Don't use multiple resources for preparation I.e if you are using pastest or Passmedicine /onexamination online qbank then stick with one because key for passing the exam is Perseveration,

Repeat it as long as it become reflex action.

I.e when you see a patient with flank pain and severe headache ,you must know it is Adult polycystic kidney disease .

The one problem doctors face during preparation of exam is how to revise ! Because you have extended your study resources so much that it will be almost impossible to revise it in the end ,hence minimize your resources be as precise you can be and  believe me Reading Passmedicine and 'the only MRCP notes you ever need ' will be enough to sail through the exam.

4.don't get bogged down by seeing low score on online question banks,use it as revision tool not assessment tool! You are doing retrograde learning not anterograde so it doesn't matter your score is 45% or 65% as long you read the explanation very well and put it intact in your cortex.

5.Don't panic by the length of the questions,MRCP designs these questions in this manner because they want you to quickly scan through important datas and be able to find relevant findings ASAP .

( even in real life practice ,if you are working in acute medicine ,you do the same thing,ain't it?)

MRCP (UK) Part 2

Part 2 preperation is a different ball game.
Here simply knowing stuff wont help you but you have to corelate it accordingly,  you must be good at data interpretation, identifying important signs and symptoms, fluent in Xray and ekg interpretation, though you are not required to posses high skills in radiology but RCP does need you to know about imp CT scans,MRIs, Dexa scans, angioplasty etc.
What study material you should Use:
Unfortunately we don't have many quality online subscriptions available and the most important online qbank is Pastest , in comparison to onexamination.com(another qbank) it has tougher questions and pastest resembles closely to real questions.
Onexam is simply not good enough for part 2 as it has way off the topic questions.

You also need to see goggle images for pictorial questions as there will be 40 to 50 pictorial qs in the part 2 exam and usually it includes 4-5 ekg, 5-6 xray, 3-4 ct scan,1-2 dexa scan,1-2 angiography; 5-6 dermatology slides, few rheumatology slides and so on.
This is not exactly for everyone but  this is the pattern asked in majority of question papers.

For ekg you should refer Hamptons's 150 ekg cases , its very good book and will take care of ekg section of mrcp .I have also found there are many online ekg libraries available and they have excellent collections.you may want ro refer them.
For radiology slide ,I would suggest ro read Radiopedia.com .it has vast collection of radio slides but all you need to see is important diseases such as Sarxoidosis, histoplasmosis, silicosis,asbestosis,tubercluosis, lung cancers; pan coast tumor,thymoma,inyerstitial pneumonia,ARDS,CHF,dilated cardiomyopathies, emphysema,pulmonary edema etc to name a few.

Last but not least is to get yourself familiar with route of administration of imp drugs such as during ACLS ,mode of ADRENALINE administration in case of no IV acess available, how do you inject adrenaline in anaphylaxis etc , its very common theme and often asked in exams.

You also need to know dosage of some important drugs such as digoxin, aldactone,lasix,amlodipine, azithromycin,augmentin , phenytoin ,etc.