The Only MRCP Notes You Will Ever Need 5th Edition PDF PDF

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Published by dr-notes.com The Only MRCP Notes You Will Ever Need, 5th edition Preface & Acknowledgment  I’d like to start by quoting my friend Dr Ahmed Elmotaz, who told me that “when  preparing for the MRCP, study MRCP! Don’t study medicine!”. This book helps  you to prepare for both written pa...

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The Only MRCP Notes You Will Ever Need, 5th edition

Preface & Acknowledgment  I’d like to start by quoting my friend Dr Ahmed Elmotaz, who told me that “when  preparing for the MRCP, study MRCP! Don’t study medicine!”. This book helps  you to prepare for both written parts of the exam. I also used it to refresh my  knowledge when I was preparing for the PACES and it was quite useful. I must  admit this was many years ago.  “The  Only  MRCP  Notes  You  Will  Ever  Need”  has  been  a  favourite  for  many  around the world. I hope this edition, with the most up to date diagnosis and  management  guidelines,  will  come  handy  to  those  preparing  for  the  membership exam.  The study pattern I recommend for the written exam is:  1. Study one chapter of your choice from this book 2. Solve the same chapter’s questions on your online question bank of choice, there are many now. 3. Study another chapter and go online to solve its question, continue until you finish all the chapters in the book and questions on your website of choice. 4. Revise the whole book. 5. Start solving questions randomly from another website (other than the website you have chosen to solve chapter by chapter) 6. By this time you’d probably have solved around 3000‐4000 BOF questions, and you’d have seen all the question patterns in MRCP. 7. I think the most important step is to revise this book again just before the exam, this should be the last thing you do in the days ahead of your exam. Solving question till the last moment is not recommended, you have probably gathered enough information in your study, try to consolidate the information by revising this book once more. I  would  like  thank  my  parents,  Abuelgasim  and  Bothaina  who  have  always  supported me by all possible and impossible means. My wife, Ahlam and the  two little ones; Yousif and Yasmin who have been very kind and patient during  my life journeys, I can’t thank them enough. I have two friends, both are called  Wael, each of them has been a blessing to have as a friend, I must thank them  both.  Hani Abuelgasim 

Preface & Acknowledgment

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The Only MRCP Notes You Will Ever Need, 5th edition

Contents   Preface & Acknowledgment ............................................................................... 1  Contents ......................................................................................................... 2  BASIC SCIENCES .............................................................................................. 7  CELLULAR & MOLECULAR ANATOMY ................................................................. 8  GROSS ANATOMY .............................................................................................. 12  IMMUNOLOGY .................................................................................................. 14  ELECTROLYTES AND ITS IMBALANCE ................................................................ 22  BODY & DISEASES MARKERS.............................................................................29 VITAMINS & ESSENTIAL MINERALS DEFICIENCY .............................................. 37  GENETICS & HEREDITARY DISORDERS .............................................................. 42  STATISTICS & EVIDENCE BASED MEDICINE ....................................................59 BASICS OF STATISTICS ........................................................................................ 60  EVIDENCE BASED MEDICINE ............................................................................. 71  GENERAL MEDICINE .....................................................................................75 ESSENTIAL TO KNOW ........................................................................................ 76  GENERAL ONCOLOGY .......................................................................................84 HEREDITARY MULTISYSTEM DISORDERS........................................................... 86  ENT RELATED CONDITIONS ............................................................................... 91  CARDIOVASCULAR SYSTEM ........................................................................... 95  PHYSIOLOGY & BASICS ...................................................................................... 96  ECGs ................................................................................................................ 101  GENERAL CARDIOLOGY ................................................................................... 104  CORONARY ARTERY DISEASES ........................................................................ 119  CARDIAC ARRHYTHMIA ................................................................................... 129  VALVULAR ABNORMALITIES ............................................................................ 148  Contents :

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The Only MRCP Notes You Will Ever Need, 5th edition MAJOR VESSELS ABNORMALITIES .................................................................. 159  CONGENITAL HEART DISEASES ....................................................................... 163  RESPIRATORY SYSTEM ................................................................................ 171  PHYSIOLOGY & BASICS .................................................................................... 172  GENERAL RESPIRATORY MEDICINE ................................................................. 179  RESPIRATORY INFECTIONS .............................................................................. 192  AIRWAY DISEASE ............................................................................................. 197  ALVEOLAR & INTERSTITIAL LUNG DISEASES ................................................... 213  PULMONARY CANCERS ................................................................................... 219  GASTROINTESTINAL SYSTEM ...................................................................... 225  PHYSIOLOGY & BASICS .................................................................................... 226  GENERAL GI INFECTIONS ................................................................................ 229  UPPER GI DISORDERS ...................................................................................... 236  LOWER GI DISORDERS .................................................................................... 247  PANCREATIC DISORDERS ................................................................................. 263  HEPATOLOGY ................................................................................................... 269  COMMON GI SURGICAL PROBLEMS IN MRCP................................................ 289  RENAL SYSTEM ........................................................................................... 293  PHYSIOLOGY & BASICS .................................................................................... 294  RENAL DISORDERS .......................................................................................... 302  INHERITED RENAL DISORDERS ........................................................................ 314  COMMON UROLOGICAL PROBLEMS .............................................................. 319  NERVOUS SYSTEM ...................................................................................... 325  NEUROLOGY BASICS ........................................................................................ 326  NEURO‐OPHTHALMOLOGY ............................................................................. 328  GENERAL NEUROLOGY .................................................................................... 333  HEADACHE & PAIN .......................................................................................... 349  Contents :

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The Only MRCP Notes You Will Ever Need, 5th edition IMMUNE‐MEDIATED NEURO. DISORDER ....................................................... 356  NEURODEGENERATIVE DISORDERS ................................................................ 363  CEREBROVASCULAR DISEASES ........................................................................ 370  INHERITED NEUROLOGICAL DISORDERS ........................................................ 379  SPINAL CORD ABNORMALITIES ...................................................................... 382  PERIPHERAL NEUROLOGICAL  ABNORMALITIES............................................. 387  NEUROLOGICAL INFECTIONS .......................................................................... 389  COMMON INTRACRANIAL TUMOURS IN MRCP ............................................. 395  MUSCULOSKELETAL SYSTEM ....................................................................... 397  ANATOMY & BASICS ........................................................................................ 398  MUSCULAR DISORDERS .................................................................................. 403  COMMON UPPER LIMB PROBLEMS IN MRCP ................................................408 COMMON LOWER LIMB PROBLEMS IN MRCP ...............................................411 BONE DISORDERS............................................................................................ 413  RHEUMATOLOGY........................................................................................421 JOINTS DISEASES ............................................................................................. 422  Seronegative Spondyloarthropathies ......................................................... 433  AUTOIMMUNE CONNECTIVE TISSUE DISEASES .............................................437 VASCULITIDES .................................................................................................. 447  HAEMATOLOGY .......................................................................................... 455  GENERAL HAEMATOLOGY ............................................................................... 456  HAEMOGLOBIN ABNORMALITIES ................................................................... 467  Inherited Anaemia ...................................................................................... 480  HAEMATO‐ONCOLOGY .................................................................................... 485  COAGULOPATHIES & BLEEDING DISORDERS .................................................. 509  ENDOCRINOLOGY ....................................................................................... 519  PITUITARY GLAND ........................................................................................... 520  Contents :

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The Only MRCP Notes You Will Ever Need, 5th edition THYROID & PARATHYROID GLANDS ................................................................ 528  DIABETES & PANCREAS ................................................................................... 542  ADRENAL & ENDOCRINE‐ELECTROLYTES ........................................................ 563  METABOLISM, OBESITY & LIPID ...................................................................... 573  ENDOCRINE SYNDROMES & NEOPLASIA ........................................................ 583  INFECTIOUS DISEASES................................................................................. 587  BACTERIAL CLASSIFICATION ............................................................................ 588  VACCINATION & PROPHYLAXIS ....................................................................... 592  BACTERIAL INFECTIONS .................................................................................. 595  Mycobacteria .............................................................................................. 606  VIRAL INFECTIONS .......................................................................................... 611  PARASITIC INFECTIONS ...................................................................................621 STI & HIV .........................................................................................................628 GYNAECOLOGY & OBSTETRICS .................................................................... 645  GYNAECOLOGY................................................................................................646 OBSTETRICS ..................................................................................................... 653  DERMATOLOGY .......................................................................................... 661  DISEASES‐RELATED SKIN CONDITIONS ...........................................................662 DERMATOLOGICAL CONDITIONS .................................................................... 664  PSYCHIATRY ................................................................................................ 695  COMMON PSYCHIATRIC DISEASES IN MRCP .................................................. 696  COMMON PSYCHIATRIC TREATMENTS ........................................................... 707  OPHTHALMOLOGY ..................................................................................... 713  EXTRA‐OCULAR DISEASES ............................................................................... 714  INTRA‐OCULAR DISEASES ............................................................................... 718  PROBLEMS RELATED TO SYSTEMIC DISEASES ................................................. 729  PHARMACOLOGY & TOXICOLOGY ............................................................... 735  Contents :

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The Only MRCP Notes You Will Ever Need, 5th edition  

GENERAL PHARMACOLOGY ............................................................................ 736  TOXICOLOGY .................................................................................................... 748  NERVOUS SYSTEM MEDICATIONS .................................................................. 759  CARDIOVASCULAR MEDIATIONS ..................................................................... 764  OTHER MEDICATIONS ..................................................................................... 780  ANTIMICROBIAL .............................................................................................. 791       

 

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The Only MRCP Notes You Will Ever Need, 5th edition

BASIC SCIENCES  Many MRCP candidates do not realise the importance of basic sciences until they go into the exam hall and get surprised by the amount of basic science knowledge required, either directly or through questions related to clinical scenarios. When  faced  with  a  long  scenario,  it  might  be  wise  to  check  the  question  at  the  bottom of the scenario; this is a  common theme of basic science  questions. 

BASIC SCIENCES :

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CELLULAR & MOLECULAR ANATOMY  Cell Organelles: Endoplasmic reticulum  Translation  and  folding  of  new  proteins  (rough  endoplasmic  reticulum),  expression  of  lipids  (smooth endoplasmic reticulum) 

Mitochondrion  Energy  production.  Contains  mitochondrial  genome  as  circular  double stranded DNA 

Golgi apparatus  Sorting  and  modification  of  proteins 

Nucleus  DNA  maintenance  and  RNA  transcription 

Lysosome  Breakdown  of  large  molecules  such  as  proteins  and  polysaccharides 

Nucleolus  Ribosome production 

Ribosome  Translation of RNA into proteins 

Peroxisome  Breakdown of metabolic hydrogen  peroxide 

Proteasome  Along with lysosome pathway: degradation of large protein molecules 

 M: Mitosis ‐ cell division  G1:  Gap  phase  1, determines  length  of cell  cycle  under influence of p53  S: DNA Synthesis  G2: Gap phase

BASIC SCIENCES : Cellular & Molecular Anatomy

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Hyponatraemia:  may  be  caused  by  water  excess  or  sodium  depletion. Causes of pseudohyponatremia include ↑ lipids or ↑ proteins (↑ in serum  volume)  or  a  taking  blood  from  a  drip  arm.  Urinary  sodium  and  osmolarity  levels  aid  making  a  diagnosis.  It  is  important  to  note  that  every  100mg/dL  increase of blood glucose will lower the Na as much as 1.6 meq. 

Urinary sodium > 20 mmol/L Na+ depletion, renal loss  (patient often hypovolaemic)  Diuretics  Diuretic stage of renal failure  Addison's Patient often euvolaemic   SIADH  (urine  osmolality  >  500 mmol/kg)  Hypothyroidism

Urinary sodium  FSGS > Membranous > Membranoproliferative  Nephrotic presentation  1. Minimal change disease  Typically, a child with nephrotic syndrome (accounts for 80%)  Causes: Hodgkin's, NSAIDs  Good response to steroids 2. Focal segmental glomerulosclerosis  May be idiopathic (primary): o presentation: proteinuria / nephrotic syndrome / CRF o less responsive to steroids. o can occur after transplantation. o high recurrence rate in renal transplants  Secondary to HIV, heroin, Alport’s syndrome, sickle cell anaemia, morbid obesity or chronic hypertension o presents with variable proteinuria and outcome 3. Membranous glomerulonephritis  Common cause of adult idiopathic nephrotic syndrome  Presentation: proteinuria / nephrotic syndrome / CRF  Cause: o infections: Hepa B. o rheumatoid drugs: Penicillamine, NSAIDs. o malignancy  Immune deposit: granular subepithelial IgG  1/3 resolve, 1/3 respond to cytotoxics, 1/3 develop CRF

RENAL SYSTEM : Renal Disorders

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Mild glomerulonephritic presentation  1. IgA nephropathy ‐ AKA Berger's disease, mesangioproliferative GN   Typically young adult with haematuria following an URTI, liver disease  or coeliac disease.   Associated with Henoch‐Schonlein Purpura (HSP)   Mesangial hypercellularity (mesangioproliferative)   Immune deposit: mesangial IgA (and C3)    2. Mesangiocapillary glomerulonephritis (membranoproliferative) (MPGN)   Immunoglobulin type:  o most  common  pattern  found  in  association  with  subacute  bacterial  infection,  but  also  with  cryoglobulinaemia  (monoclonal gammopathies) ± Hepa C.  o associated with low C4.   Complement type:  o partial lipodystrophy  o associated with low C3.   

Rapidly progressive glomerulonephritis presentation  1. Diffuse proliferative glomerulonephritis   Classical post‐streptococcal glomerulonephritis in child   Presents  as  nephritic  syndrome  /  ARF:  severe  sodium  and  fluid  retention, hypertension, haematuria and oliguria.   Most common form of renal disease in SLE (IV)    2. Rapidly progressive glomerulonephritis (RPGN):   Focal necrotising glomerulonephritis.   Rapid onset, often presenting as ARF.   Immune deposit: typically, negative or (pauciimmune)   Causes  include  Goodpasture's,  ANCA  positive  vasculitis  (e.g.  Wegener's granulomatosis)   Responds well to steroids and immunosuppressants.    3. Anti‐glomerular basement membrane disease   Crescentic glomerulonephritis   Immune deposit: Linear IgG along GBM.   Associated  with  lung  haemorrhage  but  renal  or  lung  disease  may  occur alone   Treatment: steroids, cyclophosphamide and plasma exchange.   

 

 

RENAL SYSTEM : Renal Disorders  

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Disorders associated with glomerulonephritis and low serum C3 levels:   Post‐streptococcal glomerulonephritis   Subacute bacterial endocarditis   Systemic lupus erythematosus   Mesangiocapillary glomerulonephritis   

Minimal  Change  Glo...