MRCP Part 1

MRCP Part 1 revision notes

Free, full-length MRCP Part 1 revision notes from Examrix — acid–base, acute kidney injury, diabetic emergencies, thyroid disease, ECG interpretation and more, each written to Best of Five depth.

Nephrology

Acid-Base DisordersMetabolic acid-base disorders represent complex alterations in systemic bicarbonate concentrations and extracellular fluid volume. Evaluation must begin with arterial or venous blood gas analysis to establish the primary process, followed by calculation of the anion gap (corrected for albumin) and assessment of respiratory compensation using Winter's formula. Metabolic acidosis is divided into high anion gap (accumulation of unmeasured organic acids) and normal anion gap (bicarbonate loss or renal tubular dysfunction) variants, while metabolic alkalosis is subclassified by its responsiveness to saline resuscitation, guided by urinary chloride levels. Comprehensive metabolic and urinary electrolyte profiles remain the cornerstone of differential diagnosis. Free to read 30 min read
Acute Kidney InjuryAcute Kidney Injury (AKI) is a rapid decline in renal excretory function characterized by accumulation of nitrogenous waste products and inability to maintain fluid and electrolyte homeostasis. Diagnosed and staged using the KDIGO criteria (based on serum creatinine rises and urine output decline), its etiology is categorized into prerenal (hypoperfusion), intrinsic (ATN, AIN, glomerulonephritis), and postrenal (obstructive) pathways. Systematic investigation requires clinical volume status assessment, urinary biochemistry (FE Na , FE Urea ), urine sediment microscopy, and renal tract imaging. Management is centered around treating the underlying cause, hemodynamic optimization via balanced crystalloids, strict avoidance of nephrotoxins, and timely correction of life-threatening complications like hyperkalemia, metabolic acidosis, and fluid overload, with RRT reserved for refractory cases. Free to read 30 min read
CKD Complications and TreatmentManagement of advanced CKD complications requires balancing haematological, metabolic, and immunological systems. Anaemia of CKD is managed with targeted iron replacement followed by ESA therapy to a strict target Hb of 100–120 g/L. CKD-MBD is managed by controlling hyperphosphataemia and secondary hyperparathyroidism using dietary restriction, calcium-free binders (e.g., Sevelamer), and calcimimetics, with the goal of avoiding adynamic bone disease and vascular calcification. When GFR falls below 15 mL/min/1.73m², preparation for renal replacement therapy is mandatory. Renal transplantation offers the best survival advantage; success relies on HLA-DR matching and triple immunosuppressive therapy, while vigilantly monitoring for CNI nephrotoxicity, BK virus nephropathy, and acute rejection. Free to read 30 min read

Endocrinology

Cell Biology

Cell Membrane PhysiologyCell membrane physiology underpins cellular homeostasis, volume regulation, and signal transduction. Primary active transport via the Na+/K+-ATPase establishes the critical electrochemical gradients that drive secondary active transport (such as SGLT1/2 and NCX) and set the stage for excitability. The resting membrane potential is highly sensitive to extracellular potassium concentration due to high resting potassium conductance. Genetic or pharmacological disruptions of these membrane proteins manifest as distinct clinical channelopathies and metabolic syndromes, which are frequently tested in high-level postgraduate examinations. Free to read 30 min read

Gastroenterology

Anatomy

Clinical NeuroanatomyMastery of clinical neuroanatomy for the MRCP Part 1 requires a systematic approach to differentiating radiculopathies from peripheral nerve entrapments. By evaluating specific motor maneuvers—such as foot inversion for L5 vs. peroneal lesions, or checking the thenar muscles and pupillary signs in suspected lower brachial plexus injuries—candidates can confidently localize lesions to the root, plexus, or peripheral nerve. This anatomical precision forms the bedrock of both clinical safety and exam success. Free to read 30 min read

Cardiology

Rheumatology

Connective-Tissue Disease OverviewConnective tissue diseases are systemic, autoimmune disorders characterized by distinct autoantibody profiles and clinical phenotypes. SLE is defined by multi-system involvement, where monitoring anti-dsDNA and C3/C4 levels helps track renal flares. Sjögren syndrome presents with exocrine gland dysfunction (sicca symptoms) but carries a high risk of MALT lymphoma. Systemic sclerosis is divided into limited (anti-centromere, late PAH risk) and diffuse (anti-Scl-70 and anti-RNA polymerase III, early ILD and renal crisis risk) forms. Mixed Connective Tissue Disease represents a true overlap clinical entity, strictly requiring high-titer anti-U1-RNP. Management focuses on targeted immunosuppression, close monitoring for visceral complications, and immediate intervention with ACE inhibitors in emergencies like scleroderma renal crisis. Free to read 30 min read

Psychiatry

Depressive Disorders and Suicide RiskManagement of depressive disorders at the postgraduate level requires integrating advanced psychopharmacology, clinical risk assessment, and understanding somatic-psychiatric interactions. Key pharmacological rules include choosing sertraline in cardiac patients, avoiding citalopram in prolonged QT conditions, and recognizing the risk of upper GI bleeds when SSRIs are paired with NSAIs without PPI protection. Psychiatric emergencies, such as Serotonin Syndrome, must be quickly differentiated from NMS, while self-harm presentations (like paracetamol overdose) mandate medical stabilization before a comprehensive psychiatric risk and capacity evaluation. Free to read 30 min read

Biostatistics and Evidence-Based Medicine

Diagnostic Test PerformanceMastery of diagnostic test statistics is essential for navigating modern clinical guidelines and passing postgraduate medical examinations. Diagnostic decisions rely on balancing intrinsic parameters (sensitivity and specificity, which define a test's biological boundaries) with clinical context (prevalence and pre-test probability, which dictate real-world predictive value). Likelihood ratios bridge this gap by allowing seamless, patient-specific updating of disease probability via Fagan's nomogram or manual odds conversion. Ultimately, the choice of diagnostic cut-offs and test sequencing, visualized dynamically via ROC curve analysis, underpins the scientific framework of clinical decision-making, minimizing both false positives and missed opportunities for intervention. Free to read 30 min read

Geriatric Medicine

Falls and MobilityAssessment of falls and mobility impairment requires a highly structured, multidisciplinary approach. Evaluation must systematically address modifiable risk factors: performing lying/standing blood pressures to identify orthostatic hypotension, reviewing and deprescribing fall-risk increasing drugs (FRIDs), and analyzing gait patterns to differentiate between neurological and musculoskeletal etiologies. Management should focus on non-pharmacological interventions (e.g., strength and balance training, home hazard modification) alongside targeted pharmacotherapy (e.g., fludrocortisone or midodrine for neurogenic OH, or vitamin D supplementation in patients with proven deficiency). Unmanaged immobility leads to rapid deconditioning, pressure ulcers, thromboembolism, and functional dependency, making prompt, active rehabilitation the cornerstone of geriatric medicine. Free to read 30 min read

Physiology and Biochemistry

Fluid, Electrolyte and Acid-Base Physiology Free to read 30 min read

Genetics

Genetic PrinciplesPostgraduate genetic evaluation requires moving past simplistic Mendelian models to account for epigenetic and molecular variations. Reduced penetrance requires the clinical application of Bayesian probability to accurately counsel families on disease risk. Anticipation, driven by DNA polymerase slippage and progressive trinucleotide repeat expansion during gametogenesis, is heavily influenced by the parent of origin, dictating both the age of onset and severity of clinical phenotypes in subsequent generations. Free to read 30 min read

Immunology

Immune ResponseThe human immune response relies on a highly regulated interplay between innate and adaptive pathways. Innate immunity provides rapid, germline-encoded protection via pattern recognition receptors, complement cascades, and phagocytosis. Adaptive immunity offers antigen-specific clonal expansion, relying on MHC-mediated antigen presentation, somatic recombination, and cytokine-driven helper T-cell polarization (Th1, Th2, Th17, Treg). Dysregulation at any node within these cascades manifests as distinct clinical pathology, ranging from early classical complement deficiency-mediated autoimmunity (SLE) to NADPH-oxidase deficiency (CGD), each demanding specific diagnostic assays (such as DHR flow cytometry) and targeted biological interventions. Free to read 30 min read

Respiratory

Interstitial Lung DiseaseInterstitial Lung Diseases (ILD) represent a heterogeneous group of parenchymal lung disorders characterized by varying degrees of inflammation and fibrosis. Idiopathic Pulmonary Fibrosis (IPF) is a progressive, inevitably fatal fibrotic disease of older adults characterized by a UIP pattern on imaging and managed strictly with antifibrotics (Pirfenidone or Nintedanib) rather than immunosuppression. Hypersensitivity Pneumonitis is an immunologically mediated reaction to inhaled organic dusts (e.g., avian proteins, actinomycetes) characterized by centrilobular nodules, mosaic attenuation, and marked BAL lymphocytosis, requiring antigen avoidance and corticosteroids. Pneumoconioses are occupational lung diseases driven by inorganic dusts, including Silicosis (which drastically raises tuberculosis risk and displays eggshell hilar calcification) and Asbestosis (associated with pleural plaques, parenchymal fibrosis, bronchogenic carcinoma, and mesothelioma). Free to read 30 min read

Metabolic Disorders

MetabolismMetabolic biochemistry at the MRCP level focuses on the regulatory checkpoints and clinical manifestations of enzymatic blocks. Carbohydrate, lipid, and protein pathways converge at the level of acetyl-CoA and the TCA cycle. Hormonal control is governed primarily by the insulin-to-glucagon ratio, which determines the phosphorylation state of key bifunctional enzymes and rate-limiting proteins. Genetic defects in these pathways present as metabolic crises, typically characterized by combinations of hypoglycemia, lactic acidosis, hyperammonemia, or ketosis, depending on the specific enzyme involved. Free to read 30 min read

Haematology

Neurology

Oncology

Oncological EmergenciesOncological emergencies require a high index of clinical suspicion and immediate action. Neutropenic sepsis mandates empirical, broad-spectrum IV antibiotics within 1 hour without waiting for FBC confirmation. Metastatic Spinal Cord Compression (MSCC) requires high-dose Dexamethasone, emergency whole-spine MRI within 24 hours, and urgent surgical or oncological referral to preserve motor function. Tumour Lysis Syndrome (TLS) is characterized by hyperkalaemia, hyperurinaemia, hyperphosphataemia, and hypocalcaemia; management focuses on aggressive hydration and rasburicase (contraindicated in G6PD deficiency). Superior Vena Cava Obstruction (SVCO) is a medical emergency managed with steroids and urgent endovascular stenting for immediate airway or cerebral protection, followed by definitive chemo- or radiotherapy. Free to read 30 min read

Palliative and end of life care

Palliative Symptom ControlEffective palliative symptom control relies on rational, mechanism-based prescribing. Pain control requires careful calculation of breakthrough doses (1/6th of the daily total) and meticulous rotation to renal-safe opioids like alfentanil or fentanyl when the eGFR falls below 30 mL/min. Nausea must be treated with receptor-specific agents, avoiding prokinetics in mechanical obstruction. Breathlessness and terminal agitation are managed with low-dose opioids and targeted benzodiazepines (midazolam), while terminal respiratory secretions are best managed with peripherally acting antimuscarinics to prevent central neurotoxicity. Free to read 30 min read

Clinical Pharmacology and Therapeutics

Prescribing in Special PopulationsSafe prescribing in special populations requires shifting from a "one-dose-fits-all" mentality to a physiologically tailored approach. In pregnancy, clinicians must balance fetal risk against maternal benefit, accounting for expanded plasma volume, induced CYP450 pathways, and increased renal clearance. In geriatric medicine, the STOPP/START and Beers criteria serve as vital frameworks to mitigate the risks of polypharmacy, recognizing that sarcopenia masks renal impairment and that altered tissue sensitivity amplifies drug toxicity. In obesity, dosing calculations must be meticulously chosen based on a drug's lipophilic or hydrophilic profile using Ideal, Adjusted, or Actual body weights to optimize the therapeutic index. Free to read 30 min read

Medical Ophthalmology

Red Eye and Painful EyeA structured approach to the acute red eye is essential for postgraduate clinicians. Benign, superficial conditions such as conjunctivitis and episcleritis present with diffuse injection, minimal pain, and preserved visual acuity. In contrast, deep-tissue pathologies present with ciliary flush, severe pain, photophobia, and visual impairment. Acute anterior uveitis, strongly linked to HLA-B27, requires prompt pupil dilation with cycloplegics to prevent posterior synechiae. Acute angle-closure glaucoma is a medical emergency requiring rapid intraocular pressure reduction with IV acetazolamide and topical agents prior to definitive laser peripheral iridotomy. Infectious keratitis, particularly HSV or Pseudomonas in contact lens wearers, requires immediate, pathogen-specific antimicrobials while strictly avoiding topical steroids in active epithelial disease. Free to read 30 min read

Infectious Diseases

Dermatology

Skin CancerThis tutorial covers the spectrum of cutaneous oncology vital for postgraduate exams. Basal Cell Carcinoma (BCC) is slow-growing and locally invasive, requiring excision or Mohs micrographic surgery for high-risk facial 'H-zone' lesions. Squamous Cell Carcinoma (SCC) presents as a hyperkeratotic, potentially metastatic lesion, with dramatically elevated incidence in immunosuppressed cohorts. Melanoma is classified by Breslow thickness, which dictates wide-local excision margins and prognosis; it is increasingly managed with advanced immunotherapies (anti-PD-1/anti-CTLA-4) and targeted BRAF/MEK inhibitors. Finally, benign pigmented lesions like seborrheic keratoses and dermatofibromas must be confidently distinguished using clinical signs (e.g., Fitzpatrick's sign, horn pseudocysts) to avoid unnecessary surgical intervention. Free to read 30 min read

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