Road To MRCP

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29/07/2026

Pearl For MRCP Part-2

Mnemonic: "A.B.C.D.S."

Antiplatelets

Beta-blockers

Cholesterol control (statins)

Diet and lifestyle changes

Stabilize with ACE inhibitors.

★ MI Complications

Common Complications:

VSD: Pansystolic murmur

Mitral Regurgitation: Rupture of papillary muscles

Tamponade: Free wall rupture

Heart Failure or Cardiogenic Shock

Most Confirmatory Investigation: Echocardiography

Most Appropriate Next Step: Stabilize hemodynamics

Most Appropriate Intervention: Urgent surgical repair for mechanical complications



Mnemonic: "C.R.A.S.H."

CHF or cardiogenic shock

Rupture (VSD, free wall)

Arrhythmias

Stabilize with supportive care

Hemodynamic collapse = surgery.

★ Marfan Syndrome and Aortic Dissection

Marfan Syndrome:

Scenario: Tall stature, arachnodactyly, and lens dislocation + On exam: high-arched palate, pectus deformity + Investigation shows: aortic root dilation on echocardiography >>

Most Likely Dx: Marfan Syndrome

Most Common Cause: FBN1 gene mutation

Most Confirmatory Investigation: Genetic testing

Most Appropriate Next Step: Echocardiography screening for aortic complications

Most Appropriate Intervention: Beta-blockers or losartan; prophylactic aortic surgery



Aortic Dissection:

Scenario: Tearing chest pain radiating to the back + On exam: unequal BP in limbs + Investigation shows: widened mediastinum on CXR >>

Most Likely Dx: Aortic Dissection

Most Common Causes: Hypertension, connective tissue disorders

Most Confirmatory Investigation: CT angiography

Most Appropriate Next Step: Control BP with IV beta-blockers

Most Appropriate Intervention: Type A → urgent surgery; Type B → medical management

29/07/2026

A 20-year-old woman presents to the Endocrine Clinic complaining of hirsutism, acne and irregular heavy
periods. She has excess hair over the moustache and beard line and over her upper chest and has acne
affecting the face and neck particularly. Her blood pressure is 122/73 mmHg and her pulse is 70 bpm and
regular. Her body mass index is 23 kg/m2. She has normal axillary and p***c hair.
What is the most useful investigation?

A. Adrenocorticotrophic hormone (ACTH) stimulation test
B. 17-OH progesterone
C. 21-OH progesterone
D. Karyotyping
E. Prolactin

25/07/2026

Pearl For MRCP Part-1

★★★Triad in Neurology:
★Young pt + limb weakness + flaccid paralysis following exercise >> Familial periodic paralysis.

★Clumsiness in young pt + ataxic gait + Leg weakness >> Friedreich ataxia.

★UMNL + LMNL + Fasciculation + Dysarthria + dysphagia >> Motor neuron disease.

★Vertigo provoked by rolling movement in the bed + Hallpike test positive >> Benign positional vertigo.

★Typical facies (temporal atrophy + atrophy) + Muscle weakness (specially hand) ± (Myotonia) + Cataract >> Dystonia myotonia.

★Ataxia + ophthalmoplegia + areflexia >> Miller-fisher syndrome.

★ Headache + visual obscuration + papilledema in obese young female >> Benign intracranial hypertension.

★ Severe recurrent retro -orbital headache+ lacrimation + rhinorrhea >> Cluster headache.

★Recurrent unilateral headache + vomiting (nausea) + visual aura? >> Migraine.

★Dysphagia + dysarthria/dystonia + spastic tongue >> Pseudobulbar palsy.

★Instantaneous headache + vomiting + neck stiffness >> Subarachnoid hemorrhage.

★Blank spell + lip smacking + visual/auditory hallucination >> Complex partial seizure.

★Bradykinesia + rigidity + resting tremor >> Parkinson's disease.

★Tremor (action or postural) + head tremor + absence of Parkinson fx >> Essential tremor.

★Dysarthria + intension tremor + Nystagmus >> Cerebellar disease.

★Transient visual blurring in Caucasian female + limb weakness + paresthesia of limb >> Multiple sclerosis.

★Dementia + Ataxia+ Myoclonus >> Creutzfeldt Jacob syndrome.

★Drowsiness + vomiting + headache (in morning) >> Raised intracranial pressure.

★Ascending weakness in limbs and face + areflexia >> GBS

★Miosis + anhidrosis + enophthalmos + ptosis >> Horner's syndrome

★Raised ICP + vomiting + focal lesion + epilepsy >> Cerebral tumor.

★Fatigue + weakness in eyelid and limbs + bulbar weakness >> MYASTHENIA GRAVIS.

★Episodic vertigo + vomiting + hearing loss >> Meniere's disease.

25/07/2026

A 27-year-old woman is brought to the Emergency Department with progressive confusion, drowsiness and
short-term memory loss over the past few days, accompanied by a flu-like illness. She has been brought to
the Emergency Department by her husband. She has no past medical history of note and takes no regular
medications. Her temperature is 37.8 °C, her blood pressure is 123/82 mmHg and heart rate is 82 bpm and
regular. She has no rashes. She is complaining of a headache, has obvious neck stiffness and cannot comply
with a neurological examination. Her Glasgow Coma Scale (GCS) score is 13/15.

What is the most likely cause of the patient’s neurological symptoms?

A. Behçet’s disease

B. Herpes simplex encephalitis

C. Multiple sclerosis

D. Pneumococcal meningitis

E. Subacute sclerosing panencephalitis

Congratulations Dr Firdaus for passing MRCP PACES in Diet 2/26 from Brunei. We the ROAD TO PACES TEAM is really happy ...
24/07/2026




Congratulations Dr Firdaus for passing MRCP PACES in Diet 2/26 from Brunei. We the ROAD TO PACES TEAM is really happy and proud to be a part of your journey. Wishing you all the best for your future endeavours.

Let's take a moment to applause Dr. Firdaus👏

Dr. Firdaus Enrolled our April Online Long Case and Communication Course By @⁨Dr Esan Rc/⁩ and Virtual Mock Exam 👏👏

🟠 Explore All Success Stories: https://medmonarchy.com/wall-of-honor?view=carousel

Regards,
ROAD TO PACES
A wing of MedMonarchy.com

23/07/2026

Pearl For MRCP Part-1

✅ Gastric Outlet Obstruction:
55-year-old man presents with persistent burping and early satiety + History of a duodenal ulcer two years ago + On exam: Mild epigastric tenderness but no palpable masses + Investigation shows: Not provided + What is the most likely diagnosis >> Gastric outlet obstruction

✅ Renovascular Hypertension:
24-year-old woman presents with persistent headaches and fatigue + Noted to have elevated BP uncontrolled by medications + On exam: Abdominal bruit; no oedema or palpable abnormalities + Investigation shows: Not provided + What is the most appropriate investigation to confirm the likely diagnosis >> CT angiography of the renal arteries

✅ Measles Virus:
19-year-old woman presents with a 3-day history of fever, fatigue, and worsening rash + Also complains of conjunctivitis, cough, and malaise + On exam: Maculopapular rash on the face and upper chest, small white spots on the buccal mucosa + Investigation shows: Not provided + What is the most likely causative agent >> Measles virus

✅ Pulmonary Tuberculosis:
35-year-old man presents with cough and weight loss over the last three months + Recently returned from Somalia + On exam: Not provided + Investigation shows: Chest X-ray reveals bilateral hilar lymphadenopathy, CT shows tree-in-bud nodularity in the upper lobes + What is the most likely diagnosis >> Tuberculosis




✅ Polymyalgia Rheumatica:
70-year-old woman presents with a two-month history of bilateral shoulder and hip girdle pain + Difficulty rising from a chair + On exam: Not provided + Investigation shows: Morning stiffness lasting over one hour and significantly elevated ESR and CRP + What is the most likely diagnosis >> Polymyalgia rheumatica

✅ Euthyroid Sick Syndrome:
58-year-old woman intubated for acute respiratory failure secondary to severe COVID-19 + No prior history of thyroid disease + On exam: Haemodynamically stable + Investigation shows: Routine thyroid function tests show low TSH and normal T4 level + What is the most likely underlying cause of this thyroid function abnormality >> Euthyroid sick syndrome

✅ Community-Acquired Pneumonia in Pregnancy:
32-year-old woman (22 weeks pregnant) presents with 3 days of fever, significant joint pain, productive cough, and shortness of breath + No significant past medical history + On exam: Crackles in the right lung base + Investigation shows: Chest X-ray shows consolidation in the right lower lobe + What is the most appropriate antibiotic management >> Azithromycin

23/07/2026

A 74-year-old man with chronic obstructive pulmonary disease (COPD) is admitted to the Emergency
Department with a dry cough, fever and diarrhoea a few days after returning from holiday to Spain. He is
currently weaning off oral steroids after a COPD exacerbation. Apparently, at least five other pensioners who
were staying at the hotel have been admitted to the hospital with similar symptoms. His temperature is 38.4
°C, blood pressure 118/84 mmHg and heart rate 74 bpm and regular. There is consolidation at the right base
on auscultation.

What is the most appropriate intervention?

A. Azithromycin
B. Co-amoxiclav
C. Levofloxacin
D. Oxytetracycline
E. Trimethoprim

22/07/2026

Glimpses of Communication Intensive Course.

22/07/2026

An 18-year-old student is admitted to the Emergency Department with left-sided weakness affecting her
face, arm and leg. She also has a left-sided frontal headache which came on shortly after the weakness. On
further questioning, she admits to frequent left-sided frontal headaches lasting for some hours and nausea
over the past few months. She started the combined oral contraceptive pill some two months ago. She is
anxious. Her blood pressure is 135/85 mmHg and her heart rate is 88 bpm and regular. She has an obvious
left cranial nerve VII palsy, 2/5 power weakness affecting her left arm and 3/5 power weakness affecting her
left leg.

What is the most likely diagnosis?

A Cluster headache
B Hemiplegic migraine
C Ischaemic stroke
D Pituitary apoplexy
E Subarachnoid haemorrhage

Address

Gibson House (1st Floor) Northwest Associates Ltd, 800 High Road
Dhaka
N170DH

Telephone

+8801979411927

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