Road To MRCP

05/06/2026

Pearl For MRCP PART-2

🔵 78 yrs pt was brought to the memory clinic with progressive forgetfulness, and frequent visual hallucination + On exam: Shuffling gait and increased Limb rigidity, tremor affecting left-hand side + Most likely cause of pt's symptoms >> Lewy body dementia

🔵 24 yrs man presented with difficulty in passing urine, numbers of bumps affecting his p***s and sc***um following unprotected sexual exposure 2 weeks ago + In exam: They are itchy, and when scratched forms ulcer + Most appropriate intervention for this pt >> Valaciclovir. (Dx: Herepes simplex type 2 infection)

🔵 18 yrs boy presented with increasing proximal arm and leg weakness and muscle cramps + Exam shows: Proximal muscle weakness affecting shoulder and Hip girdle, Calf muscle hypertrophy + CK: 1250 IU/L + Most likely underlying cause of pt's symptoms >> Becker muscular dystrophy (X-linked disorder)

🔵 38 yrs man presented with a severe headache affecting his left eye and lasting for 15 minutes to 2 hours + During the headache, he has a stuffy nose and his eye becomes red + Most appropriate preventive therapy for this pt >> Verapamil PO (DX: Cluster headache)

04/06/2026

Pearl For MRCP Part-1

62. Known Diabetic, hypertensive pt taking Metformin, basal-bolus insulin, Ramipril, amlodipine, and atorvastatin + her eGFR has fallen to 22ml/min from 35 ml/min in last 6 months + most appropriate next step >> Stop metformin.

At GFR below 30 ml/min, metformin is associated with an increased risk of lactic acidosis.

63. Recently severe coronavirus survivor patient presented with an abnormal thyroid function test, no sign of hypo-hyperthyroidism + Lab test: TSH, FT3, FT4 all are low + Most likely dx >> Euthyroid sick syndrome.

64. Young animal electrician pt presented with SOB, cough, wheeze + symptoms worse at the workplace, improves when away from work + Most Appropriate next step >> Twice daily peak flow monitoring and review (Dx: Occupational asthma)

65. Most appropriate step to monitor pt's post-operative prognosis following resection of Pheochromocytoma >> 24-hrs urinary catecholamine.

66. Known PCOS pt presented with Excessive facial hair, beard, and mustache growth + most appropriate tx of pt's hirsutism >> Eflornithine.

67. Pt with bloody diarrhea and mucus + Colonoscopy shows proctitis + biopsy: inflammation with evidence of cryptitis and crypt abscess + Most appropriate initial treatment >> Re**al mesalamine (Dx: Ulcerative Colitis)

04/06/2026

Pearl For MRCP Part-1

✅ Marfan Syndrome Follow-up:
28-year-old asymptomatic man with Marfan syndrome presents for routine evaluation + He has a high-arched palate and long fingers + On exam: Arachnodactyly and blood pressure 120/80 mmHg + Investigation shows: High risk for aortic root dilatation + What is the most appropriate follow-up investigation >> ECHO

✅ Restrictive Lung Disease:
18-year-old woman presents with progressive shortness of breath + She has a long history of severe scoliosis + On exam: Severe spinal deformity and reduced chest expansion + Investigation shows: Pulmonary function tests reveal restrictive pattern + What pattern are this patient's PFTs most likely to demonstrate >> Reduced forced vital capacity

✅ Conn Syndrome:
55-year-old man presents with severe headaches and muscle weakness + Blood pressure is significantly elevated at 160/100 mmHg + On exam: Hypertension and signs of muscle weakness + Investigation shows: Hypokalaemia with elevated aldosterone and suppressed renin >> Start spironolactone therapy

✅ Secondary Hyperparathyroidism:
58-year-old man with CKD stage 4 presents with bone pain + He reports worsening fatigue and muscle weakness over months + On exam: Generalised bone tenderness noted + Investigation shows: Hyperphosphataemia and raised parathyroid hormone levels + What is the most likely cause of this patient's symptoms >> Secondary hyperparathyroidism

03/06/2026

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03/06/2026

Pearl For MRCP Part-2

🔵 24 yrs man presented with difficulty in passing urine, numbers of bumps affecting his p***s and sc***um following unprotected sexual exposure 2 weeks ago + In exam: They are itchy, and when scratched forms ulcer + Most appropriate intervention for this pt >> Valaciclovir. (Dx: Herepes simplex type 2 infection)

🔵 18 yrs boy presented with increasing proximal arm and leg weakness and muscle cramps + Exam shows: Proximal muscle weakness affecting shoulder and Hip girdle, Calf muscle hypertrophy + CK: 1250 IU/L + Most likely underlying cause of pt's symptoms >> Becker muscular dystrophy (X-linked disorder)

🔵 38 yrs man presented with a severe headache affecting his left eye and lasting for 15 minutes to 2 hours + During the headache, he has a stuffy nose and his eye becomes red + Most appropriate preventive therapy for this pt >> Verapamil PO (DX: Cluster headache)

02/06/2026

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19/05/2026