MRCP(UK) Part I Examination

Some Tips for Part I

What is it?

The MRCP(UK) Part I is the first part of an entrance exam for higher training in UK. Without it you
can’t enter into a Specialist training post in medicine.

It is not easy and the qualities required are:

• High standard of Knowledge

• Mental Stamina
• Self Discipline

• Determination...

What is being tested?

• Factual knowledge applied to clinical situations.

In particular the areas being tested include common medical conditions, new areas of knowledge e.g.

new genetics, important areas of ignorance e.g. statistics and other important topics.

WHAT IS THE FORM OF THE EXAM?

• There are 2 papers of "Best of Five" questions

• Printed question book with an optically marked answer card
• i.e. there is a STEM or STATEMENT

• plus 5 items in relation to stem

• NB items are not related to each other but all items are related to the stem

Example question (courtesy of www.ydr.org.uk)

A 30-year-old female presents with fatigue, weight loss, red, painful tender nodules over her shins and
breathlessness. The chest X-ray shows bilateral hilar lymphadenopathy. Investigations show that she
has hypercalcaemia.
The cause of the hypercalcaemia is:

a) Increased parathyroid hormone production in the lungs

b) A high serum ACE causing increased hydroxylation of 25 hydroxycholecalciferol to 1,25

dihydroxycholecalciferol in the kidney

c) Alpha hydroxylation of 25 hydroxycholecalciferol to 1, 25 dihydroxycholecalciferol by

macrophages in the lung

d) Lytic lesions in the bones

e) Hyperventilation

Answer:

c)

The patient has sarcoidosis. In this condition alpha hydroxylation of 25 hydroxycholecalciferol to 1,25
dihydroxycholecalciferol takes place in sarcoid macrophages in the lungs. This increases levels of
calcitriol in the blood and results in hypercalcaemia.

Facts acquired by book work are tested as well as those acquired by clinical experience (c).

WHAT TYPES OF QUESTIONS ARE ASKED

Of the medical specialties the following is a guide to the number of questions

asked…

• Clinical Pharmacology 5
• Cardiology 4
• Respiratory Medicine 4
• Gastroenterology 4
• Endocrine/metabolic medicine 4
• Neurology 4
• Rheumatology 4
• Nephrology 4
• Haematology 4
• Infection/Tropical Medicine 4 (41)
• Psychiatry 2
• Geriatric Medicine 2
• Dermatology 1
• Occupational Medicine 1
• GenitoUrinary 1

etc.
example of the types of question asked…. CLINICAL PHARMACOLOGY

• Drug interactions
• Pregnancy, Breast milk
• Liver & Renal disease
• Drug induced disease
• Basic pharmacology e.g. drug elimination
• Clinical toxicology

In ALL 9 MAJOR SPECIALTIES

Questions asked concern the following…

• Physical signs e.g. cannon waves, pulsus paradoxus, bronchial breathing, extensor plantars,
with absent ankle jerks, haematuria, etc.
• Investigations e.g. ECGs, PFTs
• Systemic disease e.g. SABE, TB

MINOR SPECIALTIES

Examples of the sort of things asked about…

• Psychiatry - drugs used, psychosis vs. neurosis, delirium vs. dementia

• Geriatric Medicine - normal ageing changes, drugs
• Dermatology - skin manifestations of systemic disease
• Occupational - Dust exposure
• GUM - Aids, syphilis, gonorrhea
• Genetics – dominant recessive
• Paediatrics - foetal detection markers
• Ophthalmology - eyes and systemic diseases etc.

PREPARING FOR THE EXAM

 There is no substitute for hard work i.e. you must know
the facts

1 Individual planned approach is appropriate – but ask for guidance from your consultant or your
friendly MRCP course organiser, etc. Don’t be afraid to ask for this.

2. Concentrate your efforts in reasonable time. You cannot do everything at the last moment.

3. Don't encourage distractions

4. Don't waste time by questioning answers in test papers. If you really think the answers are wrong
then they may well be! Move on to something better, please!

Remember to keep generally fit!

READ & KNOW BY UNDERSTANDING (not by heart)

It is essential that you have core knowledge which you have an understanding of…
Examples of the material to understand include…

• Medicine International
• One standard text e.g. Souhami/Moxon or Kumar/Clark Davidson
• BNF – know your therapeutics!

HAVE ACCESS TO REFERENCE TEXTS

Read regularly about topics in…

• Oxford TBM or
• Harrison's

MAKE YOUR OWN LISTS AND SENTENCES

Most people find this is a good way to learn….and you might be able to write a book or web page –
who knows?

Score the goals you wan't to.

HOW TO TACKLE "BEST OF FIVES"

Doing many can help you in your preparation as well as being aware of the common types of question.

So practice lots! Visit www.ydr.org.uk for numerous examples.

Learn from the ones you get wrong — make a real effort to concentrate the learning on the ones you
got wrong.

ADVANTAGES of doing "BEST OF FIVES"

• provides valuable practice

• display range of knowledge required

DISADVANTAGES

• not validated
• answers might not be correct

RULES

1. Read the question very carefully e.g. don’t , mix up chlorpropamide and chlorpromazine

2. Try to work out what the examiner is trying to find out

3. Do not be over suspicious looking for tricks or pitfalls in the question

4. Do not guess any answer

5. Logical reasoning may help you answer some questions

WORDS THAT CAUSE DIFFICULTY IN "BEST OF FIVES"

• Always, never and invariably - should not be seen in real exam

• Frequent = common >55%
• Characteristic = typical, usual - occurs so often to be of diagnostic significance
• Rare = seldom though uncommon but does occur
• Recognised = you can work this out
• Pathognomonic = you can work this out

WILL YOU PASS?

 • 35% do pass - the mean mark plus 1 standard deviation
• Max score is 300
• 180 will definitely pass
• 170 probably you will pass
• 160 possibly you will pass
• 159 probably you will fail
• To score 180 you need 250 answered with 35 incorrect...etc.

The more facts you know the more likely you are to pass.

If you don't pass you'll have to try again.

EXAM DAY!

Preparing for the exam day means the following things…

• Good night's sleep

• No excess fluid

• Arrive Early not late - leave time for traffic

• At the exam
• Go through answer book methodically
• Do not guess
• Count responses
• if >210 or more - likely to have passed
• If <210 try hard to compete 210

• If you can't do >160 after 3 reviews record your answers and answer 40 by guess but
don't look at the questions! The theory being your as likely to score well with this method as
any other.

Q. Who is more likely to pass

A. The student who works hard and prepares well in advance and who can relax on

the day.