MRCP UK

MRCP UK Welcome to MRCP UK – Your Trusted Study Hub! This group is dedicated to medical professionals preparing for the MRCP (UK) exams – Part 1, Part 2, and PACES.
(3)

Join thousands of like-minded candidates to share resources, ask questions.

12/05/2026

Acanthosis nigricans is a clinical sign strongly associated with insulin resistance.

It typically appears as:

Hyperpigmented
Thickened
Velvety plaques
Commonly in neck, axilla, groin

Why it happens

In insulin resistance:

↑ insulin levels (hyperinsulinemia)
Insulin acts on IGF-1 receptors in skin
This leads to keratinocyte and dermal fibroblast proliferation

Common associated conditions

Type 2 diabetes mellitus
Obesity
Polycystic o***y syndrome (PCOS)
Metabolic syndrome

12/05/2026

𝗣𝗥𝗘𝗠𝗘𝗗𝗜𝗖𝗔𝗧𝗜𝗢𝗡 𝗥𝗘𝗚𝗜𝗠𝗘𝗡 𝗙𝗢𝗥 𝗜𝗢𝗗𝗜𝗡𝗔𝗧𝗘𝗗 𝗖𝗢𝗡𝗧𝗥𝗔𝗦𝗧 𝗔𝗟𝗟𝗘𝗥𝗚𝗬
(Prevention of contrast hypersensitivity reactions)

𝗘𝗟𝗘𝗖𝗧𝗜𝗩𝗘 / 𝗦𝗧𝗔𝗡𝗗𝗔𝗥𝗗 𝗣𝗥𝗘𝗠𝗘𝗗𝗜𝗖𝗔𝗧𝗜𝗢𝗡

Steroid options (choose one regimen):

• Methylprednisolone regimen (IV)
→ 40 mg IV at 4 hours before contrast
→ Repeat 40 mg IV at 1 hour before contrast

OR

• Hydrocortisone regimen (IV)
→ 200 mg IV at 5 hours before contrast
→ Repeat 200 mg IV at 1 hour before contrast

OR

• Prednisolone (oral option)
→ 50 mg PO at 13 hours before contrast
→ 50 mg PO at 7 hours before contrast
→ 50 mg PO at 1 hour before contrast

Antihistamine (all regimens)
• Diphenhydramine 25–50 mg IV/PO
→ Given 1 hour before contrast

𝗘𝗠𝗘𝗥𝗚𝗘𝗡𝗖𝗬 / 𝗥𝗔𝗣𝗜𝗗 𝗣𝗥𝗘𝗠𝗘𝗗𝗜𝗖𝗔𝗧𝗜𝗢𝗡
(When scan cannot be delayed)

Limited evidence if

12/05/2026

𝗛𝗘𝗔𝗗𝗔𝗖𝗛𝗘 𝗥𝗘𝗗 𝗙𝗟𝗔𝗚𝗦
(SAH vs Migraine vs Temporal Arteritis )

𝗦𝗔𝗛 (Subarachnoid Hemorrhage)
Thunderclap Danger

Subarachnoid Hemorrhage

Classic Red Flags:
• Sudden “thunderclap” headache (peaks in 50
• Change in pattern
• Neurological deficit (NOT typical migraine)

𝗧𝗘𝗠𝗣𝗢𝗥𝗔𝗟 𝗔𝗥𝗧𝗘𝗥𝗜𝗧𝗜𝗦

Giant Cell Arteritis

High-Yield Red Flags:
• Age >50 years
• Temporal headache (localized, new type)
• Jaw claudication (very specific)
• Visual symptoms / transient vision loss
• Scalp tenderness (pain combing hair)
• Fever, fatigue, weight loss

Danger: Untreated → irreversible vision loss

12/05/2026

Anti-Mi-2 Antibodies

Phenotype association:
Strongly associated with classic dermatomyositis skin and muscle phenotype, including:
– Heliotrope rash
– Gottron’s papules/sign
– Prominent photosensitive rash
– Marked proximal muscle weakness
– Often good response to therapy

Prevalence:
Anti-Mi-2 antibodies are found in approximately 10–20% of dermatomyositis (DM) cases

• Disease course and prognosis:
Generally associated with a favourable prognosis, including:
– Good response to corticosteroids and immunosuppression
– Lower risk of interstitial lung disease (ILD) compared to anti-MDA5 or antisynthetase syndrome
– Traditionally considered lower malignancy risk, though this is not zero (important nuance: malignancy risk is lower than TIF1-γ but still warrants age-appropriate screening)

Diagnostic implications

• Anti-Mi-2 is part of the myositis-specific antibody (MSA) panel used in suspected inflammatory myopathy.

• A positive anti-Mi-2 supports dermatomyositis diagnosis, especially in the presence of typical cutaneous features, but is not required for diagnosis.

• A negative result does not exclude DM, as many patients are antibody-negative or have other MSAs.

12/05/2026

𝗠𝗢𝗬𝗔𝗠𝗢𝗬𝗔 𝗗𝗜𝗦𝗘𝗔𝗦𝗘 (𝗠𝗠𝗗)

A rare progressive cerebrovascular disease causing narrowing of major cerebral arteries with development of fragile collateral vessels.

Named “moyamoya” because angiography shows a classic “puff of smoke” appearance.

𝗣𝗮𝘁𝗵𝗼𝗽𝗵𝘆𝘀𝗶𝗼𝗹𝗼𝗴𝘆

Progressive stenosis affects:

• Distal internal carotid arteries (ICA)
• Proximal middle cerebral arteries (MCA)
• Proximal anterior cerebral arteries (ACA)

Compensatory fragile collateral vessels develop at the base of the brain.

These collaterals are:

• Fragile
• Inefficient for cerebral perfusion
• Prone to thrombosis and rupture

Result:

• Recurrent cerebral ischemia
• TIA / ischemic stroke
• Intracranial hemorrhage

𝗘𝗽𝗶𝗱𝗲𝗺𝗶𝗼𝗹𝗼𝗴𝘆

• More common in East Asians
• Female predominance
• Bimodal age distribution:

Children → 5–10 years
Adults → 30–50 years

𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗙𝗲𝗮𝘁𝘂𝗿𝗲𝘀

𝗖𝗵𝗶𝗹𝗱𝗿𝗲𝗻 → usually ischemic presentation

• Recurrent TIAs
• Ischemic stroke
• Seizures
• Headache
• Cognitive decline
• Weakness/paralysis

Symptoms may be precipitated by:

• Crying
• Hyperventilation
• Fever

𝗔𝗱𝘂𝗹𝘁𝘀 → often hemorrhagic presentation

• Intracerebral hemorrhage
• Subarachnoid hemorrhage
• Stroke symptoms
• Headache
• Cognitive impairment

𝗜𝗺𝗽𝗼𝗿𝘁𝗮𝗻𝘁 𝗔𝘀𝘀𝗼𝗰𝗶𝗮𝘁𝗶𝗼𝗻𝘀

May occur with:

• Down syndrome
• Neurofibromatosis type 1
• Sickle cell disease
• Prior cranial irradiation
• Autoimmune disease

When associated with another disorder → termed 𝗠𝗼𝘆𝗮𝗺𝗼𝘆𝗮 𝘀𝘆𝗻𝗱𝗿𝗼𝗺𝗲

𝗗𝗶𝗮𝗴𝗻𝗼𝘀𝗶𝘀

𝗠𝗥𝗜 𝗕𝗿𝗮𝗶𝗻

May show:

• Ischemic infarcts
• Chronic ischemic changes
• Intracranial hemorrhage

𝗠𝗥𝗔 / 𝗖𝗧 𝗔𝗻𝗴𝗶𝗼𝗴𝗿𝗮𝗽𝗵𝘆

Shows:

• ICA stenosis
• Abnormal collateral vessels

𝗚𝗼𝗹𝗱 𝗦𝘁𝗮𝗻𝗱𝗮𝗿𝗱 → Cerebral angiography

Classic finding:
“Puff of smoke” collateral network

𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁

𝗠𝗲𝗱𝗶𝗰𝗮𝗹

Mainly for symptom prevention:

• Antiplatelet therapy (e.g. aspirin)
• Control vascular risk factors
• Adequate hydration
• Avoid hypotension

Medical therapy alone is often insufficient.

𝗗𝗲𝗳𝗶𝗻𝗶𝘁𝗶𝘃𝗲 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁 → Revascularization surgery

𝗗𝗶𝗿𝗲𝗰𝘁 𝗯𝘆𝗽𝗮𝘀𝘀

STA → MCA bypass

Provides immediate cerebral blood flow improvement.

𝗜𝗻𝗱𝗶𝗿𝗲𝗰𝘁 𝗯𝘆𝗽𝗮𝘀𝘀

Examples:

• EDAS
• EMS

Gradual development of new collateral circulation.

𝗖𝗼𝗺𝗽𝗹𝗶𝗰𝗮𝘁𝗶𝗼𝗻𝘀

• Recurrent stroke
• Intracranial hemorrhage
• Epilepsy
• Cognitive impairment

𝗕𝗟𝗢𝗢𝗗 𝗧𝗥𝗔𝗡𝗦𝗙𝗨𝗦𝗜𝗢𝗡 𝗜𝗡 𝗖𝗛𝗥𝗢𝗡𝗜𝗖 𝗞𝗜𝗗𝗡𝗘𝗬 𝗗𝗜𝗦𝗘𝗔𝗦𝗘 (𝗖𝗞𝗗)𝗔𝘀𝘀𝗲𝘀𝘀 𝗛𝗲𝗺𝗼𝗱𝘆𝗻𝗮𝗺𝗶𝗰 𝗦𝘁𝗮𝘁𝘂𝘀• Hemodynamically unstable(e.g., acute hemorrh...
12/05/2026

𝗕𝗟𝗢𝗢𝗗 𝗧𝗥𝗔𝗡𝗦𝗙𝗨𝗦𝗜𝗢𝗡 𝗜𝗡 𝗖𝗛𝗥𝗢𝗡𝗜𝗖 𝗞𝗜𝗗𝗡𝗘𝗬 𝗗𝗜𝗦𝗘𝗔𝗦𝗘 (𝗖𝗞𝗗)

𝗔𝘀𝘀𝗲𝘀𝘀 𝗛𝗲𝗺𝗼𝗱𝘆𝗻𝗮𝗺𝗶𝗰 𝗦𝘁𝗮𝘁𝘂𝘀

• Hemodynamically unstable
(e.g., acute hemorrhage, shock, symptomatic severe anemia)
Transfuse packed red blood cells (PRBCs)

• Hemodynamically stable: Measure hemoglobin (Hb)

𝗛𝗲𝗺𝗼𝗴𝗹𝗼𝗯𝗶𝗻-𝗕𝗮𝘀𝗲𝗱 𝗗𝗲𝗰𝗶𝘀𝗶𝗼𝗻

• Hb < 7 g/dL: Consider transfusion
• Hb ≥ 7 g/dL: Usually avoid transfusion and monitor clinically

Higher transfusion thresholds may be considered in:
• Active ischemia / ACS
• Symptomatic anemia
• Ongoing bleeding
• Severe hypoxia
• Hemodynamic compromise

𝗜𝗺𝗺𝗲𝗱𝗶𝗮𝘁𝗲 𝗥𝗶𝘀𝗸𝘀 𝗼𝗳 𝗧𝗿𝗮𝗻𝘀𝗳𝘂𝘀𝗶𝗼𝗻

Hyperkalemia (↑ K⁺)
Transfusion-associated circulatory overload (TACO)
Acute hemolytic reactions
Febrile or allergic reactions
TRALI (rare)

𝗟𝗼𝗻𝗴-𝗧𝗲𝗿𝗺 𝗥𝗶𝘀𝗸𝘀 𝗶𝗻 𝗖𝗞𝗗

Iron overload with repeated transfusions
HLA alloimmunization
(important in future renal transplant candidates)
Delayed hemolytic reactions
Very low infection transmission risk

In stable CKD anemia:
Prefer iron replacement ± ESA therapy
Avoid unnecessary transfusions due to sensitization risk before kidney transplantation

12/05/2026

𝗟𝗮𝗺𝗯𝗲𝗿𝘁 𝗘𝗮𝘁𝗼𝗻 𝗠𝘆𝗮𝘀𝘁𝗵𝗲𝗻𝗶𝗰 𝗦𝘆𝗻𝗱𝗿𝗼𝗺𝗲 (𝗟𝗘𝗠𝗦)

𝗠𝗲𝗰𝗵𝗮𝗻𝗶𝘀𝗺

• Autoantibodies against presynaptic voltage-gated calcium channels (VGCC)
• ↓ acetylcholine release

𝗖𝗹𝗮𝘀𝘀𝗶𝗰 𝗖𝗹𝘂𝗲𝘀

• Weakness improves with repeated use
• Proximal leg weakness prominent
• Difficulty climbing stairs / rising from chair

𝗥𝗲𝗳𝗹𝗲𝘅𝗲𝘀

• Reduced or absent
• May improve after exercise

𝗔𝘂𝘁𝗼𝗻𝗼𝗺𝗶𝗰 𝗦𝘆𝗺𝗽𝘁𝗼𝗺𝘀

Common:
• Dry mouth
• Erectile dysfunction
• Constipation
• Orthostatic hypotension

𝗔𝘀𝘀𝗼𝗰𝗶𝗮𝘁𝗶𝗼𝗻

• Strongly associated with small-cell lung cancer (SCLC)

𝗗𝗶𝗮𝗴𝗻𝗼𝘀𝗶𝘀

• VGCC antibodies
• Repetitive nerve stimulation:

* Incremental response after exercise

𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁

• Treat underlying malignancy
• Amifampridine (3,4-DAP)
• Pyridostigmine sometimes helps
• Immunotherapy in autoimmune disease

12/05/2026

𝗠𝘆𝗮𝘀𝘁𝗵𝗲𝗻𝗶𝗮 𝗚𝗿𝗮𝘃𝗶𝘀 (𝗠𝗚) MG = fatigable weakness + ocular symptoms + normal reflexes+ 𝗔𝘂𝘁𝗼𝗻𝗼𝗺𝗶𝗰 𝗦𝘆𝗺𝗽𝘁𝗼𝗺𝘀 usually absent

𝗟𝗮𝗺𝗯𝗲𝗿𝘁–𝗘𝗮𝘁𝗼𝗻 𝗠𝘆𝗮𝘀𝘁𝗵𝗲𝗻𝗶𝗰 𝗦𝘆𝗻𝗱𝗿𝗼𝗺𝗲 (𝗟𝗘𝗠𝗦) LEMS = proximal weakness + autonomic symptoms + absent reflexes + SCLC

Stroke Thrombolysis Window The thrombolysis window refers to the time period in which IV clot-dissolving therapy (Altepl...
11/05/2026

Stroke Thrombolysis Window

The thrombolysis window refers to the time period in which IV clot-dissolving therapy (Alteplase) can be safely and effectively administered in acute ischemic stroke.

Ischemic Stroke – IV Thrombolysis

Standard window:
• Within 4.5 hours from symptom onset

Best outcome window:
• Within 3 hours → maximal neurological recovery benefit

Extended window (selected patients):
• Up to 9 hours OR unknown onset (e.g., wake-up stroke)
• Requires advanced imaging (MRI / CT perfusion) to confirm salvageable brain tissue

Mechanical Thrombectomy (Large Vessel Occlusion)

Routine window:
• Up to 6 hours from onset

Extended window (selected cases):
• Up to 24 hours
• Based on imaging selection (penumbra vs infarct core mismatch)

Address

Hofuf
36441

Website

Alerts

Be the first to know and let us send you an email when MRCP UK posts news and promotions. Your email address will not be used for any other purpose, and you can unsubscribe at any time.

Shortcuts

Share

Category