Respiratory for MRCP Parts 1 and 2 Written

As promised, I’ve finally gotten around to writing specialty specific information for the written parts of MRCP. Starting off with my favourite respiratory, hopefully you’ll find this guide somewhat useful on your quest to becoming a medical reg.

Before we dive in, let’s look at what role respiratory plays in both the written exams.

It turns out 15 marks (out of 200) are specifically dedicated to resp in Part 1 so you should ideally spend 7.5% of your time preparing. That means if you have 100 hours before the exam, you can afford 7.5 of those on respiratory.

In Part 2, our favourite topic plays an even bigger part in our overall success, consisting of 25 marks out of 270. That roughly equates to 9.3% of your time so again if you have 100 hours then you can afford to spend 9 hours and 18 minutes on respiratory.

Now that we have that out of way, we should consider what resources to use. Try not to get overwhelmed or bogged down too much because as they say the one thousand mile journey always begins with the first step.

Your first port of call should always be a tried-and-tested question bank like Passmedicine – tackle questions by specialty and spend a good few hours really focusing on respiratory diseases, reading the relevant explanations and guidelines on the way.

The BTS guidelines and NICE guidelines are therefore probably your best friends (or enemies) here.

Personally when I studied for MRCP I found the majority of guidelines so dry and unreadable that I would either fall asleep after dinner or give myself iatrogenic SVT with caffeine. I simply preferred reading textbooks. Another reason for textbooks is that all the information is tidied up for you, rather than scattered all over the internet like your kid’s lego pieces.

The two books I would recommend are the oxford handbook or the blue book.

They both contain all the information you require (plus more) for both the written exams and will ensure you don’t miss anything pertinent. Like the name suggests the respiratory handbook is a small but compact and detailed book the size of those ancient mobile phones. If you prefer a slightly larger hardcover old school textbook then opt for the blue book which I found much more readable and contained a lot more radiological pictures. At the end of the day, any textbook that can captivate your attention is a good one!

Now onto business…

COPD

Asthma

Pneumonia

Pleural diseases (pneumothorax, pleural effusions and mesothelioma)

Tuberculosis

PE and DVT

As you’re probably not surprised to see, the six respiratory subjects above need to be studied in some detail. To break it down, you’ll need to know how to diagnose, investigate and manage these conditions. You’ll also be required to demonstrate knowledge of the prognosis and likely response to therapy.

For example in COPD, establishing a diagnosis depends on a convincing history and examination consistent with an older patient who is a long term smoker presenting with breathlessness and wheeze. On spirometry you’d expect an obstructive picture with reduced FEV1 and FEV1/FVC ratio. Know the different grading of COPD using the GOLD criteria and be able to interpret pulmonary function tests (both numbers and graphs), especially for Part 2.

To demonstrate your knowledge for prognosis in community acquired pneumonia for example, you’ll have to revise the CURB65 score and understand that you can probably discharge a patient home safely if their score is 1 as the risk of death is something like 1%. This is in stark contrast to a score of 5 which approximately equates to a 40% mortality.

Lung cancer

Respiratory failure and modes of respiratory support

Interstitial lung disease

Obstructive sleep apnoea

Cystic fibrosis

Bronchiectasis

Respiratory failure and cor pulmonale

Pulmonary hypertension

The remaining eight respiratory subjects seen above only require you to have a clear understanding of diagnosis, investigations and management. Little or no knowledge of prognosis or likely response to treatment are expected as these conditions are more subspecialty and less commonly encountered/managed on the acute take.

Here you may want a reasonable idea of how lung cancer is diagnosed i.e. CXR followed by CT followed by bronchoscopy, EBUS or CT guided biopsy. Understand the indications for when to use BIPAP or CPAP. Another example would be knowing what drugs specialist pulmonary vascular centres use for pulmonary hypertension. We need to decipher whether it’s primary or secondary PH and depending on that we either treat the underlying cause or we consider medications such as prostaglandin analogues or phosphodiesterase inhibitors.

Even though there are 14 core respiratory conditions to cover which is quite a lot considering it’s only 7 – 9% of the exams, it’s always better to have an outline of what you need to know rather than being kept in the dark and assuming you only need to know how to treat COPD, asthma and lung cancer. Blissful ignorance does not have a place here!

Furthermore, use your acute take time wisely. Instead of prescribing antibiotics, salbutamol nebulisers and prednisolone for an exacerbation of COPD, you should read up on how to diagnose and what types of inhalers we use and why. That way it’ll be much more relevant and less abstract to you. Not using your on call time wisely is like reading about chest drains for the above pneumothorax (assuming you saw it on the CXR, I hope) but you’ve never seen what a chest drain actually looks like!

I would recommend this book which is what I used for clinical sciences in general but it also contains information specific to respiratory clinical sciences. As a summary you’ll need to know the basic principles of:

Anatomy (airways, lungs and chest wall)

Physiology of gas exchange

Acid base homeostasis

Pulmonary function tests (Useful guide)

Pharmacology of major drug classes i.e. Bronchodilators, ICS, LTRAs and immunosuppressants

If you enjoyed this article make sure you get your own copy of my MRCP Part 1 & 2 Written Guide. In this guide, I explore the above and other concepts such as time allocation and the most preferable resources for the written exams in much more detail.

4 thoughts on “Respiratory for MRCP Parts 1 and 2 Written

  • April 15, 2017 at 7:18 am
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    Hi Rory,

    As a complete non medic I recognise some of the terms above, what they mean and how they can impact on peoples lives, but I wouldn’t have a clue about diagnosing them – but glad that there are still people who are going into medicine despite what repeated governments have done to the NHS!

    Am sure this will be of use to others who thinking about medicine or starting out on it. I always remember it used to seem to take an age to get there in medicine – university, med school and training from house (I can’t remember the exact wording – house man or something I think?), up through reg and to consultant, or maybe surgeon (I am not sure the exact routes!) – hats off to you for going for it – like FI, its a long slow journey, but will be worth it (I hope!) in the long run

    Cheers,
    FiL

    • April 16, 2017 at 3:49 pm
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      Hi FiL,

      You’re absolutely right, we start out as housemen or housewomen before progressing through the core and specialty reg ranks eventually culminating in the consultant grade. Really old school and hierarchical but nothing worth having ever comes easy right? Exactly like FIRE

      Rory

      • April 16, 2017 at 6:31 pm
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        Hi Rory,
        Yes – a very long time to work through but at least its clear on the path ahead compared to some worlds, but keep going at it! As you say its not easy and time consuming but at least you will continue to see the pay rises hopefully keep ticking up (subject to the government!) and it will help over the time!
        Keep at it and good luck for the next set of exams!
        FiL

        • April 16, 2017 at 10:11 pm
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          Thanks man

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