, Rapid Review of
Clinical
Medicine
for MRCP Part 2
Second Edition
Sanjay Sharma
BSc (Hons) MD FRCP (UK) FESC
Professor of Clinical Cardiology
Consultant Cardiologist and Physician
St George’s University of London
St George’s Hospital NHS Trust
University Hospital Lewisham
London, UK
Rashmi Kaushal
BSc (Hons) FRCP (UK)
Consultant Physician and Endocrinologist
West Middlesex Hospital
Kingston, UK
MANSON
PUBLISHING
,Dedication
For Ravi, Ashna, Anushka, Ishan, Shivani and Milan
Acknowledgements
We are grateful for the help of several colleagues who helped provide slides for the book:
Dr L Wilkinson, Ms S Gowrinath, Ms H Derry, Mr P Radomskij, Dr J Waktare, Ms A O’Donoghue, Dr S Rosen,
Dr A Mehta, Dr L Shapiro, Professor M E Hodson, Dr G Rai, Dr A Ghuran, Professor C Oakley, Ms F Goulder,
Dr J Axford, Dr S Jain, Dr M Stodell, Dr B Harold, Dr D Seigler, Dr C Travill, Dr G Barrison, Dr D Hackett,
Dr J Bayliss, Dr R Lancaster, Dr R Foale, Dr W Davies, Professor D Sheridan, Professor W McKenna,
Professor G MacGregor, Dr A Belli, Dr Adams, Dr J Joseph, Dr M Impallomeni, Dr D Banerjee, Dr N Essex,
Dr S Nussey, Dr S Hyer, Dr A Rodin, Dr M Prentice, Dr N Mir, Mrs K Patel and Dr J Jacomb-Hood.
We are also grateful for the assistance of the Audiovisual Departments at Luton and Dunstable Hospital, St Mary’s
(Paddington) Hospital and St George’s Hospital Medical School and the ECG, Echocardiography and Radiology
Department at St George’s Hospital Medical School and University Hospital Lewisham.
Fourth impression 2010
Third impression 2009
Second impression 2007
Copyright © 2006 Manson Publishing Ltd
ISBN: 978-1-84076-070-5
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means without the written permission of
the copyright holder or in accordance with the provisions of the Copyright Act 1956
(as amended), or under the terms of any licence permitting limited copying issued by
the Copyright Licensing Agency, 33–34 Alfred Place, London WC1E 7DP.
Any person who does any unauthorized act in relation to this publication may be liable
to criminal prosecution and civil claims for damages.
A CIP catalogue record for this book is available from the British Library.
For full details of all Manson Publishing titles, please write to:
Manson Publishing Ltd
73 Corringham Road
London NW11 7DL, UK
Tel: +44 (0)20 8905 5150
Fax: +44 (0)20 8201 9233
Website: www.mansonpublishing.com
Printed in Spain
, 3
Contents
Acknowledgements 2
Preface 3
Classification of Cases 4
Abbreviations 5
Clinical Cases 7
Data Interpretations Tutorials 415
Calcium Biochemistry 415
Genetics 415
Audiograms 416
Guidelines for the Interpretation of Cardiac Catheter Data 418
Respiratory Function Tests 419
Interpretation of Respiratory Flow Loop Curves 420
Echocardiography 421
Acid–base Disturbance 426
Normal Ranges 427
Index 429
Preface
Passing specialist examinations in internal medicine is a diagnoses, diagnostic algorithms and up-to-date medical
difficult milestone for many doctors, but is a mandatory lists are presented. Many questions comprise illustrated
requirement for career progression. Pass rates in these material in the form of radiographic material, electro-
examinations are generally low due to ‘high standards’ cardiograms, echocardiograms, blood films, audiograms,
and ‘stiff competition’. Thorough preparation is essential respiratory flow loops, histological material, and slides in
and requires a broad knowledge of internal medicine. ophthalmology, dermatology and infectious diseases.
The pressures of a busy clinical job and nights ‘on call’ Over 200 commonly examined illustrations are included.
make it almost impossible for doctors to wade through Tutorials are included at the end of the book to aid
heaps of large text books to acquire all the knowledge the interpretation of illustrated material as well as impor-
that is required to pass the examinations. tant, and sometimes difficult, clinical data, such as respir-
The aim of this book is to provide the busy doctor with atory function tests, cardiac catheter data and dynamic
a comprehensive review of questions featured most endocrine tests.
frequently in the MRCP (II) examination in internal The book will prove invaluable to all those studying
medicine. The MRCP (II) examination has a best of 5/n for higher examinations in internal medicine, and to their
from many answer format. The vast majority of the instructors.
questions in the book follow the same pattern; however,
we have chosen to include several scenarios with open
ended questions to stimulate the medical thought process. Sanjay Sharma
The level of difficulty of each question is of the same Professor of Clinical Cardiology
standard as MRCP (II) examination. However, some cases Consultant Cardiologist and Physician
are deliberately more difficult for teaching purposes. Lecturer for Medibyte Intensive Courses
A broad range of subjects is covered in over 400 for the MRCP Part 2
questions ranging from metabolic medicine to infectious
diseases. Precise answers and detailed discussion follow Rashmi Kaushal
each question. Where appropriate, important differential Consultant Physician and Endocrinologist
Clinical
Medicine
for MRCP Part 2
Second Edition
Sanjay Sharma
BSc (Hons) MD FRCP (UK) FESC
Professor of Clinical Cardiology
Consultant Cardiologist and Physician
St George’s University of London
St George’s Hospital NHS Trust
University Hospital Lewisham
London, UK
Rashmi Kaushal
BSc (Hons) FRCP (UK)
Consultant Physician and Endocrinologist
West Middlesex Hospital
Kingston, UK
MANSON
PUBLISHING
,Dedication
For Ravi, Ashna, Anushka, Ishan, Shivani and Milan
Acknowledgements
We are grateful for the help of several colleagues who helped provide slides for the book:
Dr L Wilkinson, Ms S Gowrinath, Ms H Derry, Mr P Radomskij, Dr J Waktare, Ms A O’Donoghue, Dr S Rosen,
Dr A Mehta, Dr L Shapiro, Professor M E Hodson, Dr G Rai, Dr A Ghuran, Professor C Oakley, Ms F Goulder,
Dr J Axford, Dr S Jain, Dr M Stodell, Dr B Harold, Dr D Seigler, Dr C Travill, Dr G Barrison, Dr D Hackett,
Dr J Bayliss, Dr R Lancaster, Dr R Foale, Dr W Davies, Professor D Sheridan, Professor W McKenna,
Professor G MacGregor, Dr A Belli, Dr Adams, Dr J Joseph, Dr M Impallomeni, Dr D Banerjee, Dr N Essex,
Dr S Nussey, Dr S Hyer, Dr A Rodin, Dr M Prentice, Dr N Mir, Mrs K Patel and Dr J Jacomb-Hood.
We are also grateful for the assistance of the Audiovisual Departments at Luton and Dunstable Hospital, St Mary’s
(Paddington) Hospital and St George’s Hospital Medical School and the ECG, Echocardiography and Radiology
Department at St George’s Hospital Medical School and University Hospital Lewisham.
Fourth impression 2010
Third impression 2009
Second impression 2007
Copyright © 2006 Manson Publishing Ltd
ISBN: 978-1-84076-070-5
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means without the written permission of
the copyright holder or in accordance with the provisions of the Copyright Act 1956
(as amended), or under the terms of any licence permitting limited copying issued by
the Copyright Licensing Agency, 33–34 Alfred Place, London WC1E 7DP.
Any person who does any unauthorized act in relation to this publication may be liable
to criminal prosecution and civil claims for damages.
A CIP catalogue record for this book is available from the British Library.
For full details of all Manson Publishing titles, please write to:
Manson Publishing Ltd
73 Corringham Road
London NW11 7DL, UK
Tel: +44 (0)20 8905 5150
Fax: +44 (0)20 8201 9233
Website: www.mansonpublishing.com
Printed in Spain
, 3
Contents
Acknowledgements 2
Preface 3
Classification of Cases 4
Abbreviations 5
Clinical Cases 7
Data Interpretations Tutorials 415
Calcium Biochemistry 415
Genetics 415
Audiograms 416
Guidelines for the Interpretation of Cardiac Catheter Data 418
Respiratory Function Tests 419
Interpretation of Respiratory Flow Loop Curves 420
Echocardiography 421
Acid–base Disturbance 426
Normal Ranges 427
Index 429
Preface
Passing specialist examinations in internal medicine is a diagnoses, diagnostic algorithms and up-to-date medical
difficult milestone for many doctors, but is a mandatory lists are presented. Many questions comprise illustrated
requirement for career progression. Pass rates in these material in the form of radiographic material, electro-
examinations are generally low due to ‘high standards’ cardiograms, echocardiograms, blood films, audiograms,
and ‘stiff competition’. Thorough preparation is essential respiratory flow loops, histological material, and slides in
and requires a broad knowledge of internal medicine. ophthalmology, dermatology and infectious diseases.
The pressures of a busy clinical job and nights ‘on call’ Over 200 commonly examined illustrations are included.
make it almost impossible for doctors to wade through Tutorials are included at the end of the book to aid
heaps of large text books to acquire all the knowledge the interpretation of illustrated material as well as impor-
that is required to pass the examinations. tant, and sometimes difficult, clinical data, such as respir-
The aim of this book is to provide the busy doctor with atory function tests, cardiac catheter data and dynamic
a comprehensive review of questions featured most endocrine tests.
frequently in the MRCP (II) examination in internal The book will prove invaluable to all those studying
medicine. The MRCP (II) examination has a best of 5/n for higher examinations in internal medicine, and to their
from many answer format. The vast majority of the instructors.
questions in the book follow the same pattern; however,
we have chosen to include several scenarios with open
ended questions to stimulate the medical thought process. Sanjay Sharma
The level of difficulty of each question is of the same Professor of Clinical Cardiology
standard as MRCP (II) examination. However, some cases Consultant Cardiologist and Physician
are deliberately more difficult for teaching purposes. Lecturer for Medibyte Intensive Courses
A broad range of subjects is covered in over 400 for the MRCP Part 2
questions ranging from metabolic medicine to infectious
diseases. Precise answers and detailed discussion follow Rashmi Kaushal
each question. Where appropriate, important differential Consultant Physician and Endocrinologist
