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High-Yield Respiratory for MRCP Part 1

TL;DR

This high-yield respiratory for MRCP Part 1 summary distils the most tested pulmonary conditions — asthma, COPD, PE, ILD, and lung cancer — into concise exam-ready notes. It highlights diagnostic patterns, common traps, and practical study strategies with an illustrative case. Perfect for rapid revision before the MRCP Part 1 exam.


Why this matters

Respiratory Medicine consistently features across both papers of MRCP Part 1, typically contributing 20–25 questions. The topics test your ability to interpret patterns — spirometry, ABGs, and radiology — rather than recall obscure eponyms.

A solid command of pulmonary physiology and pharmacology often helps eliminate distractors in mixed-system MCQs. Building fluency in “respiratory reasoning” directly boosts performance in general medicine domains.


High-yield respiratory topics and quick recall

Subtopic

Common Exam Focus

Rapid Tip

Asthma

Stepwise therapy, inhaler escalation

Check BTS/SIGN 2023 guideline — always review inhaler technique before stepping up.

COPD

GOLD classification, oxygen targets

Maintain SaO₂ 88–92%; LTOT if PaO₂ < 7.3 kPa.

Pulmonary Embolism

Wells score, ECG/CTPA

Classic clue: pleuritic chest pain with sinus tachycardia.

Interstitial Lung Disease

HRCT pattern recognition

Honeycombing = UIP; ground-glass = NSIP.

Lung Cancer

Paraneoplastic syndromes

SIADH → SCLC; PTHrP → squamous carcinoma.

Authoritative source: NICE guideline NG115 on COPD management and BTS/SIGN Asthma Guideline 2023.


1. Asthma — still a frequent favourite

  • Spirometry: Obstructive pattern with reversibility ≥15% post-bronchodilator.

  • Stepwise management:

    1. SABA as needed

    2. Add low-dose ICS

    3. Add LABA or LTRA

    4. Escalate to high-dose ICS or MART

  • Exam trap: Forgetting to confirm adherence before dose escalation.

2. COPD — GOLD criteria and oxygen therapy

  • Diagnosis: Post-bronchodilator FEV₁/FVC < 0.7 with limited reversibility.

  • Severity: GOLD 1–4 based on % predicted FEV₁.

  • Oxygen: Offer LTOT if PaO₂ < 7.3 kPa or < 8 kPa with polycythaemia, cor pulmonale, or nocturnal desaturation.

  • Pharmacotherapy:

    • Dual bronchodilators (LAMA + LABA) as baseline.

    • Add ICS if eosinophils ≥ 300 cells/µL.

    • Refer to NICE NG115 for up-to-date drug escalation.

3. Pulmonary Embolism — speed is key

  • Diagnosis: Start with Wells score and D-dimer.

  • Definitive test: CT pulmonary angiography (CTPA).

  • Treatment: DOAC (apixaban, rivaroxaban) preferred; LMWH if malignancy.

  • Exam pearl: The most common ECG finding is sinus tachycardia — not S₁Q₃T₃.

See full algorithm on NICE NG158: Venous thromboembolic diseases.

4. Interstitial Lung Disease (ILD) — pattern-based recall

  • Idiopathic Pulmonary Fibrosis (IPF): Older males, dry cough, clubbing, basal crackles. HRCT: subpleural honeycombing.

  • Sarcoidosis: Non-caseating granulomas, erythema nodosum, bilateral hilar lymphadenopathy.

  • Asbestosis: Pleural plaques; risk of mesothelioma.

  • Key drug causes: Amiodarone, methotrexate, nitrofurantoin.

Exam trick: “Honeycombing + clubbing” = IPF unless proven otherwise.

5. Lung Cancer — classification and paraneoplastic clues

  1. Small-Cell Carcinoma (SCLC): Central; ACTH or SIADH secretion.

  2. Squamous Cell Carcinoma: Central; produces PTHrP → hypercalcaemia.

  3. Adenocarcinoma: Peripheral; common in non-smokers and women.

  4. Large-Cell Carcinoma: Undifferentiated; poor prognosis.


Mnemonic: S for Syndromes (SCLC), Sq for Calcium, A for Adeno-Peripheral.

For epidemiology and histology details, see Cancer Research UK: Lung cancer statistics.


Stethoscope and chest X-ray representing respiratory medicine study for MRCP Part 1.

Mini-Case Example

Question: A 58-year-old man, former shipyard worker, presents with exertional dyspnoea and finger clubbing. HRCT shows basal subpleural honeycombing. What is the most likely diagnosis?

Answer: Idiopathic Pulmonary Fibrosis (UIP pattern).

Explanation: IPF presents with “Velcro” crackles, clubbing, and basal fibrosis. Differentiating from asbestosis requires occupational clues and pleural plaques. Remember antifibrotics: pirfenidone or nintedanib improve progression-free survival.


Common pitfalls and exam traps

  • Asthma vs COPD: Don’t label fixed obstruction as asthma; check reversibility.

  • PE diagnosis: Expect atypical symptoms — syncope or unexplained tachycardia.

  • Oxygen misuse: Avoid high-flow O₂ in COPD; it can worsen CO₂ retention.

  • Drug-induced ILD: Think amiodarone in any chronic cough with new infiltrates.

  • Occupational ILD: Asbestos, silica, beryllium — always ask exposure history.


Practical study-tip checklist

  1. Focus on patterns — spirometry, CXR, ABG trends.

  2. Use repetition — revisit every topic thrice with spaced recall.

  3. Do timed MCQs daily in the Free MRCP MCQs section.

  4. Simulate exam conditions — full 3-hour practice papers via Start a mock test.

  5. Watch integrated system lectures via MRCP Part 1 overview to link pathophysiology and pharmacology.


Note: Crack Medicine app users get monthly new mocks and performance analytics with subject-wise breakdowns.

FAQs

1. How many Respiratory questions appear in MRCP Part 1?

Usually 20–25 questions, often mixed with Physiology or Clinical Pharmacology.

2. Are NICE guidelines directly tested?

Not verbatim — but management flowcharts (asthma, COPD) are indirectly examined.

3. What’s the most efficient way to revise respiratory medicine?

Use QBank and mocks to reinforce reasoning rather than memorisation.

4. Is ABG interpretation a must-know?

Yes. Expect at least one mixed acid–base question in every paper.

5. Should I memorise all ILD subtypes?

Focus on patterns: IPF, sarcoidosis, hypersensitivity pneumonitis, and drug-induced fibrosis.


Ready to start?

Mastering Respiratory Medicine is about clinical reasoning, not volume of facts. Review the top patterns, practise under timed settings, and benchmark your progress with Crack Medicine’s Free MRCP MCQs and mock tests. For a full integrated roadmap, visit the MRCP Part 1 overview.


Sources

  • MRCP(UK) Official Part 1 Examination Format

  • British Thoracic Society (BTS/SIGN) Asthma Guideline 2023

  • NICE NG115: Chronic obstructive pulmonary disease in over 16s

  • NICE NG158: Venous thromboembolic diseases

  • Cancer Research UK — Lung cancer statistics

  • Davidson’s Principles and Practice of Medicine, 24th Edition.

 
 
 

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