Most Frequently Tested Respiratory Topics (MRCP Part 1)
- Crack Medicine
- Oct 21
- 5 min read
TL;DR In MRCP Part 1, respiratory medicine consistently contributes ~ 14 questions per exam based on the blueprint. thefederation.uk This article lists the most frequently tested respiratory topics (MRCP Part 1), gives a mini-case with rationale, and provides a practical checklist to guide your focused revision.
Why respiratory topics deserve attention
The MRCP Part 1 examination is structured via a blueprint, in which respiratory medicine is allocated ~ 14 questions per diet. thefederation.uk Given time constraints and wide syllabus coverage, targeting the respiratory subtopics most likely to appear improves efficiency.
Respiratory questions often integrate physiology, pharmacology, radiology, and internal medicine heuristics. Understanding the recurrent “exam patterns” allows you to convert weak areas into scoring ones.
This article complements other system guides and works best when paired with high-volume practice in your QBank or mock tests.
Top 8–12 high-yield respiratory topics for MRCP Part 1
Below is a numbered list of the respiratory topics that appear with the greatest frequency (based on past papers, QBank analytics, and guideline alignment). Focus on mastering these first.
Asthma (diagnosis, monitoring, and pharmacotherapy)
Chronic Obstructive Pulmonary Disease (COPD)
Pulmonary Embolism (PE) and V/Q mismatch
Wells’ score, D-dimer, CT pulmonary angiography, pathophysiology of dead space and V/Q mismatch.
Recognising acute right ventricular strain signs.
Interstitial Lung Disease (ILD) & Pulmonary Fibrosis
HRCT patterns (honeycombing, reticulation), restrictive physiology, cause lists (IPF, connective tissue disease).
Pneumonia (Community-acquired, hospital-acquired, atypical organisms)
CURB-65 score, imaging patterns, resistance considerations, guideline antibiotic choices.
Tuberculosis (TB)
Latent versus active, diagnostic modalities (IGRA, sputum microscopy, GeneXpert), first-line regimen and side effects.
Pleural disease (Effusions, empyema, pneumothorax)
Light’s criteria (pleural fluid protein ratio > 0.5 or LDH ratio > 0.6), distinguishing transudate vs exudate.
Indications for drainage, chest tube, pleurodesis.
Lung Cancer & Paraneoplastic syndromes
Distinguish small cell from non-small cell, staging, common paraneoplastic manifestations (SIADH, Lambert-Eaton).
Respiratory physiology and gas exchange
Diffusion limitation, alveolar–arterial gradient, hypoxia types (shunt, V/Q mismatch, diffusion impairment).
Lung volumes and flow–volume loops (obstructive vs restrictive).
Sleep-disordered breathing / Obstructive Sleep Apnoea (OSA)
Pathophysiology, consequences (pulmonary hypertension), indications for CPAP.
Bronchiectasis & chronic suppurative lung disease
Recognising features, management principles, recurrent infection approach. British Thoracic Society
Acute respiratory failure / ARDS
Berlin criteria, ventilatory strategies, permissive hypercapnia, PEEP effects.
These should form the core of your respiratory revision. You can layer additional rarer topics (e.g. pulmonary hypertension, lymphangioleiomyomatosis) afterward.
Mini-case / MCQ with explanation
Case: A 60-year-old ex-smoker (30 pack-years) presents with one month of progressive dyspnoea and dry cough. His high-resolution CT (HRCT) shows bibasal subpleural reticulation and honeycombing. Lung function shows FEV₁ and FVC both reduced, FEV₁/FVC ~ 0.85 (normal). DLCO is markedly reduced.
Which is the most likely diagnosis, and which feature supports it best?
A. Usual interstitial pneumonia (UIP) — subpleural honeycombingB. Non-specific interstitial pneumonia (NSIP) — ground-glass dominantC. Hypersensitivity pneumonitis — centrilobular nodulesD. Sarcoidosis — upper lobe nodules and perilymphatic distributionE. Cryptogenic organising pneumonia — patchy consolidation
Answer: A. Usual interstitial pneumonia (UIP).Explanation: The pattern of basal subpleural reticulation and honeycombing plus restrictive spirometry with preserved FEV₁/FVC fits UIP. The presence of honeycombing (fibrotic architectural distortion) strongly points toward IPF (UIP pattern). NSIP typically has more ground-glass and less honeycombing.
You may see this type of ILD vignette with combined imaging + PFT clues in MRCP Part 1 style.
Common pitfalls and exam traps
Pitfall 1: Using high oxygen without restriction in hypercapnic patients (COPD).
The BTS guideline suggests target saturations 88–92% in known risk of hypercapnia. PMC
Pitfall 2: Equating LABA monotherapy in asthma — LABA monotherapy (without inhaled corticosteroid) is contraindicated in asthma.
This often confuses exam candidates mixing asthma and COPD pharmacology.
Pitfall 3: Misapplying Light’s criteria (forgetting LDH ratio or absolute cutoffs).
Pitfall 4: Overlooking paraneoplastic syndromes in lung cancer questions (e.g., SIADH, Lambert-Eaton).
Pitfall 5: Ignoring diffusion limitation vs V/Q mismatch distinction — exam questions sometimes hinge on which mechanism predominates.
Pitfall 6: Forgetting acute exacerbation protocols (e.g. dosing of corticosteroids, antibiotic choice in COPD exacerbation). BMJ Best Practice
Pitfall 7: Treating all pleural effusions as exudates; forgetting transudate possibilities (e.g., heart failure).
Pitfall 8: Applying community pneumonia antibiotic guidelines to hospital / immunocompromised settings without adjusting.
Practical study-tip checklist
🔍 Drill the distinctive imaging patterns (HRCT) for ILD, organising pneumonia, UIP.
📊 Practice interpreting pulmonary function test outputs, including DLCO and flow–volume loops.
⏱ Do timed QBank sessions focused on respiratory vignettes.
📘 Read relevant guideline synopses: BTS/NICE/SIGN for asthma, NICE for COPD.
🗂 Use flashcards to memorize key thresholds, cutoffs, and differential lists.
🧠 After each wrong MCQ, write a short note summarising why the distractors were wrong.
📝 Take at least one respiratory-focused mock test before final exam.
🔄 Cycle back weak topics in spaced repetition (e.g. revisit asthma, ILD 2–3 times).
FAQs
1. Which respiratory topic appears most often in MRCP Part 1?
Asthma and COPD are perhaps the most recurrent respiratory topics, frequently tested in both pathophysiology and pharmacology domains.
2. How many respiratory questions in MRCP Part 1?
Typically, 14 questions are allocated to respiratory medicine per the MRCP(UK) blueprint. thefederation.uk
3. Are respiratory physiology questions hard for MRCP Part 1?
They can be demanding, but they're also predictable: focus on diffusion, V/Q mismatch, gas exchange, and lung volumes.
4. Should I memorise antibiotic regimens for pneumonia?
Yes — but by clinical scenario (community, hospital, immunocompromised). Understand first-line vs. step-up treatments.
5. How far should guideline detail go in prep?
Familiarise yourself with summary and practical recommendations (e.g. from BTS/NICE), rather than every footnote. NICE+2NCBI+2
Ready to start?
Mastering respiratory topics boosts your confidence—and marks—in MRCP Part 1. Combine systematic revision of the high-yield list above with high-volume practice in your QBank and mock tests. Also explore our complete system guides and lecture series for further reinforcement.
For further systematic preparation, see our parent perhaps: the MRCP Part 1 hub (for overall structure and other systems), and sibling posts such as “High-yield cardiology topics for MRCP Part 1.”
Sources
Federation of the Royal Colleges of Physicians: MRCP Part 1 format and blueprint — respiratory 14 questions thefederation.uk
BTS/NICE/SIGN joint asthma guideline 2024 (diagnosis, monitoring, chronic management) PMC+1
NICE guideline for COPD in over-16s: diagnosis and management NICE+1
BTS Guideline for oxygen use in adults (target saturations, hypercapnia) PMC
Acute exacerbation of COPD Best Practice overview BMJ Best Practice
BTS Guideline for bronchiectasis in adults (management summary)
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