MRCP Part 1 Respiratory: 50 Rapid-Review Facts

TL;DR This post provides “MRCP Part 1 Respiratory: 50 Rapid-Review Facts”—a compact, high-yield list of respiratory facts you can scan just before attempting your respiratory questions. Use it to rapidly consolidate lung disease, investigation, and management knowledge, then attempt a full question block using a QBank or mock test.

Why respiratory matters in MRCP Part 1

In MRCP Part 1, respiratory topics typically contribute around 10–15% of questions, embedded within pulmonary physiology, pathology, pharmacology, and radiology. The exam tests not only recall but your ability to interpret investigations (spirometry, CXR, ABG) and manage common lung diseases. The exam itself is conducted in two papers, each 3 hours long with 100 “best of five” MCQs. Royal Colleges of Physicians UK+1

Given limited revision time, mastering a “rapid facts” list helps you solidify core principles and avoid distractors. Below is a condensed list you should memorise and revisit periodically.

50 Rapid-Review Respiratory Facts

#	Topic	Key Fact / Mnemonic
1	Asthma diagnosis	Reversibility: improvement in FEV₁ ≥12% (and ≥200 mL) post-bronchodilator
2	COPD definition	Post-bronchodilator FEV₁ / FVC < 0.7 (fixed obstruction)
3	AAT deficiency	Panacinar emphysema + liver disease; serum α₁-antitrypsin low
4	Sarcoidosis	Non-caseating granulomas + bilateral hilar lymphadenopathy + elevated ACE
5	PE presentation	Sudden dyspnoea + pleuritic chest pain + tachycardia; use Wells’ score
6	Tension pneumothorax	Tracheal deviation away, hypotension, hyperresonance
7	CAP pathogen	Streptococcus pneumoniae most common
8	Legionella clue	Hyponatraemia + deranged LFTs + recent travel history
9	HAP definition	Occurs >48 h after hospital admission; involves Pseudomonas, Klebsiella
10	Bronchiectasis	Irreversible bronchial dilatation; HRCT is diagnostic
11	Cystic fibrosis	AR mutation CFTR gene; sweat Cl⁻ > 60 mmol/L
12	Obstructive sleep apnoea	Daytime somnolence + snoring; treat with CPAP
13	ILD pattern	Restrictive spirometry + ↓ DLCO; HRCT is key
14	IPF hallmark	Basal, subpleural fibrosis; honeycomb lung on HRCT
15	Asbestosis	Lower-lobe fibrosis + pleural plaques; risk mesothelioma
16	Silicosis	Upper-lobe nodules + “egg-shell” calcified hilar nodes
17	Hypersensitivity pneumonitis	Bird/exposure history; improves on antigen avoidance
18	Pleural fluid classification	Light’s criteria: exudate if protein ratio >0.5 etc.
19	TB classic	Apical cavitation + weight loss + night sweats
20	Miliary TB	“Seed” pattern on CXR; often immunocompromised host
21	Primary TB	Ghon complex (Ghon focus + hilar node)
22	Lung carcinoma types	Central: squamous, small cell; peripheral: adenocarcinoma
23	Pancoast tumour	Apical tumour → Horner’s syndrome
24	Small cell paraneoplastic	Ectopic ACTH → Cushing’s; SIADH
25	Adenocarcinoma	Most common, often peripheral, in non-smokers
26	Mesothelioma	Diffuse pleural thickening; asbestos exposure history
27	SVC syndrome	Facial swelling, dilated chest veins; often small-cell carcinoma
28	Pulmonary hypertension sign	Loud P2, right axis deviation on ECG
29	Cor pulmonale	Right heart failure secondary to lung disease
30	Pulmonary oedema	“Bat-wing” CXR, Kerley B lines, due to LV failure
31	ARDS definition	PaO₂/FiO₂ ratio < 200, diffuse alveolar damage
32	CO poisoning	Normal PaO₂, low SaO₂; treat with 100 % O₂ or hyperbaric O₂
33	Hypoxia mechanisms	V/Q mismatch, shunt, diffusion limitation, hypoventilation
34	Finger clubbing causes	Bronchiectasis, lung abscess, carcinoma, fibrosis
35	Haemoptysis causes	Bronchiectasis > TB > carcinoma > PE
36	Bronchial breath sounds	Over consolidation/fibrosis replacing alveolar tissue
37	Crackles: fine/coarse	Fine = fibrosis; coarse = oedema / bronchiectasis
38	Wheeze	Musical expiratory sound (airway narrowing)
39	Stridor	Inspiratory sound from upper airway narrowing
40	Lung volumes	TLC ↑ in obstructive, ↓ in restrictive disease
41	DLCO changes	↓ in ILD, ↑ in asthma / polycythaemia
42	ABG in PE	Hypoxaemia + low PaCO₂ (hyperventilation)
43	Oxygen caution in COPD	Risk CO₂ retention — aim SpO₂ 88–92 %
44	Respiratory acidosis	COPD exacerbation, CNS depression
45	Respiratory alkalosis	Hyperventilation: anxiety, PE, altitude
46	Metabolic acidosis compensation	Kussmaul breathing in DKA
47	Spirometry restrictive pattern	FEV₁ & FVC both ↓, FEV₁/FVC normal or ↑
48	Lung cancer screening	Annual low-dose CT for heavy smokers aged >55
49	Bronchoscopy indication	Persistent imaging abnormality or haemoptysis
50	Radiology pearls	Air bronchogram = consolidation; silhouette sign for lobar collapse

Practical mini-case (MCQ style)

Stem: A 60-year-old male heavy smoker presents with progressive dyspnoea, weight loss, and a central hilar mass on chest X-ray showing cavitation. Which histologic subtype is most likely? A. AdenocarcinomaB. Small cell carcinomaC. Squamous cell carcinomaD. Large cell carcinomaE. Bronchioloalveolar carcinoma

Answer: C. Squamous cell carcinoma Explanation: Among central lung lesions in smokers, squamous cell carcinoma commonly presents as a cavitating hilar mass. Small-cell is also central but rarely cavitates. Peripheral lesions are more characteristic of adenocarcinoma.

Exam tip: “Central = squamous / small cell; peripheral = adenocarcinoma.” Keep that mnemonic firmly in mind when localising on radiology.

5 Most Tested Respiratory Subtopics & 5 Traps to Watch

Top 5 subtopics (and quick tips)

1. Asthma / airway disease

   • Understand BTS/NICE/SIGN 2024 updates to asthma diagnosis (use of FeNO, eosinophils) NICE+2PMC+2

   • Recognise step-up/step-down management algorithms.

2. Interstitial lung disease / pulmonary fibrosis

   • Distinguish usual interstitial pneumonia (UIP) pattern, radiologic honeycombing, and know pirfenidone/nintedanib basics.

3. Pulmonary embolism / VTE

   • Calculation of Wells score, D-dimer thresholds, imaging (CT pulmonary angiogram), anticoagulation steps.

4. Pleural disease / effusions / pneumothorax

   • Light’s criteria, exudate vs transudate, pneumothorax management.

5. Lung cancer & paraneoplastic syndromes

   • Subtypes with imaging (squamous, adenocarcinoma, small cell) and associated paraneoplastic effects (SIADH, Cushing’s, hypercalcaemia).

5 common traps / pitfalls (and remedies)

• Trap: Using FEV₁/FVC cut-off 0.8 or age-adjusted incorrectly Fix: Always apply post-bronchodilator ratio <0.7 for COPD (age caveat in elderly).

• Trap: Treating asthma with high-dose inhaled steroids without reviewing diagnosis Fix: Use objective tests (FeNO, spirometry) to confirm diagnosis per BTS/NICE guideline. brit-thoracic.org.uk+3NICE+3NICE+3

• Trap: Misclassifying a transudate as exudate because only one Light’s criterion is met Fix: Apply all three criteria (protein, LDH ratio, LDH level) before labelling exudate.

• Trap: Ignoring anticoagulation contraindications in PEFix: Always assess bleeding risk, renal function, and consider LMWH bridging carefully.

• Trap: Forgetting paraneoplastic clues (e.g. SIADH in small-cell)Fix: Always review systemic lab derangements and integrate into lung cancer subtype.

  
  

Study-Tip Checklist for Respiratory Revision

1. Divide topics by phenotype (obstructive, restrictive, infective, vascular, pleural) and master one cluster per day.

2. Flash-card the 50 facts above, revisit in spaced intervals (day 1, day 3, day 7, day 14…).

3. After each topic, attempt adjacent questions in your QBank or learning platform.

4. In final 2–3 weeks, do dedicated respiratory blocks (30–50 Qs) from a timed mock or QBank.

5. Review all errors carefully, annotate “why wrong” vs “why right.”

6. Simulate “radiology + ABG” mini-questions by picking random CXRs and ABGs to interpret under timed conditions.

7. In last 3 days, skim only one-page summaries and mnemonic lists (like the 50 facts above).

To benchmark yourself, always include at least one full mock containing respiratory questions—this tests integration. Consider interlinking with a full analysis post-mock.

FAQs

Q: How many respiratory questions appear in MRCP Part 1?

Typically around 10–15 % of the exam questions relate to respiratory medicine, integrated across physiology, pathology, and clinical medicine.

Q: Are guidelines tested (e.g. BTS/NICE asthma) in MRCP Part 1?

Yes — recent exam items emphasise adherence to up-to-date UK guidelines, such as the BTS/NICE asthma pathway published in 2024. NICE+2PMC+2

Q: Should I prioritise radiology or physiology in respiratory revision?

Balance is key—physiology gives conceptual frameworks, but radiology is high-yield for image-based questions. Alternate sessions.

Q: Can I skip rare diseases (e.g. pulmonary alveolar proteinosis)?

You can deprioritise ultra-rare entities, but know the classic ones (sarcoidosis, AAT deficiency, hypersensitivity pneumonitis) thoroughly.

Q: How to tackle combined respiratory + general medicine questions?

Always map the respiratory issue to systemic context (renal, cardiac, infective) and use a directed reasoning tree (e.g. is breathlessness due to lung, heart, anaemia, metabolic?).

Ready to start?

If you found this list useful, supplement it with more practice: attempt free respiratory MCQs in our QBank or schedule a mock test to simulate exam conditions. Consistent error review + spaced recall will turn these 50 facts into deep memory.

Wishing you clarity, confidence, and success in your MRCP Part 1 journey.

Sources

1. “Examinations – Part 1 – Format – MRCP UK,” The Federation (MRCP UK), https://www.thefederation.uk/examinations/part-1

2. “Asthma | British Thoracic Society,” British Thoracic Society, https://www.brit-thoracic.org.uk/quality-improvement/guidelines/asthma/

3. “Diagnosis, monitoring and chronic asthma management (BTS/NICE/SIGN),” NICE, https://www.nice.org.uk/guidance/ng245

4. “The Ultimate MRCP Part 1 Exam Guide 2024,” MedCourse, https://medcourse.co.uk/exam-guide/mrcp-part-1-exam-guide/

5. “Changes in standard of candidates taking the MRCP(UK) Part 1,” PMC (BMC Medicine), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1185541/