Cardio4mrcp is now free...but not for long!!

Hey there readers !

I am pleased to inform you that for a limited time only, our website is completely free to access! With over 300 questions covering various aspects of cardiology tailored to the MRCP part 1 exam, now is a better time than ever to join!

I hope all of you will make the most of this opportunity and register for free and enjoy our site. While you are there, feel free to check out our new book store which has some of the best books there are for preparation for the exam.

We look forward to seeing you there. Go to www.cardio4mrcp.com and register today!

Warm wishes

 Vik

We have an online bookstore!!

Hi everyone!

We are pleased to inform you that we now have an online bookstore! Here we have listed some of the best books available for the MRCP, all the way from preparatory text books for the MRCP part 1 to clinical scenarios for PACES.

Click on the link below to access our bookstore!

Cardio4MRCP bookstore

Warm wishes

Cardio4MRCP team.

We are on twitter!

Yes, we are on twitter! Follow us @Cardio4MRCP.

Look forward to seeing you there!

Vik

A question from our website

Q. The normal resting membrane potential of ventricular myocardium is

a. 85 to 90 mV
b. -85 to -90 mV
c. 70 to 80 mV
d. -70 to -80 mV
e. -30 to -40 mV





A. b. -85 to -90 mV

The resting membrane potential is corresponds to stage 4 of cardiac myocyte contraction. It is primarily due K+ channels. The resting membrane potential corresponds to diastole in cardiac contraction, and the normal potential is between -85 to -90 mV. When the myocyte is stimulated during the resting membrane potential, it results in influx of Na+ ions and the start of contraction.

As is seen in the above image, the cardiac action potential consists of 5 stage, beginning with phase 4 all the way back to phase 4.

Phase 4 - corresponds to resting membrane potential. K+ channels are open, and an electrolyte balance is achieved to maintain the potential between -85 to -95 mV

Phase 0 - This corresponds to the start of the action potential, and is due to rapid influx of Na+ ions and a rise in membrane potential. In essence, this is the depolarisation phase.

Phase 1 - The Na+ channels close, and the membrane potential reaches a plateau.

Phase 2 - The L-type Ca2+ channels open and calcium influx occurs. Outward movement of K+ starts in this phase.

Phase 3 - The Ca2+ channels close, and K+ efflux continues. This is the relaxation / repolarisation phase of the myocyte action potential.


For more questions like these, including various aspects of Cardiology for the MRCP part 1 exam, go to www.cardio4mrcp.com or click here.

Rivoroxaban

Good knowledge of drug pharmacology forms the basis of good clinical practice. While discussing each and every drug there is out there is out of the scope of this blog, today we shall talk briefly about Rivoroxaban.


Rivoroxaban

• Direct anti-Xa inhibitor
• Administered orally and has good bioavailability
• Unlike warfarin, it does NOT require regular monitoring, and the dose remains the same to achieve adequate anti-coagulation
• It is currently approved for use in Atrial fibrillation (ROCKET-AF)
• It is also useful in prevention of venous thromboembolism

From an MRCP point of view, clinical pharmacology forms a reasonable proportion of the exam. Make sure you get a good book with questions, rather than read a textbook. There are not many out there, here are a few:

There are more books available, but they all remain rather ancient, with no recent editions in the last 5 years.  The books listed about are cheap and affordable. Definitely spend a lot of time with clinical pharmacology. It is as important as basic sciences (see our basic sciences post), so find a study partner, and study hard! Its well worth studying pharmacology this way rather than reading a huge textbook with a lot of unnecessary information - well, from an exam point of view.

All the best! Next exam 11th September (kind of a jinxed date, isn't it!)

Clinical scenario - as promised!

Today's question is courtesy of Dr Ramachandra, senior SpR Cardiology, Leeds.

A 60 year old Asian man with a history of type 2 diabetes on insulin and hypertension presents with deteriorating renal function and is referred by his GP to the renal clinic. In the renal clinic, he is found to have leg oedema, elevated JVP with rapid x-descent, ascites, mild jaundice and bi-basal dullness. Chest X-ray shows cardiomegaly. ECG shows left ventricular hypertrophy with strain.  Resting heart rate was 100 bpm and BP of 90/70. The definitive cardiac diagnosis can be obtained by -

a. Cardiac MRI
b. CT pulmonary angiography
c. Ventilation-perfusion scan
d. Transthoracic echocardiography
e. Right and left heart catheterisation

In the patient above, which of the following observation is likely to be true?

a. Absent contrast reflux into the hepatic vein on CTPA
b. Pulsus paradoxus of 30 mmHg on clinical examination
c. Paradoxical septal motion on transthoracic echocardiography
d. Myocardial speckling on CMR
e. Pulmonary capillary wedge pressure of 15mmHg on cardiac catheter

Put your thinking caps on! Answer in a week!

Cardio4mrcp team.

Passing the PACES

Right, once you have passed the written exam, then comes the toughest part of the MRCP - (drumroll!) the PACES. 5 stations, tough clinical cases and some moody examiners! But go in with the right preparation, and you will absolutely wing it! Its really not that hard; just think of it as a ward round  or an on-call shift where you are asked to see complicated and sick patients. Beware however, sometimes you could get a normal case, like I did in my exam 6 years ago. I remember it well - abdominal station, normal abdomen but she was pseudocushingoid. Don't know how, but I got it! Phew!

Well, actually I do know how. Like many of us who passed, we had the right tutors and the right books to prepare. While you may get some old books handed down by registrars to you, just remember that newer editions and new books that emerge have new cases and sometimes provide you with valuable tips on picking up ceratin things. Of course, the whole inspection-palpation-percussion-auscultation rule always applies, but its the little things that these books will help you with.

I have listed a few books below that will no doubt be useful. Once you have these, ensure you have a study partner who will critique you every time you examine a patient. I tell you, it helps.

I have organised the MRCP PACES exam in the past, and I have seen first hand what the examiners can mark you down on, and what you can score full on. Remember the steps in examination and be cool and calm. No patient wants to see a nervous doctor!!

Books to read :

I would strongly recommend these.  Study well and you can score full marks. In my next post, I will be placing a tough clinical scenario that was in the MRCP communication station a few years ago. I look forward to hearing how you will handle it!

Happy reading!

Vik

Welcome!!

Hi there! Thanks for subscribing to cardio4mrcp, your guide to cardiology questions for the MRCP exam. For those of you who have come across this blog while generally browsing the internet, this blog is linked to our exam site www.cardio4mrcp.com. We host around 300 questions for the part 1 MRCP exam, and intend to expand it further in the future. Feel free to snoop around!

We have created this blog to keep you up to date with any new developments in cardiology that are relevant to clinical practice,and in particular, the MRCP exam. Also, we will add new questions, and welcome any sample questions or suggestions you might have. We honestly hope that you will find our website (and this blog!) useful, and look forward to seeing healthy interaction between subscribers.

We are sorry we don't have questions relevant to the part 2 exam at the moment, and will do our best to develop them soon. We also plan to develop a MRCP part 1 and part 2 course in the future, and welcome any suggestions, especially if there is anything you would like covering in more detail for the exam. This would apply to this website as well :-). Drop us an email at cardio4mrcp@gmail.com.

As with any other field in medicine, cardiology is an ever changing science, and new guidelines are being drawn up all the time. We will do our best to ensure that our website as up to date as possible.

We would like to take this opportunity to wish you all the very best not only for the exams, but for also for your future as a doctor!!

Best wishes

Vik
Director, E-medilearn.org Ltd