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MRCPI GM Part II Written study materials
MRCPI GM Part II Written study resources

MRCPI GM Part II Written: Specialty and subspecialty medicine

MRCPI GM Part II Written · Work through your exam, one topic at a time.

All guide sections

Specialty and subspecialty medicine

This domain expects working knowledge across the major specialties and the ability to choose the single next best step.

Cardiology

ACS: ECG within 10 minutes, high-sensitivity troponin, aspirin plus a P2Y12 inhibitor and anticoagulant, and primary PCI within 120 minutes of STEMI diagnosis. HFrEF: ARNI or ACE inhibitor, beta-blocker, MRA and SGLT2 inhibitor. AF: anticoagulate by CHA2DS2-VASc (≥2 in men, ≥3 in women), preferring a DOAC.

Respiratory

Acute asthma: systemic steroid and salbutamol, adding ipratropium and magnesium in severe attacks. COPD: target oxygen saturation 88–92% and use NIV for pH 7.25–7.35. PE: Wells score, D-dimer only at low or intermediate probability, CTPA otherwise; anticoagulate immediately when probability is high.

Gastroenterology and hepatology

Upper GI bleed: Glasgow-Blatchford score, terlipressin plus antibiotics for suspected varices, endoscopy within 24 hours. Ascites: diagnostic tap in every admission; spontaneous bacterial peritonitis is an ascitic neutrophil count >250/mm3, treated with a third-generation cephalosporin plus albumin.

Endocrinology, renal and neurology

Adrenal crisis: hydrocortisone 100 mg IV without waiting for results. Nephrotic syndrome: proteinuria >3.5 g/day with low albumin, then biopsy. Stroke: thrombolysis within 4.5 hours, thrombectomy up to 24 hours in selected large-vessel occlusion.

Rheumatology, haematology, oncology, infectious diseases and dermatology

GCA: steroids immediately. Neutropenic sepsis: antibiotics within one hour. Tumour lysis and hypercalcaemia: fluids first, then bisphosphonate. SJS/TEN: stop the culprit drug, provide fluid, thermal and ocular care, and involve burns or critical care early.

Worked example

A 74-year-old reports a new temporal headache, jaw claudication and ESR 84 mm/h. Reasoning: giant cell arteritis until excluded, and vision is at immediate risk. Give prednisolone 60 mg (IV methylprednisolone if visual symptoms) before any imaging, arrange temporal artery ultrasound, biopsy within two weeks, and add aspirin and bone protection.

Traps

  • Delaying steroids for a biopsy in suspected GCA.
  • Requesting D-dimer when PE probability is high.
  • Missing adrenal crisis in refractory shock.
  • Treating SJS/TEN as a simple drug allergy.