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Syllabus for MRCP Part 1 Exam

Author: RxPG, Posted on Friday, February 07 @ 00:00:00 IST by RxPG  

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MRCP Part 1

Genetics

  • Structure and function of chromosomes and genes
  • Principle of inheritance of chromosomal and genetic disorders
  • Ex:
    - Inherited diseases
    - Chromosome structure
    - Common chromosome abnormalities


Cell, molecular and membrane biology

  • Structure and function of the components of the cell and its membrane
  • How cells communicate internally and with each other by means of chemical substances and membrane receptors.
  • Ex:
    - Function of intracellular organelles
    - Cellular communication

Anatomy

  • Clinical relevant anatomy including neuroanatomy
  • Ex:
    - Peripheral nerve lesions
    - Cranial nerve abnormalities
    - Dermatomes, myotomes and reflexes

Physiology, biochemistry and metabolism

  • Structure and function of the different organs and their interaction (such as hormonal and neural influences)
  • Broad principle of metabolism such as the production of energy and pathways of carbohydrate, protein, and lipid metabolism
  • Principle of nutrition, water, electrolyte and acid base balance.
  • Physiology and biochemistry of each organ system
    Ex:
    - The mechanism of blood pressure control
    - Acid-base balance

Immunology

  • Principles of immuno-mechanisms
    Ex:
    - Humoral and cell-mediated immunity
    - Immunodeficiency syndromes
    - Phagocytic dysfunction diseases
    - Complement deficiencies
    - Hypersensitivities including allergies and autoimmune diseases
  • Immunological tests:
    - Immune system in health and disease
    Ex:
    - Common immunological laboratory tests
    - Evaluation of patients with immune disease
    - Intercellular communication and signal transduction
    - Lymphocyte and phagocytic cell biology
    - Antigen presentation
    - Humoral, cellular and mucosal immunity including Th2 and TH2 responses
    - Inflammation
    - Complement system and cytokines
    - Hypersensitivity and autoimmunity
  • Clinical condition
    - Various immunodeficiency syndromes
    Ex:
    - Mechanisms of immunodeficiency
    - Antibody immunodeficiency disorders
    - T-cell immunodeficiency disorders
    - Combined antibody and cellular immunodeficiency disorders
    - Phagocytic dysfunction diseases
    - Complement deficiencies

    - Clinical characteristics and immediate management of acute allergic emergencies
    Ex:
    - Anaphylaxis
    - Angio-oedema
    - Urticaria

    - Immunology as applied with other medical diseases (ex: Rheumatic diseases - connective tissue diseases)
    Ex:
    - Rheumatic diseases (connective tissue disease)
    - Endocrine diseases (thyroid autoimmune diseases, diabetes mellitus, Addison's disease)
    - Haematological diseases (pernicious anaemia, autoimmune haemolytic anaemia, idiopathic thrombocytopenic purpura)
    - Gastrointestinal diseases (Coleiac disease, inflammatory bowel disease, hepatobiliary diseases)
    - Renal diseases (Goodpasture's syndrome, immune-complex glomerulonephritis)
    - Dermatological diseases (demyelinating diseases, myasthenic syndromes)
  • Management
    - Principles of immunosuppressive therapy including major indications and side-effects
    Ex:
    - Immunosupressive drug therapy
    - Intravenous immunoglobulin
    - Monoclonal antibodies
    - Cytokine therapy
    - Bone marrow transplantation
    - Principle of immunisation
    - Vaccines currently in use

Infectious diseases and tropical medicine

  • Microbiology
    - Taxonomy of bacteria in terms of Gram-straining and aerobic /anaerobic metabolism
    - Virus classification for members of the herpes group
    - Virus replication with reference to the retroviruses
    - Major pathogenic protozoa and helminths
    Ex:
    -Aerobic or anaerobic bacteria
    -Gram-staining characteristics of bacteria
  • Immunology of infectious diseases
    - Immune deficiency states linked with types of opportunistic infections
    - Principle of immunisation and vaccines currently used
    Ex:
    - Opportunistic infections
    - Immunisation policy
  • Pathophysiology
    - Septic shock
    - ARDS
    - Role of cytokines in infection
  • Epidemiology
    -
    Principles relevant to infectious diseases
    Ex:
    - Mechanisms of transmission of pathogens
    - How epidemics happen
    - Knowledge of carrier states, reservoirs, vectors and zoonoses
    - Elementary concepts of the control of communicable diseases (including immunisation, isolation, contact tracing, chemoprophylaxis of close contacts)
    - Geographical variation in diseases including TB, HIV, Hepatitis B, malaria
  • Treatment
    - Broad indications for commonly employed antimicrobial agents
    - Major adverse effects for commonly employed antimicrobial agents
    Ex:
    - B-lactams
    - Tetracyclines
    - Macrolides
    - Aminoglycosides
    - Quinolines
    - Trimethoprim
    - Metronidazole
    - Antituberculous drugs
    - Antimalarial drugs
    - Antiviral agents
  • Specific infections
    - Characteristics, recognition, prevention, eradication, and pathological effects of all commonly encountered bacteria, viruses, rickettsia, fungi, protozoa, parasites and toxins.
    - Principle of infection control
    - Differential diagnostic and appropriate investigations
    - Presumptive therapies indications
    Ex:
    - Septicaemia
    - Meningitis and encephalitis
    - Endocarditis
    - Pneumonia (community-acquired, hospital-acquired, lung abscess, empyema)
    - Tuberculosis
    - PUO (appropriate investigations, when empirical therapy might be indicated)
    - Soft-tissue infection and Osteomyelitis
    - Streptococcal infection, rheumatic fever, nephritis
    - Intra-abdominal sepsis
    - Food-poisoning
    - Tropical Infections (especially malaria, bilharzias, amoebiasis, filariasis, leishmaniasis, hookworm and viral haemorrhagic fevers)
    - Viral hepatitis
    - HIV/AIDS (course of typical infection, CD4 count and HIV viral load as markers of progression; main opportunistic infections including Pneumocytis pneumonia, CNS toxoplasmosis, cryptococcal meningitis, tuberculosis)
    - Glandular fever syndrome and its differentiation from HIV seroconversion illness
    - Spirochaetosis - syphilis, leptospirosis, borrelia
    - Toxic shock syndrome and staphylococcal infections

Statistics, Epidemiology and Evidence-based medicine

  • Descriptive statistics
    - Mean, median, mode, standard deviation, standard error, confidence interval, variance
    - Range, quartile, inter-quartile range, percentile
    - Skewness
    - Contingency table, population
    - Missing values
    - Outliers
  • Graphical techniques
    - Histogram
    - Box-plot
    - Scattergram
  • Inferential techniques
    - Null hypothesis, alternative hypothesis
    - Parametric and non-parametric tests
    - Normal distribution
    - Type 1 and type 2 errors
    - False positive and false negative
    - Statistical power
    - One and two tailed tests
    - Statistical significance, P value
    - T-test
    - Mann-Whitney and Wilcoxon test
    - Chi-square test for 2 x 2 contingency table
    - Correlation (Pearson's and Spearman's)
    - Linear regression
    - Study design
  • Evidence based medicine
    - General understanding of evidence-based management and applications to management of patients
  • Clinical trials
    - Interpretation of simple clinical trial data
    - Randomisation
    - Placebo-controlled trial
    - Open trial
    - Single-blind trial
    - Double-blind trial
    - Intention-to-treat
    - Bias

Clinical haematology

  • Physiology, control and function of formed blood elements
  • Bone marrow structure and function
  • Applications of biochemistry, genetics, immunology and virology to blood disorders
  • Effects of age and pregnancy on blood diseases
  • Splenomegaly, lymphadenopathy and their causes
  • Principles and hazards of blood and blood product replacement therapy
  • Principles, but not detail, of anti-tumour chemotherapy
  • Principles of marrow transplantation
  • Adverse effects of drugs on the blood
  • Iron metabolism
    - Physiology of iron, including its absorption
    - Iron overload
    - Iron deficiency states including diagnostic, causes and treatment
    - Iron metabolism, including anaemias of chronic disorders and sideroblastic anaemias
  • Megaloblastic anaemias
    - Physiology of vitamin B12 and folic acid - Mechanisms and investigation of deficiencies and their management
  • Haemolytic anaemias
    - Mechanisms of shortened red cell survival
    - Feature and management of congenital and acquired haemolytic states
    - Molecular pathology of thalassaemia and common haemoglobinopathies
    Ex:
    - Causes of haemolysis
    - Diagnostic of haemolytic anaemia
  • Other anaemias
    - Anaemias complicating systemic disease
    - Aplastic anaemia
    - Myelodysplastic syndromes
  • Polycythaemia and myeloproliferative disorders
    - Causes, investigation and management of polycythaemia
    - Causes, investigation and management of myeloproliferative disorders
  • White cells disorders
    - Physiology of leucocytes
    - Leucocytosis and leucopenia
    - Acute and chronic leukaemias, including diagnosis, management and prognosis
    - Lymphoproliferative diseases including Hodgkin's disease, non-Hodgkin's lymphomas and plasma cell dyscrasias.
  • Disorders of haemostasis
    - Platelet function and coagulation
    - Thrombocytopenia and impaired platelet function
    - Thrombocytosis
    - Common congenital and acquired disorders of coagulation (especially anticoagulant therapy and disseminated intravascular coagulation)

Clinical pharmacology, therapeutics and clinical toxicology

  • Pharmacology
    - Mechanisms by which drugs produce their pharmacological effects
    - Basic principles of agonism and antagonism
    - Clinical implication of drugs that act at different receptor sites
    - Links between the pharmacological effects of drugs at the molecular level, the cellular level, and the tissue / organ level, and how these are affected by disease processes and other drugs
    - Principles by which both therapeutic and adverse effects occur
  • Clinical pharmacokinetics
    - Processes of drug absorption and distribution
    - Bio-transformation and excretion
    - Concepts of drug half-life and clearance
    - First order and zero order kinetics
  • Monitoring drug therapy
    - Direct measurement of therapeutic response
    - Measurement of plasma drug concentrations
    - Scientific basis for the measurement of drug concentration and its link to the principles of pharmacokinetics
  • Adverse drug reactions
    - Epidemiology of adverse drug reactions: recognition and avoidance
    - Important adverse effects of commonly used drugs
    - Importance of adverse drug reaction reporting schemes
  • Drug interactions
    - Adverse drug interactions and mechanisms by which interaction may occur
    - Common drug interactions and their clinical consequences
  • Pharmacogenetics
    - Principles of pharmacogenetics and its importance in determining variations in response to drugs in man, both in term of efficacy and toxicity
    - Clinical consequences of the common pharmacogenetic variations relevant to clinical practice
  • Therapeutics for specific patient groups
    - Principles of therapeutics as they apply in the following circumstances:
    --- The elderly
    --- Pregnancy and breast feeding
    --- Patients with renal disease
    ---
    Patients with hepatic disease
    ----- Effects of these altered physiology on the pharmacokinetics and pharmacodynamics of drugs
    -----
    Principle underlying drug choice, in pregnancy and breast feeding
    -----
    Teratogenic effects of drugs that may be used in pregnancy - Drugs that may produce toxicity in the case of renal and hepatic disease
  • Clinical toxicology
    - Principle of management of patients poisoned by drugs or other toxic substances
    - Assessment, recognition of common symptom patterns
    - Principles of removal of toxic substances
    - Antidotes where these approaches may be appropriate
  • Criteria for selecting drugs in a therapeutic class
    - Criteria used to select a drug from among drugs in a popular therapeutic class including:
    --- Differences in pharmacokinetics and pharmacodynamics
    ---
    The approved indications of the drug
    ---
    Possible adverse effects or drug inteactions
    ---
    Cost effectiveness
    -----
    Nomenclature
    ----- Used to describing studies that may be used to underpin drug selection
  • Drug formulations and routes of administration
    - Various formulations of medicines available
    - Routes by which medicines may be administered
    - Advantages and disadvantages of various routes and preparation
    - Most appropriate formulation selection and drug administration in common clinical scenarios

Rheumatology

  • Basic principles of the common musculoskeletal conditions
  • Clinical science
    - Basic physiology, biochemistry, anatomy and pathology relating to musculoskeletal diseases
    - Pathology of the common rheumatic conditions
  • Clinical conditions
    - Relative prevalence and major associations of the common rheumatological conditions
    - Symptoms and signs of the rheumatic diseases
    - Arthritis associated with other medical conditions
  • Investigations
    - Investigations relevant to the diagnosis and assessment of rheumatic diseases including
    - Acute phase proteins
    - Immunological tests relating to the connective tissue diseases
    - Contemporary imaging techniques
  • Management
    - Management of acute rheumatological emergencies including Septic arthritis, Osteomyelitis, temporal arteritis and acute spinal cord compression
    - Management of rheumatic diseases

Cardiology

  • Anatomy and physiology
    - Basic anatomy and physiology of the heart in health and disease including:
    --- Clinical relevant normal anatomy of the heart, coronary arteries and great vessels
    ---
    Determinants of the heart rate and rhythm
    ---
    Cardiac conduction
    ---
    Cardiac output
    ---
    Vascular tone
    ---
    Blood pressure
    ---
    Coronary blood flow
    ---
    Genesis of heart sound
  • Pathophysiology and pathology
    - Mechanism underlying the main pathological processes
    Ex:
    --- Thrombosis
    ---
    Infarction
    ---
    Atherogenesis
    ---
    Hypertrophy
    ---
    Heart failure
    ---
    Cardiomyopathies
    ---
    Dysrhythmias
    ---
    Hypertension
  • Cell biology
    - Topics of proven clinical relevance such as:
    --- Excitation-contraction process
    ---
    Molecular and cellular aspects of hypertrophy of the myocardium of vascular smooth muscle
  • Clinical pharmacology
    - Indications of drug therapy in cardiac disease
    - Actions, interactions, and side effects of the drugs used, with emphasis on new drugs and newly observed side effects.
  • Clinical cardiology
    - Clinical features and management of the cardiac disorders encountered in hospital practice by the general physician
    - Risk factors
    Ex:
    ---
    Clinical features of constrictive pericarditis, cardiac tamponade, endocarditis, valvular disease
    ---
    Management of acute coronary syndromes
    --- Management of cardiac failure
    ---
    Management issues in atrial fibrillation
    ---
    Indications for, and types of, permanent pacemaker
    - Important changes in clinical practice, following the publication of major clinical trials
    Ex:
    --- Use of ACE inhibitors after myocardial infarction
    --- Use of HMG CoA reductase inhibitors in primary and secondary prevention of coronary morbidity and mortality
    --- Use of beta-adrenoceptor blocking drugs in left ventricular dysfunction
    - Indications for invasive and non-invasive cardiac investigation
    - Principle of these investigative methods, their limitations and the clinical relevance
    Ex:
    --- Common ECG abnormalities
    ---
    Basic echocardiographic abnormalities such as hypertrophic obstructive cardiomyopathy or pericardial effusion
    ---
    Indication for coronary angiography

Respiratory medicine

  • Anatomy and physiology
    - Clinical relevant anatomy of the upper and lower respiratory tract and thorax including radiological anatomy
    - Principles of respiratory physiology including: How respiration is controlled
    ---
    Principles of gas exchange and oxygen transport
    ---
    Ventilation-perfusion relationships
    --- Lung volumes and transfer factor
    ---
    Respiratory aspects of sleep and exercise physiology
    - Physical, humoral and cellular aspects of respiratory defence mechanisms
    - Physiology of the proteinase inhibitors and pulmonary surfactant
  • Pathophysiology and pathology
    - Effects of disease on pulmonary physiology and anatomy including:
    --- The pulmonary and bronchial circulations as gas exchange
    --- Adaptations to chronic hypoxaemia
    --- Pleural fluid production and reabsorption
    - Application of the basic immunological processes to pulmonary pathology including:
    --- Asthma
    ---
    Alveolitis
    --- Tuberculosis
    - Humoral and cellular immunodeficiency states and sequelae
    - Microbiology of acute and chronic respiratory infections
  • Cell biology and genetics
    - Lung inflammation and repair
    - Vasculitis
    - Cystic fibrosis
    - Anti-protease deficiency
  • Clinical pharmacology
    - Indications for, and mechanisms of action of, drugs used in respiratory disease together with their interactions and side effects.
    - Important respiratory complications of other drugs (NSAIDs and beta blockers)
  • Clinical conditions
    - Clinical features, investigation and management of respiratory disease likely to be encountered by a general physician
    Ex:
    --- Pleural effusion
    --- Chest pain
    ---
    Haemoptysis
    ---
    Breathlessness
    - Impact of systemic disease on the respiratory system
    Ex:
    --- Vasculitis
    --- Neuromuscular disease
    ---
    HIV infection
    - Occupational lung disease, particularly asthma, pneumoconiosis and asbestos related disease
    - Assessment of respiratory malignant condition
    - General principles of oncological management including indication of surgery Indications for specialised investigations including bronchoscopy, CT scanning, lung biopsy, lung volumes and exercise testing
    - Investigation of sleep related disorders and of the radiological aspects of respiratory diseases
    - Indications for, and problems of, lung transplantation
    - Control of Mycobacterium tuberculosis infection·
    ---Exclusion
    - Knowledge of detailed pulmonary mechanics, oncology drug regimens, drug therapy of environmental mycobacterial infection, inhalation drug kinetics, and detailed histological descriptions is not required.

Neurology

  • Neuroanatomy
    - Detailed Neuroanatomy to appreciate the localisation of a particular neurological problem
    Ex:
    ---
    Clinical features of a lesion within the cavernous sinus
    ---
    Manifestations o a particular nerve root or peripheral nerve disorder
    --- Organisation of pathways within the spinal cord
  • Neurophysiology
    - Aspects of Neurophysiology relevant to the understanding of neurological disease
    Ex:
    - Formation, circulation, absorption and content of the cerebrospinal fluid
    - Aspect of cerebral blood flow
    - Principles of nerve conduction and its modification by disease processes
  • Neurogenetics
    - Recent advances in the understanding of the genetic basis for various neurological disorders
  • Cell biology
    - Advances in the cellular mechanisms of certain neurological disease processes which have provided better understanding of disease mechanisms and which might, in the future, lead to more rational therapy
  • Neuropharmacology
    - New drug developments in neurology
    - Established drug therapies
    Ex:
    --- Role of some recently introduced anticonvulsants
    --- Present status of immunosuppressant therapy in multiple sclerosis
  • Neuropathology
    - Pathological aspects of some common diseases such as multiple sclerosis, Parkinson's disease and Alzheimer's disease
  • Clinical neurology
    - Common disorders
    - Clinical features which have been shown to be of diagnostic value
    - Areas of recent advance, particularly those which have either led to better definition of disease entities, or have led to their improved management
    Ex:
    --- Epidemiological aspects, in particular the risk factors for stroke
    --- The evidence for the role of anti-platelet agents in transient ischaemic attacks
    - The role of carotid endarterectomy in the management of stroke patients

Psychiatry

  • Mental state
    - Conduct and scope of a mental state examination
    - Features of abnormal mental states and particularly those present commonly to physicians and to Accident and Emergency Departments
  • Aetiological factors in psychiatric illness
    - Primary aetiological factors in psychiatric areas including:
    ---
    Genetic factors
    ---Environmental factors
    ---Life events
  • Investigations
    - Potential value of, and indications for, common investigations used in psychiatric illness including:
    ---
    Psychometric testing
    ---EEG
    ---Brain imaging
  • Syndromes of psychiatric disorder and their treatment
    - Organic brain syndromes (delirium, dementia, focal brain syndromes, head injury)
    - Schizophrenia and related syndromes - Paranoid disorders and related syndromes
    - Affective disorders (anxiety states, phobic disorders, bipolar affective disorders)
    - Grief and bereavement
    - Self-harm, attempted suicide, suicide
    - Substance misuse (including alcohol dependence)
    - Eating disorders
    - Obsessive compulsive disorder
    - Abnormal illness behaviour
    - Syndromes associated with medically explained physical symptoms (including somatization and somatoform syndrome)
  • Psychiatric aspects of physical disease
    - Psychiatric presentation of physical disease including:
    ---Endocrine and metabolic disorders
    ---Toxic states
    ---AIDS
    ---Neurological disease
    ---Epilepsy
    ---Pain
  • Mental retardation
    - Features of the commoner syndromes

Gastroenterology

  • Clinical science
    - Structure and function of the gastrointestinal and hepatobilary tract
    - Neurohormonal control of gut motility
    - Secretory and absorptive functions of the gastro-intestinal tract and liver
    - Symptoms and signs of gastrointestinal, hepatobiliary and pancreatic diseases
    - Genetics of the more common gastrointestinal and liver disorders
    - Clinical pharmacology of drugs used in gastrointestinal disorders including their actions, interactions and adverse effects
  • Clinical nutrition
    - Nutritional requirements in health
    - Assessment of nutritional status
    - Nutritional deficiency states
    - Primary nutritional disorders
  • Disorders of the mouth, tongue and salivary glands
    - Mouth ulcers, periodontal and salivary disorders
    - Oral manifestations of systemic and dermatological disorders
  • Disorders of the oesophagus and stomach
    - Alchalasia
    - Carcinomas
    - Peptic ulceration
    - Gastritis
    - Gastrointestinal haemorrhage
  • Functional disorders
    - Functional chest pain and functional dyspepsia
    - Irritable bowel syndrome and functional abdominal pain
    - Functional constipation and diarrhoea
  • Disorders of the small intestine
    - Malabsoption syndromes and gluten enteropathy
    - Hormone-secreting tumours of the gut
  • Disorders of the liver, biliary tree and pancreas
    - Bilirubin metabolism and the enterohepatic circulation of bile acids
    - Causes of jaundice and cholestasis
    - Common pancreatic disorders including carcinoma
    - Fulminant liver failure
    - Acute and chronic hepatitis
    - Drugs, toxins, alcohol and the liver
  • The acute abdomen
    - Perforated viscus and peritonitis
    - Intestinal obstruction
    - Ischaemic disease of the small and large bowel
  • Inflammatory bowel diseases
    - Crohn's disease
    - Ulcerative colitis
    - Infective gastroenteritis
    - Parasitic and protozoal gut infections
  • Colorectal disorders
    - Polyps
    - Carcinomas
    - Diverticular disease
    - Anorectal disorders
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