Membership of the Royal College of Physicians (MRCP UK) Neurology Syllabus

Neurology syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Neurology in Membership of the Royal College of Physicians (MRCP UK), not a summary of it.

1. 1

   Cerebrovascular Disease

   4 topics

   • Ischaemic stroke
     • Thrombolysis and thrombectomy pathways
     • Stroke classification and territories
   • Transient ischaemic attack and secondary prevention
   • Intracerebral and subarachnoid haemorrhage
   • Cerebral venous sinus thrombosis
2. 2

   Headache and Episodic Disorders

   4 topics

   • Migraine and tension-type headache
   • Cluster headache and trigeminal autonomic cephalalgias
   • Secondary headache red flags
     • Giant cell arteritis and raised intracranial pressure
   • Epilepsy and status epilepticus
     • Seizure classification and antiepileptic drugs
3. 3

   Neuromuscular and Movement Disorders

   5 topics

   • Peripheral neuropathies
     • Guillain-Barre syndrome
     • Chronic inflammatory and hereditary neuropathies
   • Neuromuscular junction disorders
     • Myasthenia gravis and myasthenic crisis
   • Myopathies and motor neurone disease
   • Parkinson's disease and parkinsonian syndromes
   • Tremor, dystonia and other movement disorders
4. 4

   Inflammatory, Infective and Cognitive Disorders

   5 topics

   • Multiple sclerosis and demyelinating disease
   • CNS infections
     • Bacterial meningitis and encephalitis
   • Dementia and cognitive impairment
     • Alzheimer's and non-Alzheimer dementias
   • Spinal cord disease and cauda equina syndrome
   • Cerebrospinal fluid interpretation

Neurology flashcards for Membership of the Royal College of Physicians (MRCP UK)

23 of 52 cards from the Neurology deck — real questions with worked answers.

1. In acute ischaemic stroke, what is the time window for IV alteplase (thrombolysis) and the standard dose?

   Within 4.5 hours of symptom onset. Dose: $0.9\ \text{mg/kg}$ (max $90\ \text{mg}$), with 10% given as a bolus and the remainder over 60 minutes.

2. What is the time window for mechanical thrombectomy in anterior circulation large-vessel occlusion, and when can it be extended?

   Up to 6 hours from onset for proximal anterior circulation occlusion. Extendable to 24 hours if favourable imaging (CT perfusion/diffusion mismatch shows salvageable penumbra, e.g. DAWN/DEFUSE-3 criteria).

3. What antiplatelet regimen is given immediately after ischaemic stroke once haemorrhage is excluded?

   Aspirin $300\ \text{mg}$ daily for 2 weeks, then switch to long-term clopidogrel $75\ \text{mg}$ daily.

4. What does the ABCD2 score predict, and what are its components?

   It predicts early stroke risk after TIA. Components: Age $\geq 60$ (1), BP $\geq 140/90$ (1), Clinical features (unilateral weakness 2, speech disturbance without weakness 1), Duration ($\geq 60$ min 2, 10–59 min 1), Diabetes (1). Max score 7.

5. For secondary prevention after TIA/ischaemic stroke of non-cardioembolic origin, what is first-line antiplatelet therapy?

   Clopidogrel $75\ \text{mg}$ daily lifelong. If contraindicated, aspirin plus modified-release dipyridamole.

6. What degree of symptomatic carotid stenosis warrants carotid endarterectomy, and within what timeframe?

   $50$–$99\%$ stenosis (NASCET criteria) on the symptomatic side, performed ideally within 2 weeks of the index event.

7. In a patient with TIA/stroke and atrial fibrillation, what is the preferred secondary prevention and timing of anticoagulation?

   A DOAC (e.g. apixaban) is preferred over warfarin. Timing follows the '1-3-6-12 day' rule based on stroke size (delay anticoagulation in large strokes due to haemorrhagic transformation risk).

8. What is the most common cause of spontaneous (non-traumatic) intracerebral haemorrhage, and its typical locations?

   Hypertension, causing deep haemorrhages from Charcot–Bouchard microaneurysms in the basal ganglia, thalamus, pons, and cerebellum.

9. What is the classic presentation and diagnostic finding of subarachnoid haemorrhage?

   Sudden 'thunderclap' worst-ever headache. Non-contrast CT (sensitivity highest within 6h); if CT negative, lumbar puncture at $\geq 12\ \text{hours}$ showing xanthochromia.

10. What is the most common cause of spontaneous subarachnoid haemorrhage, and what is the definitive treatment?

    Ruptured saccular (berry) aneurysm, most often at the anterior communicating artery. Treatment: endovascular coiling (preferred) or surgical clipping.

11. What drug is given to prevent vasospasm/delayed cerebral ischaemia after subarachnoid haemorrhage?

    Nimodipine $60\ \text{mg}$ orally every 4 hours for 21 days (a calcium-channel blocker).

12. Name the imaging sign and typical presentation of cerebral venous sinus thrombosis.

    Presents with headache (often progressive), seizures, focal deficits, and signs of raised ICP. CT venogram/MR venogram shows the 'empty delta sign' (filling defect in the superior sagittal sinus).

13. What is the treatment of cerebral venous sinus thrombosis, even in the presence of haemorrhagic venous infarction?

    Anticoagulation with LMWH (then warfarin/DOAC), because the haemorrhage is a consequence of venous congestion. Anticoagulation is not contraindicated by the venous infarct.

14. List the main risk factors for cerebral venous sinus thrombosis.

    Pregnancy/puerperium, combined oral contraceptive pill, thrombophilia, dehydration, malignancy, and local infection (e.g. mastoiditis, sinusitis).

15. State the diagnostic criteria features distinguishing migraine without aura from tension-type headache.

    Migraine: $\geq 5$ attacks lasting 4–72h, unilateral, pulsating, moderate–severe, aggravated by activity, with nausea/vomiting or photophobia+phonophobia. Tension-type: bilateral, pressing/tightening, mild–moderate, not aggravated by activity, no nausea.

16. What are the acute and prophylactic treatment options for migraine?

    Acute: oral triptan (e.g. sumatriptan) + NSAID/paracetamol $\pm$ antiemetic. Prophylaxis: propranolol, topiramate, or amitriptyline (consider CGRP monoclonal antibodies if refractory).

17. Which migraine treatment is contraindicated in pregnancy and which is preferred for prophylaxis in women of childbearing age?

    Triptans are generally avoided and topiramate is contraindicated/teratogenic in pregnancy. Propranolol is preferred for prophylaxis in women of childbearing age (amitriptyline also used).

18. Describe the classic features of cluster headache.

    Severe strictly unilateral periorbital pain lasting 15–180 min, occurring in clusters (1–8/day for weeks), with ipsilateral autonomic features: lacrimation, conjunctival injection, rhinorrhoea, ptosis/miosis, and restlessness/agitation.

19. What are the acute and preventive treatments for cluster headache?

    Acute: high-flow $100\%$ oxygen ($12$–$15\ \text{L/min}$) via non-rebreathe mask and subcutaneous sumatriptan. Prevention: verapamil (first-line), short course of prednisolone to break a cluster.

20. Name the trigeminal autonomic cephalalgias and the key distinguishing feature of paroxysmal hemicrania.

    Cluster headache, paroxysmal hemicrania, SUNCT/SUNA, and hemicrania continua. Paroxysmal hemicrania has shorter attacks (2–30 min), higher frequency, and shows an absolute response to indomethacin.

21. List the red-flag features ('SNOOP') suggesting a secondary headache requiring investigation.

    Systemic symptoms/Secondary risk (fever, weight loss, cancer, HIV), Neurological deficits, Onset sudden (thunderclap), Older age (>50, consider GCA), Pattern change/Positional/Papilloedema/Precipitated by Valsalva.

22. In a patient over 50 with new headache, jaw claudication and scalp tenderness, what is the diagnosis, key blood test, and immediate treatment?

    Giant cell (temporal) arteritis. ESR markedly raised ($>50$); confirm with temporal artery biopsy. Start high-dose prednisolone immediately (do not wait for biopsy) to prevent blindness.

23. Define status epilepticus and state the first-line drug treatment.

    A seizure lasting $\geq 5\ \text{minutes}$ or recurrent seizures without recovery of consciousness between them. First-line: IV lorazepam $4\ \text{mg}$ (or buccal midazolam/rectal diazepam), repeated once if needed.

See more Neurology flashcards →

Planning Neurology for Membership of the Royal College of Physicians (MRCP UK)

Neurology (Membership of the Royal College of Physicians (MRCP UK)) FAQ