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MRCP Part 1 Sample Questions

Try a selection of MRCP-style best-of-five questions before you use the full Examrix bank. Every question below is taken from the Examrix MRCP Part 1 question bank, with the correct answer and a concise explanation you can reveal once you have committed to a choice.

There are 24 free sample questions on this page spanning 12 specialty areas, drawn from a bank of 3,461 active MRCP Part 1 SBAs. They are written by doctors for MRCP Part 1 preparation — no external question-bank material is reproduced here.

Access the full MRCP Part 1 question bankRead the MRCP Part 1 preparation guide

What to expect in MRCP Part 1 questions

MRCP Part 1 is a best-of-five (single best answer) paper: two three-hour papers of 100 questions each, with no negative marking. Each question gives a short clinical vignette — often a presenting complaint, a focused examination finding and a block of investigations — and asks for the single most likely diagnosis, the most appropriate next investigation, the best initial management or the underlying mechanism.

The distractors are deliberately plausible. Several options will be defensible in isolation; only one is the best answer given the specific details in the stem. Questions are weighted towards general internal medicine, cardiology, endocrinology, gastroenterology, respiratory medicine, neurology, nephrology and haematology, with clinical sciences, pharmacology and therapeutics woven throughout rather than tested separately.

Data interpretation matters as much as recall. Expect ECGs described in text, arterial blood gases, renal and liver profiles, thyroid function tests, autoantibody panels and pharmacokinetic values. The sample questions below reflect that mix.

How to approach SBA questions

  • Read the last line first. Knowing whether you are being asked for a diagnosis, an investigation or a management step changes which details in the stem matter.
  • Form an answer before reading the options. Committing first protects you from being led by an attractive distractor.
  • Use the discriminating detail. Examiners include one or two facts — an age, a drug, a single abnormal value — that separate the best answer from the rest. If your choice does not explain that detail, reconsider.
  • Eliminate systematically. Rule out clearly wrong options, then compare the remaining two on the specifics of the case rather than on general plausibility.
  • Never leave a blank. There is no negative marking, so an educated guess on a flagged question always beats an unanswered one.
  • Watch the clock. Roughly 1.8 minutes per question. If a question stalls you past two minutes, flag it and move on.

How to use practice questions during revision

Questions are a learning tool, not just an assessment. Early in your preparation, work in untimed tutor mode: answer, read the full explanation, and note the reasoning rather than the fact. The value is in understanding why the other four options were wrong.

As the diet approaches, shift towards timed blocks that mirror the paper — 100 mixed questions in three hours — so pacing and stamina become automatic. Review every block afterwards, including the questions you answered correctly by guessing, and use your analytics to identify the specialties where accuracy is consistently below your average.

A workable rhythm is topic-based blocks while you are still building knowledge, mixed random blocks in the middle third of your revision, and full-length timed mocks in the final four to six weeks. Repeat incorrect questions after a delay rather than immediately, so you are recalling rather than recognising.

24 free MRCP Part 1 sample questions

Choose your answer, then reveal the explanation. Keep a note of any question where you were unsure even though you answered correctly — those are the topics to revisit.

Question 1· Cardiology· Easy

A 62-year-old man reports a 3-month history of central chest tightness that occurs after walking uphill or in cold weather. The discomfort is relieved within 3–4 minutes of resting or using his GTN spray. He denies any chest discomfort at rest. Which classification best describes his presentation according to NICE guidance on stable chest pain?

  1. A. Atypical angina
  2. B. Non-anginal chest pain
  3. C. Non-cardiac chest pain
  4. D. Typical (definite) angina
  5. E. Unstable angina
Question 2· Cardiology· Easy

A 65-year-old woman with stable angina uses a sublingual glyceryl trinitrate (GTN) spray during episodes of exertional chest pain, with relief typically within 2–3 minutes. Which of the following best describes the mechanism by which this drug relieves her symptoms?

  1. A. Inhibition of cyclo-oxygenase reducing platelet thromboxane production
  2. B. Inhibition of the sinoatrial node funny current reducing heart rate
  3. C. Nitric oxide-mediated smooth muscle relaxation causing predominantly venodilation and reduced preload
  4. D. Selective beta-1 adrenoreceptor blockade reducing myocardial contractility and heart rate
  5. E. Voltage-gated L-type calcium channel blockade causing coronary and peripheral vasodilation
Question 3· Clinical Pharmacology and Therapeutics· Easy

A 68-year-old man with stable angina is started on oral propranolol. He has no liver disease. The prescriber notes that only a proportion of the drug reaches the systemic circulation unchanged after oral administration because of extensive hepatic metabolism during the first pass. Which of the following best describes this process?

  1. A. Bioavailability
  2. B. First-pass metabolism
  3. C. Protein binding
  4. D. Volume of distribution
  5. E. Zero-order elimination
Question 4· Clinical Pharmacology and Therapeutics· Easy

A 74-year-old woman is treated with a drug that is highly lipid soluble and has a large volume of distribution. Blood concentrations fall rapidly after administration, but the total body drug amount remains substantial because much of the drug is in tissues. Which of the following best explains this finding?

  1. A. Drug is extensively protein bound in plasma
  2. B. Drug distributes widely into tissue compartments
  3. C. Drug is eliminated by glomerular filtration only
  4. D. Drug has poor membrane permeability
  5. E. Drug undergoes no hepatic metabolism
Question 5· Clinical Sciences· Easy

A 32-year-old man is found to have a total cholesterol of 10.1 mmol/L and an LDL cholesterol of 8.2 mmol/L. His father had a myocardial infarction aged 41 years. Examination shows tendon xanthomata. A pathogenic variant affecting the LDL receptor is identified. Which cellular process is most directly impaired?

  1. A. Caveolin-mediated endocytosis
  2. B. Clathrin-mediated endocytosis
  3. C. Exocytosis
  4. D. Macropinocytosis
  5. E. Phagocytosis
Question 6· Clinical Sciences· Easy

A 79-year-old woman with atrial fibrillation presents with nausea, confusion and blurred vision. She takes digoxin and furosemide. Her creatinine is 190 µmol/L and potassium is 5.7 mmol/L. Digoxin toxicity is suspected. Which membrane protein is directly inhibited by digoxin?

  1. A. H+/K+ ATPase
  2. B. Na+/Ca2+ exchanger
  3. C. Na+/K+ ATPase
  4. D. Na+/K+/2Cl− cotransporter
  5. E. Voltage-gated calcium channel
Question 7· Dermatology· Easy

A 6-year-old boy is brought to clinic with itchy, relapsing patches of dry skin affecting the flexural creases of his elbows and behind his knees. His mother reports that the rash worsens in winter and after swimming. Examination shows poorly demarcated erythematous plaques with excoriations and mild lichenification. He has no fever and is otherwise well. Which of the following is the most appropriate first-line emollient advice?

  1. A. Apply an emollient only to visibly inflamed areas once daily
  2. B. Use a soap substitute and apply an emollient liberally and frequently
  3. C. Start oral prednisolone to prevent further flares
  4. D. Prescribe topical antifungal therapy for 2 weeks
  5. E. Recommend daily antibacterial washes as maintenance
Question 8· Dermatology· Medium

A 42-year-old man with chronic plaque psoriasis asks about treatment. He has thick plaques on his elbows, knees, and scalp affecting approximately 8% of his body surface area. He has no joint symptoms. He has used a potent topical corticosteroid and vitamin D analogue combination intermittently with only partial benefit. Which of the following is the most appropriate next step in management?

  1. A. Commence narrowband ultraviolet B phototherapy
  2. B. Start oral acitretin immediately
  3. C. Reassure him that no further treatment is required
  4. D. Switch to a topical antibiotic preparation
  5. E. Treat with oral flucloxacillin for 7 days
Question 9· Endocrinology· Easy

A 24-year-old woman with type 1 diabetes presents with vomiting, abdominal pain and deep rapid breathing. She omitted insulin for 2 days because of gastroenteritis. Investigations show: • Capillary glucose 18.6 mmol/L • Blood ketones 5.2 mmol/L • Venous pH 7.19 • Bicarbonate 12 mmol/L Which diagnosis is most likely?

  1. A. Diabetic ketoacidosis
  2. B. Hyperosmolar hyperglycaemic state
  3. C. Lactic acidosis
  4. D. Starvation ketosis
  5. E. Uraemic acidosis
Question 10· Endocrinology· Easy

An 81-year-old man with type 2 diabetes presents with 1 week of increasing thirst, polyuria and confusion. He is profoundly dehydrated but has no abdominal pain or Kussmaul breathing. Investigations show: • Glucose 46 mmol/L • Venous pH 7.36 • Bicarbonate 20 mmol/L • Blood ketones 0.8 mmol/L • Calculated osmolality 352 mOsm/kg Which diagnosis is most likely?

  1. A. Diabetic ketoacidosis
  2. B. Hyperosmolar hyperglycaemic state
  3. C. Hyperventilation syndrome
  4. D. Lactic acidosis
  5. E. Starvation ketosis
Question 11· Gastroenterology and Hepatology· Easy

A 46-year-old man reports a 6-month history of burning retrosternal discomfort and acid regurgitation, particularly after large meals and when lying down. He has no dysphagia, weight loss or gastrointestinal bleeding. His examination is normal. Which physiological abnormality most commonly underlies gastro-oesophageal reflux disease?

  1. A. Delayed relaxation of the lower oesophageal sphincter during swallowing
  2. B. Increased basal lower oesophageal sphincter pressure
  3. C. Increased frequency of transient lower oesophageal sphincter relaxations
  4. D. Reduced gastric acid secretion after meals
  5. E. Reduced oesophageal exposure to gastric contents
Question 12· Gastroenterology and Hepatology· Easy

A 38-year-old woman has troublesome heartburn and acid regurgitation on most days of the week. She has no alarm symptoms. She is prescribed omeprazole. Which action is principally responsible for the therapeutic effect of this drug?

  1. A. Competitive antagonism of histamine H2 receptors
  2. B. Inhibition of gastric H+/K+-ATPase
  3. C. Neutralisation of hydrogen ions within the gastric lumen
  4. D. Promotion of gastric prostaglandin synthesis
  5. E. Stimulation of lower oesophageal sphincter contraction
Question 13· Geriatric Medicine· Easy

An 84-year-old woman is reviewed after two hospital admissions in 4 months. She has unintentionally lost 5 kg, walks slowly with a frame, reports persistent exhaustion and has stopped shopping independently. A minor urinary tract infection recently caused a marked decline in her mobility. Which concept best explains her vulnerability to disproportionate deterioration after a minor illness?

  1. A. Age-related physiological adaptation
  2. B. Frailty syndrome
  3. C. Functional neurological disorder
  4. D. Normal biological ageing
  5. E. Somatic symptom disorder
Question 14· Geriatric Medicine· Easy

An 86-year-old man is recovering from community-acquired pneumonia. He can feed himself, use the toilet and transfer from bed to chair, but requires help with bathing and dressing. Which category of function is being assessed?

  1. A. Advanced mobility activities
  2. B. Basic activities of daily living
  3. C. Instrumental activities of daily living
  4. D. Occupational performance measures
  5. E. Social participation activities
Question 15· Haematology· Easy

A 36-year-old woman presents with fatigue, exertional breathlessness and a persistent desire to chew ice. She has heavy menstrual bleeding. Examination shows pale conjunctivae and spoon-shaped fingernails. Blood tests show: Haemoglobin 89 g/L MCV 70 fL MCH 21 pg Which diagnosis is most likely?

  1. A. Anaemia of chronic disease
  2. B. Beta-thalassaemia trait
  3. C. Iron deficiency anaemia
  4. D. Sideroblastic anaemia
  5. E. Vitamin B12 deficiency
Question 16· Haematology· Easy

A 68-year-old man is found to have haemoglobin 94 g/L and MCV 73 fL during investigation of fatigue. Serum ferritin is 8 micrograms/L. He has no overt bleeding and takes no regular medication. Which underlying condition is most important to exclude?

  1. A. Colorectal carcinoma
  2. B. Hereditary haemochromatosis
  3. C. Immune thrombocytopenia
  4. D. Multiple myeloma
  5. E. Polycythaemia vera
Question 17· Infectious disease· Easy

A 56-year-old man presents with a 2-day history of increasing pain, redness and swelling of his left lower leg. He has a temperature of 38.1°C. Examination shows a warm, tender, poorly demarcated area of erythema extending from the ankle to the mid-calf. There is no fluctuance or crepitus. Which diagnosis is most likely?

  1. A. Cellulitis
  2. B. Deep-vein thrombosis
  3. C. Erysipelas
  4. D. Necrotising fasciitis
  5. E. Superficial thrombophlebitis
Question 18· Infectious disease· Medium

A 64-year-old woman presents with her third episode of left lower-leg cellulitis in 18 months. She has chronic unilateral leg swelling following pelvic lymph-node dissection for cervical cancer. Between episodes the skin remains intact, although the leg is persistently oedematous. Which factor most strongly predisposes her to recurrent cellulitis?

  1. A. Chronic lymphoedema
  2. B. Hypercholesterolaemia
  3. C. Iron deficiency
  4. D. Osteoarthritis
  5. E. Vitamin D deficiency
Question 19· Infectious Diseases· Easy

A 72-year-old man presents with dysuria and fever. He is confused and drowsy. Observations are: Temperature 38.7°C Heart rate 118/min Blood pressure 86/52 mmHg Respiratory rate 26/min Oxygen saturation 94% on air Which diagnosis is most likely?

  1. A. Acute cystitis
  2. B. Pyelonephritis without systemic involvement
  3. C. Sepsis
  4. D. Stable bacteraemia
  5. E. Viral syndrome
Question 20· Infectious Diseases· Easy

An 81-year-old woman from a residential home presents with reduced mobility and new confusion. She has no fever. Observations are: Temperature 36.1°C Heart rate 104/min Blood pressure 94/58 mmHg Respiratory rate 24/min Urinalysis is positive for nitrites and leucocytes. Which feature should most increase concern for severe systemic infection?

  1. A. Absence of fever
  2. B. New confusion
  3. C. Positive urinary nitrites
  4. D. Reduced mobility
  5. E. Residence in a care home
Question 21· Medical Ophthalmology· Easy

A 68-year-old woman presents with sudden-onset severe pain in her right eye, blurred vision, and haloes around lights, accompanied by nausea and vomiting. Examination shows a red eye with a hazy cornea and a fixed, mid-dilated pupil. The globe feels firm on gentle palpation. Which of the following is the most likely diagnosis?

  1. A. Acute angle-closure glaucoma
  2. B. Acute conjunctivitis
  3. C. Anterior uveitis
  4. D. Episcleritis
  5. E. Herpes simplex keratitis
Question 22· Medical Ophthalmology· Easy

A 25-year-old man presents with bilateral red eyes, watery discharge, and a gritty sensation following a recent upper respiratory tract infection. Examination reveals tender preauricular lymphadenopathy. Visual acuity and pupil reactions are normal. Which of the following is the most likely diagnosis?

  1. A. Allergic conjunctivitis
  2. B. Bacterial conjunctivitis
  3. C. Herpes zoster ophthalmicus
  4. D. Anterior uveitis
  5. E. Viral conjunctivitis
Question 23· Neurology· Easy

A 67-year-old man with hypertension develops sudden weakness of his right arm and difficulty speaking while eating breakfast. His wife notices that the right side of his face is drooping. The symptoms resolve completely after 25 minutes. Neurological examination 1 hour later is normal. Which diagnosis is most likely?

  1. A. Focal seizure
  2. B. Hypoglycaemia
  3. C. Migraine with aura
  4. D. Transient ischaemic attack
  5. E. Vestibular neuritis
Question 24· Neurology· Easy

A 72-year-old woman presents 1 hour after a 15-minute episode of left arm weakness and dysarthria. Her symptoms have completely resolved. Capillary glucose is normal. She has no history of gastrointestinal bleeding, aspirin allergy or anticoagulant use. Which treatment should be given immediately?

  1. A. Aspirin 300 mg
  2. B. Clopidogrel 75 mg
  3. C. Dipyridamole 200 mg
  4. D. No antithrombotic treatment
  5. E. Warfarin 5 mg

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