100+ Free RACP DWE Practice Questions

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2026 Statistics

Key Facts: RACP DWE Exam

2 papers

Clinical Applications and Medical Sciences, both entirely selected-response

RACP - Divisional Written Examination

170 questions

100 in Clinical Applications and 70 in Medical Sciences across the two papers

RACP - Divisional Written Examinations FAQs

92 MCQ + 8 EMQ

Clinical Applications paper structure of 100 questions

RACP - Divisional Written Examination

66 MCQ + 4 EMQ

Medical Sciences paper structure of 70 questions

RACP - Divisional Written Examination

24 months

Minimum certified Basic Training required before sitting the DWE

RACP - DWE February 2026

Modified Angoff

Standard-setting method used to set the pass mark each sitting

RACP - Divisional Written Examinations FAQs

AUD $2,329

Approximate 2026 examination fee for Australian candidates

RACP - Become a physician: fees

100

Free original practice questions here

OpenExamPrep

The RACP Divisional Written Examination (DWE) is the written barrier exam in RACP Basic Training for the Adult Internal Medicine and Paediatrics & Child Health pathways in Australia and Aotearoa New Zealand. It has two selected-response papers: Clinical Applications (100 questions = 92 MCQ + 8 EMQ, 3 hours 10 minutes) testing diagnosis, investigation and management, and Medical Sciences (70 questions = 66 MCQ + 4 EMQ, 2 hours 10 minutes) testing the basic sciences. There is no fixed pass mark; the standard is set each sitting by the Modified Angoff method. Candidates need at least 24 months of certified Basic Training to be eligible. This 100-question bank gives original practice weighted about 60% Clinical Applications and 40% Medical Sciences with an Australasian internal-medicine focus.

Sample RACP DWE Practice Questions

Try these sample questions to test your RACP DWE exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 64-year-old man presents with central crushing chest pain for 40 minutes. ECG shows ST elevation in leads II, III and aVF. Which coronary artery is most likely occluded?

A.Left anterior descending artery

B.Right coronary artery

C.Left circumflex artery

D.Left main coronary artery

Explanation: ST elevation in the inferior leads II, III and aVF indicates an inferior STEMI, which is most commonly caused by occlusion of the right coronary artery in the majority of patients (right-dominant circulation). Recognising the territory directs management such as caution with nitrates if right ventricular involvement is present.

2A 72-year-old woman with heart failure with reduced ejection fraction is already on an ACE inhibitor, beta-blocker and a mineralocorticoid receptor antagonist but remains symptomatic. Switching the ACE inhibitor to sacubitril/valsartan acts by which additional mechanism?

A.Inhibiting neprilysin to increase natriuretic peptide levels

B.Blocking the funny current in the sinoatrial node

C.Inhibiting sodium-glucose cotransporter 2

D.Blocking If channels and aldosterone simultaneously

Explanation: Sacubitril is a neprilysin inhibitor that prevents the breakdown of natriuretic peptides, promoting vasodilation and natriuresis, while valsartan provides angiotensin receptor blockade. The combination (an ARNI) reduced mortality compared with enalapril in the PARADIGM-HF trial. A 36-hour washout from the ACE inhibitor is needed to avoid angioedema.

3A 55-year-old man with newly diagnosed non-valvular atrial fibrillation has a CHA2DS2-VASc score of 3. Which is the most appropriate management to reduce stroke risk?

A.Aspirin 100 mg daily

B.Long-term oral anticoagulation

C.No antithrombotic therapy

D.Dual antiplatelet therapy

Explanation: A CHA2DS2-VASc score of 2 or more in men warrants long-term oral anticoagulation, preferably a direct oral anticoagulant, to reduce thromboembolic stroke. Antiplatelet therapy is inferior and is no longer recommended for stroke prevention in atrial fibrillation.

4A 30-year-old woman presents with exertional dyspnoea and a mid-diastolic rumbling murmur best heard at the apex with the patient in the left lateral position. She had rheumatic fever as a child. Which valve lesion is most likely?

A.Aortic stenosis

B.Mitral stenosis

C.Aortic regurgitation

D.Mitral regurgitation

Explanation: A low-pitched mid-diastolic rumble at the apex accentuated in the left lateral position, with a history of rheumatic fever, is characteristic of mitral stenosis. Rheumatic heart disease remains the most common cause of mitral stenosis worldwide and is relevant in Australasian and Indigenous populations.

5A 48-year-old man with hypertension is found to have hypokalaemia and a suppressed plasma renin with an elevated aldosterone-to-renin ratio. Which is the most likely diagnosis?

A.Primary hyperaldosteronism

B.Phaeochromocytoma

C.Renal artery stenosis

D.Cushing syndrome

Explanation: An elevated aldosterone-to-renin ratio with suppressed renin and hypokalaemia in a hypertensive patient indicates primary hyperaldosteronism (for example an aldosterone-producing adenoma or bilateral adrenal hyperplasia). It is an increasingly recognised and treatable cause of secondary hypertension.

6A 68-year-old smoker presents with progressive exertional dyspnoea. Spirometry shows FEV1/FVC of 0.58 with FEV1 55% predicted and minimal bronchodilator reversibility. Which diagnosis best fits?

A.Asthma

B.Chronic obstructive pulmonary disease

C.Restrictive lung disease

D.Pulmonary embolism

Explanation: A post-bronchodilator FEV1/FVC ratio below 0.70 that is not fully reversible, in a smoker with progressive dyspnoea, defines chronic obstructive pulmonary disease. The reduced FEV1 to 55% predicted places this in the moderate (GOLD 2) severity range.

7A 25-year-old woman with poorly controlled asthma uses her short-acting beta-agonist most days. According to current stepwise management, what is the most appropriate next step?

A.Add a regular inhaled corticosteroid or ICS-formoterol

B.Increase the short-acting beta-agonist dose

C.Start oral prednisolone long term

D.Add a long-acting muscarinic antagonist alone

Explanation: Frequent reliever use indicates inadequate control, and the next step is to introduce regular inhaled corticosteroid-based preventer therapy, with ICS-formoterol now preferred as both maintenance and reliever in many guidelines. This reduces airway inflammation and exacerbation risk.

8A 60-year-old man presents with sudden pleuritic chest pain and breathlessness two weeks after a long-haul flight. He is tachycardic and hypoxic with a clear chest. Which initial investigation best confirms suspected pulmonary embolism in a haemodynamically stable patient?

A.CT pulmonary angiography

B.Chest radiograph

C.D-dimer in a high pre-test probability patient

D.Transthoracic echocardiography

Explanation: In a haemodynamically stable patient with high clinical probability of pulmonary embolism, CT pulmonary angiography is the imaging test of choice to confirm or exclude the diagnosis. It directly visualises filling defects in the pulmonary arteries.

9A 45-year-old man presents with haematemesis. He has known cirrhosis from alcohol-related liver disease. After resuscitation, which combination best reduces rebleeding from suspected oesophageal varices?

A.Endoscopic band ligation plus a vasoactive agent and antibiotic prophylaxis

B.Proton pump inhibitor infusion alone

C.Oral propranolol started immediately during the acute bleed

D.Tranexamic acid as the primary therapy

Explanation: Acute variceal bleeding is managed with endoscopic band ligation, a vasoactive splanchnic vasoconstrictor such as octreotide or terlipressin, and prophylactic antibiotics, which independently reduce mortality and infection in cirrhotic patients. Early endoscopy within 12 hours is recommended.

10A 28-year-old woman has chronic diarrhoea, weight loss and iron-deficiency anaemia. Anti-tissue transglutaminase IgA antibodies are markedly elevated. Which is the most appropriate confirmatory investigation?

A.Colonoscopy with random biopsies

B.Duodenal biopsy on a gluten-containing diet

C.Faecal calprotectin

D.Hydrogen breath test

Explanation: Positive anti-tissue transglutaminase IgA suggests coeliac disease, and the confirmatory test is duodenal biopsy showing villous atrophy, performed while the patient is still consuming gluten. Stopping gluten before biopsy can normalise histology and obscure the diagnosis.

About the RACP DWE Exam

The RACP Divisional Written Examination (DWE) is the written barrier examination in Royal Australasian College of Physicians Basic Training, taken by trainees in the Adult Internal Medicine and Paediatrics & Child Health pathways in Australia and Aotearoa New Zealand. It is made up of two papers. The Clinical Applications paper has 100 questions (92 A-type single-best-answer MCQs and 8 Extended Matching Questions) and examines the practice of medicine and therapeutics across the internal-medicine specialties. The Medical Sciences paper has 70 questions (66 MCQs and 4 EMQs) and examines the basic sciences underpinning clinical medicine, including physiology, pharmacology, pathology, immunology, genetics and biostatistics. Both papers are entirely selected-response, and candidates must have completed at least 24 months of certified Basic Training to sit. Passing the DWE is required before progressing to the Divisional Clinical Examination.

Assessment

Two selected-response papers: Clinical Applications (100 questions = 92 A-type MCQ + 8 EMQ) and Medical Sciences (70 questions = 66 MCQ + 4 EMQ), 170 questions in total.

Time Limit

Clinical Applications paper 3 hours 10 minutes (including 10 minutes reading time); Medical Sciences paper 2 hours 10 minutes (including 10 minutes reading time), usually sat on the same day.

Passing Score

No fixed percentage. The pass mark is determined for each sitting by the Modified Angoff standard-setting method, based on expert judgement of how a borderline candidate would perform on each item.

Exam Fee

The 2026 fee was about AUD $2,329 for Australian candidates, with a separate New Zealand-dollar fee for Aotearoa New Zealand candidates; the RACP reviews fees each examination cycle. (Royal Australasian College of Physicians (RACP))

RACP DWE Exam Content Outline

60%

Clinical Applications

Official paper: 100 questions (92 A-type MCQ + 8 EMQ) in 3 hours 10 minutes assessing the practice of medicine and therapeutics. Practice here covers diagnosis, investigation and management across cardiology, respiratory medicine, gastroenterology and hepatology, nephrology, endocrinology, neurology, rheumatology, haematology, oncology, infectious disease and acute/critical care.

40%

Medical Sciences

Official paper: 70 questions (66 MCQ + 4 EMQ) in 2 hours 10 minutes assessing the principles of medicine and basic sciences. Practice here covers physiology, clinical pharmacology, pathology, immunology, microbiology, genetics and biostatistics/epidemiology applied to internal medicine.

How to Pass the RACP DWE Exam

What You Need to Know

Passing score: No fixed percentage. The pass mark is determined for each sitting by the Modified Angoff standard-setting method, based on expert judgement of how a borderline candidate would perform on each item.
Assessment: Two selected-response papers: Clinical Applications (100 questions = 92 A-type MCQ + 8 EMQ) and Medical Sciences (70 questions = 66 MCQ + 4 EMQ), 170 questions in total.
Time limit: Clinical Applications paper 3 hours 10 minutes (including 10 minutes reading time); Medical Sciences paper 2 hours 10 minutes (including 10 minutes reading time), usually sat on the same day.
Exam fee: The 2026 fee was about AUD $2,329 for Australian candidates, with a separate New Zealand-dollar fee for Aotearoa New Zealand candidates; the RACP reviews fees each examination cycle.

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

RACP DWE Study Tips from Top Performers

1Build a reading programme that covers all the general internal-medicine specialties, then drill timed single-best-answer MCQs daily so you learn to choose the single most appropriate answer under time pressure.

2Practise Extended Matching Questions separately: read the lead-in carefully, decide your answer before scanning the long option list, and watch for closely related distractors that share features with the correct answer.

3For Clinical Applications, anchor each topic on a clear diagnostic and management framework (presentation, key investigation, first-line therapy) rather than memorising isolated facts.

4For Medical Sciences, link each basic-science concept back to a clinical example, for example a drug mechanism to its main adverse effect or a physiology principle to an acid-base disturbance.

5Master the high-yield biostatistics and epidemiology concepts (sensitivity, specificity, predictive values, number needed to treat, relative versus absolute risk) because they recur and are quick marks once understood.

6Sit full-length timed mock papers in Australasian context using local guidelines, and review every wrong answer until you can explain why each distractor is incorrect, not just why the key is right.

Frequently Asked Questions

How many papers and questions are in the RACP Divisional Written Examination?

There are two papers totalling 170 questions. Clinical Applications has 100 questions (92 A-type MCQs and 8 Extended Matching Questions) and Medical Sciences has 70 questions (66 MCQs and 4 EMQs). Both are entirely selected-response.

How long is each DWE paper?

The Clinical Applications paper runs 3 hours and 10 minutes including 10 minutes reading time, and the Medical Sciences paper runs 2 hours and 10 minutes including 10 minutes reading time. The two papers are usually sat on the same examination day.

What is the pass mark for the RACP written exam?

There is no fixed percentage pass mark. The pass standard is set for each sitting using the Modified Angoff standard-setting method, which uses expert judgement of how a borderline candidate would perform on each question, so the required score varies between examinations.

Who is eligible to sit the Divisional Written Examination?

Candidates must be enrolled in RACP Basic Training in the Adult Internal Medicine or Paediatrics & Child Health pathway and have completed at least 24 months full-time-equivalent certified Basic Training (or the Consolidation phase of the new curriculum) before the clinical year of the exam.

How much does the RACP Divisional Written Examination cost?

The 2026 fee was about AUD $2,329 for Australian candidates, with a separate New Zealand-dollar fee for Aotearoa New Zealand candidates. The RACP reviews examination fees each cycle, so confirm the current fee on the RACP website before applying.

Are these official RACP practice questions?

No. These are original OpenExamPrep questions modelled on the RACP single-best-answer and EMQ style and weighted across the Clinical Applications and Medical Sciences content. The RACP publishes its own sample questions and resources separately.