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100+ Free MRCP(UK) Diploma Practice Questions

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A patient has crushing chest pain and ECG shows ST elevation in contiguous anterior leads within two hours of onset. What pathway should be activated?

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Key Facts: MRCP(UK) Diploma Exam

3 parts

Part 1, Part 2 Written and PACES

Federation overview

200 + 200

Written best-of-five questions across Part 1 and Part 2 Written

Federation format pages

5 stations

PACES clinical carousel

Federation PACES page

450 / 444 / 126

Current listed Part 1, Part 2 Written and PACES pass marks

Federation pass-marks page

MRCP(UK) Diploma has three official parts: Part 1, Part 2 Written and Part 2 Clinical (PACES). The Federation states that completing all three parts is required before starting specialist internal medicine training in the UK. Part 1 is a 200-question best-of-five written exam across cardiology, clinical pharmacology, clinical sciences, dermatology, endocrinology, gastroenterology, geriatrics, haematology, infection, neurology, oncology, ophthalmology, palliative care, psychiatry, renal, respiratory and rheumatology. Part 2 Written also uses two 3-hour papers of 100 best-of-five questions each and emphasises clinical judgement, investigations, management and prognosis. PACES is a half-day clinical examination with five stations and eight patient encounters. Current pass-mark guidance lists Part 1 at 450 from 2026/1, Part 2 Written at 444 from 2026/1 and PACES at 126 with skill minima.

Sample MRCP(UK) Diploma Practice Questions

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

1A man with an inferior STEMI is hypotensive with raised JVP, clear lungs and ST elevation in V4R. What is the safest immediate haemodynamic approach while reperfusion is arranged?
A.Give cautious intravenous crystalloid and avoid nitrates
B.Start an intravenous nitrate infusion
C.Give high-dose intravenous furosemide
D.Delay reperfusion until blood pressure normalises
Explanation: Inferior STEMI with right ventricular involvement is preload dependent. Cautious fluid can support output if there is no pulmonary oedema, while nitrates and unnecessary diuretics can precipitate severe hypotension.
2A 78-year-old woman with hypertension and persistent atrial fibrillation has no contraindication to anticoagulation. Which intervention most directly reduces her embolic stroke risk?
A.Aspirin monotherapy
B.Start long-term oral anticoagulation after bleeding risk assessment
C.Routine rhythm-control cardioversion without anticoagulation
D.Digoxin solely to control resting heart rate
Explanation: Older patients with atrial fibrillation and vascular risk factors usually have a high CHA2DS2-VASc score. Oral anticoagulation, not aspirin or rate control alone, is the key stroke-prevention treatment when bleeding risk is acceptable.
3An elderly patient has exertional syncope, a slow-rising pulse and a harsh ejection systolic murmur radiating to the carotids. Which diagnosis best explains this presentation?
A.Mitral regurgitation
B.Hypertrophic obstructive cardiomyopathy
C.Severe aortic stenosis
D.Aortic regurgitation
Explanation: Exertional syncope, angina or dyspnoea with a slow-rising pulse and a carotid-radiating ejection systolic murmur is classic severe aortic stenosis.
4A young adult has pleuritic chest pain relieved by sitting forward, widespread concave ST elevation and PR depression. Troponin is not significantly elevated. What is first-line treatment if there are no high-risk features?
A.Immediate thrombolysis
B.Long-term anticoagulation
C.Permanent pacemaker insertion
D.NSAID therapy with colchicine
Explanation: Acute uncomplicated pericarditis is treated with an anti-inflammatory regimen, commonly an NSAID plus colchicine, with evaluation for high-risk features or myocardial involvement.
5A patient with fever, new regurgitant murmur and splinter haemorrhages is haemodynamically stable. What investigation should be prioritised before empirical antibiotics?
A.Obtain multiple sets of blood cultures from separate venepuncture sites
B.Start oral antibiotics and review in one week
C.Perform exercise tolerance testing
D.Give corticosteroids before cultures
Explanation: In stable suspected infective endocarditis, multiple blood cultures should be taken before antibiotics to maximise microbiological yield. Echocardiography is also required, but cultures before antibiotics are a key early step.
6A patient with chronic heart failure with reduced ejection fraction remains symptomatic despite loop diuretic treatment. Which drug class has prognostic benefit rather than only symptom relief?
A.A thiazide-like diuretic solely for oedema
B.A beta blocker licensed for heart failure
C.A short-acting nitrate used only as needed
D.A calcium-channel blocker for ankle swelling
Explanation: Evidence-based HFrEF therapy includes disease-modifying classes such as ACE inhibitor/ARB/ARNI, beta blocker, mineralocorticoid receptor antagonist and SGLT2 inhibitor. Loop diuretics are important for fluid symptoms but are not the main prognostic therapy.
7A cancer patient develops hypotension, raised JVP, muffled heart sounds and pulsus paradoxus. Echocardiography shows right atrial collapse with a large pericardial effusion. What is the definitive urgent treatment?
A.High-dose oral diuretics
B.Elective outpatient echocardiography in six weeks
C.Urgent pericardiocentesis with drainage
D.Sublingual glyceryl trinitrate
Explanation: Cardiac tamponade causes obstructive shock from impaired ventricular filling. Echo evidence of chamber collapse with clinical shock requires urgent drainage.
8A patient on QT-prolonging drugs has recurrent polymorphic ventricular tachycardia twisting around the baseline. What immediate drug treatment is most appropriate?
A.Intravenous verapamil
B.Oral bisoprolol only
C.Adenosine bolus
D.Intravenous magnesium sulfate
Explanation: Torsades de pointes is polymorphic VT associated with prolonged QT. Intravenous magnesium and correction of precipitants such as hypokalaemia, hypomagnesaemia and QT-prolonging drugs are central.
9A patient with severe COPD exacerbation is drowsy and saturating 84% on air. Previous notes document hypercapnic respiratory failure. What oxygen target is safest while an arterial blood gas is obtained?
A.Controlled oxygen aiming for saturation 88-92%
B.High-flow oxygen aiming for 100% saturation
C.Withhold oxygen until cyanosis appears
D.Aim for saturation 94-98% regardless of history
Explanation: COPD patients at risk of hypercapnic respiratory failure should receive controlled oxygen to a target of 88-92% while urgent blood gas assessment guides further therapy.
10A woman with asthma is unable to complete sentences, has PEFR 35% predicted and widespread wheeze. What initial treatment bundle is most appropriate?
A.Oral antihistamine alone
B.High-flow oxygen, nebulised salbutamol, ipratropium and systemic corticosteroid
C.Long-acting beta agonist monotherapy
D.Delay treatment until spirometry is repeated
Explanation: Acute severe asthma requires oxygen, repeated or continuous nebulised short-acting beta agonist, ipratropium in severe attacks and systemic corticosteroids, with escalation if response is inadequate.

About the MRCP(UK) Diploma Exam

The MRCP(UK) Diploma is the three-part postgraduate assessment for physicians training in internal medicine. The official route consists of Part 1, Part 2 Written and Part 2 Clinical (PACES). The written components test internal medicine knowledge, clinical sciences and best-of-five clinical reasoning; PACES tests bedside clinical skills, communication, judgement and professionalism in a structured clinical station format. This source row named a Diploma in General Internal Medicine, but the verified official name is MRCP(UK) Diploma.

Assessment

Three-part Diploma: MRCP(UK) Part 1, MRCP(UK) Part 2 Written, and MRCP(UK) Part 2 Clinical (PACES)

Time Limit

Part 1: two 3-hour papers; Part 2 Written: two 3-hour papers; PACES: half-day five-station clinical examination with eight patient encounters

Passing Score

Part 1 scaled score 450 from 2026/1; Part 2 Written scaled score 444 from 2026/1; PACES total 126 plus seven skill pass marks

Exam Fee

From 2025/03: GBP 502 UK written, GBP 672 international written, GBP 716 UK PACES, with international PACES fees varying by centre (Federation of the Royal Colleges of Physicians of the UK / MRCP(UK))

MRCP(UK) Diploma Exam Content Outline

14/200 Part 1 indicative

Cardiology

Acute coronary syndromes, arrhythmias, valve disease, heart failure, pericardial disease and emergency cardiac presentations.

14/200 Part 1 indicative

Respiratory Medicine

COPD, asthma, pneumonia, pulmonary embolism, tuberculosis, pneumothorax, interstitial lung disease and sleep medicine.

14/200 Part 1 indicative

Gastroenterology and Hepatology

Upper GI bleeding, varices, inflammatory bowel disease, pancreatitis, malabsorption, cirrhosis complications and colorectal cancer presentations.

14/200 Part 1 indicative

Endocrinology, Diabetes and Metabolic Medicine

DKA, HHS, thyroid disease, adrenal emergencies, pituitary disease, calcium disorders and diabetes medication safety.

14/200 Part 1 indicative

Renal Medicine

Acute kidney injury, nephrotic and nephritic syndromes, hyperkalaemia, CKD complications and renovascular disease.

14/200 Part 1 indicative

Infectious Diseases

Meningitis, endocarditis, HIV opportunistic infection prevention, C difficile, malaria, sepsis and soft-tissue infection.

14/200 Part 1 indicative

Neurology

Stroke, subarachnoid haemorrhage, neuromuscular disease, movement disorders, demyelination and neuro-inflammatory emergencies.

25/200 Part 1 indicative

Clinical Sciences and Statistics

Physiology, immunology, genetics, diagnostic test interpretation, epidemiology, evidence-based medicine and risk calculations.

How to Pass the MRCP(UK) Diploma Exam

What You Need to Know

  • Passing score: Part 1 scaled score 450 from 2026/1; Part 2 Written scaled score 444 from 2026/1; PACES total 126 plus seven skill pass marks
  • Assessment: Three-part Diploma: MRCP(UK) Part 1, MRCP(UK) Part 2 Written, and MRCP(UK) Part 2 Clinical (PACES)
  • Time limit: Part 1: two 3-hour papers; Part 2 Written: two 3-hour papers; PACES: half-day five-station clinical examination with eight patient encounters
  • Exam fee: From 2025/03: GBP 502 UK written, GBP 672 international written, GBP 716 UK PACES, with international PACES fees varying by centre

Keys to Passing

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

MRCP(UK) Diploma Study Tips from Top Performers

1Use the Part 1 blueprint to schedule revision across every specialty rather than over-weighting familiar systems.
2For Part 2 Written, practise next-best investigation and immediate management questions rather than isolated diagnosis recall.
3Review wrong options carefully; MRCP stems often separate plausible answers by safety, urgency and guideline sequencing.
4Build a recurring weak-topic log for pharmacology, statistics, renal electrolytes and emergency presentations.
5Prepare for PACES with supervised bedside practice, concise case presentation and structured communication rehearsal.

Frequently Asked Questions

Is this the same as a Diploma in General Internal Medicine?

The source row used that wording, but the official Federation page identifies the qualification as the MRCP(UK) Diploma. It has three parts: Part 1, Part 2 Written and Part 2 Clinical (PACES).

What is the MRCP(UK) Diploma format?

The written components each contain two 3-hour papers of 100 best-of-five questions. PACES is a half-day clinical examination with five stations and eight patient encounters.

What are the current MRCP(UK) pass marks?

The Federation pass-marks page lists Part 1 at a scaled score of 450 from 2026/1, Part 2 Written at 444 from 2026/1, and PACES at total score 126 with separate minimum standards across seven skills.

What does Part 1 cover?

The Part 1 blueprint covers broad internal medicine and clinical sciences, including cardiology, clinical pharmacology, clinical sciences, dermatology, endocrinology, gastroenterology, geriatrics, haematology, infection, neurology, oncology, ophthalmology, palliative care, psychiatry, renal, respiratory and rheumatology.

Does this practice set match the official five-option format exactly?

No. The official written MRCP(UK) exams use best-of-five questions. This site-wide practice bank uses 100 original four-option MCQs while preserving the same clinical reasoning and broad internal medicine topic coverage.