Free Practice Questions for MRCP(UK) Part 1

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Sample MRCP(UK) Part 1 Practice Questions

Try these sample questions to review concepts for the MRCP(UK) Part 1 exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 125+ question experience with AI tutoring.

1A 68-year-old man with atrial fibrillation is started on amiodarone. Six weeks later his INR, taken because he is also on warfarin, has risen sharply despite no change in warfarin dose. Which mechanism best explains this interaction?

A.Amiodarone displaces warfarin from renal tubular secretion

B.Amiodarone induces hepatic synthesis of clotting factors

C.Amiodarone increases gut absorption of vitamin K

D.Amiodarone inhibits CYP2C9 and CYP3A4, reducing warfarin metabolism

Explanation: Amiodarone is a potent inhibitor of several cytochrome P450 enzymes, including CYP2C9 (the main enzyme metabolising S-warfarin) and CYP3A4. This reduces warfarin clearance, raises plasma levels and potentiates the anticoagulant effect, so the warfarin dose usually needs reducing by roughly a third to a half.

2A drug has a half-life of 8 hours and is given by continuous intravenous infusion at a constant rate. Approximately how long will it take to reach steady-state plasma concentration?

A.About 8 hours

B.About 16 hours

C.About 36-40 hours

D.About 8 days

Explanation: Steady state during a constant-rate infusion is reached after approximately 4-5 half-lives, irrespective of infusion rate. With a half-life of 8 hours, 4-5 half-lives equals roughly 32-40 hours. The infusion rate determines the magnitude of the steady-state concentration, not the time to reach it.

3A 24-year-old woman presents 6 hours after taking 30 paracetamol tablets in a single overdose. Her plasma paracetamol concentration is above the treatment line on the nomogram. Which is the most appropriate immediate management?

A.Activated charcoal

B.Intravenous N-acetylcysteine

C.Haemodialysis

D.Oral methionine

Explanation: N-acetylcysteine replenishes hepatic glutathione, allowing safe conjugation of the toxic metabolite NAPQI, and is most effective when started within 8 hours but is still indicated when the level is above the treatment line at any time. Intravenous NAC is the standard UK route for an established significant overdose.

4Which of the following antihypertensive drugs acts primarily by blocking the conversion of angiotensin I to angiotensin II?

A.Losartan

B.Amlodipine

C.Ramipril

D.Doxazosin

Explanation: Ramipril is an ACE inhibitor; it blocks angiotensin-converting enzyme, preventing formation of the vasoconstrictor angiotensin II and reducing aldosterone secretion. Reduced bradykinin breakdown also contributes to its action and to the characteristic dry cough.

5A patient on long-term lithium for bipolar disorder develops a coarse tremor, ataxia, confusion and a lithium level of 2.4 mmol/L. Which recently added medication is the most likely precipitant?

A.Atorvastatin

B.Levothyroxine

C.Bendroflumethiazide

D.Omeprazole

Explanation: Thiazide diuretics reduce renal lithium clearance by increasing proximal tubular sodium and lithium reabsorption, raising serum lithium and precipitating toxicity. NSAIDs and ACE inhibitors do likewise; statins, levothyroxine and PPIs do not meaningfully affect lithium levels.

6Which statement about zero-order (saturation) kinetics is correct?

A.The rate of elimination is proportional to drug concentration

B.A fixed amount is eliminated per unit time

C.The half-life is constant at all concentrations

D.It applies to the majority of drugs at therapeutic doses

Explanation: In zero-order kinetics the elimination pathways are saturated, so a fixed amount of drug is removed per unit time independent of plasma concentration. Phenytoin, ethanol and high-dose aspirin show this behaviour, meaning small dose increases can produce disproportionately large rises in plasma level.

7A 30-year-old woman taking the combined oral contraceptive pill is prescribed rifampicin for latent tuberculosis. What is the most important counselling point regarding her contraception?

A.Rifampicin increases oestrogen levels

B.Rifampicin and the pill do not interact

C.She should double the contraceptive dose

D.Rifampicin reduces contraceptive efficacy

Explanation: Rifampicin is a powerful inducer of CYP3A4 and other hepatic enzymes, accelerating metabolism of ethinylestradiol and progestogens and reducing contraceptive efficacy. Women should use an alternative or additional non-hormonal method during, and for a period after, rifampicin therapy.

8A patient develops a hypertensive crisis after eating mature cheese and red wine. Which class of antidepressant is most likely responsible?

A.Selective serotonin reuptake inhibitor

B.Monoamine oxidase inhibitor

C.Tricyclic antidepressant

D.Serotonin-noradrenaline reuptake inhibitor

Explanation: Non-selective monoamine oxidase inhibitors prevent breakdown of dietary tyramine, allowing it to act as an indirect sympathomimetic that releases stored noradrenaline and causes a hypertensive crisis (the cheese reaction). Patients on MAOIs must avoid tyramine-rich foods.

9In a study evaluating a new troponin assay for diagnosing myocardial infarction, the test correctly identifies 90 of 100 patients who truly have MI and gives a negative result in 270 of 300 patients without MI. What is the sensitivity of the test?

A.98%

B.75%

C.90%

D.30%

Explanation: Sensitivity is the proportion of those with the disease who test positive: true positives divided by (true positives + false negatives) = 90/100 = 90%. It measures the test's ability to detect disease when it is present.

10A randomised controlled trial reports that a new drug reduces the absolute risk of stroke from 8% to 4% over 5 years. What is the number needed to treat (NNT) to prevent one stroke?

A.4

B.12

C.25

D.50

Explanation: The absolute risk reduction is 8% minus 4% = 4%, or 0.04. The number needed to treat is the reciprocal of the absolute risk reduction: 1/0.04 = 25. Thus 25 patients must be treated for 5 years to prevent one additional stroke.

About the MRCP(UK) Part 1 Exam

MRCP(UK) Part 1 is the first written component of the Membership of the Royal Colleges of Physicians examination, comprising 200 best-of-five MCQs over two 3-hour papers. It tests basic and clinical sciences alongside core internal medicine mapped to the UK Internal Medicine Training curriculum, and is the gateway to MRCP(UK) Part 2 and PACES.

Exam sponsor: Federation of the Royal Colleges of Physicians of the UK (RCP London, RCP Edinburgh, RCPS Glasgow). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Two 3-hour papers, each with 100 best-of-five (single best answer) MCQs, taken on the same day. No images are used and there is no negative marking.

Time Limit

Two 3-hour papers (6 hours total) on the same day.

Passing Score

Pass mark is a scaled ability score of 450 (scale runs from about 200 to 800), applied from the 2026/1 diet and set by Item Response Theory equating rather than a fixed percentage.

Exam / Certification Fees

GBP 520 (UK) and GBP 696 (international) from the 2026/3 diet in September 2026 onward; the 2026/1 and 2026/2 diets cost GBP 502 (UK) and GBP 672 (international).

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

12.5%

Clinical sciences

Approximately 25 of the 200 questions. Cell, molecular and membrane biology (2), clinical anatomy (3), clinical biochemistry and metabolism (4), clinical physiology (4), genetics (3), immunology (4) and statistics, epidemiology and evidence-based medicine (5).

7.5%

Clinical Pharmacology and Therapeutics

Approximately 15 of the 200 questions. Pharmacokinetics, pharmacodynamics, cytochrome P450 interactions, adverse drug reactions, therapeutic drug monitoring and the management of poisoning.

Cardiology

Approximately 14 of the 200 questions. Acute coronary syndromes, heart failure, arrhythmias, valvular and pericardial disease, cardiomyopathy and ECG interpretation.

Endocrinology, diabetes and metabolic medicine

Approximately 14 of the 200 questions. Diabetes and its emergencies, thyroid disease, pituitary and adrenal disorders, calcium homeostasis and metabolic bone disease.

Gastroenterology and Hepatology

Approximately 14 of the 200 questions. Peptic ulcer disease, coeliac and inflammatory bowel disease, gastrointestinal bleeding, viral and autoimmune liver disease and complications of cirrhosis.

Infectious diseases

Approximately 14 of the 200 questions. Sepsis and meningitis, HIV and opportunistic infection, tuberculosis, malaria, imported fevers and antimicrobial therapy.

Neurology

Approximately 14 of the 200 questions. Stroke and TIA, headache disorders, demyelination, epilepsy, movement disorders and neuromuscular disease.

Renal medicine

Approximately 14 of the 200 questions. Acute kidney injury, glomerulonephritis, tubulointerstitial and inherited renal disease, electrolyte disorders and acid-base balance.

Respiratory medicine

Approximately 14 of the 200 questions. Asthma and COPD, interstitial lung disease, pneumonia, pulmonary embolism, pleural disease and respiratory failure.

Rheumatology

Approximately 14 of the 200 questions. Rheumatoid arthritis, spondyloarthropathies, connective-tissue disease, systemic vasculitis, crystal arthropathy and DMARD monitoring.

Haematology

Approximately 10 of the 200 questions. Anaemias and haemoglobinopathies, leukaemias, lymphomas, plasma cell dyscrasias, coagulation disorders and transfusion medicine.

4.5%

Psychiatry

Approximately 9 of the 200 questions. Mood and psychotic disorders in medical patients, psychopharmacology, serotonin syndrome, substance misuse and the Mental Capacity Act.

Dermatology

Approximately 8 of the 200 questions. Psoriasis and eczema, immunobullous disease, severe cutaneous adverse reactions and skin malignancy.

Geriatric medicine

Approximately 8 of the 200 questions. Comprehensive geriatric assessment, frailty, delirium, falls, polypharmacy and pressure ulcers.

2.5%

Oncology

Approximately 5 of the 200 questions. Neutropenic sepsis, metastatic spinal cord compression, superior vena cava obstruction, malignant hypercalcaemia and tumour lysis syndrome.

Medical ophthalmology

Approximately 4 of the 200 questions. The acute red eye, sudden painless visual loss and retinopathy in systemic disease.

Palliative medicine and end of life care

Approximately 4 of the 200 questions. The WHO analgesic ladder, strong opioid titration and conversion, syringe drivers and terminal symptom control.

Preparing for the MRCP(UK) Part 1 Exam

What You Need to Know

Passing score: Pass mark is a scaled ability score of 450 (scale runs from about 200 to 800), applied from the 2026/1 diet and set by Item Response Theory equating rather than a fixed percentage.
Assessment: Two 3-hour papers, each with 100 best-of-five (single best answer) MCQs, taken on the same day. No images are used and there is no negative marking.
Time limit: Two 3-hour papers (6 hours total) on the same day.
Exam / certification fees: GBP 520 (UK) and GBP 696 (international) from the 2026/3 diet in September 2026 onward; the 2026/1 and 2026/2 diets cost GBP 502 (UK) and GBP 672 (international). Official sources

Using Our Practice Resources

Work through all 125 available questions
Review every answer and explanation
Track weak areas and revisit them
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MRCP(UK) Part 1: Suggested Study Strategy

1Prioritise by blueprint weight: clinical sciences (25 questions) plus clinical pharmacology and therapeutics (15) are worth 40 marks, more than any single specialty.

2Practise under strict timing of roughly 1.8 minutes per question, because 200 best-of-five questions across two 3-hour papers makes pacing a common reason for under-performance.

3Anchor revision in current UK sources such as NICE guidance and the BNF, since the Federation states that knowledge of UK national guidelines is required.

Frequently Asked Questions

How many questions are on MRCP(UK) Part 1 and how is the exam structured?

The MRCP(UK) Part 1 examination consists of 200 best-of-five (single best answer) multiple-choice questions administered across two 3-hour papers on the same day, with 100 questions per paper. No images are used, each correct answer scores one mark, and there is no negative marking.

What is the pass mark for MRCP(UK) Part 1?

There is no fixed percentage pass mark. The Federation converts raw marks into an overall scaled score, usually between 200 and 800, using Item Response Theory equating. The scaled pass mark applied from the 2026/1 diet is 450, reduced from the previous standard of 540.

How much does the MRCP(UK) Part 1 exam cost in 2026?

From the 2026/3 diet in September 2026 the Federation entry fee is GBP 520 for candidates sitting in the United Kingdom and GBP 696 for candidates sitting internationally. The earlier 2026/1 and 2026/2 diets cost GBP 502 and GBP 672 respectively.

Who is eligible to sit the MRCP(UK) Part 1 exam?

The exam is open to doctors with a minimum of 12 months' postgraduate experience in medical employment. First-time applicants must email evidence of their primary medical qualification to the Federation, although candidates holding UK GMC provisional or full registration only need to supply their GMC registration number.

What is the maximum number of attempts permitted for MRCP(UK) Part 1?

The General Medical Council requires colleges to cap attempts, and the Federation allows a maximum of six attempts at each part of the MRCP(UK) Diploma. Candidates who reach six attempts may apply for one exceptional seventh attempt based on additional educational attainment, signed off by their educational supervisor and training programme director and approved by the MRCP(UK) Regulatory Sub-Group. Withdrawals do not count as attempts.