100+ Free MRCP(UK) Part 1 Practice Questions

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A microbiologist explains that a particular antibiotic works by inhibiting bacterial cell-wall synthesis. Which of the following antibiotics shares this mechanism?

Ciprofloxacin

Gentamicin

Clarithromycin

Vancomycin

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Sample MRCP(UK) Part 1 Practice Questions

Try these sample questions to test your MRCP(UK) Part 1 exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ 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 constant amount of drug is eliminated per unit time regardless of concentration

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, raising thrombosis risk

B.Rifampicin and the pill have no clinically relevant interaction

C.She should double the contraceptive dose while on rifampicin

D.Rifampicin reduces contraceptive efficacy by inducing hepatic enzymes

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.

Assessment

Two 3-hour papers, each with 100 best-of-five (single best answer) MCQs, taken on the same day. No negative marking.

Time Limit

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

Passing Score

Scaled pass mark set by test equating; recent diets require a scaled score above 540 (range approximately 200-800), not a fixed percentage.

Exam Fee

GBP 502 (UK) and GBP 672 (international) for the 2026 diets, as set by the Federation. (Federation of the Royal Colleges of Physicians of the UK (RCP London, RCPE, RCPSG))

MRCP(UK) Part 1 Exam Content Outline

12%

Clinical sciences

Cell and molecular biology, anatomy, physiology, biochemistry, genetics, immunology, statistics and evidence-based medicine.

Cardiology

Acute coronary syndromes, heart failure, arrhythmias, valvular and structural heart disease and ECG interpretation.

Clinical pharmacology, therapeutics and toxicology

Pharmacokinetics, drug mechanisms, interactions, adverse effects and management of poisoning.

Respiratory medicine

COPD, asthma, interstitial lung disease, pleural disease, sarcoidosis and respiratory failure.

Gastroenterology and hepatology

Peptic ulcer disease, malabsorption, inflammatory bowel disease, liver disease and complications of cirrhosis.

Endocrinology and diabetes

Thyroid, adrenal and pituitary disorders, diabetes and its acute complications and calcium homeostasis.

Renal medicine

Acute kidney injury, glomerular disease, electrolyte and acid-base disorders and inherited renal disease.

Neurology

Stroke, headache disorders, demyelination, movement and neuromuscular disorders and neurological emergencies.

Rheumatology

Inflammatory and crystal arthritis, connective-tissue disease, vasculitis and immunosuppressant monitoring.

Infectious diseases and tropical medicine

Sepsis, HIV, tuberculosis, malaria, endocarditis and antimicrobial pharmacology.

Haematology

Anaemias, leukaemias and lymphomas, myeloproliferative disorders, coagulation and bleeding disorders.

Psychiatry

Mood and psychotic disorders, psychiatric emergencies and substance misuse.

Dermatology

Inflammatory skin disease, skin malignancy and immunobullous and drug-induced eruptions.

Geriatric medicine

Delirium, falls, frailty, comprehensive geriatric assessment and safe prescribing in older people.

Oncology and palliative medicine

Oncological emergencies, metabolic complications of cancer and end-of-life symptom control.

Ophthalmology

Acute red eye, glaucoma and diabetic eye disease relevant to general medicine.

How to Pass the MRCP(UK) Part 1 Exam

What You Need to Know

Passing score: Scaled pass mark set by test equating; recent diets require a scaled score above 540 (range approximately 200-800), not a fixed percentage.
Assessment: Two 3-hour papers, each with 100 best-of-five (single best answer) MCQs, taken on the same day. No negative marking.
Time limit: Two 3-hour papers (6 hours total) on the same day.
Exam fee: GBP 502 (UK) and GBP 672 (international) for the 2026 diets, as set by the Federation.

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) Part 1 Study Tips from Top Performers

1Prioritise the high-yield blocks first: clinical sciences plus pharmacology, then cardiology, respiratory, gastroenterology, neurology, endocrinology and renal medicine, which together carry most of the marks.

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

3Anchor your revision in current UK sources such as NICE guidance and the BNF, since the exam expects knowledge of UK national guidelines alongside core pathophysiology.

Frequently Asked Questions

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

The exam has 200 best-of-five (single best answer) multiple-choice questions divided into two papers of 100 questions each. Each paper lasts 3 hours and both are sat on the same day, giving six hours of testing with no negative marking.

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

There is no fixed percentage pass mark. The Federation uses statistical equating to set a scaled pass mark; in recent diets candidates have needed a scaled score above 540 on a scale that typically runs from about 200 to 800.

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

For the 2026 diets the Federation fee is GBP 502 for candidates sitting in the UK and GBP 672 for those sitting internationally.

What does MRCP(UK) Part 1 cover?

It tests basic and clinical sciences together with core internal medicine, mapped to the UK Internal Medicine Training curriculum, with the single largest block being clinical sciences and pharmacology and the highest-yield specialties being cardiology, respiratory, gastroenterology, neurology, endocrinology and renal medicine.