100+ Free MRCP(UK) Part 2 Written Practice Questions

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A 55-year-old woman presents with an irregularly pigmented lesion on her back measuring 9 mm with asymmetry, colour variation and recent change in size. What is the most appropriate next step?

Topical corticosteroid

Urgent excision biopsy

Reassure and review in 6 months

Cryotherapy

to track

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MRCP(UK) PACES (Practical Assessment of Clinical Examination Skills)

Practice Questions100 questions

MRCP(UK) Part 1

Practice Questions100 questions

Sample MRCP(UK) Part 2 Written Practice Questions

Try these sample questions to test your MRCP(UK) Part 2 Written 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 presents with central crushing chest pain for 40 minutes. His ECG shows 2 mm ST elevation in leads II, III and aVF with reciprocal depression in I and aVL. His blood pressure is 88/54 mmHg and his JVP is raised. What is the single most appropriate immediate management priority?

A.Primary percutaneous coronary intervention

B.Intravenous furosemide 80 mg

C.Glyceryl trinitrate infusion

D.Intravenous beta-blocker

Explanation: This is an inferior STEMI with hypotension and a raised JVP, suggesting right ventricular involvement. The definitive treatment for STEMI within the recommended window is primary PCI to restore coronary flow. Reperfusion is the priority and should not be delayed.

2A 24-year-old woman is found to have an early diastolic murmur best heard at the left sternal edge in expiration. She has collapsing pulse and wide pulse pressure. Echocardiography confirms severe aortic regurgitation with a dilated aortic root. Which underlying condition is most likely?

A.Rheumatic heart disease

B.Infective endocarditis

C.Bicuspid aortic valve calcification

D.Marfan syndrome

Explanation: In a young patient with severe aortic regurgitation due to aortic root dilatation, Marfan syndrome is the most likely cause. Connective tissue disease causes aortic root dilation that disrupts valve coaptation, producing chronic AR. The collapsing pulse and wide pulse pressure are classic peripheral signs.

3A 72-year-old man with chronic heart failure (LVEF 28%) remains symptomatic (NYHA II) despite optimal doses of ramipril, bisoprolol and spironolactone. He is in sinus rhythm at 78 bpm. According to NICE/ESC guidance, which change is most likely to reduce mortality and hospitalisation?

A.Add digoxin

B.Add ivabradine

C.Add amlodipine

D.Switch ramipril to sacubitril-valsartan

Explanation: In HFrEF patients who remain symptomatic on an ACE inhibitor, beta-blocker and MRA, switching the ACE inhibitor to sacubitril-valsartan (an ARNI) reduces cardiovascular death and heart failure hospitalisation, as shown in the PARADIGM-HF trial. The ACE inhibitor must be stopped 36 hours before starting to avoid angioedema.

4A 55-year-old man presents with palpitations. ECG shows a regular narrow-complex tachycardia at 180 bpm with no clearly visible P waves. Carotid sinus massage transiently slows then terminates the rhythm. What is the most likely diagnosis?

A.Atrial fibrillation

B.Sinus tachycardia

C.Ventricular tachycardia

D.Atrioventricular nodal re-entrant tachycardia

Explanation: A regular narrow-complex tachycardia that terminates with vagal manoeuvres is characteristic of AVNRT, a re-entrant circuit involving the AV node. Vagal manoeuvres or adenosine block AV nodal conduction and break the circuit. P waves are often buried within or just after the QRS.

5A 60-year-old woman with non-valvular atrial fibrillation has a CHA2DS2-VASc score of 4 and a HAS-BLED score of 2. She has normal renal function. Which is the most appropriate antithrombotic strategy?

A.Aspirin 75 mg daily

B.Clopidogrel plus aspirin

C.No antithrombotic therapy

D.A direct oral anticoagulant such as apixaban

Explanation: With a CHA2DS2-VASc score of 4, the annual stroke risk is high and oral anticoagulation is indicated. NICE recommends a DOAC such as apixaban in preference to warfarin for non-valvular AF. The moderate HAS-BLED score warrants attention to modifiable bleeding factors but does not contraindicate anticoagulation.

6A 45-year-old man collapses while playing football. He has a family history of sudden cardiac death. His ECG shows deep narrow Q waves, tall R waves in lateral leads and voltage criteria for left ventricular hypertrophy. Echocardiography shows asymmetric septal hypertrophy with systolic anterior motion of the mitral valve. What is the diagnosis?

A.Dilated cardiomyopathy

B.Cardiac amyloidosis

C.Hypertensive heart disease

D.Hypertrophic cardiomyopathy

Explanation: Asymmetric septal hypertrophy with systolic anterior motion of the mitral valve, a family history of sudden death and exertional collapse are classic for hypertrophic cardiomyopathy. It is the commonest cause of sudden cardiac death in young athletes. Dynamic left ventricular outflow tract obstruction underlies the haemodynamic effects.

7A 30-year-old intravenous drug user presents with fever and a new pansystolic murmur at the lower left sternal edge, louder on inspiration. Blood cultures grow Staphylococcus aureus. Which valve is most likely affected?

A.Aortic valve

B.Mitral valve

C.Tricuspid valve

D.Pulmonary valve

Explanation: Right-sided endocarditis in intravenous drug users most commonly affects the tricuspid valve, as injected organisms reach the right heart first. The murmur of tricuspid regurgitation is pansystolic at the lower left sternal edge and increases on inspiration (Carvallo sign). Septic pulmonary emboli are a typical complication.

8A 70-year-old man with exertional syncope has an ejection systolic murmur radiating to the carotids, a slow-rising pulse and a soft second heart sound. Echocardiography shows a peak aortic valve gradient of 70 mmHg and a valve area of 0.7 cm2. What is the most appropriate management?

A.Aortic valve replacement

B.Balloon aortic valvuloplasty

C.Medical therapy with a beta-blocker

D.Annual echocardiographic surveillance

Explanation: This is severe symptomatic aortic stenosis (valve area below 1 cm2, peak gradient above 40 mmHg, with syncope). Symptomatic severe aortic stenosis carries a poor prognosis without intervention, and aortic valve replacement (surgical or transcatheter) is the definitive treatment. Intervention should not be delayed once symptoms develop.

9A 50-year-old man presents with sharp pleuritic chest pain relieved by sitting forward, two weeks after a viral illness. ECG shows widespread saddle-shaped ST elevation and PR depression. What is the most appropriate first-line treatment?

A.Ibuprofen plus colchicine

B.Intravenous heparin

C.Prednisolone

D.Urgent coronary angiography

Explanation: The presentation is acute pericarditis: pleuritic positional chest pain, widespread concave ST elevation and PR depression. First-line therapy is an NSAID such as ibuprofen combined with colchicine, which reduces recurrence. Corticosteroids are reserved for refractory or specific aetiologies because they increase recurrence risk.

10A 65-year-old woman presents with breathlessness. Examination shows a loud first heart sound, an opening snap and a rumbling mid-diastolic murmur at the apex in the left lateral position. She is in atrial fibrillation. What is the most likely valvular lesion?

A.Mitral regurgitation

B.Aortic stenosis

C.Tricuspid stenosis

D.Mitral stenosis

Explanation: A loud S1, opening snap and rumbling mid-diastolic apical murmur are the classic auscultatory features of mitral stenosis, usually rheumatic in origin. Left atrial enlargement predisposes to atrial fibrillation. The murmur is best heard at the apex with the patient in the left lateral decubitus position.

About the MRCP(UK) Part 2 Written Exam

The MRCP(UK) Part 2 (Written) is a two-paper, best-of-five multiple choice examination assessing the diagnosis, investigation, management and prognosis of acute and chronic medical conditions across internal medicine specialties. Each of the two 3-hour papers contains 100 questions, frequently based on clinical scenarios with investigation results and images. It is the written component candidates pass before progressing to the PACES clinical examination.

Assessment

Two papers, each containing 100 best-of-five multiple choice questions (200 total), often illustrated with investigations and clinical images.

Time Limit

Two papers of 3 hours each (6 hours in total).

Passing Score

Pass mark is standard-set using test equating, which adjusts for paper difficulty and the ability range of candidates; there is no fixed percentage and no negative marking.

Exam Fee

GBP 502 (UK) / GBP 672 (international) for sittings up to July 2026, rising to GBP 520 (UK) / GBP 696 (international) from the November 2026 sitting. (Federation of the Royal Colleges of Physicians of the UK)

MRCP(UK) Part 2 Written Exam Content Outline

10%

Cardiology

Acute coronary syndromes, heart failure, arrhythmias, valvular disease, endocarditis and cardiomyopathy.

10%

Endocrinology, diabetes and metabolic medicine

Thyroid, pituitary, adrenal and calcium disorders, diabetes management and diabetic emergencies.

10%

Gastroenterology and Hepatology

Inflammatory bowel disease, chronic liver disease, variceal bleeding, malabsorption and luminal GI disease.

10%

Infectious diseases

Sepsis, tropical and zoonotic infection, HIV-related disease, CNS infection and antimicrobial therapy.

Clinical Pharmacology and Therapeutics

Drug interactions, adverse drug reactions, poisoning, prescribing in special populations and drug monitoring.

Renal medicine

Acute kidney injury, glomerular disease, electrolyte emergencies, chronic kidney disease and inherited renal disease.

Respiratory medicine

Asthma, COPD, lung cancer, interstitial lung disease, pleural disease and pulmonary embolism.

Neurology

Stroke and TIA, demyelination, movement disorders, neuromuscular disease, headache and CNS tumours.

Dermatology

Immunobullous disease, skin malignancy, psoriasis and cutaneous markers of systemic disease.

Geriatric medicine

Falls, delirium, dementia subtypes, frailty, osteoporosis and polypharmacy.

Haematology

Anaemias, leukaemias and lymphomas, thrombophilia and coagulation disorders.

Rheumatology

Gout, systemic lupus erythematosus, vasculitis and spondyloarthropathy.

Oncology

Oncological emergencies such as spinal cord compression, tumour lysis syndrome and malignant hypercalcaemia.

Medical ophthalmology

Visual loss, retinal disease and ocular features of systemic disease.

Palliative medicine and end of life care

Cancer pain control, opioid titration and management in the last days of life.

Psychiatry

Substance misuse, psychotropic drug effects and overlap presentations relevant to physicians.

How to Pass the MRCP(UK) Part 2 Written Exam

What You Need to Know

Passing score: Pass mark is standard-set using test equating, which adjusts for paper difficulty and the ability range of candidates; there is no fixed percentage and no negative marking.
Assessment: Two papers, each containing 100 best-of-five multiple choice questions (200 total), often illustrated with investigations and clinical images.
Time limit: Two papers of 3 hours each (6 hours in total).
Exam fee: GBP 502 (UK) / GBP 672 (international) for sittings up to July 2026, rising to GBP 520 (UK) / GBP 696 (international) from the November 2026 sitting.

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 2 Written Study Tips from Top Performers

1Use the official blueprint to weight your revision: cardiology, endocrinology, gastroenterology and infectious diseases each carry around 10% of questions, so prioritise breadth across these high-yield specialties.

2Practise applied best-of-five questions with clinical vignettes, investigation results and images rather than pure recall, because the exam tests interpretation and clinical problem-solving.

3Anchor answers in current UK practice (NICE guidance and the BNF), as questions reflect UK diagnostic thresholds, first-line drugs and management pathways.

Frequently Asked Questions

How many questions are on the MRCP(UK) Part 2 Written exam?

The exam has 200 best-of-five multiple choice questions in total, split across two papers of 100 questions each. Each paper lasts 3 hours and there is no negative marking.

How is the MRCP(UK) Part 2 Written delivered in 2026?

It is computer-based and administered by Surpass. From the 2026/02 sitting it is delivered in-centre at UK and international test centres; the 2026/01 sitting and Myanmar/Sudan centres continued via Remote Online Proctoring.

What is the pass mark for MRCP(UK) Part 2 Written?

There is no fixed percentage. The pass mark is standard-set using test equating, which adjusts for the difficulty of each paper and the ability range of candidates, ensuring a consistent standard between sittings.

How much does the MRCP(UK) Part 2 Written exam cost?

The fee is GBP 502 for UK candidates and GBP 672 for international candidates for sittings up to July 2026, rising to GBP 520 (UK) and GBP 696 (international) from the November 2026 sitting.