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100+ Free MRCPCH Clinical Practice Questions
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You must explain inhaler technique to a parent and child in a Communication station. Which technique best confirms effective teaching?
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Sample MRCPCH Clinical Practice Questions
Try these sample questions to test your MRCPCH Clinical exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1In a Cardiovascular station you palpate a 4-year-old and find the apex beat in the 6th intercostal space, lateral to the mid-clavicular line, with a heave at the left sternal edge. Which interpretation should you offer the examiner?
A.A normal apex position for this age with no haemodynamic significance
B.Cardiomegaly with a displaced apex and a right ventricular heave suggesting volume/pressure load
C.Dextrocardia, since the heave indicates a mirror-image heart
D.Pectus excavatum causing apparent displacement only
Explanation: A laterally and inferiorly displaced apex beat indicates cardiomegaly (usually left ventricular dilatation), and a left parasternal heave reflects right ventricular hypertrophy or volume overload. Describing the location precisely and interpreting it as cardiomegaly with RV load is exactly the structured commentary examiners reward in the D domain (clinical reasoning).
2During the Cardiovascular station you hear a continuous 'machinery' murmur loudest at the left infraclavicular region in a 2-year-old ex-premature child. What is the most likely diagnosis to present to the examiner?
A.Innocent venous hum
B.Ventricular septal defect
C.Aortic stenosis
D.Patent ductus arteriosus
Explanation: A continuous machinery murmur heard best in the left infraclavicular/upper left sternal border area is the classic sign of a patent ductus arteriosus, which is more common in children born prematurely. Recognising and naming the sign, then linking it to the relevant risk factor, demonstrates the integration of examination and reasoning the station tests.
3You are asked to examine the cardiovascular system of a 5-year-old. Which feature would most strongly distinguish an INNOCENT murmur from a pathological one in your presentation?
A.A soft, short systolic murmur that varies with posture, with normal pulses and no thrill
B.A pansystolic murmur radiating to the axilla
C.A loud (grade 4) murmur associated with a palpable thrill
D.A diastolic murmur at the apex
Explanation: Innocent murmurs are typically soft, systolic, short, positionally variable, asymptomatic and accompanied by normal pulses, normal heart sounds and no thrill. Demonstrating that you actively screen for the reassuring 'S' features (Soft, Systolic, aSymptomatic, left Sternal edge, no added Sounds) is the safe, examiner-pleasing approach.
4A child in the Cardiovascular station has a midline sternotomy scar, central cyanosis and clubbing. The most appropriate next statement to the examiner is that these findings are most consistent with which group of conditions?
A.Repaired innocent murmur
B.Acyanotic left-to-right shunt
C.Previously palliated/repaired cyanotic congenital heart disease such as tetralogy of Fallot
D.Kawasaki disease in the acute phase
Explanation: Central cyanosis plus clubbing plus a sternotomy scar points to cyanotic congenital heart disease that has undergone cardiac surgery, with tetralogy of Fallot being the commonest example seen in MRCPCH stations. Synthesising the scar and the cyanosis into a coherent unifying diagnosis is precisely the higher-order reasoning examiners look for.
5When examining pulses in the Cardiovascular station, you find the femoral pulses are weak and delayed compared with the right brachial (radio-femoral delay). What is the most important diagnosis this finding raises?
A.Patent ductus arteriosus
B.Atrial septal defect
C.Mitral stenosis
D.Coarctation of the aorta
Explanation: Radio-femoral delay with diminished femoral pulses is the cardinal sign of coarctation of the aorta and should prompt a four-limb blood pressure check. Demonstrating that you palpate the femoral pulses and compare them with the brachial pulse is a deliberate routine examiners expect.
6In the Cardiovascular station, what is the correct sequence in which to conduct your examination to satisfy the examiner's expectation of a structured approach?
A.Auscultate first, then inspect, then palpate
B.General inspection and observations, then palpation (pulses, precordium), then auscultation, then complete with peripheral signs
C.Measure blood pressure only, then auscultate
D.Palpate the liver first, then the precordium
Explanation: The recognised paediatric cardiovascular routine is inspection (including from the end of the bed and observations), palpation of pulses and the precordium, auscultation, then completion (hepatomegaly, oedema, sats, blood pressure). Following inspection-palpation-auscultation-completion shows the systematic technique that the B (physical examination) domain rewards.
7A 6-year-old in the Cardiovascular station has an ejection systolic murmur at the upper right sternal edge radiating to the neck, with a slow-rising carotid pulse. What is the most likely diagnosis?
A.Pulmonary stenosis
B.Ventricular septal defect
C.Atrial septal defect
D.Aortic stenosis
Explanation: An ejection systolic murmur at the upper right sternal edge radiating to the carotids, with a slow-rising (plateau) pulse, is characteristic of aortic stenosis. Linking the murmur location, radiation and pulse character together gives a confident, well-reasoned diagnosis.
8You complete a cardiovascular examination and wish to check for signs of heart failure in an infant. Which sign is MOST specific for heart failure in a baby?
A.Hepatomegaly with tachypnoea and poor feeding/sweating
B.A single palmar crease
C.Epicanthic folds
D.A capillary refill of 1 second
Explanation: In infants, heart failure presents with hepatomegaly, tachypnoea, tachycardia, poor feeding and sweating on feeds rather than the classical adult picture. Demonstrating that you look for hepatomegaly and a feeding history shows you understand age-appropriate signs.
9A child has fixed splitting of the second heart sound and an ejection systolic murmur at the upper left sternal edge. Which lesion does this combination most strongly suggest?
A.Patent ductus arteriosus
B.Coarctation of the aorta
C.Atrial septal defect
D.Hypertrophic cardiomyopathy
Explanation: Wide, fixed splitting of S2 with a pulmonary outflow (ejection systolic) murmur at the upper left sternal edge is the classic combination for an atrial septal defect, caused by increased right-heart flow. Identifying the fixed split as the key sign distinguishes ASD from other left-to-right shunts.
10The examiner asks how you would conclude a cardiovascular examination station to demonstrate completeness. Which is the best closing statement?
A.State you have finished and stand back silently
B.Offer to check oxygen saturations, blood pressure in all four limbs, plot growth, and look for hepatomegaly and oedema
C.Immediately request an echocardiogram before presenting findings
D.Ask the parent to leave so you can think
Explanation: A polished completion explicitly offers the additional manoeuvres you have not yet performed: saturations, four-limb blood pressure, growth plotting, hepatomegaly and peripheral oedema. Verbalising these to the examiner secures marks in the completion component without needing to perform every step.
About the MRCPCH Clinical Practice Questions
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