100+ Free MRCPCH Clinical Practice Questions

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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 Exam

The MRCPCH Clinical examination is the final, practical component of the Membership of the Royal College of Paediatrics and Child Health, taken after passing the three theory exams (FOP, TAS and AKP). It is a 10-station OSCE assessing whether candidates have reached the clinical standard expected of a newly appointed Specialty Trainee 4 (ST4) in paediatrics.

Assessment

A 10-station OSCE circuit: clinical examination short cases (cardiovascular, respiratory, abdominal, neurological, musculoskeletal/other), child development, history-taking and management planning, two communication stations, and a video station.

Time Limit

Full circuit approximately 152-160 minutes; clinical examination and communication stations are 9 minutes, history-taking and video stations are 22 minutes, with 4-minute breaks between stations.

Passing Score

Candidates must achieve an examination score of 62 or higher out of a maximum 82 marks (RCPCH regulations).

Exam Fee

UK fee GBP 925 for 2026; overseas centre fees vary (approximately GBP 1,300 in Nepal to GBP 1,930 in Oman). (Royal College of Paediatrics and Child Health (RCPCH))

MRCPCH Clinical Exam Content Outline

52%

Clinical examination stations

Short-case examination of cardiovascular, respiratory, abdominal, neurological and musculoskeletal/other systems, with identification of signs and discussion of diagnosis and management.

14%

History taking and management planning

Focused history from a role-player, summary of key issues, prioritisation and formulation of a structured management plan in a 22-minute station.

14%

Video / acute paediatrics

Video scenarios, frequently acute paediatrics, testing recognition of clinical signs, diagnosis and management discussion with the examiner.

10%

Child development

Developmental assessment across gross motor, fine motor and vision, speech/language/hearing and social domains, with estimation of developmental age.

10%

Communication

Scenario-based stations on breaking news, consent, ethics, conflict and explanation to parents, children or colleagues.

How to Pass the MRCPCH Clinical Exam

What You Need to Know

Passing score: Candidates must achieve an examination score of 62 or higher out of a maximum 82 marks (RCPCH regulations).
Assessment: A 10-station OSCE circuit: clinical examination short cases (cardiovascular, respiratory, abdominal, neurological, musculoskeletal/other), child development, history-taking and management planning, two communication stations, and a video station.
Time limit: Full circuit approximately 152-160 minutes; clinical examination and communication stations are 9 minutes, history-taking and video stations are 22 minutes, with 4-minute breaks between stations.
Exam fee: UK fee GBP 925 for 2026; overseas centre fees vary (approximately GBP 1,300 in Nepal to GBP 1,930 in Oman).

Keys to Passing

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MRCPCH Clinical Study Tips from Top Performers

1Practise full timed circuits across all station types - clinical examination, history, development, communication and video - because the exam rewards fluent, structured technique under time pressure rather than rote recall.

2Rehearse each system examination (cardiovascular, respiratory, abdominal, neurological, pGALS musculoskeletal, development) with real or simulated children, finishing each with a clear summary, differential and management plan.

3Study the RCPCH anchor statements and mark domains (A1, A2, B, C, D1, D2, E1, E2, E3) so you know exactly what examiners reward in information gathering, examination, reasoning and communication.

Frequently Asked Questions

How many stations are in the MRCPCH Clinical exam and how long is it?

The MRCPCH Clinical is a 10-station OSCE. Clinical examination and communication stations last 9 minutes each, while the history-taking and video stations last 22 minutes each, with 4-minute breaks. The full circuit takes roughly 152-160 minutes.

What is the pass mark for the MRCPCH Clinical examination?

Candidates must achieve an examination score of 62 or higher. Marks come from 41 examiner-rated domains across the 10 stations, each scored 0, 1 or 2, giving a maximum total of 82 marks (RCPCH regulations).

How much does the MRCPCH Clinical exam cost in 2026?

For 2026 the UK fee is GBP 925. Overseas centre fees vary, for example approximately GBP 1,300 in Nepal, GBP 1,750 in India and GBP 1,930 in Oman, payable online to the RCPCH.

What standard does the MRCPCH Clinical exam assess?

It assesses whether candidates have reached the clinical skills standard expected of a newly appointed Specialty Trainee 4 (ST4) in paediatrics, and must be taken after passing the three theory exams (FOP, TAS and AKP).