100+ Free MRCPCH FOP Practice Questions

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A 2-year-old presents with a 24-hour history of fever, dysuria, foul-smelling urine and irritability. A clean-catch urine sample is positive for nitrites and leucocytes on dipstick. According to NICE, what is the most appropriate next step in a child of this age?

Reassure without treatment

Send urine for culture and start antibiotics

Treat with antibiotics without any culture in all children under 3

Arrange immediate renal biopsy

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Sample MRCPCH FOP Practice Questions

Try these sample questions to test your MRCPCH FOP exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 2-year-old presents in winter with a barking cough, inspiratory stridor at rest, and a hoarse voice. He is alert with mild subcostal recession and no drooling. Temperature is 37.9C. What is the most appropriate first-line treatment?

A.Oral dexamethasone 0.15 mg/kg

B.Nebulised adrenaline (epinephrine)

C.Intravenous ceftriaxone

D.Inhaled salbutamol via spacer

Explanation: This is classic viral croup (laryngotracheobronchitis). A single dose of oral dexamethasone (0.15 mg/kg) is first-line for all severities including mild croup, reducing the need for re-attendance and reducing symptom duration.

2A 6-month-old infant has a 3-day history of coryza followed by cough, wheeze and feeding difficulty. Examination shows fine bibasal crepitations and widespread wheeze, respiratory rate 60, SpO2 93% in air. What is the most appropriate management according to NICE guidance?

A.Nebulised hypertonic saline

B.Supportive care with feeding and oxygen support as needed

C.Oral prednisolone

D.Nebulised ipratropium bromide

Explanation: This is bronchiolitis, most commonly RSV. NICE recommends supportive management only: ensure adequate hydration/feeding, give supplemental oxygen if SpO2 persistently falls below 90-92%, and observe. No specific drug therapy alters the disease course.

3A 5-year-old with known asthma presents with an acute attack. He is too breathless to complete sentences, respiratory rate 40, heart rate 150, SpO2 91% in air, and PEF is 45% of predicted. Which single feature most strongly indicates this is a SEVERE rather than moderate exacerbation?

A.SpO2 91% in air

B.Heart rate 150

C.Inability to complete sentences in one breath

D.Cough on exertion

Explanation: In UK/BTS-SIGN paediatric asthma classification for a child over 5, a severe exacerbation includes SpO2 below 92%, PEF 33-50% predicted, too breathless to talk or feed, heart rate over 125, and respiratory rate over 30. Inability to complete sentences is a defining severe-attack feature here.

4A newborn is found on heel-prick screening to have a raised immunoreactive trypsinogen, and a sweat test shows a chloride concentration of 75 mmol/L. Genetic testing confirms two CFTR mutations. Which organism is the most common cause of early respiratory infection in young children with this condition?

A.Pseudomonas aeruginosa

B.Aspergillus fumigatus

C.Burkholderia cepacia complex

D.Staphylococcus aureus

Explanation: This child has cystic fibrosis (sweat chloride above 60 mmol/L plus two CFTR mutations). In the first years of life Staphylococcus aureus is the most common respiratory pathogen; Pseudomonas tends to colonise later and worsens prognosis.

5A 3-year-old presents with sudden-onset cough and unilateral wheeze after eating peanuts at a party. Chest examination reveals reduced air entry on the right with localised monophonic wheeze, and the child is otherwise stable. What is the most appropriate next investigation?

A.Chest X-ray

B.Immediate rigid bronchoscopy

C.Trial of inhaled bronchodilator

D.D-dimer

Explanation: A foreign-body aspiration is likely. In a stable child, a chest X-ray (including expiratory or lateral decubitus films) can show air trapping/hyperinflation on the affected side. Bronchoscopy is then arranged for removal if aspiration is confirmed or strongly suspected.

6A 7-year-old has recurrent nocturnal cough, exercise-induced wheeze and a personal history of eczema. Spirometry shows an obstructive pattern with significant reversibility after bronchodilator. According to NICE/BTS-SIGN, what is the recommended first-line maintenance therapy for paediatric asthma?

A.Regular inhaled long-acting beta-agonist alone

B.Low-dose inhaled corticosteroid

C.Oral montelukast as monotherapy

D.Regular oral prednisolone

Explanation: A low-dose inhaled corticosteroid is the cornerstone first-line preventer (maintenance) therapy for childhood asthma needing regular treatment, reducing airway inflammation and exacerbations.

7A 4-year-old has a 5-day history of fever, sore throat and difficulty swallowing. He is sitting forward, drooling, with a muffled voice and soft inspiratory stridor; he looks toxic. He is unimmunised. What is the most appropriate immediate action?

A.Examine the throat with a tongue depressor

B.Give nebulised salbutamol

C.Keep the child calm and arrange urgent senior anaesthetic and ENT input

D.Take a throat swab and start oral antibiotics

Explanation: This is acute epiglottitis (more likely in an unimmunised child due to Haemophilus influenzae type b). The priority is to avoid distressing the child, keep them upright, and summon senior anaesthetic and ENT teams for controlled airway management; intubation may be needed.

8A 3-year-old has a 2-week history of recurrent right-sided ear discharge and pulling at the ear, with intermittent fever. Otoscopy shows a perforated tympanic membrane with purulent discharge. There is no mastoid tenderness or swelling. What is the most appropriate first-line antibiotic?

A.Topical ciprofloxacin only

B.Oral flucloxacillin

C.Intravenous ceftriaxone

D.Oral amoxicillin

Explanation: This is acute otitis media with perforation. Oral amoxicillin is the recommended first-line antibiotic in the UK for acute otitis media when antibiotics are indicated, covering the common pathogens including Streptococcus pneumoniae and Haemophilus influenzae.

9A 10-month-old presents with fever, tachypnoea and focal crackles at the right base, with SpO2 96% in air, feeding adequately. A diagnosis of community-acquired pneumonia is made. What is the most appropriate first-line oral antibiotic in the UK?

A.Amoxicillin

B.Erythromycin

C.Co-trimoxazole

D.Ciprofloxacin

Explanation: Amoxicillin is first-line oral therapy for community-acquired pneumonia in children because Streptococcus pneumoniae is the most common bacterial cause. A macrolide may be added if atypical infection (e.g. Mycoplasma) is suspected, typically in older children.

10A 6-week-old infant presents with paroxysms of coughing followed by an inspiratory whoop and post-tussive vomiting. The mother had a persistent cough recently. A pernasal swab confirms Bordetella pertussis. Which antibiotic is most appropriate?

A.Amoxicillin

B.Azithromycin

C.Doxycycline

D.Cefalexin

Explanation: A macrolide such as azithromycin (or clarithromycin/erythromycin) is the treatment of choice for pertussis, eradicating nasopharyngeal carriage and reducing transmission, especially important in young infants at risk of apnoea.

About the MRCPCH FOP Exam

Foundation of Practice (FOP) is one of three MRCPCH theory exams and also forms the theory component of the Diploma of Child Health (DCH). Since September 2024 it consists of 100 SBA best-of-five questions sat over 2 hours, testing core paediatric knowledge and clinical decision-making at the level of a doctor entering core specialist training.

Assessment

100 single best answer (SBA), best-of-five questions delivered by computer; no negative marking.

Time Limit

2 hours

Passing Score

Pass mark is set per diet using the Modified Angoff method; RCPCH does not publish a fixed percentage cut score.

Exam Fee

GBP 365 (UK) / GBP 455 (international) for 2026 (RCPCH). (Royal College of Paediatrics and Child Health (RCPCH))

MRCPCH FOP Exam Content Outline

20-80%

Respiratory/ENT, Gastroenterology & Hepatology, Infection/Immunology/Allergy

The highest-weighted blueprint group covering common acute and chronic paediatric respiratory, ENT, gastrointestinal, hepatobiliary, surgical-abdominal, infectious, immunological and allergic conditions.

10-50%

Neonatology, Emergency, Endocrine & Growth, Diabetes, Haem/Onc, Neurodisability, Nephrology, Dermatology, MSK, Nutrition, Pharmacology

Mid-weighted clinical and applied areas including newborn medicine, paediatric emergencies and resuscitation, endocrine and growth disorders, childhood cancers, renal disease, skin and joint disorders, nutrition and safe prescribing.

5-30%

Cardiology, Neurology, Safeguarding, Genetics, Ethics & Law, Behavioural, Adolescent, Metabolism, Ophthalmology, Palliative Care, Patient Safety, Science of Practice

Smaller-weighted blueprint areas spanning congenital and acquired heart disease, neurology, child protection, genetics and dysmorphology, medical ethics and consent, mental health, metabolic disease and evidence-based practice.

How to Pass the MRCPCH FOP Exam

What You Need to Know

Passing score: Pass mark is set per diet using the Modified Angoff method; RCPCH does not publish a fixed percentage cut score.
Assessment: 100 single best answer (SBA), best-of-five questions delivered by computer; no negative marking.
Time limit: 2 hours
Exam fee: GBP 365 (UK) / GBP 455 (international) for 2026 (RCPCH).

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

MRCPCH FOP Study Tips from Top Performers

1Weight your revision toward the largest blueprint group (respiratory/ENT, gastroenterology and infection), which can make up a substantial share of the paper, while still covering smaller areas like ethics, safeguarding and statistics.

2Study UK clinical standards: NICE paediatric guidelines, the BNF for Children for doses, and the UK immunisation schedule (Green Book), as international candidates often lose marks on UK-specific management.

3Practise timed SBAs at roughly 1.2 minutes per question to build exam pace, and review every explanation, since there is no negative marking and pattern recognition of common presentations is heavily rewarded.

Frequently Asked Questions

How many questions are in the MRCPCH FOP exam and how long is it?

Since September 2024 the FOP exam contains 100 single best answer (best-of-five) questions and lasts 2 hours. There is no negative marking, so candidates should attempt every question.

How much does the MRCPCH FOP exam cost in 2026?

For 2026 the RCPCH fee is GBP 365 for UK candidates and GBP 455 for international candidates. The exam is offered three times a year, usually in February, June and October.

What is the pass mark for the FOP exam?

RCPCH does not publish a fixed percentage pass mark. The standard is set for each diet using the Modified Angoff method, so the cut score can vary slightly between sittings.

How is the FOP exam delivered?

The theory exams have been delivered on the TestReach platform since 2025 and can be sat at a test centre or via remote invigilation. Drugs are referred to by UK-approved names and measurements use SI units.