100+ Free MRCPsych Paper A Practice Questions

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In Piaget's theory of cognitive development, a child who understands that the amount of liquid is unchanged when poured into a differently shaped container has achieved which concept?

Egocentrism

Object permanence

Conservation

Theory of mind

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Sample MRCPsych Paper A Practice Questions

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

1A researcher studying long-term potentiation (LTP) in the hippocampus removes magnesium from the extracellular medium and observes enhanced calcium influx at a particular glutamate receptor even at resting membrane potential. Which receptor is responsible for this magnesium-dependent, voltage-gated behaviour?

A.AMPA receptor

B.NMDA receptor

C.Kainate receptor

D.Metabotropic mGluR1 receptor

Explanation: The NMDA receptor is blocked by Mg2+ at resting potential; depolarisation (or removing Mg2+) relieves the block and permits Ca2+ influx, which is central to LTP and synaptic plasticity. This voltage- and ligand-dependence makes NMDA a coincidence detector.

2Which of the following is the primary degradative enzyme for dopamine in the synaptic cleft and is the target of selegiline?

A.Catechol-O-methyltransferase (COMT)

B.Dopamine beta-hydroxylase

C.Tyrosine hydroxylase

D.Monoamine oxidase B (MAO-B)

Explanation: Selegiline is a selective MAO-B inhibitor; MAO-B preferentially metabolises dopamine in the human brain. Inhibiting it raises synaptic dopamine, which is why selegiline is used as an adjunct in Parkinson's disease.

3A patient with Korsakoff syndrome shows profound anterograde amnesia. Damage to which paired structures, classically associated with thiamine deficiency, best accounts for this presentation?

A.Mammillary bodies and mediodorsal thalamic nuclei

B.Caudate nucleus and putamen

C.Substantia nigra and locus coeruleus

D.Superior colliculi and pulvinar

Explanation: Wernicke-Korsakoff syndrome from thiamine deficiency damages the mammillary bodies and mediodorsal/anterior thalamic nuclei, key nodes of the Papez circuit, producing dense anterograde amnesia and confabulation.

4Which neuroimaging technique relies on the differential magnetic properties of oxygenated versus deoxygenated haemoglobin to infer regional neural activity?

A.Positron emission tomography (PET)

B.Diffusion tensor imaging (DTI)

C.Blood-oxygen-level-dependent functional MRI (BOLD fMRI)

D.Single-photon emission computed tomography (SPECT)

Explanation: BOLD fMRI detects changes in the ratio of oxyhaemoglobin (diamagnetic) to deoxyhaemoglobin (paramagnetic), providing an indirect measure of neural activity through neurovascular coupling. It requires no radioactive tracer.

5A 70-year-old man develops a resting tremor, bradykinesia and rigidity. Post-mortem the substantia nigra pars compacta shows depigmentation and intracytoplasmic eosinophilic inclusions. These inclusions are principally composed of which protein?

A.Tau

B.Alpha-synuclein

C.Beta-amyloid

D.TDP-43

Explanation: Lewy bodies, the hallmark of Parkinson's disease and dementia with Lewy bodies, are composed predominantly of aggregated alpha-synuclein. Their presence in the nigra correlates with dopaminergic cell loss.

6Which of the following describes the action of GABA at the GABA-A receptor?

A.It opens a chloride-permeable ionotropic channel causing hyperpolarisation

B.It activates a Gs-coupled receptor increasing cAMP

C.It opens a sodium channel causing depolarisation

D.It activates a Gq-coupled receptor mobilising intracellular calcium

Explanation: The GABA-A receptor is a ligand-gated chloride ionotropic channel; chloride influx hyperpolarises the neuron and produces fast inhibition. Benzodiazepines and barbiturates are positive allosteric modulators at this receptor.

7A medical student is asked about the dopaminergic pathway whose dysfunction is most directly implicated in the hyperprolactinaemia caused by antipsychotics. Which pathway is this?

A.Mesolimbic pathway

B.Mesocortical pathway

C.Nigrostriatal pathway

D.Tuberoinfundibular pathway

Explanation: The tuberoinfundibular pathway runs from the hypothalamus to the pituitary, where dopamine tonically inhibits prolactin release. D2 blockade here removes that inhibition, raising prolactin and causing galactorrhoea and menstrual disturbance.

8Huntington's disease is caused by an expanded CAG trinucleotide repeat. Which mode of inheritance and phenomenon best characterises its transmission?

A.Autosomal recessive with variable penetrance

B.Autosomal dominant with anticipation

C.X-linked recessive with lyonisation

D.Mitochondrial inheritance

Explanation: Huntington's disease is autosomal dominant, caused by CAG expansion in the HTT gene on chromosome 4. Anticipation occurs because the repeat tends to expand across generations (especially paternal transmission), causing earlier, more severe disease.

9Which EEG finding is most characteristic of sporadic Creutzfeldt-Jakob disease?

A.Triphasic periodic sharp wave complexes

B.Three-per-second spike-and-wave discharges

C.Diffuse alpha rhythm slowing only

D.Hypsarrhythmia

Explanation: Sporadic CJD classically produces periodic triphasic sharp wave complexes at roughly 1 Hz, alongside rapidly progressive dementia and myoclonus. This is a supportive diagnostic feature.

10The serotonergic cell bodies that give rise to most ascending 5-HT projections in the brain are located in which region?

A.Locus coeruleus

B.Nucleus basalis of Meynert

C.Ventral tegmental area

D.Raphe nuclei

Explanation: The raphe nuclei of the brainstem contain the principal serotonergic cell bodies projecting widely to cortex and limbic structures. This explains why serotonergic modulation has such broad effects on mood, sleep and appetite.

About the MRCPsych Paper A Exam

MRCPsych Paper A is the first written examination of the Royal College of Psychiatrists, testing the scientific and theoretical basis of psychiatry. It comprises 150 MCQ and EMI questions over 3 hours across five syllabus areas, including basic neurosciences and clinical psychopharmacology.

Assessment

150 questions in 3 hours, approximately two-thirds best-of-five MCQs and one-third extended matching items (EMIs).

Time Limit

3 hours

Passing Score

Criterion-referenced pass mark set per sitting by modified Angoff standard setting; not a fixed percentage

Exam Fee

Approx GBP 565 for College trainees/affiliates; approx GBP 627 for non-members (2025 rates; verify 2026 with RCPsych) (Royal College of Psychiatrists (RCPsych))

MRCPsych Paper A Exam Content Outline

25%

Basic Neurosciences

Neuroanatomy, neurophysiology, neurochemistry, neuropathology, neuroimaging and the genetics underlying behaviour and psychiatric disorders.

25%

Clinical Psychopharmacology

Pharmacokinetics, pharmacodynamics, mechanisms, adverse effects, drug interactions, monitoring and evidence-based prescribing of psychotropics.

16.7%

Behavioural Science and Sociocultural Psychiatry

Learning theory, psychological models, social psychology, sociology, defence mechanisms and sociocultural influences on mental illness.

16.7%

Human Development

Attachment, temperament, cognitive, moral and psychosocial development across the lifespan, with the main developmental theories.

16.7%

Classification and Assessment in Psychiatry

Descriptive psychopathology and phenomenology, ICD-11 classification, rating scales, epidemiology, research methods and statistics.

How to Pass the MRCPsych Paper A Exam

What You Need to Know

Passing score: Criterion-referenced pass mark set per sitting by modified Angoff standard setting; not a fixed percentage
Assessment: 150 questions in 3 hours, approximately two-thirds best-of-five MCQs and one-third extended matching items (EMIs).
Time limit: 3 hours
Exam fee: Approx GBP 565 for College trainees/affiliates; approx GBP 627 for non-members (2025 rates; verify 2026 with RCPsych)

Keys to Passing

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

MRCPsych Paper A Study Tips from Top Performers

1Weight your revision toward neurosciences and psychopharmacology, which together make up around half of Paper A.

2Practise EMI-style questions specifically, as the extended matching format differs from standard MCQs and rewards systematic elimination.

3Drill descriptive psychopathology terms (delusions, hallucinations, thought disorder, catatonia) with precise definitions, as these recur frequently.

Frequently Asked Questions

How many questions are on MRCPsych Paper A and how long is the exam?

Paper A consists of 150 questions worth 150 marks, answered in 3 hours. About two-thirds are multiple choice questions and about one-third are extended matching items.

What topics does MRCPsych Paper A cover?

It covers five syllabus areas: basic neurosciences and clinical psychopharmacology (each about 25%), and behavioural science and sociocultural psychiatry, human development, and classification and assessment in psychiatry (each about one sixth).

How is the MRCPsych Paper A pass mark determined?

The pass mark is criterion-referenced and set for each sitting using the modified Angoff standard-setting method, so it is not a fixed percentage and varies slightly between diets.

Where is MRCPsych Paper A delivered?

Paper A is delivered through Pearson VUE, either online with remote proctoring or at authorised Pearson VUE test centres worldwide.