Membership of the Royal Colleges of Physicians (MRCP) Practice Exam

These questions are part of the practice quiz. Start practicing

• What is the most appropriate first step in managing a patient presenting with haematemesis and signs of liver cirrhosis?
• Which skin condition is often associated with a well-demarcated, scaly plaque?
• Which drug is most likely to cause a hand tremor in a patient who had a successful renal transplant?
• What is a key investigation for suspected pancreatic issues in a patient with diabetes symptoms?
• A group of 26 passengers developed acute gastrointestinal illness after a cruise. What is the most likely causative agent?
• A 33-year-old man has cough and breathlessness, worsening during the week related to his occupation. What further investigation is most appropriate?
• In a clinical trial involving a statin, what is the number-needed-to-treat (NNT) to prevent one cardiovascular event?
• What is the first-line treatment for post-operative nausea and vomiting in surgical patients?
• In a patient with long-term breathlessness and a history of radiotherapy, what is the most likely diagnosis?
• What is the best way to address an alarming reading from a doctor about genetic predisposition to heart disease?
• What is the most likely diagnosis for a patient with weight loss, lethargy, and a solid lesion at the left lung apex with a history of pulmonary tuberculosis?
• What symptom would be least indicative of dementia in an elderly patient?
• What laboratory finding would best support a diagnosis of Wilson's disease in a 30-year-old woman with tremor and hepatomegaly?
• A man ingests 40 tablets of slow-release theophylline. What is the most appropriate initial management?
• Which characteristic of insulin lispro might improve glycaemic control in a patient with type 1 diabetes?
• A 43-year-old woman with a history of guttate psoriasis presents with swollen fingers and toes. What is the most likely diagnosis?
• Which parameter is most likely to have contributed to the patient's high Waterlow score?
• A 77-year-old man presents with lower back pain and increased serum alkaline phosphatase. What is the most likely cause of his pain?
• What is the most likely cause of elevated serum IgG levels in a patient with isolated liver test abnormalities?
• What measurement corresponds most closely to the serum osmolality of a patient with significantly elevated serum sodium and potassium?
• For a patient with signs of liver dysfunction and a history of significant alcohol use, what is the most crucial next step?
• In a case of partial lower tibial fracture with laboratory findings indicating low calcium and high alkaline phosphatase, what is the most appropriate treatment?
• What is the most appropriate next investigation for a patient with rheumatoid arthritis experiencing recurrent knee inflammation?
• A 54-year-old man with type 2 diabetes has poor blood pressure and renal function. What is the most appropriate next step in his management?
• In the context of urinary issues, which of the following is typically considered after failed medical therapy for overactive bladder?
• What is the most appropriate additional pharmacological treatment for a patient with congestive heart failure and a left ventricular ejection fraction of 25%?
• What is the most appropriate initial treatment for a patient with generalized reddening of the skin and history of psoriasis?
• Which investigation finding would correlate with a low serum potassium level in a patient on furosemide for heart failure?
• Which drug is most likely to maintain sinus rhythm following successful DC cardioversion in a patient with atrial fibrillation?
• What is the most likely diagnosis for a 47-year-old man experiencing episodes resembling heart attacks, associated with palpitations and sweating?
• What is the most likely cause of hypophosphataemia in a patient with increased serum calcium levels?
• What is the most likely cause of agitation, confusion, and suicidal thoughts in a patient recently started on VAD chemotherapy?
• What is the most likely diagnosis for a 17-year-old boy with recurrent renal calculi since the age of 8, and a family history of similar issues?
• What type of analysis should be performed in a clinical trial that had high patient withdrawal rates for estimating benefits?
• What cellular process is primarily responsible for the success of combination chemotherapy in treating testicular cancer?
• Which protein is most commonly abnormal in Marfan syndrome?
• What is the most appropriate treatment for onychomycosis caused by Trichophyton rubrum in a diabetic patient?
• What is the most appropriate next step in management for a 21-year-old man who vomited blood after severe retching?
• A woman experiences difficulty in reading after a left parietal lobe infarct. What additional feature is likely to be present?
• In a scenario of post-fall deterioration leading to unconsciousness, which potential injury could result in such symptoms?
• What is the most appropriate statistical technique to compare mean blood pressure between the treatment groups in a clinical trial?
• What is the most appropriate initial intravenous treatment for a patient with tachycardia, hypotension, and an empty bottle of amitriptyline?
• Which antibiotic is most likely to further prolong the QT interval in a patient with long QT syndrome?
• A 52-year-old man with a GCS of 5 and respiratory distress presents with an acid-base imbalance. What disturbance is most likely?
• What cellular component contains double-stranded circular DNA?
• What condition is characterized by a significant increase in alkaline phosphatase levels?
• What is the most likely mechanism for hypokalaemia in a patient treated with bendroflumethiazide?
• What is the most likely diagnosis for a man presenting with central cyanosis and a steel-grey complexion?
• What is the most likely site of the lesion in a patient with sudden onset of painless diplopia, left eye movement limitation, and ptosis?
• Which factor is a common precipitating cause of acute confusion in elderly patients?
• Which condition is characterized by elevated serum creatinine and pitting edema?
• What is the most likely diagnosis for a patient with diplopia, unsteadiness, and absent tendon reflexes?
• A 72-year-old man experienced sudden shortness of breath during dialysis. What is the most likely immunological diagnosis?
• A 72-year-old man has an inferior altitudinal field defect in the right eye. What is the most likely diagnosis?
• What factor is most likely to increase the cancer risk in a patient with ulcerative colitis?
• What condition is strongly associated with a 65-year-old woman presenting with headache and rapid cognitive changes?
• What dietary substrate is broken down into glucose and galactose by intestinal enzymes?
• In a case of dermatitis with violaceous, flat-topped papules, what clinical feature is most likely to be present?
• Which condition is most likely found in patients with an anterior wall myocardial infarction presenting with syncope?
• What is the site of origin of circulating B-type natriuretic peptide in patients with chronic heart failure?
• What is the most likely diagnosis for a man who presents with auditory hallucinations and social withdrawal?
• What is the key symptom leading to the diagnosis of a possible primary hepatic tumor in adults?
• For a patient with rheumatoid arthritis presenting with lower leg edema and proteinuria, what further investigation is most likely to provide diagnostic value?
• What is the most appropriate prophylaxis for housemates of a patient diagnosed with meningococcal meningitis?
• What is the most likely cause of abnormal liver function tests in a patient with a long history of ulcerative colitis?
• What intervention is least likely to be needed for a young woman with a suspected post-contraceptive pill amenorrhoea?
• What is the most likely diagnosis for a 36-year-old HIV-positive man with jaundice and elevated liver enzymes after unprotected anal sex?
• A patient with chronic cough and low serum α1-antitrypsin is likely to have which condition related to lung function?
• What best describes the mechanism of action of alteplase in managing ischaemic stroke?
• What class of medication is most commonly used for chemoprophylaxis in cases of meningococcal exposure?
• What glomerular abnormality is likely present in a 17-year-old boy with non-blanching rash, swollen knee, and visible haematuria?
• What is the most likely mode of inheritance for hereditary hemorrhagic telangiectasia?
• What is the most likely diagnosis for a 28-year-old man who experienced weight loss, abdominal distension, and foul-smelling diarrhoea after a trip to India?
• A 78-year-old man shows signs of abnormal blood film and anemia. What is the most likely underlying cause?
• Which drug is commonly used to manage acute coronary syndrome in conjunction with anticoagulation?
• What laboratory finding is commonly associated with adult-onset Still's disease?
• For a 27-year-old man with fever and cellulitis after allergic reactions, what is the most appropriate empirical treatment?
• What symptom is typically associated with multiple myeloma?
• Which skin condition is characterized by erythematous, scaly rash typically found in specific facial areas?
• A young man presents with symptoms suggesting acute epiglottitis. What is the most likely causative organism?
• What additional finding would typically be associated with a diagnosis of Paget's disease of bone?
• What is the most likely outcome of erythropoietin therapy in a woman with early-stage chronic kidney disease and anemia?
• What type of headache is often noted in patients with exertional or physical activity-related triggers?
• A woman with breast cancer has a BRCA1 mutation. What is the normal function of BRCA1?
• For a patient with isolated non-visible hematuria and normal urine analysis, what is the most appropriate next investigation?
• What is the most appropriate next step in managing a patient who is anuric after admission with symptoms of dehydration?
• What would be a common symptom of acute hepatitis, based on liver enzyme abnormalities and clinical presentation?
• A 52-year-old woman presents with upper limb weakness and dysphagia. What is the most likely diagnosis?
• What is the initial haemodynamic response during a Valsalva manoeuvre?
• What feature most strongly suggests maturity-onset diabetes of the young in a patient?
• What is the most useful next investigation for assessing suitability for surgical resection in a patient with squamous cell lung carcinoma?
• What additional investigation is most likely to confirm a diagnosis of acromegaly?
• What receptors are chiefly involved in mediating the antipsychotic effects of risperidone?
• In the context of evolving abdominal symptoms, what indicates a need for surgical intervention?
• Which finding would indicate that an exacerbation of asthma should be regarded as life-threatening?
• For a 32-year-old man with weight loss, dizziness especially on sudden posture change, and hyperpigmentation, what is the most likely biochemical finding?
• For a patient with foul-smelling diarrhea who recently returned from Borneo, what is the most likely causative organism?
• For a patient on lithium with hypertension, what is the most appropriate antihypertensive drug?
• Which finding is least likely in a patient with a parietal lobe infarct?
• What is the most likely diagnosis for a 16-year-old girl with non-scaly, discrete hair loss areas and a history of atopic eczema?
• Which viral infection is notorious for widespread outbreaks on cruise ships, often causing gastrointestinal symptoms?
• What best describes the data generated from a post-marketing observational study on 5000 patients?
• Antagonism of which neurotransmitter is most likely to improve symptoms of urge incontinence in an elderly woman?
• What echocardiogram finding indicates the highest potential risk for pregnancy in a woman with a ventricular septal defect?
• What is a potential risk factor for a patient developing type 1 hypersensitivity reactions?
• In a cocaine-intoxicated patient with elevated blood pressure and pulse, what complication is most likely to occur?
• During haemodialysis, a patient develops fever and chills. What is the most likely cause of this infection?
• A woman with discoid lupus erythematosus is experiencing an exacerbation of her rash despite corticosteroid use. What is the most appropriate additional treatment?
• What is the most likely diagnosis for a woman who believes she has moving worms in her skin despite no physical findings?
• A 65-year-old man has a pituitary lesion with no hormone excess. What is the most likely clinical consequence of this finding?
• A 51-year-old man with a history of angina reports intermittent breathlessness. Which medication is likely causing his symptoms?
• A patient presents with visual disturbances and normal vision in one eye with a swollen disc. Which condition is primarily suspected?
• Which organism is the most likely cause of a patient presenting with facial weakness and headache after camping in southern Germany?
• After a head injury, a patient has a left-sided torticollis. Which muscle is most likely responsible?
• In a patient with MRSA cellulitis, what is the most appropriate antibiotic in addition to vancomycin?
• A patient with vegetation on the mitral valve after a colonoscopy is most likely infected by which organism?
• What condition might be indicated by elevated MCV and low haemoglobin in an elderly man with anaemia?
• What is the principal role of BRCA1 in cellular function?
• A patient with a 2-day history of knee pain and positive crystals might have what type of arthritis?
• Where is the main site of action for haloperidol when used as an antiemetic in a patient with metastatic cancer?
• A 76-year-old man with a slowly enlarging leg plaque likely has which skin condition?
• What should be suspected in a young male patient with new-onset seizures and potential history of head trauma?
• What common feature is associated with Burkitt lymphoma aside from the gene expression abnormality?
• What is the most likely diagnosis for a 79-year-old woman with pale skin, splenomegaly, and a high white blood cell count?
• Which coagulation factor is most likely to be present at a reduced activity in a patient on long-term warfarin therapy?
• Which of the following conditions is indicated by a hemoglobin A1c greater than 6.5%?
• What is the most likely diagnosis for a woman with hypopigmented scaly lesions post-sun exposure?
• What investigation is most likely to establish the liver diagnosis in a patient with abnormal liver function tests?
• What is the most likely cause of eye pain in a woman with rheumatoid arthritis and a red eye?
• What mechanism does clopidogrel primarily use to inhibit platelet aggregation?
• What is the first-line therapy for a 54-year-old diabetic patient with hypertension and renal impairment?
• What is the most appropriate next investigation for a patient with iron deficiency anemia following an upper gastrointestinal endoscopy showing a duodenal ulcer?
• What percentage of a novel anti-obesity drug will be eliminated 20 hours after ingestion, given its half-life is 4 hours?
• What pulmonary function test result is most characteristic of idiopathic pulmonary fibrosis?
• A 30-year-old with a facial rash and normal secondary sexual characteristics is suspected to have which condition?
• What abnormality on a 24-hour ambulatory ECG is clinically most important for a patient with intermittent lightheadedness?
• Which infection is commonly associated with seizures in children?
• In a patient presenting with joint pain, which test would most likely indicate tophaceous gout as a diagnosis?
• A 28-year-old man presents with fever and joint pains, findings suggestive of which likely diagnosis?
• What is the most likely cause of anaemia in a patient who had a positive direct antiglobulin test?
• What is the most likely diagnosis for a patient with a history of rheumatoid arthritis presenting with urinary incontinence and cognitive difficulties?
• What potential complication should be monitored in a patient with a small pituitary lesion?
• What is most likely to decrease pulmonary vascular resistance in a healthy individual?
• Which condition is indicated by a patient presenting with severe pain and loss of vision accompanied by a dilated unreactive pupil?
• What is the most likely diagnosis for a patient with polyuria, nocturia, and normal serum sodium but low urinary osmolality?
• In a patient with Parkinson's disease treated with ropinirole, what is its mechanism of action?
• What is the likely diagnosis of a patient with diplopia and significant balance issues who has a history of Sjögren's syndrome?
• What is the normal range for serum thyroid-stimulating hormone?
• What is the most likely cause of symptoms in a patient with acute inflammation of multiple joints after starting allopurinol?
• Which term best describes the karyotype 47, XY, +21?
• What is the most appropriate next investigation for a patient with diarrhea, blood in stool, and a high number of daily bowel movements?
• What is the most likely cause of leg pain relieved by rest in an 83-year-old man with a history of myocardial infarction?
• A 20-year-old woman overdoses on levothyroxine but appears euthyroid after 24 hours. What is the most appropriate treatment?
• A woman with a history of subtotal thyroidectomy for Graves' disease presents with hyperlipidaemia. What is the most appropriate initial treatment?
• What investigation is most useful to determine whether a goitre is causing breathlessness in a patient with a normal chest examination?
• What is the most important mechanism of action of isosorbide mononitrate used for treating angina pectoris?
• What sensory deficit is expected 2 months after hemisection of the spinal cord at T10 level?
• In a 45-year-old man with fatigue, weight loss, and jaundice, what is the most likely diagnosis given the biochemical findings?
• In which condition would serum phosphate likely be low along with elevated parathyroid hormone levels?
• In a patient with congestive heart failure, which laboratory finding is most likely due to persistent edema despite furosemide treatment?
• For a patient with episodic sweating and hunger, what is the most appropriate next investigation after normal fasting plasma glucose?
• What associated finding is most likely to indicate a delayed transfusion reaction after a blood transfusion?
• What is the most common early side effect of beta-blockers like atenolol?
• Why might a 17-year-old girl who is a carrier of sickle haemoglobin be unable to donate blood?
• For a patient with an elevated white blood cell count during fever and joint pain, what is the first step in diagnosis?
• What is the most appropriate management for a patient diagnosed with severe hyperlipidaemia post-thyroidectomy?
• Damage to which area of the brain is most likely to have produced the gaze palsy in a patient with hemiparesis?
• Which is the most likely diagnosis for a patient presenting with severe rectal bleeding and a low hemoglobin level?
• After a fall, a teenager loses consciousness briefly but recovers fully. If his condition deteriorates two hours later, what is the most likely diagnosis?
• What condition is characterized by a complex soft-tissue lesion in the anterior mediastinum in the presence of elevated serum angiotensin-converting enzyme?
• In a 17-year-old girl with a single, painless, enlarged cervical lymph node, what is the most likely diagnosis?
• What is the most likely diagnosis for a young woman with sudden breathlessness and normal blood gases?
• In a case of Burkitt lymphoma, what is the most likely underlying abnormality of gene expression?
• What is the most useful investigation for a 16-year-old boy with a painless neck swelling and enlarged lymph nodes?
• What antibody test is most likely to be positive in a 45-year-old woman with hypertension and renal issues?
• What drug is most likely to restore sinus rhythm in a patient with atrial fibrillation and a ventricular rate of 130 beats/min?
• What is the most likely diagnosis for a patient who has a smoking history and presents with chronic cough and mixed lung function test results?
• Which condition is characterized by increasing dysphagia to liquids compared to solids?
• What is the most appropriate diagnostic investigation for a man presenting with dyspnoea and left basal chest pain, alongside other significant symptoms?
• In the case of a suspected primary malignancy in cervical lymph nodes, which thyroid adenoid would be a common differential diagnosis?
• In patients with newly diagnosed hypertension, what is a key lifestyle change that should be advised?
• In relation to Helicobacter pylori infection, which symptom is most commonly associated?
• What is the most likely diagnosis for a woman experiencing severe headache and seizures shortly after a normal vaginal delivery?
• What condition is characterized by rapid progression of muscle weakness and dysphagia in middle-aged adults?
• What is the microscopic appearance of calcium pyrophosphate crystals confirmed in the joint?
• Which of the following is a classic symptom of idiopathic pulmonary fibrosis?
• In atherosclerosis, what is the origin of foam cells observed in carotid plaque histology?
• In a patient with hyponatraemia and a history of gastroesophageal reflux treated with omeprazole, what additional information would most support a diagnosis of syndrome of inappropriate antidiuretic hormone?
• What is the most likely cause of severe right-sided flank pain in a patient with autosomal dominant polycystic kidney disease?
• What is the most likely diagnosis for a 63-year-old woman with CREST syndrome and bilateral basal crackles?
• What organism is most likely to be cultured from both the abscess and blood of an intravenous drug user?
• When considering the use of diuretics in heart failure patients, what is the primary goal of therapy?
• Which investigation is most useful to determine cardiovascular risk in a diabetic patient?
• Which imaging technique is best for evaluating renal masses in a patient with hematuria?
• Which immunoglobulin is most likely responsible for hyperacute rejection after a donor kidney transplantation?
• What is the most appropriate post-exposure prophylaxis for a doctor after a needlestick injury from a patient with HIV?
• A 24-year-old woman presents with a non-itchy rash and no improvement from topical cream. What is the most appropriate initial treatment?
• A 23-year-old woman with primary infertility has mild facial hirsutism and varied menstrual cycles. What is the most likely diagnosis?
• Helicobacter pylori infection is most strongly associated with which condition?
• Which type of stroke is characterized by the sudden onset of neurological deficits?
• A 32-year-old woman presents with fever, myalgia, headache, photophobia, and neck stiffness. What is the most likely causative organism?
• In a collapsed patient with reduced muscle tone and small pupils, what is the most likely cause of this presentation?
• What is the mechanism of renal injury associated with aciclovir?
• In a patient with hirsutism, which hormone is most likely elevated if diagnosed with polycystic ovary syndrome?
• For a patient with chronic hepatitis C being treated with antivirals, what investigation best assesses the response to treatment?
• What is the most likely cause of menstrual disturbance in a 21-year-old woman with a history of amenorrhoea after stopping the contraceptive pill?
• What associated finding is a contraindication to surgical resection in a patient with squamous cell carcinoma of the lung?
• What is the most likely diagnosis for a woman with loose stools after ileal resection for Crohn's disease?
• What is the most appropriate first-line treatment for a patient with acute exacerbation of chronic obstructive pulmonary disease (COPD)?
• In a patient with known renal issues, experiencing progressive renal failure and hypertension, which antibody should be tested?
• In a patient presenting with diffuse pain in the right arm and sensory loss in the right thumb, what is the most likely diagnosis?
• In a patient with renal cell carcinoma being treated with morphine sulfate, what is most likely to cause morphine toxicity?
• What is the optimal next step for a patient presenting with recurrent joint pains and positive ANA test?
• What is the primary treatment goal for patients diagnosed with primary biliary cirrhosis?
• What condition is indicated in a patient with a swollen, pale right optic disc and a background of glaucoma?
• What pharmacokinetic variable affects the time it takes for digoxin to show its full effect?
• In a patient with abnormal liver function tests and low serum ceruloplasmin, what is the most likely cause?
• Which condition is most likely diagnosed in an 82-year-old man presenting with confusion and visual hallucinations after surgery?
• What is the classic presentation of a patient with a subdural hematoma?
• What abnormality is most likely to be present on blood film examination in a patient with low platelet count, drowsiness, and hallucinations?
• What is the most likely diagnosis for a patient presenting with progressive muscle weakness and proximal limb weakness along with high serum creatine kinase?
• What is the most likely pathogen responsible for watery diarrhoea in a woman who just returned from Mexico?
• What is the most pertinent follow-up for a woman with discoid lupus who did not respond to her current treatment?
• In a 17-year-old girl with erythema nodosum and abnormal mediastinal silhouette, which condition is most likely diagnosed?
• Which clinical finding is most consistent with polymyalgia rheumatica?
• What structure is implicated in the pathophysiology of lipodermatosclerosis in patients with chronic venous insufficiency?
• What is the most common physical finding in patients diagnosed with constrictive pericarditis?
• What antinuclear antibody isotype most likely indicates systemic lupus erythematosus?
• Which artery is most likely occluded in a patient with ischemic bowel affecting the lower duodenum to the transverse colon?
• A 26-year-old woman has unequal pupils with the right pupil being larger. What best describes this pupillary abnormality?
• What diagnosis should be considered for a diabetic patient with a swollen toe and an ulcer present?
• In a patient with respiratory distress and metabolic acidosis, what laboratory finding is typically elevated?
• What is the most likely diagnosis for a 65-year-old woman with sudden gait unsteadiness, vomiting, headache, and increasing drowsiness?