MRCP Part 2 Sample Questions With Answers

What do MRCP Part 2 questions look like?

The MRCP(UK) Part 2 Written exam has two papers of 3 hours, each with 100 multiple-choice questions. Every question is best of five: one correct answer and four alternatives. Each correct answer earns one mark, and there is no negative marking.

The questions below come from the TopQbank MRCP Part 2 question bank, reviewed by licensed doctors. They are not real MRCP questions. The full blueprint, with how many questions each specialty gets, is in MRCP Part 2 format and blueprint.

Question 1 · Haematology

A 64-year-old man was referred after a monoclonal protein was detected during investigation of persistent fatigue. He had hypertension and osteoarthritis but remained active. He reported no recurrent infections, weight loss, night sweats or bone pain. On examination, his temperature was 36.7°C, pulse 72 beats/min and BP 138/82 mmHg. There was no lymphadenopathy, hepatosplenomegaly or bony tenderness. Haemoglobin was 137 g/L (130–180), white cell count 6.4 × 10⁹/L (4.0–11.0) and platelet count 246 × 10⁹/L (150–400). Serum creatinine was 89 µmol/L (60–110) and serum adjusted calcium 2.38 mmol/L (2.20–2.60). Serum paraprotein (IgA lambda) was 21 g/L (0), serum IgG 5.4 g/L (6.0–13.0), serum IgA 24.1 g/L (0.8–3.0) and serum IgM 0.28 g/L (0.4–2.5). Serum free light-chain ratio was 0.09 (0.26–1.65). Bone marrow aspirate showed 16% clonal plasma cells. Whole-body low-dose CT showed no osteolytic lesions. What is the most likely diagnosis?

A) Monoclonal gammopathy of undetermined significance

B) Active multiple myeloma

C) Smouldering multiple myeloma

D) IgA monoclonal gammopathy of clinical significance

E) Solitary plasmacytoma with minimal marrow involvement

Correct answer: C) Smouldering multiple myeloma. The patient has more than 10% clonal bone-marrow plasma cells and a substantial monoclonal protein, but no anaemia, renal impairment, hypercalcaemia, osteolytic lesions or stated myeloma-defining biomarker. This supports smouldering multiple myeloma rather than MGUS or active multiple myeloma.

Question 2 · Neurology

A 38-year-old woman presents with progressive headache, pulsatile tinnitus and transient visual obscurations. Her body mass index is 39 kg/m². She takes the combined oral contraceptive pill and recently completed doxycycline for acne. Temperature is 36.6°C, pulse 82/min and blood pressure 132/78 mmHg. Visual acuity is 6/6 in each eye. Colour vision is preserved. Fundoscopy shows bilateral optic-disc swelling with peripapillary haemorrhages. Automated perimetry shows enlarged blind spots. MRI of the brain shows no mass lesion or hydrocephalus. It also shows a partially empty sella and distension of the optic-nerve sheaths. Routine blood tests are unremarkable. There are no focal neurological signs apart from a partial right sixth-nerve palsy. Which investigation should be performed before lumbar puncture to exclude an important secondary cause?

A) CT angiography of the circle of Willis

B) MR venography of the intracranial venous sinuses

C) Carotid Doppler ultrasonography

D) Orbital ultrasonography with optic-nerve sheath measurement

E) Temporal artery ultrasonography

Correct answer: B) MR venography of the intracranial venous sinuses. The presentation resembles idiopathic intracranial hypertension, but cerebral venous sinus thrombosis must first be excluded. The combined oral contraceptive pill is an additional thrombotic risk factor. MR venography directly evaluates the major intracranial venous sinuses and should accompany brain imaging in this setting. A normal conventional MRI does not reliably exclude venous thrombosis. Lumbar puncture is then used to measure opening pressure and assess cerebrospinal fluid composition after structural and venous causes are excluded.

Question 3 · Rheumatology

A 46-year-old woman presents with deep boring pain in her right eye radiating to the temple and jaw. The pain wakes her at night and worsens with eye movement. She has chronic sinus symptoms, arthralgia and two recent episodes of haemoptysis. Temperature is 37.6°C, pulse 92/min and blood pressure 148/86 mmHg. Visual acuity is 6/12 on the right and 6/6 on the left. There is diffuse violaceous scleral injection and marked globe tenderness. The vessels do not blanch after topical phenylephrine. The cornea has peripheral stromal thinning but no epithelial ulcer. Anterior chamber cells are present. Fundoscopy shows no retinal detachment. Urinalysis demonstrates blood 3+ and protein 2+. Chest radiography shows bilateral cavitating nodules. Which underlying diagnosis best integrates these findings?

A) Granulomatosis with polyangiitis

B) Behçet disease

C) Relapsing polychondritis

D) Rheumatoid arthritis

E) Sarcoidosis

Correct answer: A) Granulomatosis with polyangiitis. The ocular findings indicate scleritis rather than episcleritis. Deep severe pain, violaceous injection, globe tenderness and failure to blanch with phenylephrine are discriminating features. Haemoptysis, cavitating pulmonary nodules and active urinary sediment suggest pulmonary–renal small-vessel vasculitis. Chronic destructive upper-airway symptoms further support granulomatosis with polyangiitis. Urgent systemic immunosuppression is required because both vision and life are at risk.

Question 4 · Clinical pharmacology

An 81-year-old woman with moderate Alzheimer disease attends a medication review. Donepezil was increased to 10 mg daily 6 weeks ago. Since then she has had nausea, two falls and one brief episode of collapse. Her other medicines are ramipril, atorvastatin and alendronic acid. Pulse is regular at 44 beats/min and blood pressure is 138/70 mmHg. There is no postural fall in blood pressure. ECG shows sinus bradycardia with a PR interval of 230 ms. Echocardiography performed last year showed normal ventricular function. Her cognition had improved modestly after donepezil was originally introduced. There is no history of beta-blocker or rate-limiting calcium-channel blocker use. Neurological examination is unchanged from baseline. The family wishes to preserve cognitive benefit if this can be done safely. What is the most appropriate next step?

A) Continue donepezil and arrange routine 24-hour ECG monitoring

B) Reduce donepezil to 5 mg while awaiting recurrence of syncope

C) Stop donepezil and assess whether bradycardia and syncope resolve

D) Add memantine immediately while continuing donepezil 10 mg

E) Refer directly for permanent pacemaker implantation to permit continued donepezil

Correct answer: C) Stop donepezil and assess whether bradycardia and syncope resolve. Acetylcholinesterase inhibitors can produce vagotonic bradycardia, atrioventricular conduction delay and syncope. The temporal relationship to dose escalation and absence of another rate-limiting drug make donepezil the likely cause. Symptomatic marked bradycardia requires withdrawal rather than routine continuation or watchful waiting. Pulse, symptoms and ECG should be reviewed after withdrawal, with cardiology assessment if abnormalities persist.

Question 5 · Gastroenterology

A 46-year-old man reports 8 months of retrosternal burning and sour regurgitation. Symptoms occur after meals and improve partially with alginate. He has no dysphagia, weight loss, haematemesis or anaemia. His body mass index is 31 kg/m² and abdominal examination is normal. He does not smoke and drinks 8 units of alcohol weekly. Omeprazole 20 mg once daily for 8 weeks produced little improvement. Adherence is good and he takes the dose 30 minutes before breakfast. A further 8 weeks of omeprazole 20 mg twice daily has not relieved his symptoms. Gastroscopy performed while taking omeprazole shows a normal oesophagus and stomach. Oesophageal biopsies show no eosinophilia. High-resolution manometry shows normal peristalsis and lower oesophageal sphincter relaxation. The gastroenterologist wishes to establish whether persistent symptoms correlate with acid or non-acid reflux despite treatment. Which investigation is most appropriate?

A) Ambulatory oesophageal pH monitoring after stopping omeprazole

B) Barium swallow with provocation manoeuvres

C) Ambulatory pH-impedance monitoring while taking omeprazole

D) Repeat gastroscopy after stopping omeprazole

E) Gastric emptying scintigraphy

Correct answer: C) Ambulatory pH-impedance monitoring while taking omeprazole. He has persistent typical reflux symptoms despite correctly timed, optimised proton-pump inhibitor treatment. Gastroscopy has excluded erosive disease and structural pathology, while biopsies do not support eosinophilic oesophagitis. Normal manometry excludes a major motility disorder and permits accurate positioning of the reflux probe. Combined pH-impedance monitoring detects both acid and weakly acidic or non-acid reflux and assesses symptom association. Testing while treatment continues is appropriate when the question is whether ongoing symptoms represent breakthrough reflux despite acid suppression.

Question 6 · Cardiology

An 84-year-old man has three abrupt episodes of syncope without prodrome. Two occurred while seated and one while walking indoors. He recovers within 1 minute and has no post-event confusion. His history includes hypertension and ischaemic heart disease. He takes aspirin, atorvastatin and ramipril. Examination reveals no murmur or focal neurological deficit. Supine blood pressure is 154/78 mmHg and standing blood pressure is 150/76 mmHg. ECG shows sinus rhythm, right bundle branch block and left anterior fascicular block. Echocardiography shows left ventricular ejection fraction 55% and no significant valve disease. A 24-hour ambulatory ECG records sinus rhythm without symptoms. There is no witness description suggesting seizure. The next episode could cause serious injury. Which investigation is most appropriate to establish a symptom–rhythm correlation?

A) Repeat 24-hour ambulatory ECG monitoring

B) Implantable loop recorder insertion

C) Carotid sinus massage without continuous ECG monitoring

D) Electroencephalography with sleep deprivation

E) CT angiography of the cerebral circulation

Correct answer: B) Implantable loop recorder insertion. Abrupt, infrequent syncope without prodrome raises concern for intermittent bradyarrhythmia. Bifascicular block increases the possibility of episodic high-grade atrioventricular block. A normal 24-hour recording does not exclude an infrequent rhythm disturbance. An implantable loop recorder provides prolonged monitoring and can document the rhythm during a spontaneous event.

Question 7 · Palliative medicine

An 81-year-old woman receiving palliative treatment for metastatic breast cancer has severe constipation. She takes modified-release morphine with immediate-release morphine for breakthrough pain. Regular macrogol and senna have been taken correctly for 7 days. She has passed no stool for 6 days despite rectal bisacodyl. She has colicky discomfort but no vomiting. The abdomen is soft with no guarding or palpable mass. Digital rectal examination shows an empty rectum. Abdominal CT shows faecal loading but no mechanical obstruction, perforation or ileus. Renal and hepatic function are satisfactory. Her pain is well controlled and reducing the opioid is not acceptable. She can swallow oral medicines but wants rapid relief. The palliative-care team considers a peripherally acting opioid antagonist. Which treatment is most appropriate?

A) Naloxone by intravenous infusion until bowel movement occurs

B) Methylnaltrexone with dosing determined by body weight

C) Loperamide followed by a reduced dose of senna

D) Prucalopride as emergency treatment for possible mechanical obstruction

E) Neostigmine with cardiac monitoring for uncomplicated constipation

Correct answer: B) Methylnaltrexone with dosing determined by body weight. This is refractory opioid-induced constipation despite appropriate stimulant and osmotic laxatives. Mechanical obstruction and faecal impaction have been excluded before use of an opioid antagonist. Methylnaltrexone acts peripherally and can restore bowel function without materially reversing central analgesia. Its regimen depends on the clinical formulation and, for relevant subcutaneous dosing, body weight and renal function.

Question 8 · Infectious diseases

A 68-year-old man presents with a painful vesicular eruption over the left forehead and upper eyelid. The rash began 36 hours ago. He has type 2 diabetes controlled with metformin and an estimated glomerular filtration rate of 72 mL/min/1.73 m². Temperature is 37.5°C and blood pressure is 136/80 mmHg. Vesicles extend to the tip and side of the nose. The left eye is red and photophobic. Visual acuity is 6/12 on the left and 6/6 on the right. Slit-lamp examination shows punctate epithelial keratitis and mild anterior chamber cells. Intraocular pressure is normal. The cornea has no bacterial infiltrate. Fundoscopy is normal. He is not immunocompromised and can swallow tablets. Which antiviral regimen is most appropriate?

A) Aciclovir 200 mg orally five times daily for five days

B) Aciclovir 400 mg orally three times daily for three days

C) Aciclovir 800 mg orally five times daily for seven days

D) Aciclovir 800 mg intravenously once daily for fourteen days

E) Topical aciclovir ointment alone for ten days

Correct answer: C) Aciclovir 800 mg orally five times daily for seven days. This is herpes zoster ophthalmicus with ocular involvement and Hutchinson's sign. Systemic antiviral treatment should start promptly, ideally within 72 hours of rash onset. Oral aciclovir 800 mg five times daily for seven days is an appropriate standard regimen in an immunocompetent adult with adequate renal function. Hutchinson's sign reflects nasociliary involvement and increases the likelihood of ocular complications. Urgent ophthalmological assessment is also required for keratitis and anterior uveitis.

Question 9 · Respiratory medicine

An 80-year-old woman is recovering after surgical fixation of a hip fracture. She has osteoporosis, mild dementia and chronic obstructive pulmonary disease. On postoperative day 4 she becomes newly hypoxic and tachycardic. She reports vague upper abdominal discomfort but no chest pain. Temperature is 37.1°C, pulse 118 beats/min and blood pressure 106/64 mmHg. Oxygen saturation is 88% on air and respiratory rate is 28 breaths/min. Chest examination reveals no focal crackles or wheeze. Her left calf is swollen by 3 cm compared with the right. ECG shows sinus tachycardia with a new right ventricular strain pattern. Chest radiography shows no consolidation or pulmonary oedema. She has received intermittent rather than regular thromboprophylaxis because of missed doses. Renal function is adequate for contrast administration. Which investigation should be performed next?

A) CT pulmonary angiography

B) Ventilation–perfusion scanning as the mandatory first-line test after surgery

C) Transthoracic echocardiography as the definitive diagnostic test

D) Serial chest radiography over the next 24 hours

E) D-dimer measurement before any imaging

Correct answer: A) CT pulmonary angiography. Acute hypoxia, tachycardia, unilateral calf swelling and right-heart strain after hip surgery create a high clinical probability of pulmonary embolism. CT pulmonary angiography is the appropriate definitive imaging test when contrast is not contraindicated. The missed prophylaxis and immobilisation further increase the pre-test probability.

Question 10 · Geriatric medicine

An 80-year-old woman reports six unexplained falls during the past year. The episodes occur while walking and are not preceded by vertigo, palpitations or loss of consciousness. She has bilateral knee osteoarthritis and early cataracts. Her medicines are ramipril, sertraline and occasional paracetamol. Blood pressure is 148/76 mmHg supine and 142/74 mmHg after standing for 3 minutes. Cardiovascular and neurological examinations are unremarkable. Visual acuity is mildly reduced, and she cannot perform a tandem stance. Timed Up and Go takes 18 seconds using no walking aid. ECG shows sinus rhythm with normal intervals. A recent full blood count, renal profile and serum calcium are normal. She has not sustained injury but has restricted outdoor activity because of fear of falling. She asks whether a single intervention can reduce her risk. Which management strategy is most appropriate?

A) Routine vitamin D supplementation as the principal falls-prevention intervention

B) A home hazard assessment without a supervised exercise programme

C) A multifactorial falls assessment followed by individually targeted interventions

D) Long-term use of a wheeled walking frame without further assessment

E) Withdrawal of ramipril despite the absence of orthostatic hypotension

Correct answer: C) A multifactorial falls assessment followed by individually targeted interventions. Recurrent falls with gait and balance impairment warrant a comprehensive multifactorial assessment. Relevant domains include gait, strength, vision, cognition, continence, cardiovascular causes, medicines and home hazards. Interventions should be matched to identified risks and commonly include progressive strength-and-balance training.

The Federation’s free practice test

The Federation of the Royal Colleges of Physicians offers a free online Part 2 practice test. You start it with your email address, get a restart code so you can pause and resume, and see the answers when you finish.

To plan your revision, follow the 12-week MRCP Part 2 study plan, and practise full papers in the TopQbank MRCP Part 2 question bank.