MRCP 2-Written Exam Format

Dr.Harinath
. August 25, 2020
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MRCP Part 2 Written Exam Format

The MRCP Part 2 Written Exam has 200 questions in a two-paper format held over one day.
Each paper in the Part 2 Written Examination is 3 hours in duration and contains 100 multiple choice questions.

Specialty	Number of questions
Cardiology	19
Dermatology	9
Endocrinology and metabolic medicine	19
Gastroenterology	19
Geriatric medicine	9
Haematology	9
Infectious diseases and GUM	19
Neurology	17
Nephrology	19
Oncology and palliative medicine	9
Ophthalmology	3
Psychiatry	3
Respiratory medicine	19
Rheumatology	9
Therapeutics and toxicology	18
	200

NB: This should be taken as an indication of the likely number of questions – the actual number may vary by up to 2%.
A proportion of the questions will be on adolescent medicine.

MRCP Part 2 Written Exam content

The questions will usually have a clinical scenario, may include the results of investigations and may be illustrated with images such as:
1. clinical photographs,
2. pathology slides,
3. inheritance trees,
4. ECGs, X-rays,
5. CT and MR scans,
6. echocardiograms.
Questions are asked about the diagnosis, investigation, management, and prognosis of patients using multiple choice questions in ‘best of five‘ format.
- This format, in addition to testing core knowledge and comprehension, also assesses the ability to interpret information and to solve clinical problems.
- There will be five options: one correct answer and four alternatives to the correct answer.
- The four distractors will be closely related to the preferred option but less correct, therefore acting as plausible alternatives.
- The candidate chooses the best answer from the five possible answers. Each correct answer is awarded one mark; there is no negative marking.
The results of each examination are benchmarked using a process of test equating which ensures that the pass mark is adjusted for the difficulty of the paper and the ability range of the candidates.
- The reliability of every examination is monitored, and provides assurance that the results identify those candidates who have achieved the required standard.
A detailed explanation of the marking system used for the MRCP(UK) Part 2 Written Examination can be viewed on the exam pass mark page of our website and in the MRCP(UK) Regulations.

Sample MRCP Part 2 Written Exam questions

1. A 67-year-old woman was referred with a 3-month history of painful legs, malaise and weight loss. She had had type 2 diabetes mellitus and hypertension for 18 years. Her medication was gliclazide 160 mg twice daily, ramipril 2.5 mg daily and atorvastatin 20 mg daily. On examination, her BP was 145/90 mmHg. She had some tenderness over her spine and legs. Investigations:

serum sodium	138 mmol/L (137–144)
serum potassium	5.5 mmol/L (3.5–4.9)
serum creatinine	240 µmol/L (60–110)
serum corrected calcium	1.80 mmol/L (2.20–2.60)
eGFR (MDRD)	19 mL/min/1.73 m² (>60)
serum phosphate	1.60 mmol/L (0.80–1.45)
plasma parathyroid hormone	22.2 pmol/L (0.9–5.4)

What therapy is most likely to correct the calcium and parathyroid hormone concentrations?

A: alendronic acid

B: alfacalcidol

C: calcitonin

D: cinacalcet

E: ergocalciferol

2. A 52-year-old man presented with a 4-month history of altered bowel habit with occasional bright-red blood per rectum. Colonoscopy showed an annular sigmoid tumour, and histology confirmed an adenocarcinoma. A staging CT scan showed two adjacent 1-cm lesions in the right lobe of the liver, highly suspicious for liver metastases. What is the most appropriate management?

A: biopsy of liver lesions

B: palliative chemotherapy

C: palliative radiotherapy

D: staged surgical resection of carcinoma and liver lesions

E: stenting of colorectal carcinoma

3. A 53-year-old man presented with a 2-week history of diarrhoea associated with cramping abdominal pain. He was passing up to 15 very loose and watery stools per day. He had no blood in his stools. He had undergone a heart transplant 2 years previously, and his medication comprised ciclosporin, prednisolone, aspirin and ramipril. Investigations:

haemoglobin	110 g/L (130–180)
white cell count	12.5 × 10⁹/L (4.0–11.0)
serum urea	14.4 mmol/L (2.5–7.0)
serum creatinine	135 µmol/L (60–110)
serum CRP	35 mg/L (<10)
stool culture	negative
stool microscopy	cysts identified on modified acid-fast stain

What is the most likely pathogen?

A: Cryptosporidium parvum

B: Entamoeba histolytica

C: Giardia intestinalis

D: Pneumocystis jirovecii

E: Toxoplasma gondii

4. An 87-year-old man presented to the emergency department with a 4-week history of breathlessness, dry cough and confusion. He also complained of headaches that were worse in the morning. He had a history of tuberculosis as a teenager. On examination, he was drowsy. His GCS was 14. His pulse was 102 beats per minute, and his respiratory rate was 24 breaths per minute. His oxygen saturation was 85% (94–98) breathing air. On auscultation of his chest, there were some crackles in the left lower zone and generally decreased breath sounds on the right. Investigations:

Arterial blood gases breathing air
PO₂	6.8 kPa (11.3–12.6)
PCO₂	9.8 kPa (4.7–6.0)
pH	7.25 (7.35–7.45)
H⁺	56 nmol/L (35–45)
bicarbonate	32 mmol/L (21–29)
base excess	+10.0 mmol/L (±2.0)

exam MRCP 2-Written Exam Format

What is the most appropriate treatment?

A: aminophylline

B: continuous positive airway pressure

C: doxapram

D: furosemide

E: non-invasive ventilation

5. A 75-year-old man presented with widespread aches and pains. He had a 20-year history of haemodialysis for end-stage renal disease. An X-ray of his hand was performed (see image).

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