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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.
SpecialtyNumber of questions
Endocrinology and metabolic medicine19
Geriatric medicine9
Infectious diseases and GUM19
Oncology and palliative medicine9
Respiratory medicine19
Therapeutics and toxicology18
  • 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 sodium138 mmol/L (137–144)
serum potassium5.5 mmol/L (3.5–4.9)
serum creatinine240 µmol/L (60–110)
serum corrected calcium1.80 mmol/L (2.20–2.60)
eGFR (MDRD)19 mL/min/1.73 m2 (>60)
serum phosphate1.60 mmol/L (0.80–1.45)
plasma parathyroid hormone22.2 pmol/L (0.9–5.4)

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

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?

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:

haemoglobin110 g/L (130–180)
white cell count12.5 × 109/L (4.0–11.0)
serum urea14.4 mmol/L (2.5–7.0)
serum creatinine135 µmol/L (60–110)
serum CRP35 mg/L (<10)
stool culturenegative
stool microscopycysts identified on modified acid-fast

What is the most likely pathogen?

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
PO26.8 kPa (11.3–12.6)
PCO29.8 kPa (4.7–6.0)
pH7.25 (7.35–7.45)
H+56 nmol/L (35–45)
bicarbonate32 mmol/L (21–29)
base excess+10.0 mmol/L (±2.0)




exam MRCP 2-Written Exam Format

What is the most appropriate treatment?

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).

Part2%20sample%20Q12 MRCP 2-Written Exam Format

What is the most likely diagnosis?

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