MRCP(UK) PART 2 WRITTEN EXAMINATION
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES
100% GUARANTEED PASS!!
<LATEST VERSION>
Question 1
A 62-year-old man presents with progressive exertional dyspnoea and ankle
swelling. He has a history of hypertension and type 2 diabetes. Examination
reveals elevated JVP, a displaced apex beat, and bilateral basal crackles.
Echocardiography shows concentric LV hypertrophy, preserved ejection fraction,
and impaired relaxation.
Which is the most appropriate long-term management strategy?
A. High-dose loop diuretics alone
B. ACE inhibitor, beta-blocker, and diuretics as needed
C. Ivabradine therapy
D. Implantable cardioverter-defibrillator
E. Cardiac resynchronisation therapy
Correct answer: B
Rationale:
This presentation is consistent with heart failure with preserved ejection
fraction (HFpEF). Management focuses on blood pressure control, regression
of LV hypertrophy, symptom relief, and management of comorbidities. ACE
inhibitors and beta-blockers are appropriate; diuretics are used for congestion.
Device therapies are not indicated in preserved EF.
,Question 2
A 45-year-old woman presents with recurrent headaches, palpitations, and
sweating. Blood pressure is persistently elevated. Urinary metanephrines are
markedly raised. CT abdomen reveals a 4 cm adrenal mass.
What is the most appropriate next step in management?
A. Immediate adrenalectomy
B. Start beta-blocker therapy
C. Start alpha-blocker therapy
D. MIBG scan prior to medical therapy
E. Start ACE inhibitor therapy
Correct answer: C
Rationale:
This is a phaeochromocytoma. Alpha-blockade must be established before any
beta-blockade or surgery to prevent unopposed alpha stimulation and
hypertensive crisis. Imaging for metastasis can follow stabilisation.
Question 3
A 70-year-old man with atrial fibrillation presents with sudden onset right-sided
weakness and aphasia. CT head shows no haemorrhage. Time from symptom onset
is 2 hours. INR is 1.1.
What is the most appropriate immediate management?
A. Aspirin therapy
B. Thrombolysis with alteplase
C. Start warfarin
D. Mechanical thrombectomy only
E. Delay treatment pending MRI
Correct answer: B
,Rationale:
This patient has an acute ischaemic stroke within the thrombolysis window, no
contraindications, and a normal INR. IV thrombolysis is indicated.
Anticoagulation is not initiated acutely.
Question 4
A 56-year-old man presents with fatigue and weight loss. Blood tests show Hb 9.8
g/dL, MCV 72 fL, ferritin 8 µg/L. Colonoscopy is normal. Upper GI endoscopy
shows atrophic gastritis.
What is the most likely underlying diagnosis?
A. Coeliac disease
B. Gastric carcinoma
C. Autoimmune gastritis
D. Chronic NSAID use
E. Hookworm infection
Correct answer: C
Rationale:
Iron deficiency anaemia with atrophic gastritis suggests autoimmune gastritis,
which impairs iron and B12 absorption. Gastric carcinoma should be considered
but would typically show focal lesions.
Question 5
A 29-year-old woman presents with tremor, heat intolerance, and weight loss. TSH
is suppressed; free T4 is elevated. She has mild eye signs.
Which investigation best confirms the underlying aetiology?
A. Thyroid ultrasound
B. Anti-thyroid peroxidase antibodies
C. Anti-TSH receptor antibodies
, D. ESR
E. Serum thyroglobulin
Correct answer: C
Rationale:
The most likely diagnosis is Graves’ disease. Anti-TSH receptor antibodies are
the most specific test to confirm the diagnosis.
Question 6
A 68-year-old man with COPD presents with increasing dyspnoea and confusion.
ABG shows:
pH 7.28, PaCO₂ 9.2 kPa, PaO₂ 7.1 kPa on air.
What is the most appropriate next step?
A. High-flow oxygen
B. Intubation and ventilation
C. Non-invasive ventilation
D. IV bicarbonate
E. Oral corticosteroids only
Correct answer: C
Rationale:
This is acute hypercapnic respiratory failure with acidosis in COPD. Non-
invasive ventilation (NIV) is first-line unless contraindicated.
Question 7
A 54-year-old woman develops proximal muscle weakness and dry mouth.
Symptoms improve with repeated muscle use.
Which antibody is most likely present?
A. Anti-acetylcholine receptor
B. Anti-MuSK
C. Anti-voltage-gated calcium channel
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES
100% GUARANTEED PASS!!
<LATEST VERSION>
Question 1
A 62-year-old man presents with progressive exertional dyspnoea and ankle
swelling. He has a history of hypertension and type 2 diabetes. Examination
reveals elevated JVP, a displaced apex beat, and bilateral basal crackles.
Echocardiography shows concentric LV hypertrophy, preserved ejection fraction,
and impaired relaxation.
Which is the most appropriate long-term management strategy?
A. High-dose loop diuretics alone
B. ACE inhibitor, beta-blocker, and diuretics as needed
C. Ivabradine therapy
D. Implantable cardioverter-defibrillator
E. Cardiac resynchronisation therapy
Correct answer: B
Rationale:
This presentation is consistent with heart failure with preserved ejection
fraction (HFpEF). Management focuses on blood pressure control, regression
of LV hypertrophy, symptom relief, and management of comorbidities. ACE
inhibitors and beta-blockers are appropriate; diuretics are used for congestion.
Device therapies are not indicated in preserved EF.
,Question 2
A 45-year-old woman presents with recurrent headaches, palpitations, and
sweating. Blood pressure is persistently elevated. Urinary metanephrines are
markedly raised. CT abdomen reveals a 4 cm adrenal mass.
What is the most appropriate next step in management?
A. Immediate adrenalectomy
B. Start beta-blocker therapy
C. Start alpha-blocker therapy
D. MIBG scan prior to medical therapy
E. Start ACE inhibitor therapy
Correct answer: C
Rationale:
This is a phaeochromocytoma. Alpha-blockade must be established before any
beta-blockade or surgery to prevent unopposed alpha stimulation and
hypertensive crisis. Imaging for metastasis can follow stabilisation.
Question 3
A 70-year-old man with atrial fibrillation presents with sudden onset right-sided
weakness and aphasia. CT head shows no haemorrhage. Time from symptom onset
is 2 hours. INR is 1.1.
What is the most appropriate immediate management?
A. Aspirin therapy
B. Thrombolysis with alteplase
C. Start warfarin
D. Mechanical thrombectomy only
E. Delay treatment pending MRI
Correct answer: B
,Rationale:
This patient has an acute ischaemic stroke within the thrombolysis window, no
contraindications, and a normal INR. IV thrombolysis is indicated.
Anticoagulation is not initiated acutely.
Question 4
A 56-year-old man presents with fatigue and weight loss. Blood tests show Hb 9.8
g/dL, MCV 72 fL, ferritin 8 µg/L. Colonoscopy is normal. Upper GI endoscopy
shows atrophic gastritis.
What is the most likely underlying diagnosis?
A. Coeliac disease
B. Gastric carcinoma
C. Autoimmune gastritis
D. Chronic NSAID use
E. Hookworm infection
Correct answer: C
Rationale:
Iron deficiency anaemia with atrophic gastritis suggests autoimmune gastritis,
which impairs iron and B12 absorption. Gastric carcinoma should be considered
but would typically show focal lesions.
Question 5
A 29-year-old woman presents with tremor, heat intolerance, and weight loss. TSH
is suppressed; free T4 is elevated. She has mild eye signs.
Which investigation best confirms the underlying aetiology?
A. Thyroid ultrasound
B. Anti-thyroid peroxidase antibodies
C. Anti-TSH receptor antibodies
, D. ESR
E. Serum thyroglobulin
Correct answer: C
Rationale:
The most likely diagnosis is Graves’ disease. Anti-TSH receptor antibodies are
the most specific test to confirm the diagnosis.
Question 6
A 68-year-old man with COPD presents with increasing dyspnoea and confusion.
ABG shows:
pH 7.28, PaCO₂ 9.2 kPa, PaO₂ 7.1 kPa on air.
What is the most appropriate next step?
A. High-flow oxygen
B. Intubation and ventilation
C. Non-invasive ventilation
D. IV bicarbonate
E. Oral corticosteroids only
Correct answer: C
Rationale:
This is acute hypercapnic respiratory failure with acidosis in COPD. Non-
invasive ventilation (NIV) is first-line unless contraindicated.
Question 7
A 54-year-old woman develops proximal muscle weakness and dry mouth.
Symptoms improve with repeated muscle use.
Which antibody is most likely present?
A. Anti-acetylcholine receptor
B. Anti-MuSK
C. Anti-voltage-gated calcium channel
