MRCP(UK) PART 1 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. Examination reveals elevated JVP with prominent v-waves and a
pansystolic murmur loudest at the left lower sternal edge that increases with
inspiration.
Which pathological process is most likely responsible?
A. Left ventricular dilatation
B. Pulmonary hypertension causing right ventricular failure
C. Rheumatic mitral valve disease
D. Papillary muscle rupture
E. Hypertrophic cardiomyopathy
Correct answer: B
Rationale:
The murmur increases with inspiration (Carvallo’s sign), indicating a right-sided
lesion. Prominent v-waves and right heart failure signs suggest tricuspid
regurgitation, most commonly secondary to pulmonary hypertension causing
right ventricular dilatation.
,Question 2
A 45-year-old woman presents with episodic headaches, sweating, and
palpitations. Her blood pressure is persistently elevated. Plasma metanephrines are
raised.
Which additional finding is most likely?
A. Hypercalcaemia
B. Medullary thyroid carcinoma
C. Hypokalaemic alkalosis
D. Bilateral adrenal hyperplasia
E. Low urinary catecholamines
Correct answer: B
Rationale:
This presentation is consistent with phaeochromocytoma, which may occur as
part of MEN type 2, commonly associated with medullary thyroid carcinoma.
Question 3
A 70-year-old man develops sudden painless loss of vision in his right eye.
Fundoscopy shows a pale retina with a cherry-red spot.
Which artery is occluded?
A. Posterior ciliary artery
B. Ophthalmic artery
C. Central retinal artery
D. Central retinal vein
E. Internal carotid artery
Correct answer: C
Rationale:
A pale retina with a cherry-red spot is classic for central retinal artery occlusion,
usually embolic in origin.
,Question 4
A 28-year-old man presents with jaundice and fatigue. Blood tests show ALT
1,200 IU/L, AST 980 IU/L, bilirubin 95 µmol/L. He is HBsAg positive and anti-
HBc IgM positive.
What is the most likely diagnosis?
A. Chronic hepatitis B
B. Acute hepatitis B
C. Resolved hepatitis B infection
D. Hepatitis C infection
E. Drug-induced liver injury
Correct answer: B
Rationale:
The presence of HBsAg and anti-HBc IgM indicates acute hepatitis B infection.
Question 5
A 65-year-old man presents with confusion and hyponatraemia. Serum osmolality
is low, urine osmolality is inappropriately high, and urine sodium is elevated.
Which underlying condition is most likely?
A. Congestive heart failure
B. Diuretic overuse
C. Syndrome of inappropriate ADH secretion
D. Addison’s disease
E. Nephrotic syndrome
Correct answer: C
Rationale:
Low serum osmolality with inappropriately concentrated urine and high urine
sodium is characteristic of SIADH.
, Question 6
A 52-year-old woman with rheumatoid arthritis develops shortness of breath. Chest
X-ray shows bilateral pleural effusions.
Which pleural fluid finding is most consistent with rheumatoid pleuritis?
A. High glucose concentration
B. Alkaline pH
C. Low lactate dehydrogenase
D. Low glucose concentration
E. Transudative effusion
Correct answer: D
Rationale:
Rheumatoid pleural effusions are exudative, often with very low glucose and low
pH.
Question 7
A 40-year-old man presents with proximal muscle weakness and difficulty
climbing stairs. Creatine kinase is elevated. Muscle biopsy shows endomysial
inflammation.
Which antibody is most likely present?
A. Anti-Jo-1
B. Anti-Mi-2
C. Anti-SRP
D. Anti-dsDNA
E. Anti-centromere
Correct answer: A
Rationale:
Anti-Jo-1 antibodies are associated with polymyositis, which presents with
proximal muscle weakness and raised CK.
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. Examination reveals elevated JVP with prominent v-waves and a
pansystolic murmur loudest at the left lower sternal edge that increases with
inspiration.
Which pathological process is most likely responsible?
A. Left ventricular dilatation
B. Pulmonary hypertension causing right ventricular failure
C. Rheumatic mitral valve disease
D. Papillary muscle rupture
E. Hypertrophic cardiomyopathy
Correct answer: B
Rationale:
The murmur increases with inspiration (Carvallo’s sign), indicating a right-sided
lesion. Prominent v-waves and right heart failure signs suggest tricuspid
regurgitation, most commonly secondary to pulmonary hypertension causing
right ventricular dilatation.
,Question 2
A 45-year-old woman presents with episodic headaches, sweating, and
palpitations. Her blood pressure is persistently elevated. Plasma metanephrines are
raised.
Which additional finding is most likely?
A. Hypercalcaemia
B. Medullary thyroid carcinoma
C. Hypokalaemic alkalosis
D. Bilateral adrenal hyperplasia
E. Low urinary catecholamines
Correct answer: B
Rationale:
This presentation is consistent with phaeochromocytoma, which may occur as
part of MEN type 2, commonly associated with medullary thyroid carcinoma.
Question 3
A 70-year-old man develops sudden painless loss of vision in his right eye.
Fundoscopy shows a pale retina with a cherry-red spot.
Which artery is occluded?
A. Posterior ciliary artery
B. Ophthalmic artery
C. Central retinal artery
D. Central retinal vein
E. Internal carotid artery
Correct answer: C
Rationale:
A pale retina with a cherry-red spot is classic for central retinal artery occlusion,
usually embolic in origin.
,Question 4
A 28-year-old man presents with jaundice and fatigue. Blood tests show ALT
1,200 IU/L, AST 980 IU/L, bilirubin 95 µmol/L. He is HBsAg positive and anti-
HBc IgM positive.
What is the most likely diagnosis?
A. Chronic hepatitis B
B. Acute hepatitis B
C. Resolved hepatitis B infection
D. Hepatitis C infection
E. Drug-induced liver injury
Correct answer: B
Rationale:
The presence of HBsAg and anti-HBc IgM indicates acute hepatitis B infection.
Question 5
A 65-year-old man presents with confusion and hyponatraemia. Serum osmolality
is low, urine osmolality is inappropriately high, and urine sodium is elevated.
Which underlying condition is most likely?
A. Congestive heart failure
B. Diuretic overuse
C. Syndrome of inappropriate ADH secretion
D. Addison’s disease
E. Nephrotic syndrome
Correct answer: C
Rationale:
Low serum osmolality with inappropriately concentrated urine and high urine
sodium is characteristic of SIADH.
, Question 6
A 52-year-old woman with rheumatoid arthritis develops shortness of breath. Chest
X-ray shows bilateral pleural effusions.
Which pleural fluid finding is most consistent with rheumatoid pleuritis?
A. High glucose concentration
B. Alkaline pH
C. Low lactate dehydrogenase
D. Low glucose concentration
E. Transudative effusion
Correct answer: D
Rationale:
Rheumatoid pleural effusions are exudative, often with very low glucose and low
pH.
Question 7
A 40-year-old man presents with proximal muscle weakness and difficulty
climbing stairs. Creatine kinase is elevated. Muscle biopsy shows endomysial
inflammation.
Which antibody is most likely present?
A. Anti-Jo-1
B. Anti-Mi-2
C. Anti-SRP
D. Anti-dsDNA
E. Anti-centromere
Correct answer: A
Rationale:
Anti-Jo-1 antibodies are associated with polymyositis, which presents with
proximal muscle weakness and raised CK.
