MRCP PART 1 EXAMINATION QUESTION BANK: 200
HIGH-YIELD MCQs COVERING ALL CORE MEDICAL
SPECIALTIES
1. A 58-year-old male with COPD is brought to the ED with worsening
dyspnea. ABG on 2 L/min nasal cannula: pH 7.31, PaCO2 68, PaO2 55,
HCO3- 32. What is the primary acid-base disorder?
A) Acute respiratory acidosis
B) Chronic respiratory acidosis
C) Acute on chronic respiratory acidosis
D) Metabolic alkalosis
Answer: C
Rationale: PaCO2 >45 indicates respiratory acidosis. Elevated HCO3-
(32) indicates renal compensation, which takes days to occur, suggesting
a chronic component. The pH is 7.31, which is lower than expected for
fully compensated chronic respiratory acidosis (which would be closer
to 7.35-7.40), indicating an acute deterioration superimposed on a
chronic condition.
2. A 24-year-old female presents with sudden onset palpitations. ECG
shows a narrow complex tachycardia with a rate of 180 bpm. The
rhythm is regular and there are no visible P waves. What is the most
appropriate initial management if she is hemodynamically stable?
A) Synchronized DC cardioversion
B) Intravenous adenosine
C) Intravenous amiodarone
D) Vagal maneuvers
,Answer: D
Rationale: In a hemodynamically stable patient with a regular narrow
complex tachycardia (likely SVT), vagal maneuvers are the first-line
intervention. If unsuccessful, adenosine is the next step. DC
cardioversion is reserved for unstable patients.
3. A 65-year-old man presents with progressive dyspnea and a dry
cough. He has a history of rheumatoid arthritis. Chest X-ray shows
bilateral lower zone interstitial changes. HRCT reveals honeycombing
and traction bronchiectasis. What is the most likely diagnosis?
A) Hypersensitivity pneumonitis
B) Usual interstitial pneumonia
C) Non-specific interstitial pneumonia
D) Cryptogenic organizing pneumonia
Answer: B
Rationale: Usual interstitial pneumonia (UIP) is characterized by
honeycombing, traction bronchiectasis, and a basal/subpleural
predominance on HRCT. It is the classic pattern seen in idiopathic
pulmonary fibrosis and rheumatoid arthritis-associated interstitial lung
disease.
4. A 45-year-old woman is admitted with severe abdominal pain
radiating to her back. Serum amylase is 1200 U/L. She drinks minimal
alcohol. Ultrasound shows gallstones. What is the most likely
underlying cause of her pancreatitis?
A) Alcohol-induced
B) Hypertriglyceridemia
C) Gallstone migration
D) Autoimmune pancreatitis
Answer: C
,Rationale: Gallstones are the most common cause of acute pancreatitis
worldwide. The pain radiating to the back and elevated amylase are
classic. The ultrasound finding of gallstones confirms the etiology.
5. A 30-year-old male presents with polyuria, polydipsia, and weight
loss. Random blood glucose is 22 mmol/L. Blood gas shows pH 7.15,
PaCO2 25, HCO3- 10. Urinalysis is positive for ketones. What is the
primary acid-base disturbance?
A) Metabolic acidosis with respiratory compensation
B) Respiratory alkalosis with metabolic compensation
C) Mixed metabolic acidosis and respiratory alkalosis
D) Metabolic alkalosis
Answer: A
Rationale: The low HCO3- (10) and low pH (7.15) indicate a primary
metabolic acidosis. The low PaCO2 (25) represents respiratory
compensation (Kussmaul breathing) attempting to blow off CO2 to raise
the pH.
6. A 72-year-old male with known atrial fibrillation is on warfarin. His
INR is 8.5. He has no active bleeding. What is the most appropriate
management?
A) Vitamin K 10 mg IV
B) Fresh frozen plasma
C) Prothrombin complex concentrate
D) Withhold warfarin and give Vitamin K 1-3 mg IV
Answer: D
Rationale: For an INR >8.0 without bleeding, the recommended
management is to withhold warfarin and administer low-dose
intravenous Vitamin K (1-3 mg). High-dose Vitamin K or blood products
are reserved for active bleeding or imminent surgery.
, 7. A 55-year-old female presents with a 6-month history of fatigue,
weight gain, and cold intolerance. TSH is elevated, and free T4 is low.
Anti-thyroid peroxidase antibodies are positive. What is the most
likely diagnosis?
A) Graves' disease
B) Hashimoto's thyroiditis
C) Subacute thyroiditis
D) Toxic multinodular goiter
Answer: B
Rationale: Hashimoto's thyroiditis is the most common cause of primary
hypothyroidism in developed countries. It is characterized by elevated
TSH, low free T4, and positive anti-TPO antibodies.
8. A 68-year-old male presents with sudden onset of severe headache,
vomiting, and neck stiffness. CT head shows a diffuse subarachnoid
hemorrhage. What is the most likely underlying cause?
A) Ruptured berry aneurysm
B) Arteriovenous malformation
C) Hypertensive hemorrhage
D) Amyloid angiopathy
Answer: A
Rationale: Ruptured berry (saccular) aneurysms are the most common
cause of non-traumatic subarachnoid hemorrhage, typically presenting
with a sudden, severe "thunderclap" headache.
9. A 40-year-old female presents with symmetrical small joint pain and
swelling in her hands and wrists for 3 months. She has morning
stiffness lasting more than 1 hour. What is the most sensitive
serological test for this condition?
A) Antinuclear antibody
HIGH-YIELD MCQs COVERING ALL CORE MEDICAL
SPECIALTIES
1. A 58-year-old male with COPD is brought to the ED with worsening
dyspnea. ABG on 2 L/min nasal cannula: pH 7.31, PaCO2 68, PaO2 55,
HCO3- 32. What is the primary acid-base disorder?
A) Acute respiratory acidosis
B) Chronic respiratory acidosis
C) Acute on chronic respiratory acidosis
D) Metabolic alkalosis
Answer: C
Rationale: PaCO2 >45 indicates respiratory acidosis. Elevated HCO3-
(32) indicates renal compensation, which takes days to occur, suggesting
a chronic component. The pH is 7.31, which is lower than expected for
fully compensated chronic respiratory acidosis (which would be closer
to 7.35-7.40), indicating an acute deterioration superimposed on a
chronic condition.
2. A 24-year-old female presents with sudden onset palpitations. ECG
shows a narrow complex tachycardia with a rate of 180 bpm. The
rhythm is regular and there are no visible P waves. What is the most
appropriate initial management if she is hemodynamically stable?
A) Synchronized DC cardioversion
B) Intravenous adenosine
C) Intravenous amiodarone
D) Vagal maneuvers
,Answer: D
Rationale: In a hemodynamically stable patient with a regular narrow
complex tachycardia (likely SVT), vagal maneuvers are the first-line
intervention. If unsuccessful, adenosine is the next step. DC
cardioversion is reserved for unstable patients.
3. A 65-year-old man presents with progressive dyspnea and a dry
cough. He has a history of rheumatoid arthritis. Chest X-ray shows
bilateral lower zone interstitial changes. HRCT reveals honeycombing
and traction bronchiectasis. What is the most likely diagnosis?
A) Hypersensitivity pneumonitis
B) Usual interstitial pneumonia
C) Non-specific interstitial pneumonia
D) Cryptogenic organizing pneumonia
Answer: B
Rationale: Usual interstitial pneumonia (UIP) is characterized by
honeycombing, traction bronchiectasis, and a basal/subpleural
predominance on HRCT. It is the classic pattern seen in idiopathic
pulmonary fibrosis and rheumatoid arthritis-associated interstitial lung
disease.
4. A 45-year-old woman is admitted with severe abdominal pain
radiating to her back. Serum amylase is 1200 U/L. She drinks minimal
alcohol. Ultrasound shows gallstones. What is the most likely
underlying cause of her pancreatitis?
A) Alcohol-induced
B) Hypertriglyceridemia
C) Gallstone migration
D) Autoimmune pancreatitis
Answer: C
,Rationale: Gallstones are the most common cause of acute pancreatitis
worldwide. The pain radiating to the back and elevated amylase are
classic. The ultrasound finding of gallstones confirms the etiology.
5. A 30-year-old male presents with polyuria, polydipsia, and weight
loss. Random blood glucose is 22 mmol/L. Blood gas shows pH 7.15,
PaCO2 25, HCO3- 10. Urinalysis is positive for ketones. What is the
primary acid-base disturbance?
A) Metabolic acidosis with respiratory compensation
B) Respiratory alkalosis with metabolic compensation
C) Mixed metabolic acidosis and respiratory alkalosis
D) Metabolic alkalosis
Answer: A
Rationale: The low HCO3- (10) and low pH (7.15) indicate a primary
metabolic acidosis. The low PaCO2 (25) represents respiratory
compensation (Kussmaul breathing) attempting to blow off CO2 to raise
the pH.
6. A 72-year-old male with known atrial fibrillation is on warfarin. His
INR is 8.5. He has no active bleeding. What is the most appropriate
management?
A) Vitamin K 10 mg IV
B) Fresh frozen plasma
C) Prothrombin complex concentrate
D) Withhold warfarin and give Vitamin K 1-3 mg IV
Answer: D
Rationale: For an INR >8.0 without bleeding, the recommended
management is to withhold warfarin and administer low-dose
intravenous Vitamin K (1-3 mg). High-dose Vitamin K or blood products
are reserved for active bleeding or imminent surgery.
, 7. A 55-year-old female presents with a 6-month history of fatigue,
weight gain, and cold intolerance. TSH is elevated, and free T4 is low.
Anti-thyroid peroxidase antibodies are positive. What is the most
likely diagnosis?
A) Graves' disease
B) Hashimoto's thyroiditis
C) Subacute thyroiditis
D) Toxic multinodular goiter
Answer: B
Rationale: Hashimoto's thyroiditis is the most common cause of primary
hypothyroidism in developed countries. It is characterized by elevated
TSH, low free T4, and positive anti-TPO antibodies.
8. A 68-year-old male presents with sudden onset of severe headache,
vomiting, and neck stiffness. CT head shows a diffuse subarachnoid
hemorrhage. What is the most likely underlying cause?
A) Ruptured berry aneurysm
B) Arteriovenous malformation
C) Hypertensive hemorrhage
D) Amyloid angiopathy
Answer: A
Rationale: Ruptured berry (saccular) aneurysms are the most common
cause of non-traumatic subarachnoid hemorrhage, typically presenting
with a sudden, severe "thunderclap" headache.
9. A 40-year-old female presents with symmetrical small joint pain and
swelling in her hands and wrists for 3 months. She has morning
stiffness lasting more than 1 hour. What is the most sensitive
serological test for this condition?
A) Antinuclear antibody
