MRCP Part 1 Sample Bank | Dr Sachin Swargiary

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001A 76-year-old has exertional syncope, angina and dyspnoea. Pulse is slow-rising and an ejection systolic murmur radiates to both carotids. Which is the single most likely diagnosis or core concept?Cardiology

A. Myasthenia gravis

B. Acute pancreatitis

C. Dermatomyositis

D. Axial spondyloarthritis

E. Severe aortic stenosis

Correct answer: E. Severe aortic stenosis
Explanation: Severe aortic stenosis is the best fit. Fixed LV outflow obstruction produces pressure overload, concentric LVH and a narrow pulse pressure.

051A COPD patient is drowsy with pH 7.25, PaCO2 9.5 kPa and PaO2 7.2 kPa despite controlled oxygen. Which is the single most likely diagnosis or core concept?Respiratory

A. Primary aldosteronism

B. Metformin-associated lactic acidosis

C. Primary adrenal insufficiency

D. Microscopic polyangiitis

E. Acute hypercapnic respiratory failure

Correct answer: E. Acute hypercapnic respiratory failure
Explanation: Acute hypercapnic respiratory failure is the best fit. Alveolar hypoventilation raises PaCO2; excessive oxygen can worsen V/Q mismatch and hypercapnia.

101A woman has fluctuating ptosis and diplopia worsening through the day with normal pupils. Which is the single most likely diagnosis or core concept?Neurology

A. Severe aortic stenosis

B. Systemic lupus erythematosus

C. Acquired long-QT torsades de pointes

D. Acute oesophageal variceal haemorrhage

E. Myasthenia gravis

Correct answer: E. Myasthenia gravis
Explanation: Myasthenia gravis is the best fit. Postsynaptic nicotinic ACh receptor dysfunction produces fatigable weakness without sensory loss.

151A 21-year-old has chronic hepatitis, tremor and psychiatric change with Kayser-Fleischer rings. Which is the single most likely diagnosis or core concept?Gastro-Hepatology

A. Wernicke encephalopathy

B. High-risk pulmonary embolism

C. Lambert-Eaton myasthenic syndrome

D. Pneumocystis jirovecii pneumonia

E. Wilson disease

Correct answer: E. Wilson disease
Explanation: Wilson disease is the best fit. ATP7B dysfunction impairs biliary copper excretion and incorporation into ceruloplasmin.

201A young adult has haematuria, RBC casts, hypertension and reduced GFR after a recent infection. Which is the single most likely diagnosis or core concept?Renal

A. Primary aldosteronism

B. Rheumatic mitral stenosis

C. G6PD deficiency haemolysis

D. CMV retinitis

E. Acute nephritic syndrome

Correct answer: E. Acute nephritic syndrome
Explanation: Acute nephritic syndrome is the best fit. Glomerular inflammation permits RBC passage and reduces filtration.

251A man has resistant hypertension, K 2.8, suppressed renin and elevated aldosterone. Which is the single most likely diagnosis or core concept?Endocrinology

A. Cryptococcal meningitis

B. Multiple endocrine neoplasia type 2

C. Cushing syndrome

D. Wolff-Parkinson-White pattern

E. Primary aldosteronism

Correct answer: E. Primary aldosteronism
Explanation: Primary aldosteronism is the best fit. Autonomous aldosterone causes sodium retention, potassium loss and renin suppression.

301A young woman has photosensitive rash, oral ulcers, arthritis, proteinuria and low complement. Which is the single most likely diagnosis or core concept?Rheumatology

A. Primary adrenal insufficiency

B. Neuroleptic malignant syndrome

C. Acquired long-QT torsades de pointes

D. G6PD deficiency haemolysis

E. Systemic lupus erythematosus

Correct answer: E. Systemic lupus erythematosus
Explanation: Systemic lupus erythematosus is the best fit. Immune-complex deposition and complement consumption drive multisystem inflammation.

351A woman has microcytic anaemia, low ferritin and high transferrin. Which is the single most likely diagnosis or core concept?Haematology

A. Multiple sclerosis

B. Obesity hypoventilation syndrome

C. Axial spondyloarthritis

D. Clostridioides difficile infection

E. Iron-deficiency anaemia

Correct answer: E. Iron-deficiency anaemia
Explanation: Iron-deficiency anaemia is the best fit. Low iron stores reduce haem synthesis; ferritin is the most useful initial store marker absent major inflammation.

401An untreated HIV patient with CD4 70 has dry cough, fever and diffuse ground-glass opacities. Which is the single most likely diagnosis or core concept?Infectious Diseases

A. Dermatomyositis

B. Post-streptococcal glomerulonephritis

C. DKA with severe hypokalaemia

D. Prolactinoma

E. Pneumocystis jirovecii pneumonia

Correct answer: E. Pneumocystis jirovecii pneumonia
Explanation: Pneumocystis jirovecii pneumonia is the best fit. PJP risk rises markedly with CD4 <200 cells/µL.

451An elderly patient on digoxin with renal impairment develops nausea, yellow vision, bradyarrhythmia and hyperkalaemia. Which is the single most likely diagnosis or core concept?Clinical Pharmacology

A. Wernicke encephalopathy

B. Neuroleptic malignant syndrome

C. Infective endocarditis

D. Huntington disease

E. Digoxin toxicity

Correct answer: E. Digoxin toxicity
Explanation: Digoxin toxicity is the best fit. Na/K-ATPase inhibition increases intracellular calcium; severe acute toxicity can produce hyperkalaemia.

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