MRCP PART 1 Study Guide 2026
Everything you need to pass the MRCP PART 1 exam in one place: the exam format, every topic to study, real practice questions with explanations, flashcards, and full-length practice tests. Free, no sign-up needed.
📋 MRCP PART 1 Exam Format at a Glance
📚 MRCP PART 1 Topics to Study (30)
✍️ Sample MRCP PART 1 Questions & Answers
1. Which valve lesion produces a mid-diastolic rumbling murmur best heard at the apex with the bell in the left lateral position?
Mitral stenosis produces a low-pitched, mid-diastolic rumbling murmur, heard best at the apex with the bell of the stethoscope, with the patient in the left lateral position. It is often preceded by an opening snap and is accentuated by exercise.
2. A patient with COPD has an FEV1/FVC ratio of 0.6 and an FEV1 of 45% predicted. According to GOLD criteria, what severity is this?
GOLD severity is based on FEV1 % predicted (post-bronchodilator): GOLD 1 ≥80%, GOLD 2 50–79%, GOLD 3 30–49%, GOLD 4 <30%. An FEV1 of 45% predicted places this patient in GOLD 3 (severe). The FEV1/FVC <0.7 confirms obstruction.
3. Which type of hypersensitivity reaction is responsible for Goodpasture's syndrome?
Goodpasture's syndrome is a type II hypersensitivity reaction where autoantibodies target the alpha-3 chain of type IV collagen in glomerular and alveolar basement membranes, causing glomerulonephritis and pulmonary haemorrhage.
4. A 25-year-old woman presents with haematuria, bilateral renal cysts on ultrasound, and a family history of renal failure. Genetic testing reveals a PKD1 mutation. What is the diagnosis?
Autosomal dominant polycystic kidney disease (ADPKD) is caused by mutations in PKD1 (chromosome 16, 85% of cases) or PKD2 (chromosome 4). It is the most common inherited kidney disease, presenting with bilateral cysts, haematuria, hypertension, and progressive renal failure.
5. A patient with known asthma presents with acute breathlessness. Arterial blood gas shows pH 7.35, PaCO2 5.5 kPa, PaO2 8.0 kPa. What does the PaCO2 suggest about the severity of this exacerbation?
In acute asthma, patients typically hyperventilate, producing a low PaCO2. A normal or rising PaCO2 (5.5 kPa) in acute asthma is a sinister sign indicating respiratory muscle fatigue and inability to maintain the hyperventilatory response. This is classified as a feature of life-threatening asthma by BTS/SIGN guidelines.
6. A 58-year-old woman with active rheumatoid arthritis is about to start methotrexate. Which baseline investigation is most critical before initiating this drug?
Methotrexate is hepatotoxic and myelosuppressive; baseline liver function tests and full blood count are mandatory before starting therapy, with regular monitoring every 4–12 weeks thereafter.