Exam guide
The MRCS Part A, explained
Applied basic sciences and the principles of surgery in general, tested as single best answer. Set by the Intercollegiate Committee for Basic Surgical Examinations, on behalf of the Royal Colleges of Surgeons of England, Edinburgh, Glasgow and Ireland.
Last checked 15 August 2026. Confirm current fees, dates and the live syllabus on the ICBSE / Royal Colleges of Surgeons's own site before booking.
How the exam is structured
| Papers | Paper 1: Applied Basic Sciences; Paper 2: Principles of Surgery in General |
|---|---|
| Questions | 300 across 2 papers |
| Time | 300 minutes total (180 min for Paper 1: Applied Basic Sciences, 120 min for Paper 2: Principles of Surgery in General) |
| Question types | 180 SBA; 120 SBA |
| Options per SBA/MCQ | 5 (A–E) |
|---|---|
| Sittings per year | 3 |
| Set by | Intercollegiate Committee for Basic Surgical Examinations, on behalf of the Royal Colleges of Surgeons of England, Edinburgh, Glasgow and Ireland |
Where the marks are
Most candidates revise every domain evenly by accident, which spends most of their time on a fraction of the paper. A SpecialityMCQ session is built to the weights below, then tilted toward whichever domain is currently costing you marks.
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Applied Surgical Anatomy
-
Applied Surgical Physiology
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Common Surgical Conditions
-
Applied Surgical Pathology
-
Perioperative Management
-
Trauma & the Multiply Injured Patient
-
Pharmacology for Surgery
2.7% -
Surgical Care of Children
2.3%
These weights are the ICBSE's own published per-topic question-count table for both papers (Candidate Guide to the MRCS Examination), not an estimate.
A sample question
Written in-house to the MRCS style and answered against a named, current source — not claimed to be from a past paper. It plays exactly as it would in the app.
A 27-year-old man is brought to the emergency department after a stab injury to the right side of his chest. He is tachypnoeic and agitated, with a respiratory rate of 34/min and oxygen saturation of 88% on high-flow oxygen. On examination there is a distended right hemithorax with absent breath sounds, hyper-resonance to percussion, and tracheal deviation to the left. His blood pressure is 84/52 mmHg. What is the most appropriate immediate management step?
- Source
- Advanced Trauma Life Support (ATLS) Student Course Manual, 11th Edition (American College of Surgeons Committee on Trauma, 2025) — Thoracic trauma: recognising and decompressing a tension pneumothorax
- Checked
- Read against this source on 12 Aug 2026. If the guidance changes, the question comes back for another read before it is shown again.
Where this answer comes from
TAKEAWAY
Tension pneumothorax is a clinical diagnosis treated on the spot, not imaged first. Current ATLS teaching places emergency needle decompression in the 5th intercostal space, anterior to the mid-axillary line — the chest wall there is thinner than at the older 2nd intercostal, midclavicular site, which failed more often in obese or muscular patients.
Why B is right
This is the current ATLS standard site and technique for emergency decompression of a tension pneumothorax, ahead of formal chest drain insertion.
Tension pneumothorax is a clinical diagnosis. Waiting for imaging in a haemodynamically unstable patient with these findings delays a life-saving intervention that should happen at the bedside.
A formal chest drain follows decompression rather than replacing it — it takes longer to place and the patient needs the pressure released now. It is the correct next step, not the first one.
CT has no role in an unstable trauma patient with a clinical tension pneumothorax; it delays treatment for a diagnosis that examination has already made.
The findings — hyper-resonance, absent breath sounds and tracheal deviation — point to the pleural space, not cardiac tamponade, which instead presents with muffled heart sounds and a raised JVP (Beck's triad).
You just answered one. Five a day are free.
Start freeA real question, written in-house to this exam's style, shown exactly as it would play in the app.
Where SpecialityMCQ fits
SpecialityMCQ's MRCS bank grows toward the weights above, written as single best answer items set in UK NHS practice. Sessions balance every domain, then tilt toward whichever is currently costing you marks. Anything you miss returns on a spacing curve until it sticks, and every answer names the source it rests on and the date that source was last read.
New questions a day are free, with no card required, and the review deck is free for good.
Questions about the MRCS exam
What is the MRCS Part A?
MRCS Part A is set by the Intercollegiate Committee for Basic Surgical Examinations, on behalf of the Royal Colleges of Surgeons of England, Edinburgh, Glasgow and Ireland. Applied basic sciences and the principles of surgery in general, tested as single best answer.
How many questions does the MRCS exam have, and how long do I get?
MRCS Part A: 300 questions across 2 papers (300 minutes), with 5 options per single-best-answer item.
What does the MRCS blueprint cover?
The chart on this page shows the highest-weighted domains. These weights are the ICBSE's own published per-topic question-count table for both papers (Candidate Guide to the MRCS Examination), not an estimate.
How many times a year can I sit MRCS?
3 sittings a year, per the ICBSE / Royal Colleges of Surgeons's own published exam calendar. Confirm current dates and fees on the college's own site before booking.
Is SpecialityMCQ affiliated with the ICBSE / Royal Colleges of Surgeons?
No. SpecialityMCQ is an independent revision tool and is not affiliated with, endorsed by, or accredited by the Intercollegiate Committee for Basic Surgical Examinations, on behalf of the Royal Colleges of Surgeons of England, Edinburgh, Glasgow and Ireland.
Sitting a different exam? SpecialityMCQ also covers MRCOG Part 1 and Part 2 , MRCPCH Foundation of Practice and Theory and Science , MRCPsych Paper A and Paper B and MRCEM Primary and MRCEM SBA , each with its own guide.
SpecialityMCQ is an independent revision tool. It is not affiliated with, endorsed by, or accredited by the Intercollegiate Committee for Basic Surgical Examinations, on behalf of the Royal Colleges of Surgeons of England, Edinburgh, Glasgow and Ireland, or any other exam authority. This page summarises the college's own published exam information for candidates and is not a substitute for it. Always confirm current syllabus, fees and dates on the college's own site before applying.