Multimodal Large Language Models (MLLMs) are becoming integral to autonomous driving (AD) systems due to their strong vision-language reasoning capabilities. However, MLLMs are vulnerable to adversarial attacks, particularly adversarial patch attacks, which can pose serious threats in real-world scenarios. Existing patch-based attack methods are primarily designed for object detection models and perform poorly when transferred to MLLM-based systems due to the latter's complex architectures and reasoning abilities. To address these limitations, we propose PhysPatch, a physically realizable and transferable adversarial patch framework tailored for MLLM-based AD systems. PhysPatch jointly optimizes patch location, shape, and content to enhance attack effectiveness and real-world applicability. It introduces a semantic-based mask initialization strategy for realistic placement, an SVD-based local alignment loss with patch-guided crop-resize to improve transferability, and a potential field-based mask refinement method. Extensive experiments across open-source, commercial, and reasoning-capable MLLMs demonstrate that PhysPatch significantly outperforms prior methods in steering MLLM-based AD systems toward target-aligned perception and planning outputs. Moreover, PhysPatch consistently places adversarial patches in physically feasible regions of AD scenes, ensuring strong real-world applicability and deployability.