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100+ Free MRCPI GM Part I Practice Questions

Pass your MRCPI in General Medicine Part I (Written) exam on the first try — instant access, no signup required.

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Key Facts: MRCPI GM Part I Exam

100 questions

Single-best-answer (best-of-five) items in one written paper

RCPI - MRCPI General Medicine Part I Exam Format

3 hours

Time allowed for the single Part I paper, online via remote invigilation

RCPI - MRCPI General Medicine Part I

No negative marking

All questions equally weighted; candidates advised to attempt every item

RCPI - MRCPI General Medicine Regulations

At least 75%

Share of the paper that is general internal medicine across the specialties

RCPI - MRCPI General Medicine Part I Exam Format

EUR 730

Part I fee from 1 January 2026 for Irish and overseas candidates

RCPI - Examinations Schedule

6 months

Minimum time after graduating before sitting Part I

RCPI - MRCPI General Medicine Part I Exam Format

6 attempts

Maximum attempts at each MRCPI component, no overall Part I time limit

RCPI - MRCPI General Medicine Regulations

100

Free original physician-level practice questions here

OpenExamPrep

MRCPI in General Medicine Part I is the first written membership exam of the Royal College of Physicians of Ireland, distinct from the UK MRCP. It is one paper of 100 single-best-answer (best-of-five) questions sat in 3 hours online under remote invigilation, with no negative marking and equally weighted questions. At least 75% of the paper is general internal medicine across the specialties; the rest covers basic and applied sciences plus elementary statistics. The fee from 1 January 2026 is EUR 730, candidates may sit from six months after graduation, and up to six attempts are allowed with no overall time limit. This 100-question bank provides original physician-level practice modelled on the exam blueprint.

Sample MRCPI GM Part I Practice Questions

Try these sample questions to test your MRCPI GM Part I exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 64-year-old man presents with central crushing chest pain for 40 minutes. ECG shows ST elevation in leads II, III and aVF. Which coronary artery is most likely occluded?
A.Left anterior descending artery
B.Right coronary artery
C.Left circumflex artery
D.Left main stem
Explanation: Inferior ST elevation in leads II, III and aVF reflects inferior wall infarction, which is most commonly supplied by the right coronary artery in a right-dominant circulation. Reciprocal ST depression is often seen in the lateral or anterior leads.
2A 72-year-old woman with an irregularly irregular pulse is found to have atrial fibrillation. Her CHA2DS2-VASc score is 4. What is the most appropriate long-term therapy to reduce stroke risk?
A.Aspirin 75 mg daily
B.Oral anticoagulation
C.Clopidogrel monotherapy
D.No antithrombotic therapy
Explanation: A CHA2DS2-VASc score of 4 confers a high annual stroke risk, and oral anticoagulation (a direct oral anticoagulant or warfarin) is indicated. Anticoagulation substantially outperforms antiplatelet therapy for stroke prevention in atrial fibrillation.
3A 55-year-old man with heart failure and reduced ejection fraction (28%) is on ramipril, bisoprolol and furosemide and remains symptomatic. Which additional agent has the strongest evidence for reducing mortality in this setting?
A.Digoxin
B.A mineralocorticoid receptor antagonist
C.Amlodipine
D.Ivabradine
Explanation: In heart failure with reduced ejection fraction that remains symptomatic on an ACE inhibitor and beta-blocker, adding a mineralocorticoid receptor antagonist such as spironolactone or eplerenone reduces mortality and hospitalisation. It is one of the four pillars of HFrEF therapy.
4A 30-year-old man collapses while playing football. He has a family history of sudden cardiac death. Echocardiography shows asymmetric septal hypertrophy with systolic anterior motion of the mitral valve. What is the diagnosis?
A.Dilated cardiomyopathy
B.Hypertrophic cardiomyopathy
C.Restrictive cardiomyopathy
D.Arrhythmogenic right ventricular cardiomyopathy
Explanation: Asymmetric septal hypertrophy with systolic anterior motion of the mitral valve causing dynamic left ventricular outflow obstruction is characteristic of hypertrophic cardiomyopathy. It is the commonest cause of sudden cardiac death in young athletes and is usually autosomal dominant.
5A 68-year-old man has an ejection systolic murmur radiating to the carotids, a slow-rising pulse and a narrow pulse pressure. Which valvular lesion is most likely?
A.Mitral regurgitation
B.Aortic stenosis
C.Aortic regurgitation
D.Mitral stenosis
Explanation: An ejection systolic murmur radiating to the carotids with a slow-rising (anacrotic) pulse and narrow pulse pressure is the classic picture of severe aortic stenosis. Calcific degeneration is the commonest cause in older adults.
6A 45-year-old woman presents with palpitations. ECG shows a regular narrow-complex tachycardia at 180 bpm with no visible P waves. Vagal manoeuvres fail. Haemodynamically stable. What is the first-line pharmacological treatment?
A.Intravenous adenosine
B.Intravenous amiodarone
C.Intravenous digoxin
D.Oral bisoprolol
Explanation: A regular narrow-complex tachycardia is most likely a supraventricular tachycardia such as AV nodal re-entry. After failed vagal manoeuvres in a stable patient, intravenous adenosine is first line: it transiently blocks the AV node and usually terminates the re-entry circuit.
7A 25-year-old previously well woman presents with sudden pleuritic chest pain and breathlessness. She is tall and thin. Chest examination reveals reduced breath sounds and hyper-resonance on the right. What is the most likely diagnosis?
A.Lobar pneumonia
B.Primary spontaneous pneumothorax
C.Pulmonary embolism
D.Pleural effusion
Explanation: Sudden pleuritic pain and breathlessness with unilateral reduced breath sounds and hyper-resonance in a tall, thin young person is a primary spontaneous pneumothorax, typically from rupture of an apical subpleural bleb. Confirm with chest radiograph.
8A 58-year-old smoker with COPD presents with increased breathlessness, increased sputum volume and purulent sputum. There is no consolidation on chest radiograph. What is the most appropriate initial management of this exacerbation in addition to controlled oxygen?
A.Oral corticosteroids and antibiotics with bronchodilators
B.Intravenous magnesium alone
C.Long-term oxygen therapy initiation
D.Immediate non-invasive ventilation
Explanation: An infective COPD exacerbation with the cardinal features (increased breathlessness, sputum volume and purulence) is treated with increased short-acting bronchodilators, a short course of oral corticosteroids and antibiotics, alongside controlled oxygen aiming for saturations of 88 to 92%.
9A 70-year-old man presents with progressive exertional dyspnoea and a dry cough. Examination reveals fine bibasal end-inspiratory crackles and finger clubbing. High-resolution CT shows basal subpleural reticulation and honeycombing. What is the most likely diagnosis?
A.Sarcoidosis
B.Idiopathic pulmonary fibrosis
C.Hypersensitivity pneumonitis
D.Bronchiectasis
Explanation: Progressive dyspnoea with fine bibasal Velcro-like crackles, clubbing and a usual interstitial pneumonia pattern (basal, subpleural reticulation with honeycombing) is characteristic of idiopathic pulmonary fibrosis. Antifibrotics such as pirfenidone or nintedanib slow decline.
10A 42-year-old woman with asthma attends with acute severe symptoms. Peak flow is 40% of predicted, she can speak only in short phrases and respiratory rate is 28. After oxygen, nebulised salbutamol and ipratropium and oral prednisolone, which feature would indicate a life-threatening attack requiring urgent escalation?
A.Peak flow 40% of predicted
B.Respiratory rate of 28
C.A normal or rising arterial carbon dioxide (PaCO2)
D.Inability to complete full sentences
Explanation: In acute asthma, hyperventilation normally produces a low PaCO2. A normal or rising PaCO2 signifies exhaustion and impending respiratory failure and is a life-threatening feature requiring urgent senior and critical-care input.

About the MRCPI GM Part I Exam

MRCPI in General Medicine Part I is the first written membership examination of the Royal College of Physicians of Ireland and a fundamental component of RCPI Basic Specialist Training, accredited by the Irish Medical Council and recognised by the General Medical Council in the UK. It is a postgraduate, knowledge-based assessment of internal medicine, distinct from the UK MRCP. The exam is a single paper of 100 single-best-answer (best-of-five) questions sat over three hours online under remote invigilation worldwide. At least three-quarters of the paper tests general internal medicine across the specialties, with the remainder covering the basic and applied sciences underpinning medical practice, including elementary statistics. There is no negative marking and all questions are equally weighted, and the syllabus follows the RCPI Basic Specialist Training curriculum blueprint.

Assessment

One written paper of 100 single-best-answer (best-of-five) questions. Each question has a stem followed by five options; the candidate selects the single best answer. There is no negative marking and all questions are equally weighted.

Time Limit

3 hours for the single 100-question paper, delivered online via remote invigilation.

Passing Score

No fixed percentage pass mark. The pass standard is set by the examiners through a criterion-referenced standard-setting process and applied uniformly across the diet. There is no negative marking, so candidates are advised to attempt every question.

Exam Fee

EUR 730 from 1 January 2026 (same for Irish and overseas candidates). Candidates working in Ireland may reclaim the fee under the HSE Clinical Course and Examination Refund Scheme. (Royal College of Physicians of Ireland (RCPI))

MRCPI GM Part I Exam Content Outline

75%

Clinical internal medicine across the specialties

RCPI blueprint: at least three-quarters of the paper covers general internal medicine on common and important hospital diseases. Practice here spans cardiology, respiratory, gastroenterology and hepatology, nephrology, endocrinology, rheumatology, haematology, oncology, infectious diseases, neurology, dermatology, geriatric medicine and acute care, testing diagnosis, investigation and evidence-based management.

10%

Clinical pharmacology and therapeutics

Drug mechanisms of action, indications, adverse effects, interactions, pharmacokinetics, toxicity and antidotes, and evidence-based prescribing decisions relevant to acute and general medicine.

10%

Basic and applied sciences

Physiology, biochemistry, immunology, genetics, microbiology and anatomy applied to clinical scenarios, framed around a clinical stem where appropriate, reflecting that clinical science underpins all medical practice.

5%

Statistics, epidemiology and clinical ethics

Elementary biostatistics and evidence-based medicine (sensitivity, specificity, predictive values, relative and absolute risk, number needed to treat, study design) and core clinical ethics and consent principles.

How to Pass the MRCPI GM Part I Exam

What You Need to Know

  • Passing score: No fixed percentage pass mark. The pass standard is set by the examiners through a criterion-referenced standard-setting process and applied uniformly across the diet. There is no negative marking, so candidates are advised to attempt every question.
  • Assessment: One written paper of 100 single-best-answer (best-of-five) questions. Each question has a stem followed by five options; the candidate selects the single best answer. There is no negative marking and all questions are equally weighted.
  • Time limit: 3 hours for the single 100-question paper, delivered online via remote invigilation.
  • Exam fee: EUR 730 from 1 January 2026 (same for Irish and overseas candidates). Candidates working in Ireland may reclaim the fee under the HSE Clinical Course and Examination Refund Scheme.

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

MRCPI GM Part I Study Tips from Top Performers

1Use the RCPI Basic Specialist Training curriculum as a blueprint and weight your revision towards common and important hospital medical diseases, which make up the bulk of the paper.
2Practise large numbers of single-best-answer questions under timed conditions, roughly under two minutes per item, so you can move on and return to harder questions on the day.
3Because there is no negative marking, never leave a question blank: eliminate options and make your best choice on every item.
4Do not neglect basic and applied sciences and statistics; review sensitivity, specificity, predictive values, study design and core physiology and pharmacology, often framed around a clinical stem.
5Allow three to four months of preparation alongside clinical work, building daily question volume gradually rather than cramming, as RCPI advises.
6Practise the on-screen calculator and notepad for biostatistics items before the exam, since the paper is delivered online under remote invigilation.

Frequently Asked Questions

How many questions are on MRCPI General Medicine Part I and how long is it?

Part I is a single written paper of 100 single-best-answer (best-of-five) questions sat over three hours online under remote invigilation. Each question has a stem followed by five options.

Is there negative marking on MRCPI Part I?

No. There is no negative marking and every question is equally weighted, so RCPI advises candidates to attempt all questions, including those they are unsure about.

What is the pass mark for MRCPI Part I?

There is no fixed percentage pass mark. The standard is set by examiners using a criterion-referenced standard-setting process and applied uniformly to all candidates in a diet.

When can I sit MRCPI General Medicine Part I?

Candidates with a medical degree acceptable to the Medical Council of Ireland may sit Part I from six months after graduating from medical school. Up to six attempts are allowed with no overall time limit to pass.

What topics does Part I cover?

At least 75% is general internal medicine across the specialties (cardiology, respiratory, gastroenterology and hepatology, nephrology, endocrinology, rheumatology, haematology, oncology, infectious diseases, neurology and more). The remainder covers basic and applied sciences plus elementary statistics.

How much does MRCPI Part I cost in 2026?

From 1 January 2026 the fee is EUR 730 for both Irish and overseas candidates. Candidates working in Ireland may reclaim it under the HSE Clinical Course and Examination Refund Scheme.