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100+ Free PRES 2 Practice Questions

Pass your PRES Level 2 - Pre-Registration Examination System (Medical Council of Ireland) exam on the first try — instant access, no signup required.

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Key Facts: PRES 2 Exam

180 questions

PRES Level 2 is a written paper of 180 multiple-choice questions

Medical Council of Ireland / PRES candidate guidance

3 hours

Time allowed to complete the PRES 2 written paper

Medical Council of Ireland / PRES candidate guidance

5 disciplines

Medicine/GP, surgery, paediatrics, obstetrics & gynaecology and psychiatry

Medical Council of Ireland - PRES

Modified Angoff

Criterion-referenced standard setting means there is no fixed percentage pass mark

PRES candidate guidance

3 attempts

Candidates are normally allowed a maximum of three attempts per PRES level

S.I. No. 480/2010 Medical Council Rules

About EUR 460

Approximate PRES Level 2 examination fee per attempt

Medical Council of Ireland fees (confirm current value)

Pass Level 2 first

PRES 2 must be passed before sitting the PRES 3 clinical OSCE

Medical Council of Ireland - PRES

100

Free original single-best-answer practice questions here

OpenExamPrep

PRES Level 2 is the written multiple-choice component of the Medical Council of Ireland's Pre-Registration Examination System for international medical graduates. It is a computer-based paper of 180 single-best-answer and extended-matching questions answered in 3 hours, covering medicine and general practice, surgery, paediatrics, obstetrics & gynaecology and psychiatry at the level of a doctor completing internship. There is no fixed pass mark; a modified-Angoff standard is set for each sitting and candidates are normally allowed three attempts. The fee is approximately EUR 460 per attempt. This 100-question bank provides original single-best-answer practice modelled on the PRES 2 disciplines and emphasises diagnosis, first-line investigation and management.

Sample PRES 2 Practice Questions

Try these sample questions to test your PRES 2 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, radiating to the left arm, with sweating and nausea. His ECG shows 2 mm ST-segment elevation in leads II, III and aVF. Which is the single most appropriate immediate management priority?
A.Arrange urgent primary percutaneous coronary intervention
B.Start oral beta-blocker and discharge with GP follow-up
C.Give a proton pump inhibitor and observe
D.Arrange an outpatient exercise stress test
Explanation: ST-elevation in II, III and aVF indicates an acute inferior ST-elevation myocardial infarction. The priority is immediate reperfusion, with primary PCI the preferred strategy when available within the recommended time window, alongside aspirin and analgesia.
2A 72-year-old woman with hypertension presents with sudden palpitations. ECG shows an irregularly irregular rhythm with absent P waves at a rate of 140/min, and she is haemodynamically stable. What is the most appropriate first-line assessment to guide stroke-prevention therapy?
A.Echocardiographic ejection fraction alone
B.CHA2DS2-VASc score
C.Serum troponin
D.24-hour urinary catecholamines
Explanation: The rhythm is atrial fibrillation. The CHA2DS2-VASc score estimates stroke risk and guides whether oral anticoagulation is indicated. A score of 2 or more in women (or 1 or more excluding the sex point) generally warrants anticoagulation.
3A 58-year-old smoker presents with progressive exertional breathlessness and a chronic productive cough. Spirometry shows a post-bronchodilator FEV1/FVC ratio of 0.62 that does not normalise. Which diagnosis is most consistent with these findings?
A.Asthma
B.Chronic obstructive pulmonary disease
C.Idiopathic pulmonary fibrosis
D.Pulmonary embolism
Explanation: A post-bronchodilator FEV1/FVC ratio below 0.70 that does not fully reverse, in a smoker with chronic symptoms, confirms COPD. Fixed airflow obstruction distinguishes it from asthma.
4A 25-year-old woman with known asthma presents acutely breathless and unable to complete sentences, with a respiratory rate of 32/min, heart rate 120/min and peak flow 40% of predicted. What is the single most appropriate first treatment?
A.Oral montelukast
B.High-flow oxygen with nebulised salbutamol
C.Intravenous antibiotics
D.Reassurance and discharge with an inhaler
Explanation: This is an acute severe asthma attack. Immediate management is high-flow oxygen to maintain saturations, nebulised short-acting beta-agonist (salbutamol) often with ipratropium, and systemic corticosteroids.
5A 45-year-old man with a history of alcohol excess presents with epigastric pain radiating to the back and vomiting. Serum lipase is markedly elevated at six times the upper limit of normal. Which is the single best initial investigation to assess severity and exclude gallstones as a cause?
A.Abdominal ultrasound
B.Upper GI endoscopy
C.Barium swallow
D.Colonoscopy
Explanation: The clinical picture and lipase confirm acute pancreatitis. Abdominal ultrasound is the recommended early imaging to detect gallstones and biliary dilatation, the most common alternative cause to alcohol.
6A 30-year-old woman presents with several months of intermittent bloody diarrhoea, lower abdominal cramping and weight loss. Colonoscopy shows continuous inflammation extending proximally from the rectum with a granular, friable mucosa. Which is the most likely diagnosis?
A.Crohn's disease
B.Ulcerative colitis
C.Coeliac disease
D.Irritable bowel syndrome
Explanation: Continuous mucosal inflammation beginning in the rectum and extending proximally, with bloody diarrhoea, is characteristic of ulcerative colitis. Crohn's disease typically causes skip lesions and transmural involvement.
7A 68-year-old man presents with reduced urine output after a vomiting illness. Investigations show urea 18 mmol/L, creatinine raised from baseline, and a urinary sodium that is low with concentrated urine. Which type of acute kidney injury is most likely?
A.Pre-renal (hypovolaemic) AKI
B.Acute tubular necrosis
C.Post-renal obstruction
D.Acute glomerulonephritis
Explanation: Volume loss from vomiting, with avid sodium retention (low urinary sodium) and concentrated urine, indicates pre-renal AKI. The kidneys are appropriately conserving sodium and water in response to hypovolaemia, and function improves with fluid resuscitation.
8A 19-year-old presents with polyuria, polydipsia, weight loss and lethargy. Capillary glucose is 26 mmol/L, blood ketones are 4.5 mmol/L and venous pH is 7.21. Which is the single most appropriate first step in management?
A.Intravenous 0.9% sodium chloride infusion
B.Subcutaneous long-acting insulin only
C.Oral metformin
D.Intravenous sodium bicarbonate
Explanation: This is diabetic ketoacidosis. The first priority is fluid resuscitation with intravenous 0.9% sodium chloride to correct dehydration, followed by a fixed-rate intravenous insulin infusion and careful potassium replacement.
9A 40-year-old woman presents with tiredness, weight gain, cold intolerance and constipation. TSH is markedly elevated and free T4 is low. Which is the most appropriate first-line treatment?
A.Carbimazole
B.Levothyroxine
C.Propranolol
D.Radioactive iodine
Explanation: A raised TSH with low free T4 confirms primary hypothyroidism. Levothyroxine is the standard replacement therapy, titrated to symptoms and TSH.
10A 70-year-old man presents with sudden right-sided weakness and slurred speech that began 90 minutes ago. CT brain shows no haemorrhage. He has no contraindications to thrombolysis. Which is the single most appropriate management?
A.Intravenous thrombolysis with alteplase
B.Aspirin 300 mg and discharge
C.Immediate carotid endarterectomy
D.Oral warfarin loading
Explanation: An acute ischaemic stroke within the treatment window, with haemorrhage excluded and no contraindications, warrants intravenous thrombolysis (alteplase). Mechanical thrombectomy may also be considered for large-vessel occlusion.

About the PRES 2 Exam

The Pre-Registration Examination System (PRES) is the Medical Council of Ireland's assessment for certain international medical graduates seeking registration to practise medicine in Ireland. PRES Level 2 is the written, computer-based multiple-choice examination that tests applied clinical knowledge across the main disciplines of medicine and general practice, surgery, paediatrics, obstetrics & gynaecology and psychiatry, framed within Irish and European clinical practice and the Council's eight domains of Good Professional Practice. It comprises 180 single-best-answer and extended-matching questions to be answered in three hours. Candidates must pass PRES Level 2 before sitting PRES Level 3, the clinical OSCE, which is a separate assessment and is not covered by this written-paper practice bank.

Assessment

A single computer-based written paper of 180 multiple-choice questions in single-best-answer and extended-matching formats, covering medicine and general practice, surgery, paediatrics, obstetrics & gynaecology and psychiatry, based on the Medical Council's eight domains of Good Professional Practice.

Time Limit

3 hours (180 minutes) for the 180-question written paper.

Passing Score

No fixed percentage pass mark. A criterion-referenced standard (modified Angoff) is applied to each sitting, so the cut score varies slightly with question difficulty. Candidates are normally allowed up to three attempts.

Exam Fee

Set by the Medical Council of Ireland and approximately EUR 460 per attempt; confirm the current fee on medicalcouncil.ie before applying. (Medical Council of Ireland)

PRES 2 Exam Content Outline

38%

Medicine and General Practice

Core internal medicine and primary care across cardiology, respiratory, gastroenterology, renal, endocrinology, neurology and infectious disease, plus common general-practice presentations. Practice here emphasises diagnosis, first-line investigation, interpretation of results and evidence-based management in an Irish/HSE context.

18%

Surgery

General surgery, the acute abdomen, trauma, urology and orthopaedics. Practice covers recognising surgical emergencies, initial assessment and resuscitation, appropriate imaging and investigation, and decisions about operative versus conservative management and referral.

16%

Paediatrics

Common and serious childhood presentations, growth and development, immunisation, fluid and feeding issues and the febrile or unwell child. Practice emphasises recognising the seriously ill child, age-appropriate management and safe prescribing.

16%

Obstetrics and Gynaecology

Antenatal and intrapartum care, obstetric emergencies such as pre-eclampsia and postpartum haemorrhage, contraception, menstrual and bleeding disorders and common gynaecological conditions. Practice emphasises early recognition and first-line management.

12%

Psychiatry

Mood, anxiety and psychotic disorders, organic and substance-related presentations, and risk and suicide assessment. Practice covers diagnosis, first-line pharmacological and psychological treatment, and recognition of psychiatric emergencies.

How to Pass the PRES 2 Exam

What You Need to Know

  • Passing score: No fixed percentage pass mark. A criterion-referenced standard (modified Angoff) is applied to each sitting, so the cut score varies slightly with question difficulty. Candidates are normally allowed up to three attempts.
  • Assessment: A single computer-based written paper of 180 multiple-choice questions in single-best-answer and extended-matching formats, covering medicine and general practice, surgery, paediatrics, obstetrics & gynaecology and psychiatry, based on the Medical Council's eight domains of Good Professional Practice.
  • Time limit: 3 hours (180 minutes) for the 180-question written paper.
  • Exam fee: Set by the Medical Council of Ireland and approximately EUR 460 per attempt; confirm the current fee on medicalcouncil.ie before applying.

Keys to Passing

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

PRES 2 Study Tips from Top Performers

1Revise core medicine and surgery system by system, prioritising common and dangerous presentations and the single best next step in diagnosis, investigation or management.
2Learn management in an Irish and European context: HSE and national clinical guidelines, Irish immunisation and antenatal schedules and locally preferred first-line drugs, rather than relying only on your original MBBS materials.
3Practise extended-matching questions specifically, since matching the best option from a long list to several vignettes is a distinct skill from single-best-answer items.
4Pace yourself to about one minute per question so you can complete 180 questions in 3 hours, flagging and returning to harder items rather than stalling.
5Drill emergency recognition across all five disciplines, for example sepsis, acute coronary syndrome, the acute abdomen, the unwell child, pre-eclampsia and acute psychiatric risk.
6Use answer explanations to understand why each distractor is wrong, building the reasoning the exam rewards rather than memorising isolated facts.

Frequently Asked Questions

What is PRES Level 2?

PRES Level 2 is the written, computer-based multiple-choice examination in the Medical Council of Ireland's Pre-Registration Examination System. It tests applied clinical knowledge across medicine, surgery, paediatrics, obstetrics & gynaecology and psychiatry for international medical graduates seeking registration in Ireland.

How many questions are on PRES 2 and how long is it?

PRES Level 2 is a written paper of 180 multiple-choice questions (single-best-answer and extended-matching) to be answered in 3 hours.

Is there a fixed pass mark for PRES 2?

No. The pass standard is set for each sitting using a criterion-referenced method (modified Angoff), so the exact cut score varies slightly between examinations depending on question difficulty. Candidates are normally allowed up to three attempts.

What is the difference between PRES 2 and PRES 3?

PRES Level 2 is the written MCQ examination of clinical knowledge. PRES Level 3 is a separate clinical OSCE that assesses practical and communication skills. Candidates must pass Level 2 before being permitted to sit Level 3.

Can I be exempt from PRES 2?

Some candidates are exempt, for example those who hold an accepted assessment such as PLAB, USMLE, AMC or MCCEE within recognised time limits, or who completed a recognised internship. Check current exemption criteria with the Medical Council of Ireland.

Are these official Medical Council of Ireland questions?

No. These are original OpenExamPrep practice questions modelled on the PRES 2 disciplines and standard. They are not copied from any Medical Council of Ireland past paper. Always confirm exam details on medicalcouncil.ie.