Free Practice Questions for Concorso Medicina Generale MMG

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Key Facts: Concorso Medicina Generale MMG Exam

100 questions

Total questions on the national examination

Ministero della Salute

120 minutes

Total examination duration

Ministero della Salute

60 / 100

Minimum qualifying score for regional merit ranking

D.Lgs. 368/1999

+1 / 0

Scoring: +1 correct, 0 incorrect or omitted

Ministero della Salute Bando Nazionale

3 years

Duration of the CFSMG vocational training program

D.Lgs. 368/1999

5 options

Multiple-choice format per question

Ministero della Salute

Simultaneous

Single nationwide date for all Italian regions

Gazzetta Ufficiale della Repubblica Italiana

The Concorso MMG (CFSMG) is Italy's official 120-minute, 100-question competitive entrance examination for the three-year vocational training program in general practice (Medicina Generale). Administered annually on a single nationwide date by the Ministero della Salute and regional health authorities, the test awards +1 point per correct answer with 0 penalty for incorrect answers. Candidates must achieve at least 60/100 points to be eligible for regional admission rankings.

Sample Concorso Medicina Generale MMG Practice Questions

Try these sample questions to review concepts for the Concorso Medicina Generale MMG exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 85+ question experience with AI tutoring.

1A 54-year-old male presents to your outpatient clinic (ambulatorio MMG) for routine follow-up. Repeated office blood pressure measurements over three separate visits average 148/94 mmHg. You order a 24-hour ambulatory blood pressure monitoring (ABPM / monitoraggio dinamico della pressione arteriosa nelle 24 ore). According to European Society of Cardiology / European Society of Hypertension (ESC/ESH) guidelines, what 24-hour average threshold defines arterial hypertension?

A.24-hour average ≥ 140/90 mmHg

B.24-hour average ≥ 130/80 mmHg

C.24-hour average ≥ 135/85 mmHg

D.24-hour average ≥ 125/75 mmHg

Explanation: According to ESC/ESH arterial hypertension guidelines, the diagnostic threshold for hypertension on 24-hour ABPM is an average blood pressure ≥ 130/80 mmHg. For daytime (awake) mean ABPM, the threshold is ≥ 135/85 mmHg, and for nighttime (asleep) mean ABPM, it is ≥ 120/70 mmHg.

2A 58-year-old female without history of diabetes or chronic kidney disease is diagnosed with grade 2 essential hypertension (office BP 166/102 mmHg). Her estimated 10-year cardiovascular risk is moderate. In accordance with current ESC/ESH guidelines, what is the recommended initial pharmacological strategy in the primary care setting?

A.Monotherapy with a beta-blocker titrated to the maximum tolerated dose

B.Monotherapy with a low-dose thiazide diuretic followed by reassessment in 6 months

C.Initial dual combination therapy (single-pill combination) with an ACE inhibitor or ARB plus a calcium channel blocker (CCB) or thiazide/thiazide-like diuretic

D.Initial triple combination therapy including an ACE inhibitor, beta-blocker, and mineralocorticoid receptor antagonist

Explanation: Current ESC/ESH guidelines recommend starting most patients with grade 1 or grade 2 hypertension on a dual single-pill combination comprising a renin-angiotensin system (RAS) blocker (ACE inhibitor or ARB) combined with either a dihydropyridine calcium channel blocker (CCB) or a thiazide/thiazide-like diuretic to achieve prompt control and improve adherence.

3A 62-year-old male is confirmed to have resistant hypertension (ipertensione resistente): his blood pressure remains 152/96 mmHg despite confirmed adherence to maximum tolerated doses of ramipril 10 mg daily, amlodipine 10 mg daily, and indapamide 2.5 mg daily. His serum potassium is 4.3 mEq/L and eGFR is 68 mL/min/1.73 m². What is the recommended next pharmacological step?

A.Add low-dose spironolactone (25–50 mg daily)

B.Add doxazosin 4 mg daily as first-line add-on therapy

C.Discontinue indapamide and substitute with furosemide 25 mg daily

D.Add an angiotensin receptor blocker (ARB) to the current ACE inhibitor regimen

Explanation: According to the PATHWAY-2 trial and ESC/ESH consensus guidelines, low-dose spironolactone (25 to 50 mg daily) is the drug of choice for resistant hypertension when serum potassium is < 4.5 mEq/L and eGFR is > 45 mL/min/1.73 m², as it effectively counteracts aldosterone-mediated sodium retention.

4An asymptomatic 51-year-old woman visits your clinic for routine health screening. Her laboratory testing reveals a fasting plasma glucose (glicemia a digiuno) of 132 mg/dL. According to Italian Standards of Care for Diabetes Mellitus (Standard Italiani per la cura del diabete mellito AMD-SID), how should the diagnosis of type 2 diabetes be confirmed in an asymptomatic patient?

A.Immediately prescribe metformin without repeating laboratory testing

B.Diagnose impaired fasting glucose (IFG) and schedule reassessment in 12 months

C.Order a 24-hour continuous glucose monitoring (CGM) sensor

D.Repeat the fasting plasma glucose or measure HbA1c on a second, separate blood sample

Explanation: In an asymptomatic patient, a single abnormal glucose parameter (such as fasting plasma glucose ≥ 126 mg/dL or HbA1c ≥ 6.5% / 48 mmol/mol) must be confirmed by repeat testing on a separate day using either the same test or another validated diagnostic test (FPG, HbA1c, or 2-hour 75g OGTT) before confirming diabetes mellitus.

5A 66-year-old man with newly diagnosed type 2 diabetes mellitus is evaluated in primary care. His HbA1c is 7.8% (62 mmol/mol) and serum creatinine is 1.4 mg/dL with an estimated glomerular filtration rate (eGFR) of 42 mL/min/1.73 m². You plan to start metformin. What is the appropriate dosing recommendation for metformin at this level of renal function?

A.Metformin is strictly contraindicated and must not be used at eGFR < 60 mL/min/1.73 m²

B.Metformin can be used, but the maximum daily dose should not exceed 1000 mg, with close renal monitoring

C.Metformin can be initiated at the full standard dose of 3000 mg daily without dose reduction

D.Metformin must be replaced with insulin therapy regardless of lifestyle modifications

Explanation: According to AIFA and international regulatory guidelines, metformin can be safely used in moderate renal impairment (eGFR 30–44 mL/min/1.73 m² / CKD stage 3b), provided the dose is reduced to a maximum of 1000 mg daily (e.g., 500 mg twice daily) and renal function is monitored every 3 to 6 months. It is contraindicated if eGFR is < 30 mL/min/1.73 m² due to lactic acidosis risk.

6A 64-year-old male with type 2 diabetes mellitus and a history of myocardial infarction 3 years ago presents to your practice. His current regimen is metformin 1000 mg twice daily; his HbA1c is 7.9% (63 mmol/mol) and eGFR is 75 mL/min/1.73 m². According to Italian AMD-SID guidelines and AIFA Nota 100, which second-line class of antidiabetic agents provides proven cardiovascular benefit for secondary prevention in this patient?

A.Sulfonylureas (e.g., gliclazide)

B.Thiazolidinediones (e.g., pioglitazone)

C.SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin) or GLP-1 receptor agonists with proven CV benefit (e.g., dulaglutide, semaglutide)

D.Meglitinides (e.g., repaglinide)

Explanation: For patients with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD), both Italian AMD-SID guidelines and AIFA Nota 100 prioritize SGLT2 inhibitors or GLP-1 receptor agonists with proven CV benefits, as they reduce major adverse cardiovascular events (MACE), cardiovascular mortality, and heart failure hospitalizations independent of baseline HbA1c.

7A 69-year-old woman is discharged from the hospital following an episode of decompensated heart failure with reduced ejection fraction (HFrEF, LVEF 32%). She attends your clinic for ongoing outpatient management. According to ESC guidelines on heart failure, what comprises the cornerstone 'four pillars' of guideline-directed medical therapy (GDMT) that should be initiated and uptitrated?

A.ARNI (or ACE inhibitor/ARB), beta-blocker, mineralocorticoid receptor antagonist (MRA), and SGLT2 inhibitor

B.Loop diuretic, digoxin, calcium channel blocker, and nitrate

C.ACE inhibitor, alpha-1 blocker, thiazide diuretic, and aspirin

D.Ivabradine, hydralazine, isosorbide dinitrate, and low-dose corticosteroid

Explanation: The ESC Guidelines for Heart Failure establish the four foundational pillars of pharmacotherapy for HFrEF that significantly reduce mortality and hospitalization: (1) an ARNI (sacubitril/valsartan) or ACEi/ARB, (2) an evidence-based beta-blocker (bisoprolol, carvedilol, metoprolol succinate), (3) a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and (4) an SGLT2 inhibitor (dapagliflozin or empagliflozin).

8A 73-year-old male with known chronic heart failure visits your surgery complaining of a 3-kg weight gain over the last 5 days, mild bilateral ankle edema, and increased dyspnea when tying his shoes. Auscultation reveals bibasilar crackles that clear partially with coughing; blood pressure is 128/78 mmHg, heart rate 72 bpm, and oxygen saturation 96% on room air. What is the most appropriate outpatient action?

A.Immediately transfer the patient by emergency ambulance to the emergency department (pronto soccorso)

B.Prescribe oral amoxicillin-clavulanate for suspected lower respiratory tract infection

C.Discontinue his beta-blocker immediately to prevent further myocardial depression

D.Temporarily increase the dose of loop diuretic (e.g., furosemide) and monitor weight, electrolytes, and renal function in 48–72 hours

Explanation: This patient exhibits mild-to-moderate hypervolemic congestion without hemodynamic instability or hypoxemia. In the outpatient general practice setting, the appropriate initial management is a temporary increase in oral loop diuretic dose, patient instruction on fluid and salt restriction, daily weighing, and re-evaluation of electrolytes and renal function within 48 to 72 hours.

9A 61-year-old male with a 40 pack-year smoking history reports progressive exertional breathlessness and chronic morning cough with mucoid sputum for the past 2 years. Physical examination is notable for reduced breath sounds and prolonged expiration. Which diagnostic test is mandatory to confirm the diagnosis of chronic obstructive pulmonary disease (COPD / BPCO) in primary care?

A.High-resolution chest computed tomography (HRCT)

B.Post-bronchodilator spirometry demonstrating an FEV1/FVC ratio < 0.70

C.Diffusing capacity of the lung for carbon monoxide (DLCO) measurement

D.Arterial blood gas analysis on room air

Explanation: According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, the presence of a post-bronchodilator FEV1/FVC < 0.70 (fixed ratio) on spirometry is the mandatory criterion to confirm persistent, non-reversible airflow limitation and establish a formal diagnosis of COPD.

10A 67-year-old patient with confirmed severe COPD has experienced two moderate exacerbations requiring oral corticosteroids in the past 12 months. He currently uses a long-acting muscarinic antagonist (LAMA) monotherapy. His peripheral blood eosinophil count is 360 cells/µL. According to GOLD recommendations, what is the most appropriate next step in his maintenance inhalation therapy?

A.Escalate to triple therapy comprising LABA + LAMA + Inhaled Corticosteroid (ICS)

B.Add daily oral prednisone 25 mg for long-term maintenance

C.Switch from LAMA to short-acting beta-2 agonist (SABA) as needed only

D.Initiate long-term oxygen therapy (LTOT) at 2 L/min

Explanation: In patients with COPD who have frequent exacerbations (GOLD Group E) and an elevated blood eosinophil count (≥ 300 cells/µL), adding an inhaled corticosteroid (ICS) to dual bronchodilator therapy (LABA + LAMA), resulting in single-inhaler or multi-inhaler triple therapy, significantly reduces exacerbation rates and improves lung function and quality of life.

About the Concorso Medicina Generale MMG Exam

The Concorso per l'ammissione al Corso di Formazione Specifica in Medicina Generale (CFSMG) is the official competitive examination governed by Legislative Decree 368/1999 and ministerial decrees for medical graduates seeking entry into the three-year post-graduate vocational training program in General Practice in Italy. The national examination takes place simultaneously across all Italian regions on a single date set by the Ministero della Salute. It comprises 100 multiple-choice questions with five options delivered over 120 minutes. The official subject specification is medicina clinica and does not publish a weighted subtopic blueprint. Scoring awards +1 point for each correct answer and 0 points for unanswered or incorrect answers, with a statutory minimum threshold of 60 points required to enter the regional merit ranking (graduatoria regionale). This independent bank contains 85 English-language, four-option MCQs grouped into local study categories; it is not an official translation or format simulation.

Exam sponsor: Ministero della Salute / Regioni e Province Autonome. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

100 multiple-choice questions (5 choices per question) administered over 120 minutes. Scoring: +1 point per correct answer, 0 points for incorrect or omitted responses; 60/100 minimum qualifying threshold. The official scope is medicina clinica; the Ministry does not publish a weighted subtopic blueprint.

Time Limit

120 minutes

Passing Score

60/100 minimum qualifying threshold for regional merit ranking

Exam / Certification Fees

Varies by regional or provincial notice

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

35 local questions (not an official percentage)

Medicina Clinica Territoriale

Primary care management of chronic cardiovascular, respiratory, metabolic, renal, gastrointestinal, musculoskeletal, and neurocognitive conditions commonly managed in general practice

20 local questions (not an official percentage)

Urgenze ed Emergenze Territoriali

Recognition, stabilization, and triage of urgent medical, surgical, and environmental presentations in outpatient clinics and territorial on-call services (Continuità Assistenziale)

15 local questions (not an official percentage)

Farmacologia Clinica e Prescrizione SSN

Rational drug therapy, geriatric polypharmacy, adverse event reporting, antimicrobial stewardship, Class A/C formulary rules, and statutory Note AIFA prescribing criteria

15 local questions (not an official percentage)

Prevenzione e Sanità Pubblica

Primary and secondary disease prevention, national cancer screening programs, adult and geriatric immunization schedules, and cardiovascular risk evaluation via Progetto CUORE

Preparing for the Concorso Medicina Generale MMG Exam

What You Need to Know

Passing score: 60/100 minimum qualifying threshold for regional merit ranking
Assessment: 100 multiple-choice questions (5 choices per question) administered over 120 minutes. Scoring: +1 point per correct answer, 0 points for incorrect or omitted responses; 60/100 minimum qualifying threshold. The official scope is medicina clinica; the Ministry does not publish a weighted subtopic blueprint.
Time limit: 120 minutes
Exam / certification fees: Varies by regional or provincial notice Official sources

Using Our Practice Resources

Work through all 85 available questions
Review every answer and explanation
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Concorso Medicina Generale MMG: Suggested Study Strategy

1Master high-yield Note AIFA regulations (especially Note 13, Note 79, Note 96, Note 97, and Note 100) and understand the exact clinical eligibility criteria for SSN reimbursement.

2Since there is no negative marking (0 points for blank or wrong answers), ensure every question is answered before the 120-minute mark expires.

3Focus heavily on the management of chronic conditions in primary care—such as initial pharmacological combinations for hypertension (ESC/ESH guidelines), target HbA1c thresholds in frailty, and COPD inhaler escalation.

4Use current national and regional clinical guidance when reviewing prescribing thresholds, vaccination, and cancer-screening pathways, because these can change between competition cycles.

5Practice rapid clinical reasoning for urgent territorial scenarios faced during Continuità Assistenziale shifts, such as red-flag symptoms in acute chest pain, suspected bacterial meningitis, or acute limb ischemia.

Frequently Asked Questions

What is the Concorso MMG (CFSMG) and what qualification does it confer?

The Concorso MMG is the competitive entrance examination for admission to the Corso di Formazione Specifica in Medicina Generale (CFSMG), a three-year full-time vocational training course administered by the Italian regions under the supervision of the Ministero della Salute. Successful completion of the CFSMG awards the Diploma di Formazione Specifica in Medicina Generale, which is a mandatory statutory prerequisite to practice as a Medico di Medicina Generale (general practitioner/family doctor) affiliated with the Servizio Sanitario Nazionale (SSN).

How is the Concorso MMG examination structured and scored?

The examination consists of 100 multiple-choice questions, each with five options and exactly one correct answer, to be completed in 120 minutes (an average of 72 seconds per question). Each correct answer is awarded +1 point, while unanswered or incorrect questions receive 0 points (no negative marking). To qualify for inclusion in the regional merit ranking, candidates must achieve a minimum score of 60 points out of 100.

What subject areas are covered in the 100 questions?

The governing rule specifies medicina clinica without an official weighted subtopic blueprint. This independent bank organizes that broad clinical scope into primary care, urgent presentations, clinical pharmacology, and prevention for study convenience; those local groupings are not official weights.

How does regional allocation and the merit ranking work?

Although the examination takes place on the same date with an identical national question set established by the Ministero della Salute, candidates compete within the specific region or autonomous province where they applied. Each region publishes its own graduatoria di merito based on test scores (and age in case of ties). Candidates who score at least 60/100 are ranked, and places in the training course are awarded down the list until all regional quotas are filled.

Is this practice resource an official publication of the Italian Ministry of Health?

No. Independent MMG practice by OpenExamPrep. These practice questions are an independent educational adaptation created to reflect the scope and topics of the CFSMG syllabus, guidelines, and Italian medical regulations. They are not sponsored, approved, or published by the Ministero della Salute or regional health authorities.