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Key Facts: Ishi Kokka Shiken Exam

400

Official Question Count Since 112th Format

MHLW Medical Council materials

15,300 yen

120th Exam Fee

MHLW administration notice

91.6%

120th Overall Pass Rate

MHLW results page

94.7%

120th New-Graduate Pass Rate

MHLW results page

2 days

120th Exam Duration

MHLW candidate instructions

For the 120th Ishi Kokka Shiken, MHLW scheduled a two-day paper examination on February 7-8, 2026, charged a 15,300 yen fee, published the A-F past-question PDFs and answer key, and reported an overall pass rate of 91.6%. The passing standard required at least 160/200 on required items, at least 224/300 on non-required items, and no more than 3 contraindicated choices.

Sample Ishi Kokka Shiken Practice Questions

Try these sample questions to review concepts for the Ishi Kokka Shiken exam. 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 has 40 minutes of crushing chest pain and ST elevations in leads II, III, and aVF. Blood pressure is stable. What is the most appropriate next management?

A.Activate urgent coronary reperfusion

B.Schedule outpatient exercise testing

C.Give oral antibiotics for presumed myocarditis

D.Observe without treatment until cardiac enzymes return

Explanation: ST elevations in contiguous inferior leads with typical ischemic pain indicate acute ST-elevation myocardial infarction. The priority is immediate reperfusion with primary PCI when available, while giving antiplatelet and supportive therapy as appropriate.

2A 22-year-old woman with known asthma has wheezing and dyspnea after cleaning a dusty room. She can speak in full sentences and oxygen saturation is 97% on room air. Which medication provides the fastest symptom relief?

A.Inhaled short-acting beta-2 agonist

B.Oral leukotriene receptor antagonist

C.Daily inhaled corticosteroid alone

D.Long-acting beta-2 agonist monotherapy

Explanation: A short-acting inhaled beta-2 agonist such as salbutamol rapidly reverses bronchoconstriction during an acute mild asthma exacerbation. Controller therapy is important for prevention, but it does not provide the same immediate bronchodilation.

3A 17-year-old with type 1 diabetes has abdominal pain, Kussmaul respirations, glucose 520 mg/dL, pH 7.12, bicarbonate 8 mEq/L, and positive serum ketones. What acid-base disorder is present?

A.High anion gap metabolic acidosis

B.Normal anion gap metabolic acidosis

C.Metabolic alkalosis

D.Primary respiratory acidosis

Explanation: Diabetic ketoacidosis produces ketoacid accumulation, causing high anion gap metabolic acidosis. Kussmaul respirations are a compensatory respiratory alkalosis that lowers PaCO2.

4A 72-year-old man develops right arm weakness and aphasia 70 minutes ago. Finger-stick glucose is normal. What should be obtained before deciding on thrombolytic therapy?

A.Noncontrast head CT

B.Carotid massage

C.Lumbar puncture

D.Electroencephalography

Explanation: In suspected acute ischemic stroke, noncontrast head CT is used first to exclude intracranial hemorrhage before thrombolysis or thrombectomy decisions. Time of onset and contraindications must be checked in parallel.

5A man has chronic cough, weight loss, upper-lobe cavitation, and sputum acid-fast bacilli on smear. Which infection-control measure is most appropriate while evaluating him in hospital?

A.Airborne isolation

B.Standard precautions only

C.Contact precautions only

D.Droplet precautions for 24 hours only

Explanation: Pulmonary tuberculosis is transmitted through airborne droplet nuclei. Suspected infectious TB requires airborne precautions, appropriate masking during transport, diagnostic testing, treatment, and public-health notification.

6A child has fever, cough, conjunctivitis, coryza, Koplik spots, and a descending maculopapular rash. Which transmission route best explains the need for strict isolation?

A.Airborne transmission

B.Vector-borne transmission

C.Fecal-oral transmission only

D.Blood-borne transmission only

Explanation: Measles is highly contagious and spreads by airborne, droplet, and contact routes. Airborne precautions are essential because susceptible exposed people can become infected even after brief shared-air exposure.

7A 4-year-old has 6 days of fever, bilateral conjunctival injection, cracked lips, cervical lymphadenopathy, rash, and swollen hands. Which treatment reduces coronary artery aneurysm risk?

A.Intravenous immunoglobulin

B.Oral amoxicillin alone

C.Inhaled corticosteroid

D.Observation without therapy

Explanation: Kawasaki disease is a medium-vessel vasculitis in children and can cause coronary artery aneurysms. Intravenous immunoglobulin, usually with aspirin under specialist guidance, reduces coronary complications when given early.

8A 30-year-old pregnant woman at 32 weeks has blood pressure 162/104 mm Hg and new proteinuria. She reports headache and visual flashing lights. What diagnosis is most likely?

A.Preeclampsia with severe features

B.Gestational diabetes

C.Placenta previa

D.Hyperemesis gravidarum

Explanation: Hypertension after 20 weeks with proteinuria indicates preeclampsia; severe-range blood pressure and neurologic symptoms are severe features. Management requires maternal stabilization, seizure prophylaxis when indicated, and timing delivery based on severity and gestational age.

9Immediately after vaginal delivery, a woman has heavy bleeding and a soft, enlarged uterus. What is the most appropriate first treatment?

A.Uterine massage and oxytocin

B.Emergency hysterectomy without resuscitation

C.Tocolysis with ritodrine

D.Delay treatment until coagulation tests return

Explanation: The most common cause of immediate postpartum hemorrhage is uterine atony. Initial management includes uterine massage, oxytocin, assessment for retained tissue or laceration, and resuscitation.

10A 35-year-old has depressed mood, anhedonia, insomnia, poor concentration, and guilt nearly every day for 3 weeks. There is no mania or psychosis. What is an appropriate initial treatment option?

A.Selective serotonin reuptake inhibitor with psychotherapy

B.Immediate electroconvulsive therapy for all cases

C.Antipsychotic monotherapy as first-line treatment

D.Reassurance only because symptoms are under 6 months

Explanation: Major depressive disorder is suggested by at least 2 weeks of depressive symptoms with functional impairment. An SSRI and evidence-based psychotherapy are appropriate initial treatments for many nonpsychotic cases, with suicide risk assessed at every encounter.

About the Ishi Kokka Shiken Exam

The Ishi Kokka Shiken is Japan's national physician licensing examination administered by MHLW under the Medical Practitioners Act. The official scope is clinical medicine and public health knowledge and skills needed by physicians. Current official materials show a two-day, paper-based, 400-question examination with required/basic items, medical general content, and organ-system clinical disease content. The Reiwa 6 MHLW blueprint emphasizes professionalism, medical safety, interviewing, common symptoms, physical examination, tests, emergency initial care, public health, prevention, treatment principles, and clinical disease management across internal medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry, emergency medicine, infectious disease, and environmental or occupational disease.

Exam sponsor: Ministry of Health, Labour and Welfare Japan. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Paper-based two-day national physician examination with required/basic items, medical general items, and medical specific clinical items. The 120th administration used six scheduled testing blocks over two days.

Time Limit

Two days; about 13 hours 40 minutes of scheduled testing time on the 120th candidate timetable

Passing Score

120th exam: required section at least 160/200, non-required total at least 224/300, and contraindicated choices no more than 3

Exam / Certification Fees

15,300 yen

Exam sponsor website

Reported exam pass rate: 91.6%. Overall 120th exam pass rate; MHLW also reported 94.7% for new graduates. This describes exam candidates, not OpenExamPrep users or results from using our resources. 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.

Required section: 100 questions

Required Basic Medical Competencies

Professionalism, society and medicine, medical records, quality and safety, interviewing, symptoms, physical examination, basic tests, clinical judgment, emergency initial care, basic diseases, treatment, procedures, end-of-life care, team medicine, lifestyle risk, and general knowledge.

Medical general blueprint: 100 questions in the post-112th structure

Medical General and Public Health

Health care systems, prevention and health promotion, normal structure and function, life-course medicine, pathophysiology, symptoms, examination, investigations, and treatment principles.

Medical specific blueprint: 200 questions in the post-112th structure

Organ-System Clinical Medicine

Perinatal and pediatric disorders, psychiatry, skin/head-neck disease, respiratory, cardiovascular, gastrointestinal, hematologic, renal and urogenital, neurologic and musculoskeletal, endocrine and metabolic, allergy/rheumatology/immunology, infectious, environmental, and occupational disease.

Preparing for the Ishi Kokka Shiken Exam

What You Need to Know

Passing score: 120th exam: required section at least 160/200, non-required total at least 224/300, and contraindicated choices no more than 3
Assessment: Paper-based two-day national physician examination with required/basic items, medical general items, and medical specific clinical items. The 120th administration used six scheduled testing blocks over two days.
Time limit: Two days; about 13 hours 40 minutes of scheduled testing time on the 120th candidate timetable
Exam / certification fees: 15,300 yen Official sources

Using Our Practice Resources

Work through all 100 available questions
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Ishi Kokka Shiken: Suggested Study Strategy

1Use the MHLW Reiwa 6 blueprint as the topic checklist before doing mixed practice blocks.

2Treat required/basic items as high priority because the passing standard has a separate required-section threshold.

3Practice contraindicated-choice avoidance: in urgent scenarios, eliminate actions that would delay lifesaving treatment or harm the patient.

4Review Japan-specific public health topics such as infectious disease reporting, routine vaccination, maternal and child health, long-term care insurance, and team-based safety systems.

5After each case, explain why the tempting alternatives are wrong; this mirrors the exam's clinical judgment emphasis.

Frequently Asked Questions

Who administers the Ishi Kokka Shiken?

Japan's Ministry of Health, Labour and Welfare administers the national physician examination and publishes the administration notice, candidate instructions, past-question PDFs, answer keys, and passing standards.

How many questions are on the exam?

MHLW Medical Council materials describe the post-112th format as 400 questions. The 120th exam materials were published as A through F question booklets with a separate answer key.

What was the 120th exam passing standard?

MHLW reported three thresholds for the 120th exam: at least 160/200 on required items, at least 224/300 on non-required general and clinical items, and no more than 3 contraindicated choices.

Can foreign medical graduates take the exam?

Foreign medical graduates or foreign-licensed physicians need MHLW eligibility recognition before taking the Japanese physician national examination. MHLW publishes the current recognition system and procedures separately.

Are these official MHLW questions?

No. These are original practice questions created from official MHLW blueprints and public materials. They do not reproduce official copyrighted question stems.