100+ Free RCPSC Internal Medicine Practice Questions
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Key Facts: RCPSC Internal Medicine Exam
2 components
A written multiple-choice component and a separate applied OSCE component, taken as decoupled exams
Royal College - Format of the Examination in Internal Medicine
70%
Pass score required for each component of the Internal Medicine examination
Royal College - Format of the Examination in Internal Medicine
Single best answer
The written component uses single-best-answer multiple-choice questions
Royal College - Format of the Examination in Internal Medicine
4 attempts
Maximum attempts allowed on a single exam component within the eligibility window
Royal College - Practice Eligibility Route FAQ
5 years
Eligibility period within which all required components must be completed
Royal College - Practice Eligibility Route FAQ
Annual
Each component is offered once per examination year on fixed dates
Royal College - Practice Eligibility Route FAQ
FRCPC
Successful candidates become certified internists and are eligible for Fellowship in the Royal College
Royal College of Physicians and Surgeons of Canada
100
Free original written-component practice questions provided here
OpenExamPrep
The Royal College Certification Examination in Internal Medicine is the Canadian national specialty exam for trainees completing Core Internal Medicine. It has two decoupled components scored independently at a 70% pass mark: a written component of single-best-answer multiple-choice questions blueprinted to the Competencies in Internal Medicine, and a separate applied OSCE. The written component samples all adult IM subspecialties, emphasizing diagnosis, investigation and evidence-based management at the standard of a newly certified internist. Candidates have up to four attempts per component within a five-year eligibility period. This 100-question bank provides original written-component practice using Canadian guidelines where they apply.
Sample RCPSC Internal Medicine Practice Questions
Try these sample questions to test your RCPSC Internal Medicine exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 62-year-old man presents with 40 minutes of crushing chest pain. ECG shows 2 mm ST elevation in leads II, III and aVF. He is at a centre with a cath lab able to perform primary PCI within 60 minutes. What is the most appropriate reperfusion strategy?
2A 74-year-old woman with newly diagnosed non-valvular atrial fibrillation has hypertension, diabetes and prior TIA. Her CHADS2-VASc components yield a high stroke risk. Renal function is normal. Which is the most appropriate stroke-prevention therapy?
3A 68-year-old man with heart failure and a reduced ejection fraction of 30% remains symptomatic (NYHA II) despite an ACE inhibitor, beta-blocker and mineralocorticoid receptor antagonist. Which medication class has been shown to reduce cardiovascular death and heart-failure hospitalization when added in this setting?
4A 55-year-old man has an office blood pressure of 156/98 mmHg confirmed on automated readings, with no diabetes or chronic kidney disease. His 10-year cardiovascular risk is low. According to Hypertension Canada, what threshold defines the treatment target most appropriate for initiating discussion of pharmacotherapy in this patient?
5A 70-year-old woman presents with exertional syncope, a slow-rising carotid pulse and a harsh late-peaking systolic murmur radiating to the carotids. Echocardiography shows a valve area of 0.8 cm2 and mean gradient of 50 mmHg. What is the most appropriate management?
6A 48-year-old man with no prior cardiac history presents with palpitations. ECG shows a narrow-complex regular tachycardia at 180 bpm with no visible P waves. Vagal maneuvers fail. He is hemodynamically stable. What is the most appropriate next step?
7A 60-year-old man presents with pleuritic chest pain relieved by leaning forward. ECG shows diffuse concave ST elevation and PR depression. Troponin is mildly elevated. Echocardiogram is normal with no effusion. What is the most likely diagnosis?
8A 58-year-old diabetic man without established cardiovascular disease is reviewed for primary prevention. His estimated 10-year cardiovascular risk is high. According to the Canadian Cardiovascular Society lipid guidelines, what is the most appropriate intervention?
9A 45-year-old woman presents with sudden dyspnea and pleuritic chest pain. She is tachycardic at 110 bpm, oxygen saturation 91%, with a swollen right calf. Her hemodynamics are stable and blood pressure is normal. CT pulmonary angiogram confirms a segmental pulmonary embolism. What is the most appropriate initial treatment?
10A 64-year-old man with a 40 pack-year smoking history has progressive dyspnea. Spirometry shows an FEV1/FVC ratio of 0.58 that does not normalize after bronchodilator, with FEV1 55% predicted. What does this confirm?
About the RCPSC Internal Medicine Exam
The Royal College Certification Examination in Internal Medicine is the national specialty exam taken by physicians completing Core Internal Medicine residency in Canada (or qualifying through the Practice Eligibility Route) to become certified internists and eligible for FRCPC. It has two decoupled components: a written component of single-best-answer multiple-choice questions and a separate applied component delivered as an Objective Structured Clinical Examination (OSCE). The written component is blueprinted to the Competencies in Internal Medicine and samples the full breadth of adult internal medicine, including cardiology, respirology, gastroenterology and hepatology, nephrology, endocrinology, rheumatology, hematology, medical oncology, infectious diseases, neurology, allergy and immunology, geriatrics, and general internal medicine and acute/critical care. The pass score is 70% for each component, and candidates have a maximum of four attempts on a component within a five-year eligibility window.
Assessment
Two decoupled components: a computer-based written component of single-best-answer multiple-choice questions blueprinted to the Competencies in Internal Medicine, and a separate applied component delivered as an OSCE. This bank covers the written MCQ component only.
Time Limit
The written component is administered over scheduled sessions on a single written exam day, with section timing set annually by the Royal College; the applied (OSCE) component is held on a separate date.
Passing Score
70% for each component. The examination is decoupled, so the written and applied components are passed independently and a passed component does not need to be repeated.
Exam Fee
The Royal College sets a single comprehensive certification examination fee each year covering both components; it is several thousand Canadian dollars (confirm the current amount on the Royal College fee schedule). Practice Eligibility Route assessment is a separate $4,845 CAD fee. (Royal College of Physicians and Surgeons of Canada (RCPSC))
RCPSC Internal Medicine Exam Content Outline
Cardiology
Acute coronary syndromes, heart failure, atrial fibrillation and other arrhythmias, valvular heart disease, hypertension and cardiovascular prevention, reflecting Canadian Cardiovascular Society and Hypertension Canada recommendations.
Respirology
Asthma and COPD management, pulmonary embolism, interstitial lung disease, pleural effusions, sleep-disordered breathing and acute respiratory failure, aligned with Canadian Thoracic Society guidance.
Gastroenterology and Hepatology
Upper and lower GI bleeding, inflammatory bowel disease, peptic ulcer disease, cirrhosis and its complications, acute pancreatitis, and liver function test interpretation.
Nephrology, Acid-Base and Electrolytes
Acute kidney injury, chronic kidney disease, glomerular disease, acid-base disorders, and disturbances of sodium, potassium and calcium with appropriate fluid management.
Endocrinology
Diabetes mellitus and its emergencies, thyroid and adrenal disorders, calcium and bone metabolism, and pituitary disease.
Rheumatology
Rheumatoid arthritis, systemic lupus erythematosus, the vasculitides, crystal arthropathies, and spondyloarthritis, including serologic interpretation and therapy.
Hematology and Medical Oncology
Anemias, thrombocytopenia, venous thromboembolism and anticoagulation, hematologic malignancies, common solid tumours, and oncologic emergencies.
Infectious Diseases
Sepsis, community-acquired pneumonia, infective endocarditis, urinary and skin/soft-tissue infections, HIV care, and antimicrobial stewardship.
Neurology
Ischemic stroke and TIA, seizures and status epilepticus, headache, neuromuscular disease, and delirium relevant to internal-medicine practice.
Allergy, Immunology and Geriatrics
Anaphylaxis and drug allergy, immunodeficiency, frailty, polypharmacy, falls and the comprehensive assessment of older adults.
General Internal Medicine and Acute/Critical Care
Undifferentiated presentations, perioperative medicine, shock and sepsis resuscitation, ICU management, fluid and electrolyte therapy, and preventive care in multimorbidity.
How to Pass the RCPSC Internal Medicine Exam
What You Need to Know
- Passing score: 70% for each component. The examination is decoupled, so the written and applied components are passed independently and a passed component does not need to be repeated.
- Assessment: Two decoupled components: a computer-based written component of single-best-answer multiple-choice questions blueprinted to the Competencies in Internal Medicine, and a separate applied component delivered as an OSCE. This bank covers the written MCQ component only.
- Time limit: The written component is administered over scheduled sessions on a single written exam day, with section timing set annually by the Royal College; the applied (OSCE) component is held on a separate date.
- Exam fee: The Royal College sets a single comprehensive certification examination fee each year covering both components; it is several thousand Canadian dollars (confirm the current amount on the Royal College fee schedule). Practice Eligibility Route assessment is a separate $4,845 CAD fee.
Keys to Passing
- Complete 500+ practice questions
- Score 80%+ consistently before scheduling
- Focus on highest-weighted sections
- Use our AI tutor for tough concepts
RCPSC Internal Medicine Study Tips from Top Performers
Frequently Asked Questions
What components make up the Royal College Internal Medicine exam?
There are two decoupled components: a written component of single-best-answer multiple-choice questions blueprinted to the Competencies in Internal Medicine, and a separate applied component delivered as an OSCE. The written component is taken before the applied component.
What is the pass score?
The pass score is 70% for each component. Because the examination is decoupled, the written and applied components are passed independently, and a component you have already passed does not need to be repeated.
Is the written component multiple choice?
Yes. The written component uses single-best-answer multiple-choice questions sampling the full Internal Medicine blueprint. The separate applied OSCE component is not multiple choice and is not covered by this question bank.
Who is eligible to sit the exam?
Physicians who complete an accredited Royal College Core Internal Medicine residency are eligible, as are candidates granted eligibility through the Practice Eligibility Route. Candidates have a maximum of four attempts per component within a five-year eligibility period.
Should I use Canadian or American guidelines to prepare?
Internal-medicine content overlaps heavily across borders, but the Royal College expects current Canadian standards of care, so use Canadian guidelines (for example Hypertension Canada, the Canadian Cardiovascular Society, Diabetes Canada and the Canadian Thoracic Society) where they differ from US sources.
Are these official Royal College questions?
No. These are original OpenExamPrep questions modelled on the Internal Medicine blueprint and written to specialist depth. The Royal College does not release its examination questions; use its objectives of training and format documents as your primary reference.