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Background: At most of the medical universities, MCQ-based examinations are often use as the first component, particularly to ensure the candidates have an adequate knowledge base, prior to entering subsequent clinical examinations. Method: In ICM , 3973 MCQs were collected from tests over a four-year period from 2005 to2009. Questions were evaluated for 10 frequently occurring item writing flows, for cognitive level and for difficulty and discrimination index. Results: Result show that 66.9% of the questions contained violations of item writing guidelines and79.1% were written at low cognitive levels. MCQs written at a low cognitive level were significantly more likely to contain item writing flows.47.3% of the questions had suitable discrimination index and 28.8% of the questions had suitable difficulty index. While there was no relationship between difficulty index and cognitive level, higher cognitive level and suitable discrimination index had significant relationship. Discussion: We should think about practically ways for using results of item analysis. Faculty members should be taught designing and using suitable questions and developing MCQs bank.