The study aims to evaluate the efficiency of distractors by analyzing the items used in 18 courses along the first year of the CBMBP curriculum. The study is among few large studies discussing distractor efficiency in the Middle East. It is the largest in Egypt and Arabic area. Tanta Faculty of Medicine, Egypt from December 2016 until July 2017. This study was conducted on the CBMBP exams after the end of the semesters of the first year. The study design was repeated cross-sectional study. 16 courses, 28 tests and 1855 MCQs were evaluated. The MCQs were analyzed using Difficulty Index (Dif I), Discrimination Index (Dis I), using the point biserial (pbs) and analysis of distractor efficiency (DE) by calculation the non-functioning distractors (NFD). The mean difficulty index (Diff I) was 0.71, 46% of the questions in the easy category while the difficult questions represented 11%. The mean discrimination index (Disc I) was 0.27 with 15% of the questions having poor discriminatory value. The presence of NFDs as following; 0 NFDs in 30%, 1 NFDs n 40%, 2 NFDs in 23% and those with>= 3 NFDs in 7%. Distractor efficiency (DE%) was 56.5%. The number of NFDs increased with increasing number of options. The number of NFDs increased with increasing number of options. The best values of NFDs were found in the three options MCQs. The 3 option MCQs had the best number of good distractors with 0 NFDs, hence they have the reasonable difficulty and best discrimination.