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Afghanistan Comprehensive Specialization Completion Exam (Takhasus)

Practice Questions100 questions

2026 Statistics

Key Facts: Afghanistan Specialization Entry Exam Exam

Basic-science reference texts named for the curative-medicine paper

MoPH General Directorate of Postgraduate Medical Education reference list

Specialty disciplines competed for at the 1405 intake

Ministry of Public Health

6,118

Candidates who sat the 1405 entrance examination

Ministry of Public Health

Competitive

Selection is by merit rank against advertised quotas

MoPH General Directorate of Postgraduate Medical Education

The Afghanistan Medical Specialization (Takhasus) Entry Exam is the national residency admission competition run by the MoPH General Directorate of Postgraduate Medical Education with the National Examination Authority. Selection is by competitive merit rank against the specialty quotas advertised for each intake — 6,118 candidates competed across 26 specialties at the 1405 sitting — and the published scope is a reference list of basic-science textbooks rather than a weighted blueprint. The official item count, duration, fee and pass mark are not published. The official examination is administered in Dari and Pashto; this bank is an English-language MCQ study adaptation for conceptual preparation, not an official translation or a simulation of the official paper.

Sample Afghanistan Specialization Entry Exam Practice Questions

Try these sample questions to test your Afghanistan Specialization Entry Exam exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 56-year-old male with a 20-pack-year smoking history presents with progressive dyspnea on exertion and chronic morning productive cough. Spirometry reveals a post-bronchodilator FEV1/FVC ratio of 0.58 and an FEV1 of 62% of predicted. He reports two moderate exacerbations in the past year requiring antibiotics. According to GOLD guidelines, what is the most appropriate initial maintenance pharmacotherapy?

A.Short-acting beta-2 agonist (SABA) as monotherapy on an as-needed basis only

B.Long-acting muscarinic antagonist (LAMA) combined with a long-acting beta-2 agonist (LABA)

C.Inhaled corticosteroid (ICS) monotherapy twice daily

D.Oral systemic corticosteroid combined with low-dose theophylline

Explanation: This patient meets criteria for COPD with airflow limitation (post-bronchodilator FEV1/FVC < 0.70) and falls into GOLD Group E (formerly C/D) due to having >=2 exacerbations per year. Current GOLD guidelines recommend initial maintenance therapy with dual bronchodilation (LAMA + LABA) to reduce exacerbations and improve lung function and symptoms. ICS is added only if blood eosinophils are >=300 cells/uL or >=100 cells/uL with persistent exacerbations.

2A 48-year-old female presents with fatigue, cold intolerance, constipation, and weight gain over 6 months. Physical examination reveals delayed deep tendon reflex relaxation and a non-tender diffuse thyroid enlargement. Laboratory tests show TSH of 18.5 mIU/L (normal: 0.4-4.0) and Free T4 of 0.4 ng/dL (normal: 0.8-1.8). What is the most specific serum antibody marker to confirm the underlying etiology?

A.Anti-thyroid peroxidase (anti-TPO) antibodies

B.Thyroid-stimulating immunoglobulin (TSI)

C.Anti-smooth muscle antibodies (ASMA)

D.Anti-double-stranded DNA (anti-dsDNA) antibodies

Explanation: The clinical presentation and biochemical findings (elevated TSH and low Free T4) confirm primary hypothyroidism. In iodine-sufficient areas, the most common etiology is Hashimoto thyroiditis (chronic lymphocytic thyroiditis), which is confirmed by the presence of high-titer anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin antibodies.

3A 62-year-old male with a history of long-standing hypertension presents with an acute right-sided hemiparesis and motor aphasia starting 75 minutes ago. Non-contrast CT of the head rules out intracranial hemorrhage and shows an ASPECTS score of 10. Blood pressure is 170/95 mmHg, and blood glucose is 130 mg/dL. He has no history of surgery, bleeding diathesis, or recent trauma. What is the most appropriate next step in management?

A.Administer oral aspirin 325 mg and clopidogrel 300 mg immediately

B.Initiate intravenous unfractionated heparin with target aPTT of 60-80 seconds

C.Administer intravenous recombinant tissue plasminogen activator (rtPA / alteplase)

D.Lower systolic blood pressure to below 120 mmHg using intravenous sodium nitroprusside

Explanation: The patient presents with an acute ischemic stroke within the 4.5-hour therapeutic window for intravenous thrombolysis without contraindications (blood pressure is <185/110 mmHg, no hemorrhage on CT). Intravenous alteplase (or tenecteplase) is the standard of care for acute ischemic stroke within 3 to 4.5 hours of symptom onset to promote reperfusion and improve functional neurological recovery.

4During exploration of a groin wound, a surgeon identifies the femoral triangle. Which structures lie within the femoral triangle, and in what order are they arranged from lateral to medial?

A.Femoral nerve, femoral artery, femoral vein, and the femoral canal containing lymphatics (lateral to medial)

B.Femoral vein, femoral artery, femoral nerve, and the inguinal ligament (lateral to medial)

C.Femoral artery, obturator nerve, great saphenous vein, and the adductor canal (lateral to medial)

D.Sciatic nerve, profunda femoris artery, femoral vein, and the pectineus muscle (lateral to medial)

Explanation: The femoral triangle is bounded superiorly by the inguinal ligament, laterally by sartorius and medially by the medial border of adductor longus, with its floor formed by iliopsoas, pectineus and adductor longus. Its contents run lateral to medial as the femoral Nerve, femoral Artery, femoral Vein, Empty space and femoral Canal containing lymphatics (the NAVEL mnemonic). The femoral sheath encloses the artery, vein and canal but not the nerve, which is why femoral nerve blocks are placed lateral to the palpable arterial pulse.

5A 28-year-old woman presents with symmetrical joint pain and morning stiffness lasting over an hour in her metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints bilaterally for 3 months. Physical examination shows synovitis in 8 joints. Lab tests reveal elevated ESR and positive Anti-Cyclic Citrullinated Peptide (anti-CCP) antibodies. What is the first-line disease-modifying anti-rheumatic drug (DMARD) of choice?

A.Oral Prednisone 40 mg daily as long-term monotherapy

B.Methotrexate orally once weekly along with Folic acid supplementation

C.Infliximab monotherapy administered intravenously every 2 weeks

D.High-dose Ibuprofen 800 mg three times daily

Explanation: Methotrexate is the anchor conventional synthetic DMARD (csDMARD) and the first-line therapy of choice for newly diagnosed rheumatoid arthritis (RA). It should be started as early as possible to prevent irreversible joint destruction, and folic acid must be co-prescribed to minimize gastrointestinal, hepatic, and hematologic toxicity.

6A 45-year-old male with a history of alcohol use disorder presents with hematemesis and melena. On physical exam, he is pale with palmar erythema, spider angiomas, and abdominal distension with shifting dullness. Heart rate is 118 bpm, blood pressure is 88/54 mmHg. After establishing two large-bore IV lines and starting crystalloid resuscitation, what is the most appropriate pharmacologic agent to reduce portal pressures before urgent upper endoscopy?

A.Oral propranolol 40 mg stat

B.Intravenous octreotide (somatostatin analogue) bolus followed by continuous infusion

C.Intravenous pantoprazole monotherapy without vasoactive agents

D.Intravenous vasopressin infusion without nitroglycerin

Explanation: In suspected acute variceal bleeding secondary to portal hypertension and cirrhosis, vasoactive agents such as octreotide (or terlipressin) should be initiated immediately upon presentation. Octreotide causes splanchnic vasoconstriction, which lowers portal venous pressure, decreases variceal bleeding, and improves outcomes prior to endoscopic band ligation.

7A 32-year-old female presents with generalized edema, frothy urine, and fatigue. Urinalysis reveals 4+ proteinuria, oval fat bodies, and no hematuria. 24-hour urine collection shows 4.8 g of protein. Serum albumin is 2.1 g/dL, total cholesterol is 340 mg/dL, and serum creatinine is 0.9 mg/dL. What is the fundamental pathophysiologic mechanism defining this syndrome?

A.Glomerular podocyte effacement or basement membrane damage leading to severe proteinuria (>3.5 g/24h), hypoalbuminemia, and hyperlipidemia

B.Immune-complex mediated inflammation of glomerular capillary loops with crescent formation and hematuria

C.Acute tubular necrosis resulting from ischemic insult to renal tubular epithelial cells

D.Retrograde obstruction of the urinary collecting duct system causing hydronephrosis

Explanation: This patient presents with classic nephrotic syndrome, defined by heavy proteinuria (>3.5 g/24 hours in adults), hypoalbuminemia (<3.0 g/dL), generalized edema, hyperlipidemia, and lipiduria. The underlying mechanism is increased glomerular permeability due to podocyte injury or basement membrane disruption.

8A 52-year-old male presents with recurrent episodes of intense, throbbing retrosternal chest pain occurring predominantly at rest and in the early morning hours. Coronary angiography shows no significant obstructive atherosclerotic plaques, but transient coronary artery spasm is provoked with ergonovine. ECG during pain shows transient ST-segment elevation. What is the first-line maintenance therapy for this condition?

A.High-dose non-selective beta-blocker (e.g., Propranolol)

B.Calcium channel blocker (e.g., Diltiazem or Amlodipine) alone or with long-acting nitrates

C.Coronary artery bypass grafting (CABG)

D.Aspirin 325 mg combined with Ticagrelor for 12 months

Explanation: This patient has vasospastic (Prinzmetal or variant) angina, characterized by coronary artery vasospasm causing transient transmural ischemia and ST elevation without fixed obstructive lesions. Calcium channel blockers (dihydropyridines or non-dihydropyridines) and long-acting nitrates promote vascular smooth muscle relaxation and are the first-line therapies.

9A 68-year-old male with long-standing poorly controlled type 2 diabetes mellitus presents with a chronic, painless ulcer on the plantar aspect of the first metatarsal head. Physical examination shows decreased sensation to 10-g monofilament testing, absent ankle reflexes, but palpable dorsalis pedis pulses. What is the primary underlying pathophysiology of this ulcer?

A.Diabetic peripheral sensorimotor neuropathy with loss of protective sensation and abnormal biomechanical pressure

B.Severe peripheral arterial occlusive disease causing acute limb ischemia

C.Venous valve incompetence leading to venous stasis ulceration

D.Cutaneous vasculitis with immune complex deposition in dermal capillaries

Explanation: Diabetic foot ulcers on pressure-bearing areas (such as the metatarsal heads) in the presence of intact peripheral pulses and loss of monofilament sensation are neuropathic in origin. Diabetic sensorimotor neuropathy causes loss of protective sensation, allowing repetitive unperceived trauma, while motor neuropathy causes intrinsic foot muscle atrophy, leading to claw deformities and localized high pressure points.

10A 35-year-old male presents with severe epigastric pain radiating directly to the back, associated with intractable vomiting. Serum lipase is 1,240 U/L (reference: 10-60 U/L). Abdominal ultrasound shows cholelithiasis without common bile duct dilation. Which prognostic scoring system is specifically designed to assess pancreatitis severity upon admission and at 48 hours based on parameters like age, WBC, glucose, LDH, and AST?

A.Ranson Criteria

B.Glasgow Coma Scale

C.Child-Pugh Classification

D.MELD Score

Explanation: Ranson criteria is a classic scoring system used to estimate the severity and mortality of acute pancreatitis. It evaluates 5 parameters at admission (Age >55, WBC >16,000, Blood glucose >200 mg/dL, AST >250 IU/L, LDH >350 IU/L) and 6 parameters within the subsequent 48 hours (hematocrit drop, BUN rise, serum calcium, PaO2, base deficit, fluid sequestration).

About the Afghanistan Specialization Entry Exam Exam

The Afghanistan Medical Specialization Entry Exam (امتحان شمولیت به برنامه اکمال تخصص) is the nationwide competitive examination for licensed medical doctors seeking admission to postgraduate clinical residency programs.

Assessment

Centralized four-option multiple-choice competition administered by NExA for the Ministry of Public Health, drawn from the published basic-science reference texts (anatomy, physiology, biochemistry, pathology, histology, microbiology and pharmacology) and scored as a competitive merit ranking against advertised specialty quotas.

Time Limit

Not published by the Ministry of Public Health or the National Examination Authority

Passing Score

Competitive merit ranking against advertised specialty quotas; no fixed pass mark published

Exam Fee

Set per sitting by the Ministry of Public Health; the current fee is not published (Ministry of Public Health (MoPH — اکمال تخصص) and National Examination Authority (NExA))

Afghanistan Specialization Entry Exam Exam Content Outline

Named reference subject

Anatomy

Gray's Anatomy for Students is the reference text named in the MoPH/NExA entrance-exam reference list.

Named reference subject

Physiology

Guyton and Hall Textbook of Medical Physiology is the named reference text.

Named reference subject

Biochemistry

Lippincott's Illustrated Reviews: Biochemistry (Ferrier) is the named reference text for the curative-medicine list.

Named reference subject

Pathology

Robbins Basic Pathology is the named reference text; the stomatology list substitutes Essentials of Oral Pathology.

Named reference subject

Histology

Junqueira's Basic Histology is the named reference text.

Named reference subject

Microbiology

Jawetz, Melnick and Adelberg's Medical Microbiology is the named reference text.

Named reference subject

Pharmacology

Lippincott's Illustrated Reviews: Pharmacology is the named reference text.

How to Pass the Afghanistan Specialization Entry Exam Exam

What You Need to Know

Passing score: Competitive merit ranking against advertised specialty quotas; no fixed pass mark published
Assessment: Centralized four-option multiple-choice competition administered by NExA for the Ministry of Public Health, drawn from the published basic-science reference texts (anatomy, physiology, biochemistry, pathology, histology, microbiology and pharmacology) and scored as a competitive merit ranking against advertised specialty quotas.
Time limit: Not published by the Ministry of Public Health or the National Examination Authority
Exam fee: Set per sitting by the Ministry of Public Health; the current fee is not published

Keys to Passing

Work through all 100 available questions
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Afghanistan Specialization Entry Exam Study Tips from Top Performers

1Focus on international clinical management guidelines (AHA, ACC, WHO, Surviving Sepsis Campaign, ATLS).

2Prioritize differential diagnosis and initial emergency management steps for acute presentations.

3Review high-yield pharmacology including antimicrobial mechanisms, adverse drug reactions, and critical drug interactions.

Frequently Asked Questions

What is the format of the Takhasus Entrance Exam?

The examination is a centralized four-option multiple-choice competition administered by NExA for the Ministry of Public Health. The ministry publishes a reference textbook list covering anatomy, physiology, biochemistry, pathology, histology, microbiology and pharmacology, but does not publish the item count or the session length.

Who can register for the Medical Specialization Entry Exam?

Medical doctors (MD) with accredited degrees, completed internships, and active Afghanistan Medical Council (AMC) licensing.

How are candidates selected into residency programs?

Candidates select hospital specialty choices during registration and are admitted strictly based on their nationwide entrance examination score ranking against allocated hospital quotas.

What language is the official examination written in?

The question items on the paper are officially drafted in English per MoPH postgraduate guidelines, with administrative communications in Dari and Pashto.