All Practice Exams
100+ Free Afghanistan Comprehensive Specialization Exam Practice Questions
Prepare for the Afghanistan Comprehensive Specialization Completion Exam (Takhasus) exam with instant access — no signup required.
✓ No registration✓ No credit card✓ No hidden fees✓ Start practicing immediately
100+ Questions
100% Free
Loading practice questions...
Same family resources
Explore More Afghanistan Postgraduate Medical Specialization Examinations
Continue into nearby exams from the same family. Each card keeps practice questions, study guides, flashcards, videos, and articles in one place.
2026 Statistics
Key Facts: Afghanistan Comprehensive Specialization Exam Exam
100
Four-option MCQs in the written theory paper
MoPH General Directorate of Postgraduate Medical Education notice
75%
Pass mark required separately on theory and practical
MoPH General Directorate of Postgraduate Medical Education notice
100 + 100
Marks available on the theory and practical components
MoPH General Directorate of Postgraduate Medical Education notice
Monograph
Successful monograph defence is a prerequisite for sitting
MoPH General Directorate of Postgraduate Medical Education notice
The Afghanistan Comprehensive Specialization Completion Exam (امتحان جامع / final specialization exam) is the board examination sat at the end of MoPH residency training. The published structure is a theory paper of 100 four-option MCQs worth 100 marks requiring 75%, plus a practical component worth 100 marks also requiring 75%, with successful monograph defence as a prerequisite. The session length and fee are not published. This bank is an English-language MCQ study adaptation of the written theory component and does not simulate the practical examination.
Sample Afghanistan Comprehensive Specialization Exam Practice Questions
Try these sample questions to test your Afghanistan Comprehensive Specialization Exam exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 64-year-old postmenopausal female presents to the emergency department 2 hours after experiencing severe emotional shock following the sudden death of her spouse. She complains of acute substernal crushing chest pain and shortness of breath. ECG shows 2 mm ST-segment elevations across leads V2–V6 without reciprocal changes. Emergent coronary angiography reveals angiographically normal coronary arteries without plaque rupture, thrombosis, or focal spasm. Left ventriculography demonstrates marked apical and mid-ventricular akinesis with basal hyperkinesis ('apical ballooning') and an estimated left ventricular ejection fraction of 30%. Cardiac magnetic resonance (CMR) imaging is scheduled. What is the characteristic CMR finding that differentiates this condition from acute myocardial infarction and acute myocarditis?
A.Transmural late gadolinium enhancement (LGE) localized to the distribution of the left anterior descending artery
B.Absence of significant late gadolinium enhancement (LGE) despite extensive myocardial edema on T2-weighted imaging
C.Subepicardial patchy late gadolinium enhancement involving the lateral and inferolateral left ventricular wall
D.Diffuse subendocardial circumferential late gadolinium enhancement not corresponding to any single vascular territory
Explanation: This patient presents with classic Takotsubo cardiomyopathy (stress-induced cardiomyopathy). Cardiac magnetic resonance (CMR) imaging plays a crucial role in differentiating Takotsubo syndrome from acute myocardial infarction and acute viral myocarditis: Takotsubo syndrome characteristically shows marked, extensive myocardial edema on T2-weighted imaging corresponding to the dysfunctional wall segments (apical/mid-ventricular) with a notable absence or minimal presence of late gadolinium enhancement (LGE). This reflects transient catecholamine-mediated myocardial stunning and microvascular dysfunction rather than irreversible ischemic necrosis or inflammatory myocardial replacement.
2A 28-year-old previously healthy woman presents with refractory hypertension (blood pressure 178/104 mmHg despite dual-agent antihypertensive therapy) and an unprovoked sudden right-sided pulsatile tinnitus. Physical examination reveals an epigastric systolic-diastolic vascular bruit and a right carotid bruit. Serum creatinine is 0.9 mg/dL and serum potassium is 3.4 mEq/L. Computed tomography angiography (CTA) of the renal and carotid arteries reveals bilateral alternating areas of arterial stenosis and aneurysmal dilation described as a 'string of beads' primarily involving the middle and distal segments of the renal arteries. What is the most definitive primary interventional therapy of choice for her renal vascular pathology?
A.Surgical renal revascularization with saphenous vein aortorenal bypass graft
B.Percutaneous balloon angioplasty (PTRA) without routine primary stent placement
C.Catheter-directed renal artery stenting with drug-eluting stents
D.Radiofrequency catheter-based bilateral renal sympathetic denervation
Explanation: The clinical presentation and classic 'string of beads' sign on CTA are diagnostic of fibromuscular dysplasia (FMD), specifically medial fibroplasia, the most common subtype occurring predominantly in young to middle-aged females. For renal artery FMD causing renovascular hypertension, percutaneous transluminal renal angioplasty (PTRA) without routine stenting is the gold standard revascularization modality. Balloon angioplasty provides high cure or significant improvement rates for hypertension without the long-term foreign-body complications of metallic stents in non-atherosclerotic, highly compliant vessels.
3A 52-year-old male with a history of bicuspid aortic valve presents to the resuscitation bay with sudden-onset excruciating 'tearing' chest pain radiating directly into the interscapular region. His blood pressure is 88/54 mmHg in the right arm and 84/50 mmHg in the left arm, with a heart rate of 118 bpm. Cardiac examination reveals distant heart sounds, jugular venous distention, and a new high-pitched decrescendo diastolic murmur at the right sternal border. Point-of-care transthoracic echocardiography demonstrates an intimal flap in the ascending aorta, severe aortic regurgitation, and a 1.2 cm pericardial effusion without frank diastolic right ventricular collapse. What is the immediate, most appropriate definitive management step?
A.Immediate emergent cardiothoracic surgical consultation for ascending aortic repair and valve replacement/resuspension
B.Immediate bedside subxiphoid pericardiocentesis under ultrasound guidance to evacuate the hemopericardium
C.Administration of high-dose intravenous beta-blocker (esmolol) to achieve target systolic blood pressure < 100 mmHg
D.Emergent transfer to the catheterization laboratory for transcatheter aortic valve implantation (TAVI)
Explanation: This patient has an acute Stanford Type A (DeBakey Type I/II) aortic dissection complicated by acute severe aortic regurgitation, hemopericardium, and cardiogenic shock/hypotension. Stanford Type A dissection is a surgical emergency with a mortality rate increasing by 1–2% per hour if untreated; emergent surgical repair (graft replacement of the ascending aorta ± aortic valve resuspension/replacement) is mandatory. In hypotensive patients with hemopericardium from Type A dissection, pericardiocentesis is contraindicated as it precipitates catastrophic re-bleeding and hemodynamic collapse by removing pericardial tamponade counterpressure.
4A 74-year-old male with a history of bilateral carpal tunnel syndrome and lumbar spinal stenosis presents with progressive exertional dyspnea, orthopnea, and lower extremity edema over the past 8 months. 12-lead ECG demonstrates normal sinus rhythm with low QRS voltage in limb leads and pseudo-infarction QS waves in leads V1–V3. Echocardiography reveals marked symmetric concentric left ventricular wall thickening (septum 18 mm), biatrial enlargement, mildly reduced LVEF (42%), and speckle-tracking global longitudinal strain showing preserved apical strain with severe basal and mid-ventricular impairment ('apical sparing' pattern). Serum and urine protein electrophoresis with immunofixation and serum free light chain (sFLC) ratio are completely normal. What is the next most definitive non-invasive diagnostic investigation to confirm the underlying etiology?
A.Endomyocardial biopsy with Congo red staining and electron microscopy
B.Coronary angiography with fractional flow reserve measurement
C.High-resolution chest CT with bronchoalveolar lavage
D.Technetium-99m pyrophosphate (99mTc-PYP) or DPD bone scintigraphy
Explanation: The patient exhibits classic clinical and echocardiographic features of cardiac amyloidosis (bilateral carpal tunnel syndrome, low ECG voltage discordant with marked LV thickening, and echocardiographic apical sparing strain pattern). When light chain (AL) amyloidosis is ruled out by normal serum and urine immunofixation and normal serum free light chain (sFLC) ratio, a Grade 2 or 3 cardiac uptake on Technetium-99m pyrophosphate (99mTc-PYP) or 99mTc-DPD bone scintigraphy achieves >99% sensitivity and 100% specificity for diagnosing transthyretin cardiac amyloidosis (ATTR-CM) non-invasively, eliminating the need for endomyocardial biopsy.
5A 23-year-old woman is brought to the hospital by her family due to dramatic behavioral changes, visual hallucinations, and acute persecutory delusions that developed over two weeks. Over the subsequent 5 days in the inpatient psychiatric unit, she developed refractory generalized tonic-clonic seizures, progressive mutism, prominent orofacial and lingual dyskinesias (lip-smacking and tongue protrusion), fluctuating hyperpyrexia, blood pressure instability, and sinus tachycardia. Brain MRI with gadolinium is normal. Routine CSF analysis reveals mild lymphocytic pleocytosis (22 WBCs/uL) with normal protein and glucose. Serum and CSF testing confirm high-titer antibodies against the GluN1 subunit of the NMDA receptor. Pelvic MRI reveals a 4.5 cm cystic and solid right adnexal mass. What is the fundamental two-pronged therapeutic strategy required for optimal long-term neurological recovery?
A.High-dose neuroleptic monotherapy (haloperidol) combined with long-term oral levetiracetam
B.Prompt surgical tumor resection (oophorectomy/cystectomy) combined with first-line immunotherapy (corticosteroids and IVIG or plasmapheresis)
C.Whole-brain radiation therapy combined with systemic cyclophosphamide
D.Empiric intravenous acyclovir for 21 days followed by maintenance interferon-beta therapy
Explanation: This patient presents with classic anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, a severe autoimmune encephalitis frequently associated with an underlying ovarian teratoma (particularly in young females). The management paradigm requires prompt identification and surgical removal of the tumor (teratoma removal removes the source of antigenic drive) combined with aggressive first-line immunotherapy (high-dose intravenous methylprednisolone pulse plus intravenous immunoglobulin [IVIG] or therapeutic plasma exchange). Patients failing first-line therapy within 10–14 days should escalate to second-line agents (rituximab or cyclophosphamide).
6A 71-year-old retired architect is evaluated for a 9-month history of progressive gait unsteadiness, described by his family as if his 'feet are stuck to the floor' (magnetic, wide-based, short-stepped gait). Over the past 4 months, he has developed new-onset urinary urgency with urge incontinence and mild executive cognitive dysfunction with psychomotor slowing. Brain MRI demonstrates marked ventriculomegaly with an Evans index of 0.38, narrowing of the high-convexity sulci with disproportionately enlarged subarachnoid space hydrocephalus (DESH), and no significant cortical atrophy or focal white matter infarctions. What is the most predictive next diagnostic procedure to assess whether this patient will benefit from ventriculoperitoneal shunt surgery?
A.24-hour continuous intracranial pressure bolt monitoring in the neuro-ICU
B.Positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) brain imaging
C.High-volume lumbar puncture (tap test) with removal of 30–50 mL of CSF and quantitative pre- and post-procedure gait assessment
D.Diagnostic cerebral digital subtraction angiography (DSA) with venous sinus pressure measurement
Explanation: This patient presents with the classic clinical triad of Hakim-Adams (gait disturbance, urinary incontinence, cognitive decline) and characteristic MRI findings of Normal Pressure Hydrocephalus (NPH), specifically DESH (disproportionately enlarged subarachnoid space hydrocephalus). The high-volume lumbar puncture tap test (removal of 30–50 mL of CSF) with standardized, timed objective gait and cognitive testing before and 2–4 hours after the procedure is the gold standard diagnostic and prognostic test to predict responsiveness to ventriculoperitoneal (VP) shunting.
7A 34-year-old man presents with progressive symmetric ascending weakness that began in both lower extremities 4 days ago and now involves his upper limbs, accompanied by distal paresthesias in a glove-and-stocking distribution. Two weeks prior, he had a self-limited episode of watery diarrhea. On physical examination, he has symmetric 3/5 strength in the lower extremities and 4/5 strength in the upper extremities, with generalized bilateral absent deep tendon reflexes (areflexia) and bilateral mild facial weakness (CN VII). Vital capacity is currently 38 mL/kg. Lumbar puncture performed on day 5 of symptom onset reveals normal opening pressure, protein 145 mg/dL (elevated), and WBC count 2 cells/uL (normal). What is the classical terminology for this CSF finding and the primary pathogen most frequently associated with this presentation?
A.Albuminocytological dissociation; Campylobacter jejuni
B.Cytoalbuminologic convergence; Clostridioides difficile
C.Xanthochromic pleocytosis; Cytomegalovirus
D.Oligoclonal band elevation; Epstein-Barr virus
Explanation: The patient presents with classic Guillain-Barré Syndrome (acute inflammatory demyelinating polyneuropathy, AIDP). The CSF analysis demonstrates 'albuminocytological dissociation'—a marked elevation in CSF total protein concentration with a normal white blood cell count (<5–10 cells/uL), reflecting nerve root inflammation without intrathecal infection. The most common antecedent trigger of GBS is Campylobacter jejuni enteritis (associated with molecular mimicry between GM1/GD1a gangliosides and bacterial lipooligosaccharides).
8A 58-year-old male heavy smoker presents with progressive proximal lower extremity muscle weakness, dry mouth (xerostomia), and erectile dysfunction over the past 5 months. On physical examination, deep tendon reflexes in the patellar and Achilles tendons are diminished at rest but become markedly brisker after 10 seconds of maximal isometric quadriceps contraction (post-exercise facilitation). Repetitive nerve stimulation (RNS) electrodiagnostic testing is performed. What is the characteristic electrophysiological finding at low-frequency (2–3 Hz) versus high-frequency (20–50 Hz) or post-exercise stimulation in this patient?
A.Significant compound muscle action potential (CMAP) decremental response at high frequency and incremental response at low frequency
B.Normal baseline CMAP with sustained decrement across all stimulation frequencies without post-exercise facilitation
C.Diffuse fibrillations and positive sharp waves on needle EMG with normal motor nerve conduction velocities
D.Low baseline CMAP amplitude, decremental response at low-frequency (2–3 Hz) stimulation, and marked incremental response (>100% CMAP increase) at high-frequency (20–50 Hz) stimulation
Explanation: This patient presents with Lambert-Eaton Myasthenic Syndrome (LEMS), a presynaptic disorder of neuromuscular transmission caused by autoantibodies directed against P/Q-type voltage-gated calcium channels (VGCC), frequently occurring as a paraneoplastic manifestation of small cell lung cancer (SCLC). On electrodiagnostic testing, LEMS is characterized by: (1) low baseline compound muscle action potential (CMAP) amplitude, (2) decremental response at low-frequency stimulation (2–3 Hz), and (3) dramatic incremental response (>100% increase in CMAP amplitude) following brief maximal exercise or high-frequency (20–50 Hz) tetanic stimulation, due to calcium accumulation in the presynaptic terminal.
9A 67-year-old male presents with a 14-month history of insidious, progressive exertional breathlessness and a dry, hacking cough. He is a former smoker (30 pack-years) with no environmental, occupational, or medication exposures, and no joint pain, skin rash, or Raynaud phenomenon. Physical examination reveals bilateral fine end-inspiratory 'Velcro-like' crackles at the lung bases and digital clubbing. High-resolution computed tomography (HRCT) of the chest demonstrates bilateral, subpleural, basal-predominant reticular opacities, traction bronchiectasis, and prominent subpleural honeycombing without ground-glass attenuation, mosaic attenuation, or micronodules. What is the most appropriate next step in establishing the definitive diagnosis according to international consensus guidelines?
A.Perform video-assisted thoracoscopic surgery (VATS) with surgical lung biopsy from two different lobes
B.Establish the diagnosis of Idiopathic Pulmonary Fibrosis (IPF) directly based on the definitive Usual Interstitial Pneumonia (UIP) HRCT pattern without requiring a surgical lung biopsy
C.Perform transbronchial cryobiopsy to confirm histological fibroblastic foci before classifying the disease
D.Obtain an open thoracotomy wedge biopsy and initiate empiric triple therapy with prednisone, azathioprine, and N-acetylcysteine
Explanation: According to ATS/ERS/JRS/ALAT clinical practice guidelines, when high-resolution chest CT (HRCT) demonstrates a definitive Usual Interstitial Pneumonia (UIP) pattern (subpleural, basal predominance, reticular abnormalities, honeycombing ± traction bronchiectasis, and absence of inconsistent features) in an older patient with unexplained chronic dyspnea and no identifiable secondary etiology (such as CTD, hypersensitivity pneumonitis, or pneumoconiosis), the clinical-radiological diagnosis of Idiopathic Pulmonary Fibrosis (IPF) is definitively established without the need for an invasive lung biopsy.
10A 48-year-old female presents to the emergency department with acute onset of severe pleuritic chest pain and breathlessness 10 days following an uncomplicated elective total knee arthroplasty. Her vital signs are: BP 122/76 mmHg, HR 108 bpm, RR 24 breaths/min, and SpO2 93% on room air. CT pulmonary angiography (CTPA) reveals extensive bilateral filling defects in the main pulmonary arteries extending into lobar branches. Transthoracic echocardiography demonstrates right ventricular dilation with an RV/LV basal diameter ratio of 1.2 and flattening of the interventricular septum during diastole (McConnell sign). Serum troponin I is elevated at 0.14 ng/mL and NT-proBNP is 1,200 pg/mL. What is the clinical risk classification of this patient's pulmonary embolism and the initial management strategy?
A.Low-risk PE; outpatient treatment with oral apixaban and discharge within 24 hours
B.High-risk (massive) PE; immediate intravenous administration of weight-based recombinant tissue plasminogen activator (rtPA)
C.Intermediate-high risk (submassive) PE; admission to an acute monitored unit, immediate therapeutic anticoagulation (e.g., LMWH or UFH), and close monitoring for hemodynamic decompensation
D.Intermediate-low risk PE; placement of an inferior vena cava (IVC) filter without systemic anticoagulation
Explanation: According to the European Society of Cardiology (ESC) guidelines, patients with acute pulmonary embolism who are hemodynamically stable (SBP >= 90 mmHg) but have both right ventricular dysfunction on imaging (RV/LV ratio > 1.0, echocardiographic strain) and elevated cardiac biomarkers (positive troponin or NT-proBNP) are classified as 'Intermediate-High Risk' (submassive PE). Recommended management is immediate therapeutic anticoagulation (preferably with low-molecular-weight heparin or weight-adjusted unfractionated heparin), admission to an intensive/monitored unit, and rescue reperfusion therapy (systemic thrombolysis or catheter-directed therapy) only if hemodynamic decompensation occurs.
About the Afghanistan Comprehensive Specialization Exam Exam
The Afghanistan Comprehensive Specialization Completion Exam (امتحان جامع خروج از اکمال تخصص) is the final national board qualifying examination for senior medical residents completing their post-graduate clinical specialty training.
Assessment
Two separately-passed components set against the curriculum of the candidate's specialty: a written theory paper of 100 four-option multiple-choice questions marked out of 100 with a 75% pass mark, and a practical examination marked out of 100 also requiring 75%. Successful defence of the monograph is a prerequisite for sitting. Session length is not published.
Time Limit
Not published by the Ministry of Public Health or the National Examination Authority
Passing Score
75% on the 100-mark theory paper and 75% on the 100-mark practical component
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 Comprehensive Specialization Exam Exam Content Outline
25 practice items in this bank
Advanced Clinical Diagnosis
Complex diagnostic reasoning, uncommon clinical syndromes, advanced imaging, and specialty evaluation.
20 practice items in this bank
Advanced Pharmacotherapy
Targeted therapies, multi-drug resistant pathogens, organ failure dosing, and drug toxicity management.
20 practice items in this bank
Critical Care & Inpatient Emergencies
ICU hemodynamic management, ARDS, mechanical ventilation, severe sepsis, and resuscitation protocols.
15 practice items in this bank
Surgical & Interventional Decision-Making
Perioperative risk assessment, procedural complications, and acute surgical indications.
10 practice items in this bank
Multi-System Disease Management
Complex multimorbid patient management, cardiorenal syndrome, and systemic auto-immune crises.
10 practice items in this bank
Clinical Governance & Research
Evidence-based practice, biostatistics, patient safety protocols, and medical jurisprudence.
How to Pass the Afghanistan Comprehensive Specialization Exam Exam
What You Need to Know
- Passing score: 75% on the 100-mark theory paper and 75% on the 100-mark practical component
- Assessment: Two separately-passed components set against the curriculum of the candidate's specialty: a written theory paper of 100 four-option multiple-choice questions marked out of 100 with a 75% pass mark, and a practical examination marked out of 100 also requiring 75%. Successful defence of the monograph is a prerequisite for sitting. Session length is not published.
- 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
- Review every answer and explanation
- Track weak areas and revisit them
- Use our AI tutor for tough concepts
Afghanistan Comprehensive Specialization Exam Study Tips from Top Performers
1Review international clinical practice guidelines (Surviving Sepsis, KDIGO, GOLD, ESC/AHA, IDSA).
2Focus on multi-organ system interactions, such as hepatorenal syndrome and cardiogenic shock with multi-organ failure.
3Practice interpreting advanced diagnostic studies including arterial blood gases, echocardiography parameters, and CT imaging findings.
Frequently Asked Questions
What are the components of the Takhasus Comprehensive Exam?
The examination consists of a 100-question written theoretical paper (MCQs) followed by a practical clinical/OSPE examination and oral defense.
What is the required passing score?
Candidates must achieve at least 75% on the written theory paper and at least 75% on the clinical practical evaluation to be awarded specialist certification.
Who is eligible to sit the Comprehensive Specialization Exam?
Senior resident doctors who have completed 3–5 years of accredited Takhasus clinical training at recognized teaching hospitals and successfully defended their graduation thesis/monograph.
What language is used in the examination?
Theoretical questions are set in English, Dari, and Pashto. Our study bank provides an English-language MCQ practice adaptation for comprehensive exam preparation.