100+ Free Facharzt FMH Allgemeine Innere Medizin Practice Questions

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Key Facts: Facharzt FMH Allgemeine Innere Medizin Exam

SGAIM / SSMIG

Exam Body

Swiss Society of General Internal Medicine

120 MCQs

Exam Questions

SGAIM Examination Commission

300 min

Exam Duration

SGAIM Examination Regulations

English

Exam Language

SGAIM Official Regulations

5 Years

Postgraduate Training

SIWF Weiterbildungsprogramm

100

Practice Bank Items

OpenExamPrep

The Facharzt FMH Allgemeine Innere Medizin is Switzerland's benchmark internal medicine specialist qualification. Board certification requires a 5-year accredited postgraduate residency and passing the official 120-question written SGAIM Facharztprüfung (5 hours, tablet-based, administered in English in Bern), assessing broad inpatient, outpatient, and emergency internal medicine competencies.

Sample Facharzt FMH Allgemeine Innere Medizin Practice Questions

Try these sample questions to test your Facharzt FMH Allgemeine Innere Medizin exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 66-year-old male with symptomatic heart failure and reduced ejection fraction (LVEF 30%) remains in NYHA class III despite treatment with sacubitril/valsartan 97/103 mg twice daily, empagliflozin 10 mg daily, and eplerenone 50 mg daily. His blood pressure is 118/74 mmHg and heart rate is 78 bpm in sinus rhythm. According to ESC and SGAIM guidelines, which medication should be added to complete the four pillars of guideline-directed medical therapy (GDMT)?

A.Bisoprolol titrated to target dose (or carvedilol/metoprolol succinate)

B.Digoxin 0.125 mg daily

C.Ivabradine 5 mg twice daily

D.Furosemide 40 mg daily

Explanation: Evidence-based beta-blockers (bisoprolol, carvedilol, or metoprolol succinate) represent one of the mandatory four foundational pillars of HFrEF therapy alongside ARNI/ACEi, MRA, and SGLT2 inhibitors, providing substantial mortality and hospitalization reductions.

2A 58-year-old female presents to the emergency department with 45 minutes of crushing substernal chest pain. The ECG shows 2.5 mm ST-segment elevations in leads II, III, and aVF with reciprocal ST depressions in I and aVL. Blood pressure is 88/54 mmHg, heart rate is 52 bpm, and clear lung fields are noted on auscultation. What is the most appropriate next step in management?

A.Right-sided precordial ECG (leads V3R-V4R) and urgent primary percutaneous coronary intervention (PCI)

B.Immediate intravenous nitroglycerin infusion and high-dose beta-blocker

C.Immediate intravenous administration of 500 mg methylprednisolone

D.Transesophageal echocardiography prior to coronary angiography

Explanation: Inferior STEMI complicated by hypotension and bradycardia frequently involves right ventricular infarction; a right-sided ECG (V3R-V4R) is essential, and emergent reperfusion via primary PCI within 120 minutes is the definitive treatment. Nitrates and diuretics must be avoided as they compromise RV preload.

3A 72-year-old woman with persistent non-valvular atrial fibrillation has a history of hypertension, type 2 diabetes mellitus, and a remote ischemic stroke (CHA2DS2-VASc score = 6). Her serum creatinine is 85 µmol/L (eGFR 68 mL/min/1.73 m²). Which anticoagulant strategy is recommended as first-line for stroke prevention according to ESC/SGAIM guidelines?

A.Direct oral anticoagulant (DOAC) such as apixaban, rivaroxaban, edoxaban, or dabigatran

B.Unfractionated heparin bridge followed by lifelong phenprocoumon with target INR 2.0-3.0

C.Dual antiplatelet therapy with aspirin and clopidogrel

D.Left atrial appendage closure without any medical anticoagulation

Explanation: DOACs are preferred over vitamin K antagonists (like phenprocoumon or warfarin) in non-valvular atrial fibrillation due to superior efficacy in reducing intracranial hemorrhage, equivalent stroke prevention, and predictable pharmacokinetics without routine coagulation monitoring.

4An 81-year-old male presents with progressive exertional dyspnea, angina, and an episode of near-syncope while walking uphill. Cardiac auscultation reveals a harsh, late-peaking systolic ejection murmur at the right upper sternal border radiating to the carotids, with a diminished and delayed carotid pulse (pulsus parvus et tardus). Echocardiography shows a mean aortic valve gradient of 48 mmHg, peak velocity of 4.3 m/s, and aortic valve area of 0.7 cm². What is the definitive treatment?

A.Aortic valve replacement (Surgical AVR or Transcatheter Aortic Valve Implantation - TAVI) evaluated by the Heart Team

B.Balloon aortic valvuloplasty as definitive monotherapy

C.Serial observation with repeat echocardiography in 12 months

D.Long-term medical therapy with high-dose verapamil and ivabradine

Explanation: The patient has severe symptomatic aortic stenosis (defined by valve area < 1.0 cm², mean gradient >= 40 mmHg, peak velocity >= 4.0 m/s with classic symptoms of angina, syncope, or dyspnea). Definitive aortic valve replacement (TAVI or SAVR) is indicated immediately because medical therapy offers no survival benefit once symptoms appear.

5A 62-year-old male with a 40 pack-year smoking history is evaluated for chronic dyspnea and cough. Post-bronchodilator spirometry demonstrates an FEV1/FVC ratio of 0.58 and an FEV1 of 52% of predicted. Over the past 12 months, he experienced two severe COPD exacerbations requiring hospitalization. His peripheral blood eosinophil count is 350 cells/µL. According to GOLD 2024/2026 guidelines, which maintenance inhaler regimen is most appropriate?

A.Triple therapy: Long-Acting Muscarinic Antagonist (LAMA) + Long-Acting Beta2-Agonist (LABA) + Inhaled Corticosteroid (ICS)

B.Short-acting beta2-agonist (SABA) monotherapy on an as-needed basis only

C.Long-term oral prednisone 20 mg daily with theophylline

D.Phosphodiesterase-4 inhibitor (roflumilast) monotherapy without bronchodilators

Explanation: According to GOLD guidelines, COPD patients in Group E (frequent exacerbations requiring hospital admission) with elevated blood eosinophil counts (>= 300 cells/µL) derive significant reduction in exacerbations and mortality from triple therapy combining a LAMA, a LABA, and an ICS.

6A 28-year-old female presents with recurrent episodes of nocturnal wheezing, chest tightness, and shortness of breath triggered by cold air. Spirometry shows an increase in FEV1 of 15% and 240 mL following inhalation of 400 µg salbutamol. According to GINA Track 1 guidelines, what is the preferred initial controller and reliever strategy for mild persistent asthma?

A.Low-dose Inhaled Corticosteroid (ICS)-formoterol taken as needed for symptom relief

B.Oral montelukast 10 mg daily with as-needed oral prednisone

C.Daily high-dose fluticasone-salmeterol plus daily tiotropium and omalizumab

D.SABA monotherapy as needed without any anti-inflammatory controller

Explanation: GINA Track 1 establishes as-needed low-dose ICS-formoterol as the preferred treatment across Steps 1 and 2, providing immediate bronchodilation while simultaneously delivering anti-inflammatory controller therapy to prevent severe exacerbations and asthma deaths.

7A 48-year-old female presents with acute pleuritic chest pain, tachypnea, and hemoptysis following a 12-hour transatlantic flight. Vital signs: BP 124/78 mmHg, HR 108 bpm, SpO2 91% on room air. Her simplified Wells score is 4.5 (PE likely). D-dimer is 2,400 ng/mL. CT pulmonary angiography confirms bilateral segmental pulmonary emboli without right ventricular strain. Transthoracic echocardiography is normal, and serum troponin is negative. What is the appropriate initial management?

A.Initiation of therapeutic anticoagulation with a DOAC (e.g., rivaroxaban or apixaban)

B.Inferior vena cava filter placement without anticoagulation

C.Systemic thrombolysis with intravenous recombinant tissue plasminogen activator (rtPA)

D.Emergent surgical pulmonary embolectomy under cardiopulmonary bypass

Explanation: This patient has low/intermediate-low risk acute pulmonary embolism (hemodynamically stable, normal RV on echo, negative troponin). According to ESC and Swiss guidelines, therapeutic anticoagulation with a DOAC (apixaban or rivaroxaban) is the standard of care without need for initial heparin bridging or thrombolysis.

8A 70-year-old male is admitted with fever, productive cough, and confusion. Vital signs: BP 85/55 mmHg, HR 112 bpm, RR 32/min, temperature 38.9°C, SpO2 89% on ambient air. Serum urea is 9.4 mmol/L. Chest radiograph demonstrates dense right lower lobe consolidation. What is his CURB-65 score and the recommended site of care?

A.CURB-65 = 4; urgent hospital admission (with consideration of intensive care/intermediate care unit)

B.CURB-65 = 2; general medical ward admission with oral clarithromycin

C.CURB-65 = 0; observation unit discharge after single dose IV ceftriaxone

D.CURB-65 = 1; outpatient oral amoxicillin

Explanation: The patient scores 4 points on CURB-65: Confusion (+1), Urea > 7 mmol/L (+1), Respiratory rate >= 30/min (+1), Blood pressure < 90/60 mmHg (+1), Age >= 65 (+1, total = 5, score >= 4 indicates severe CAP). Severe CAP carries a high 30-day mortality (>25%) requiring immediate hospital admission, typically in an ICU/IMC setting, with IV combination antibiotic therapy.

9A 54-year-old male presents with progressive exertional dyspnea and a dry cough over the past 8 months. Physical examination reveals bilateral fine end-inspiratory velcro crackles at the lung bases and digital clubbing. High-resolution CT (HRCT) of the chest shows subpleural, basal-predominant reticular abnormalities with extensive honeycombing, traction bronchiectasis, and absence of ground-glass opacities, consistent with a definitive Usual Interstitial Pneumonia (UIP) pattern. What is the most appropriate first-line pharmacotherapy?

A.Antifibrotic therapy with pirfenidone or nintedanib

B.High-dose systemic corticosteroids combined with azathioprine and N-acetylcysteine

C.Cyclophosphamide pulse therapy and therapeutic plasma exchange

D.Inhaled long-acting beta2-agonist monotherapy

Explanation: Idiopathic Pulmonary Fibrosis (IPF) confirmed by a definite UIP pattern on HRCT is treated with antifibrotic agents (nintedanib or pirfenidone), which significantly slow the rate of FVC decline. The PANTHER-IPF trial showed that immunosuppression with steroids, azathioprine, and NAC increases mortality in IPF and is harmful.

10A 62-year-old woman with a history of breast cancer treated with anthracyclines and chest radiotherapy presents with progressive fatigue, abdominal distension, and bilateral leg edema. Physical exam reveals jugular venous distension with a prominent 'y' descent and Kussmaul sign (increase in JVP during inspiration), clear lung fields, and distant heart sounds. An early diastolic sound (pericardial knock) is audible. Echocardiography shows preserved biventricular systolic function, biatrial enlargement, and marked respiratory variation in mitral inflow velocity (>25%). What is the underlying diagnosis?

A.Constrictive pericarditis

B.Dilated cardiomyopathy

C.Cardiac tamponade

D.Cor pulmonale secondary to severe emphysema

Explanation: Constrictive pericarditis is characterized by rigid, calcified/fibrotic pericardium (common after radiation or cardiac surgery) preventing diastolic filling, manifested by Kussmaul sign, rapid y-descent, pericardial knock, and exaggerated respiratory ventricular interdependence on Doppler echocardiography.

About the Facharzt FMH Allgemeine Innere Medizin Exam

The Facharzt FMH für Allgemeine Innere Medizin (Specialist in General Internal Medicine FMH) is the premier and largest clinical specialist qualification in Switzerland, certifying physicians for independent practice in hospital internal medicine, emergency departments, and ambulatory primary care practices. The qualification is regulated by the SIWF (Swiss Institute for Postgraduate and Continuous Medical Training) and governed by the SGAIM (Swiss Society of General Internal Medicine / Société Suisse de Médecine Interne Générale). The qualification process mandates completion of a rigorous 5-year postgraduate residency curriculum (incorporating inpatient acute care, outpatient clinics, emergency medicine, and intensive care rotations), certified e-Logbook documentation with mini-CEX/DOPS workplace assessments, and passing the centralized written Facharztprüfung. Notably, the official SGAIM examination is conducted entirely in English using 120 tablet-based multiple-choice questions modeled after international internal medicine standards (such as ACP MKSAP). Note on study adaptation: This question bank is an independent English-language MCQ practice resource created by OpenExamPrep—not an official release of the SGAIM or SIWF—meticulously designed to reflect the official Swiss internal medicine blueprint, international guidelines (ESC, GINA, GOLD, KDIGO, EASD), and Swiss clinical practice standards (including Swiss Society for Infectious Diseases guidelines and local epidemiology).

Assessment

A single-day electronic written examination comprising 120 clinical vignette-based multiple-choice questions (5 hours / 300 minutes) testing inpatient internal medicine, outpatient primary care, emergency management, diagnostic reasoning, and evidence-based pharmacotherapy.

Time Limit

300 minutes (5 hours continuous examination)

Passing Score

Criterion-referenced standard passing score set by the SGAIM examination commission using modified Angoff standard-setting methodology (typically ~60–65% correct answers)

Exam Fee

CHF 900 examination fee published by SGAIM, payable within 10 days of invoice; SIWF charges a separate title application fee (Schweizerische Gesellschaft für Allgemeine Innere Medizin (SGAIM / SSMIG) under the auspices of the Schweizerisches Institut für ärztliche Weiter- und Fortbildung (SIWF / FMH))

Facharzt FMH Allgemeine Innere Medizin Exam Content Outline

25%

Cardiovascular & Pulmonary Medicine

Evidence-based management of acute coronary syndromes, acute and chronic heart failure (HFrEF, HFpEF, GDMT), valvular heart disease, arrhythmias (atrial fibrillation, anticoagulation, antiarrhythmics), hypertension, dyslipidemia, COPD (GOLD guidelines), asthma (GINA SMART strategy), community-acquired and nosocomial pneumonia, pulmonary embolism/DVT, and interstitial lung diseases.

15%

Gastroenterology, Hepatology & Nutrition

Evaluation and management of acute and chronic gastrointestinal bleeding, peptic ulcer disease, H. pylori, inflammatory bowel disease (Crohn's, ulcerative colitis), acute and chronic pancreatitis, liver cirrhosis and complications (ascites, SBP, variceal bleeding, hepatic encephalopathy), viral and autoimmune hepatitis, MASLD/MASH, and malabsorption syndromes.

15%

Nephrology, Fluid, Electrolyte & Acid-Base Disorders

Diagnostic workup and therapy for acute kidney injury (KDIGO staging, pre-renal, ATN, AIN), chronic kidney disease (SGLT2i, finerenone, RAAS blockade, CKD-MBD), glomerulonephritis, nephrotic syndrome, dysnatremias (SIADH, hypovolemia, hypernatremia), potassium disorders, and complex simple and mixed acid-base disturbances.

15%

Endocrinology, Diabetes & Metabolism

Comprehensive care of type 1 and type 2 diabetes mellitus, acute complications (DKA, HHS), cardiorenal risk-reduction therapies (GLP-1 RA, SGLT2i), thyroid pathology (hyper-/hypothyroidism, thyroiditis, thyroid nodules), adrenal insufficiency, Cushing syndrome, hypercalcemia and metabolic bone disease/osteoporosis, and pituitary disorders.

15%

Infectious Diseases & Antibiotic Stewardship

Guideline-directed recognition and management of sepsis and septic shock (Sepsis-3), complex urinary tract infections, infective endocarditis (Duke criteria), tick-borne diseases endemic to Switzerland (Lyme borreliosis, tick-borne encephalitis/FSME), tuberculosis, HIV/opportunistic infections, Clostridioides difficile, and rational antimicrobial selection.

15%

Rheumatology, Hematology, Geriatrics & Outpatient General Medicine

Clinical diagnosis and treatment of rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus, giant cell arteritis/PMR, gout/pseudogout, microcytic/macrocytic/hemolytic anemias, coagulation and platelet disorders, acute and chronic leukemias/myeloma, geriatric syndromes (delirium, polypharmacy/Beers/STOPP-START), palliative symptom control, perioperative medicine, and preventive health.

How to Pass the Facharzt FMH Allgemeine Innere Medizin Exam

What You Need to Know

Passing score: Criterion-referenced standard passing score set by the SGAIM examination commission using modified Angoff standard-setting methodology (typically ~60–65% correct answers)
Assessment: A single-day electronic written examination comprising 120 clinical vignette-based multiple-choice questions (5 hours / 300 minutes) testing inpatient internal medicine, outpatient primary care, emergency management, diagnostic reasoning, and evidence-based pharmacotherapy.
Time limit: 300 minutes (5 hours continuous examination)
Exam fee: CHF 900 examination fee published by SGAIM, payable within 10 days of invoice; SIWF charges a separate title application fee

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

Facharzt FMH Allgemeine Innere Medizin Study Tips from Top Performers

1Master Guideline-Directed Medical Therapy (GDMT): Be fluent in the 'four pillars' of HFrEF therapy (ARNI/ACEi, beta-blocker, MRA, SGLT2i) and their specific initiation rules, renal function thresholds, and potassium monitoring.

2Internalize Acid-Base & Electrolyte Diagnostic Algorithms: Practice calculating serum anion gap, delta-delta ratio for mixed disorders, urine anion gap for normal AG metabolic acidosis, and urine electrolytes/osmolality in hyponatremia workups.

3Understand SGLT2 Inhibitor & GLP-1 Receptor Agonist Indications: Know the landmark cardiovascular and renal outcome trial data (EMPA-REG, DAPA-HF, CREDENCE, LEADER) that mandate these agents in patients with T2D, CKD, or atherosclerotic cardiovascular disease.

4Learn Swiss Epidemiological Nuances in Infectious Diseases: Be familiar with endemic tick-borne diseases in Switzerland (Lyme borreliosis clinical stages vs tick-borne encephalitis/FSME vaccination and supportive care), Swiss tuberculosis screening, and local antibiotic stewardship (SSI guidelines).

5Apply Geriatric & Primary Care Clinical Rules: Review delirium triggers, Beers and STOPP/START criteria for deprescribing high-risk medications in the elderly, CHA2DS2-VASc scoring for DOAC anticoagulation, and Swiss cancer screening recommendations (e.g., Swiss colorectal cancer screening).

Frequently Asked Questions

What is the Facharzt FMH für Allgemeine Innere Medizin title?

The Facharzt FMH für Allgemeine Innere Medizin is the federally accredited medical specialist title in Switzerland awarded by the SIWF / FMH. It certifies a physician as fully qualified for independent, unsupervised practice in both hospital-based internal medicine and ambulatory primary care outpatient practices throughout Switzerland.

In what language is the official Swiss SGAIM Facharztprüfung conducted?

The official SGAIM Facharztprüfung is conducted entirely in English. The exam consists of 120 multiple-choice questions presented on electronic tablets during a single 5-hour session in Bern. This aligns with international internal medicine educational benchmarks (such as the American College of Physicians MKSAP) and ensures linguistic neutrality across Switzerland's German-, French-, and Italian-speaking regions.

When should candidates take the SGAIM Facharztprüfung during their residency?

The SGAIM strongly recommends taking the examination after completing at least three years of core postgraduate clinical training (Basisweiterbildung). Candidates typically register in their 4th or 5th year of training when their clinical knowledge and diagnostic problem-solving abilities have matured through daily inpatient and emergency ward experience.

How often is the examination offered, and where does it take place?

The SGAIM Facharztprüfung is administered twice annually (a Spring session and an Autumn session), typically hosted centrally at the Hochschulzentrum vonRoll in Bern, Switzerland.

What learning materials are officially recommended for exam preparation?

The SGAIM recommends the ACP Medical Knowledge Self-Assessment Program (MKSAP) as the primary learning and question resource. In addition, trainees frequently utilize specialized preparatory courses such as the ZAIM MediKurs (Zurich Academy of Internal Medicine), European clinical society guidelines (ESC, GINA, GOLD, KDIGO, EASD, EASL), and Swiss Society for Infectious Diseases (SSI) clinical guidance.

What are the passing standards and retake policies for the exam?

The passing score is determined through standard-setting by the SGAIM examination commission (typically around 60–65% correct answers). Candidates who do not pass may re-register for subsequent sessions, up to a maximum of four attempts according to SIWF regulations.

100+ Free Facharzt FMH Allgemeine Innere Medizin Practice Questions

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