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Key Facts: Iran Specialty Board - Cardiology Exam

152

Total MCQs on the official national cardiology specialty board written examination

Sanjesh Pezeshki & Council for Medical and Specialized Education

240 min

Total written examination time limit (approx. 95 seconds per question)

Sanjesh Pezeshki Examination Rules

70% (105/150)

Written passing threshold (scaled 150 points) required to advance to the oral stage

Secretariat for the Council for Medical and Specialized Education

Negative marking penalty: incorrect answers receive zero points without deduction

Sanjesh Pezeshki Examination Regulations

Annual (Shahrivar)

National board examination administration held annually in late summer

Sanjesh Pezeshki Annual Assessment Calendar

The Iranian Specialty Board in Cardiology is a high-stakes national certification examination consisting of a 152-question, 240-minute written stage followed by a computer-based oral board. A written score of 70% (105/150 points) with no negative marking is required to qualify for the oral examination and attain specialist board certification (Daneshnameh).

Sample Iran Specialty Board - Cardiology Practice Questions

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1A 62-year-old man presents with typical angina on exertion. Coronary angiography reveals an intermediate 50% to 60% stenosis in the mid-left anterior descending artery. Fractional flow reserve (FFR) is performed using intravenous adenosine. Which FFR cutoff value is the recognized threshold indicating hemodynamically significant ischemia requiring revascularization?

A.0.70 or less

B.0.85 or less

C.0.90 or less

D.0.80 or less

Explanation: A fractional flow reserve (FFR) of 0.80 or less during maximal hyperemia (typically induced with intravenous adenosine) is the universally established clinical cutoff for hemodynamically significant coronary stenosis. Major clinical trials such as FAME and DEFER demonstrated that revascularization of lesions with FFR <= 0.80 improves clinical outcomes, whereas deferring lesions with FFR > 0.80 is safe and associated with low adverse event rates.

2A 54-year-old woman with severe rheumatic mitral stenosis undergoes transthoracic echocardiography to assess suitability for percutaneous transvenous mitral commissurotomy (PTMC / balloon valvuloplasty). Which echocardiographic scoring system evaluates leaflet mobility, thickening, calcification, and subvalvular thickening to predict procedural success?

A.EuroSCORE II

B.Wilkins score

C.HFA-PEFF score

D.STS score

Explanation: The Wilkins echocardiographic score (Boston score) assesses four morphological features of the mitral valve: leaflet mobility, leaflet thickening, subvalvular thickening, and valvular calcification. Each component is graded from 1 to 4, yielding a total score between 4 and 16. A Wilkins score <= 8 is strongly predictive of favorable immediate and long-term outcomes following percutaneous balloon mitral valvuloplasty.

3A 48-year-old man presents with recurrent episodes of sudden-onset, regular, narrow-complex tachycardia at a rate of 180 beats per minute. An electrophysiology study reveals that the tachycardia is initiated with critical PR prolongation following an atrial extrastimulus, with simultaneous activation of the atrium and ventricle (retrograde P wave buried within the QRS). What is the most likely diagnosis?

A.Typical (slow-fast) atrioventricular nodal reentrant tachycardia

B.Atypical (fast-slow) atrioventricular nodal reentrant tachycardia

C.Orthodromic atrioventricular reentrant tachycardia via a left lateral accessory pathway

D.Atrial flutter with 2:1 atrioventricular block

Explanation: Typical (slow-fast) atrioventricular nodal reentrant tachycardia (AVNRT) involves anterograde conduction over the slow pathway and retrograde conduction over the fast pathway. Because retrograde conduction up the fast pathway is rapid, atrial and ventricular depolarizations occur almost simultaneously, burying the retrograde P wave within or at the very end of the QRS complex (pseudo-r' in V1 or pseudo-s in inferior leads) with a very short RP interval (< 70 ms).

4A 68-year-old woman with chronic heart failure with reduced ejection fraction (LVEF 28%) remains in NYHA functional class III despite receiving guideline-directed medical therapy comprising sacubitril/valsartan, metoprolol succinate, and empagliflozin. Serum potassium is 4.3 mEq/L and estimated GFR is 54 mL/min/1.73 m². Which medication should be added next to complete guideline-directed quadruple therapy?

A.Digoxin

B.Spironolactone

C.Ivabradine

D.Hydralazine and isosorbide dinitrate

Explanation: A mineralocorticoid receptor antagonist (MRA), such as spironolactone or eplerenone, is a foundational component of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF). The four pillars of foundational HFrEF therapy are an ARNI (sacubitril/valsartan), a guideline-directed beta-blocker, an MRA, and an SGLT2 inhibitor. Because the patient has normal potassium and adequate renal function (eGFR > 30 mL/min), adding an MRA provides substantial mortality and hospitalization reduction.

5A 35-year-old woman is evaluated for exertional dyspnea. Echocardiography demonstrates right ventricular volume overload, a dilated pulmonary artery, and a secundum atrial septal defect (ASD). Cardiac catheterization reveals a pulmonary-to-systemic blood flow ratio (Qp:Qs) of 2.1:1 and normal pulmonary vascular resistance. What is the most appropriate management?

A.Lifelong oral anticoagulation with warfarin and observation

B.Medical therapy with oral pulmonary vasodilators

C.Percutaneous device closure of the atrial septal defect

D.Heart-lung transplantation evaluation

Explanation: Secundum atrial septal defects with evidence of right ventricular volume overload and significant left-to-right shunting (Qp:Qs >= 1.5:1) in the absence of severe irreversible pulmonary arterial hypertension are indicated for closure. Percutaneous transcatheter closure using an ASD occluder device is the first-line treatment for secundum ASDs with adequate anatomical rims (>= 5 mm, except towards the aorta).

6A 74-year-old man presents with syncope and exertional angina. Physical examination reveals a harsh, late-peaking systolic ejection murmur at the right upper sternal border with radiation to the carotids, alongside a delayed and diminished carotid pulse (pulsus parvus et tardus). Echocardiography confirms severe aortic stenosis. Which hemodynamic criteria define severe high-gradient aortic stenosis?

A.Aortic valve area <= 1.5 cm², peak jet velocity >= 3.0 m/s, and mean gradient >= 25 mmHg

B.Aortic valve area <= 1.0 cm², peak jet velocity >= 4.0 m/s, and mean gradient >= 40 mmHg

C.Aortic valve area <= 0.8 cm², peak jet velocity >= 2.5 m/s, and mean gradient >= 20 mmHg

D.Aortic valve area <= 1.2 cm², peak jet velocity >= 3.5 m/s, and mean gradient >= 30 mmHg

Explanation: Standard international criteria define severe high-gradient aortic stenosis as an aortic valve area (AVA) <= 1.0 cm² (or indexed AVA <= 0.6 cm²/m²), a peak aortic jet velocity >= 4.0 m/s, and a mean transvalvular pressure gradient >= 40 mmHg. The classic triad of symptoms in severe aortic stenosis is angina, syncope, and heart failure dyspnea.

7A 28-year-old male athlete undergoes pre-participation cardiovascular screening. His electrocardiogram shows marked ST-segment elevation (> 2 mm) with a coved-type morphology followed by a negative T wave in leads V1 and V2, recorded with high precordial lead placement. He has a family history of sudden nocturnal death in his maternal uncle. What is the electrocardiographic diagnosis?

A.Type 2 Brugada pattern

B.Type 1 Brugada pattern

C.Arrhythmogenic right ventricular cardiomyopathy

D.Early repolarization syndrome

Explanation: The coved-type ST-segment elevation >= 2 mm followed by a negative T wave in >= 1 right precordial lead (V1-V2), positioned in either the second, third, or fourth intercostal space, defines the Type 1 Brugada pattern. This pattern is diagnostic of Brugada syndrome when accompanied by clinical criteria such as documented ventricular arrhythmias or a family history of sudden cardiac death.

8A 68-year-old man with long-standing type 2 diabetes and a 40 pack-year smoking history reports calf pain after walking 200 metres that resolves with rest. Resting ankle-brachial index measurement returns 1.48 on the right and 1.52 on the left, and the pedal arteries are difficult to compress with the cuff. How should these values be interpreted, and what is the appropriate next test?

A.The values are diagnostic of critical limb-threatening ischaemia and warrant urgent invasive angiography

B.The values are normal and reliably exclude peripheral artery disease, so no further vascular testing is warranted

C.Values above 1.40 indicate medial calcification with non-compressible tibial vessels, so the study cannot exclude disease and a toe-brachial index should be measured

D.The values fall in the borderline range, so the measurement should simply be repeated in twelve months

Explanation: An ankle-brachial index of 0.90 or less establishes peripheral artery disease, 0.91 to 0.99 is borderline, and 1.00 to 1.40 is normal. A value above 1.40 does not indicate healthy arteries; it means the tibial vessels are incompressible because of medial (Monckeberg) calcification, which is common in long-standing diabetes and in chronic kidney disease. The measurement is then uninterpretable and cannot rule out disease in a patient with typical claudication. A toe-brachial index should be obtained instead, because the digital arteries are largely spared by medial calcification; a toe-brachial index below 0.70 confirms peripheral artery disease.

9A 56-year-old woman with a history of breast cancer treated with doxorubicin 3 years ago presents with progressive exertional fatigue and lower extremity edema. Echocardiography demonstrates biatrial enlargement, normal left ventricular cavity dimensions with preserved LVEF (55%), and marked mitral inflow E/A ratio of 2.6 with a deceleration time of 130 ms. Which hemodynamic pattern does this represent?

A.Restrictive filling pattern (Grade III diastolic dysfunction)

B.Impaired relaxation pattern (Grade I diastolic dysfunction)

C.Pseudonormal filling pattern (Grade II diastolic dysfunction)

D.Normal physiological diastolic filling

Explanation: A restrictive mitral inflow pattern (Grade III diastolic dysfunction) is characterized by an elevated early filling velocity (tall E wave), diminutive late filling velocity (small A wave) resulting in an E/A ratio > 2.0, and a shortened deceleration time (< 160 ms). This pattern reflects severely elevated left atrial filling pressures and reduced left ventricular compliance, characteristic of restrictive cardiomyopathy (such as anthracycline cardiotoxicity or amyloidosis).

10A 54-year-old man is referred to an outpatient cardiac rehabilitation programme three weeks after an uncomplicated anterior STEMI treated with primary PCI. His left ventricular ejection fraction is 48% and he has no residual ischaemia or arrhythmia. Before prescribing aerobic training intensity, which assessment should the rehabilitation team perform?

A.A resting transthoracic echocardiogram alone, setting intensity from the ejection fraction

B.A resting 12-lead electrocardiogram alone, setting intensity from the resting heart rate

C.An age-predicted maximum heart rate calculation (220 minus age) without any exercise testing

D.A symptom-limited exercise test (or cardiopulmonary exercise test) to derive the training target from measured heart-rate reserve or peak oxygen uptake

Explanation: Exercise-based cardiac rehabilitation carries a Class I recommendation after acute coronary syndrome and PCI, and the aerobic training prescription is individualised from an objective measurement of exercise capacity. A symptom-limited exercise test, or ideally a cardiopulmonary exercise test, establishes the patient's peak capacity and any ischaemic or arrhythmic threshold, so that training can be prescribed as a percentage of heart-rate reserve or peak oxygen uptake. Testing also confirms that the patient can exercise safely before entering a supervised programme.

About the Iran Specialty Board - Cardiology Exam

The Iranian Specialty Board Examination in Cardiovascular Diseases (آزمون دانشنامه تخصصی بیماری‌های قلب و عروق - Daneshnameh Takhasosi Qalb va Orooq) is the definitive national certification examination for physicians completing an accredited four-year direct-entry Cardiology residency (دستیاری تخصصی) in the Islamic Republic of Iran. Governed by the Secretariat of the Council for Medical and Specialized Education (دبیرخانه شورای آموزش پزشکی و تخصصی) and administered centrally by the National Center for Health Assessment (مرکز سنجش آموزش پزشکی - Sanjesh Pezeshki), achieving the Board diploma (Daneshnameh) is mandatory for academic faculty appointments, subspecialty fellowship training eligibility (such as interventional cardiology, electrophysiology, or pediatric cardiology), and advanced clinical consultant privileges. The written examination consists of 152 multiple-choice questions administered in Persian over 240 minutes, referencing Braunwald's Heart Disease alongside international and Iranian clinical guidelines. The examination encompasses core cardiology domains including Coronary Artery Disease & Acute Coronary Syndromes (18%), Heart Failure & Cardiomyopathies (18%), Cardiac Arrhythmias & Device Therapy (16%), Valvular Heart Disease (14%), Advanced Imaging & Hemodynamics (12%), Adult Congenital Heart Disease & Pulmonary Hypertension (12%), and Preventive Cardiology & Vascular Diseases (10%). Candidates securing at least 70% (105/150 points) with zero negative marking advance to the computer-based (electronic) oral board examination. This practice bank is an independent English-language MCQ study adaptation authored by OpenExamPrep. It provides 100 comprehensive clinical vignettes with in-depth diagnostic rationales and distractor analyses based on Braunwald's principles. It is an educational study aid and is neither an official translation nor affiliated with Sanjesh Pezeshki.

Exam sponsor: National Center for Health Assessment / Sanjesh Pezeshki & Council for Medical and Specialized Education. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

The national specialty board examination is administered annually in Shahrivar (late summer) by the National Center for Health Assessment (مرکز سنجش آموزش پزشکی - Sanjesh Pezeshki) under the Council for Medical and Specialized Education. The written stage consists of 152 multiple-choice questions administered electronically in a single continuous session of 240 minutes (approx. 95 seconds per question) with answers recorded on paper answer sheets. There is NO negative marking (zero points for incorrect responses, no deductions). Candidates scoring at or above 70% (105 of 150 points) qualify for the subsequent electronic/computer-based oral board examination.

Time Limit

240 minutes

Passing Score

70% of the written total (105 of 150 points)

Exam / Certification Fees

Set annually by the Ministry of Health and Medical Education, payable online via sanjeshp.ir during official board examination registration

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

18%

Coronary Artery Disease & Acute Coronary Syndromes

Pathophysiology of atherothrombosis, non-ST and ST-segment elevation myocardial infarction, cardiogenic shock, mechanical complications of MI, invasive coronary angiography, fractional flow reserve and intravascular imaging, complex percutaneous coronary intervention (PCI), and antiplatelet/anticoagulation regimens.

18%

Heart Failure, Cardiomyopathies & Myocardial Diseases

Heart failure with reduced, mildly reduced, and preserved ejection fraction (HFrEF, HFmrEF, HFpEF), guideline-directed medical therapy, acute decompensated heart failure, hypertrophic cardiomyopathy, dilated cardiomyopathy, cardiac amyloidosis, sarcoidosis, acute myocarditis, and advanced therapies (inotropes, LVAD, heart transplantation).

16%

Cardiac Arrhythmias, Electrophysiology & Device Therapy

Supraventricular tachycardias, atrial fibrillation and flutter, ventricular arrhythmias, channelopathies (long QT, Brugada, CPVT), bradyarrhythmias and conduction blocks, catheter ablation principles, and indications for permanent pacemakers, cardiac resynchronization therapy (CRT), and implantable cardioverter-defibrillators (ICD).

14%

Valvular Heart Disease & Endocarditis

Aortic stenosis and regurgitation, mitral stenosis and regurgitation, tricuspid valve disease, rheumatic heart disease epidemiology and management in Iran, transcatheter aortic valve implantation (TAVI), transcatheter edge-to-edge repair (TEER), surgical valve replacement, and infective endocarditis diagnosis and antimicrobial therapy.

12%

Advanced Cardiovascular Imaging & Hemodynamics

Transthoracic and transesophageal echocardiography (Doppler assessment, strain imaging), cardiovascular magnetic resonance (CMR tissue characterization, late gadolinium enhancement), coronary computed tomography angiography (CCTA), nuclear cardiology (SPECT, PET viability), and invasive hemodynamic catheterization.

12%

Adult Congenital Heart Disease & Pulmonary Hypertension

Simple and complex adult congenital heart diseases (ASD, VSD, PDA, coarctation of aorta, repaired Tetralogy of Fallot, Fontan circulation), pulmonary arterial hypertension classification and targeted therapies, Eisenmenger syndrome, and chronic thromboembolic pulmonary hypertension (CTEPH).

10%

Preventive Cardiology, Vascular & Pericardial Diseases

Resistant hypertension, dyslipidemia management (statins, ezetimibe, PCSK9 inhibitors), acute aortic syndromes (dissection, intramural hematoma), thoracic and abdominal aortic aneurysms, peripheral artery disease, acute pericarditis, pericardial effusion, cardiac tamponade, and constrictive pericarditis.

Preparing for the Iran Specialty Board - Cardiology Exam

What You Need to Know

Passing score: 70% of the written total (105 of 150 points)
Assessment: The national specialty board examination is administered annually in Shahrivar (late summer) by the National Center for Health Assessment (مرکز سنجش آموزش پزشکی - Sanjesh Pezeshki) under the Council for Medical and Specialized Education. The written stage consists of 152 multiple-choice questions administered electronically in a single continuous session of 240 minutes (approx. 95 seconds per question) with answers recorded on paper answer sheets. There is NO negative marking (zero points for incorrect responses, no deductions). Candidates scoring at or above 70% (105 of 150 points) qualify for the subsequent electronic/computer-based oral board examination.
Time limit: 240 minutes
Exam / certification fees: Set annually by the Ministry of Health and Medical Education, payable online via sanjeshp.ir during official board examination registration Official sources

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Iran Specialty Board - Cardiology: Suggested Study Strategy

1Master Braunwald's Heart Disease: The Iranian cardiology board exam draws heavily on Braunwald's text, diagnostic algorithms, and clinical tables. Prioritize key summary boxes, diagnostic criteria, and management flowcharts.

2Emphasize coronary interventions and acute care: ACS, invasive hemodynamics, complex bifurcation PCI, cardiogenic shock, and mechanical circulatory support form a major pillar of both written and oral testing.

3Refine multimodality imaging interpretation: Thoroughly review echocardiographic hemodynamic formulas, strain patterns in amyloidosis, cardiac MRI late gadolinium enhancement distribution, and CCTA plaque analysis.

4Understand regional pathology: Ensure solid familiarity with rheumatic heart disease patterns, mitral balloon valvuloplasty criteria, and premature CAD risk profiles prevalent in the Iranian population.

5Pace carefully and answer every item: With 152 questions in 240 minutes and zero negative marking, maintain an average pace of 90 seconds per question and never leave any item unanswered.

Frequently Asked Questions

What is the Iranian Specialty Board Examination in Cardiology (Daneshnameh Takhasosi)?

The Iranian Specialty Board Examination in Cardiology (آزمون دانشنامه تخصصی بیماری‌های قلب و عروق) is the national exit certification examination administered by the National Center for Health Assessment (Sanjesh Pezeshki) under the Council for Medical and Specialized Education. Physicians completing a four-year direct-entry Cardiology residency sit for this exam to earn the Board Diploma (Daneshnameh), which is required for academic appointments, faculty positions, and subspecialty fellowship entrance.

What is the structure and passing score of the written board examination?

The written examination consists of 152 four-option multiple-choice questions administered over 240 minutes (approx. 95 seconds per question). Candidates must achieve a score of 70% (105 points out of a scaled total of 150 points) to pass the written stage and qualify for the computer-based oral board examination.

Is there negative marking on the Iranian Cardiology Specialty Board Exam?

No. The Iranian medical specialty board written examination has no negative marking. Incorrect answers receive zero points without penalty, meaning candidates should attempt every question on the examination.

What is the primary reference textbook for the exam?

The official curriculum reference designated by the Iranian Ministry of Health and the National Board Examination Committee is Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine (current edition), supplemented by national protocols and recognized international practice guidelines.

What format is used for the cardiology oral examination?

Per official announcements by Sanjesh Pezeshki, the oral stage for Cardiovascular Diseases (بیماری‌های قلب و عروق) is conducted as a computer-based electronic examination (آزمون الکترونیک) incorporating interactive clinical scenarios, diagnostic imaging, and hemodynamic interpretation.

Is this OpenExamPrep question bank an official Sanjesh Pezeshki product?

No. This question bank is an independent English-language clinical MCQ study adaptation authored by OpenExamPrep for conceptual practice and revision. The official Iranian examination is administered in Persian by Sanjesh Pezeshki, and OpenExamPrep is not affiliated with or endorsed by Sanjesh Pezeshki, the Council for Medical and Specialized Education, or the Iranian Ministry of Health and Medical Education.

Free Practice Questions for Iran Specialty Board - Cardiology

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