Free Practice Questions for Iran Specialty Board - Internal Medicine

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Key Facts: Iran Specialty Board - Internal Medicine Exam

150

Total MCQs on the official national specialty board written examination

Sanjesh Pezeshki & Council for Medical and Specialized Education

210 min

Total written examination time (95 seconds per question)

Sanjesh Pezeshki Examination Rules

70% (105/150)

Written qualifying passing score required to advance to clinical OSCE/oral board

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 period in late summer / September

Sanjesh Pezeshki Annual Assessment Calendar

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

Sample Iran Specialty Board - Internal Medicine Practice Questions

Try these sample questions to review concepts for the Iran Specialty Board - Internal Medicine exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 58-year-old man presents to the emergency department with 90 minutes of crushing substernal chest pressure radiating to his left jaw. Electrocardiography demonstrates 3 mm ST-segment elevation in leads V1 through V4 with reciprocal ST depressions in leads II, III, and aVF. The facility has an active cardiac catheterization laboratory. What is the most appropriate next step in management?

A.Immediate transfer to the cardiac catheterization suite for primary percutaneous coronary intervention

B.Administration of intravenous alteplase followed by admission to the coronary intensive care unit

C.Immediate computed tomography coronary angiography to rule out triple-vessel disease

D.Transesophageal echocardiography to evaluate left ventricular regional wall motion abnormalities

Explanation: Primary percutaneous coronary intervention (PCI) is the gold standard reperfusion strategy for acute ST-segment elevation myocardial infarction (STEMI) when available within 90 to 120 minutes of first medical contact. It provides superior rates of infarct vessel patency, reduces reinfarction, and decreases mortality compared to fibrinolysis. Fibrinolytic therapy is reserved for situations where timely PCI cannot be achieved.

2A 66-year-old woman with ischemic cardiomyopathy (left ventricular ejection fraction 25%) presents with acute severe dyspnea, orthopnea, and bibasilar crackles. Blood pressure is 168/98 mmHg, heart rate is 104 bpm, and oxygen saturation is 88% on ambient air. In addition to supplemental oxygen and intravenous loop diuretics, which medication provides immediate afterload reduction and symptomatic relief?

A.Intravenous dopamine infusion titrated to renal dose

B.Intravenous nitroglycerin infusion titrated to symptom resolution

C.Intravenous metoprolol tartrate to achieve rate control below 70 bpm

D.Oral spironolactone 50 mg daily as an aldosterone antagonist

Explanation: Intravenous nitroglycerin acts rapidly as both a venodilator and arteriolar vasodilator in hypertensive acute decompensated heart failure, rapidly lowering preload, afterload, and pulmonary capillary wedge pressure. This reduces myocardial oxygen demand and resolves pulmonary edema without inducing inotropic tachycardia. Beta-blockers should not be initiated or uptitrated during acute uncompensated pulmonary edema.

3A 32-year-old man presents with palpitations and lightheadedness. His 12-lead ECG reveals an irregularly irregular wide-complex tachycardia with variable QRS morphologies and ventricular rates varying between 190 and 260 beats per minute. Blood pressure is 112/74 mmHg. Which pharmacologic intervention is strictly contraindicated in this patient?

A.Intravenous ibutilide

B.Intravenous procainamide

C.Intravenous diltiazem

D.Synchronized electrical cardioversion

Explanation: The electrocardiogram demonstrates pre-excited atrial fibrillation conducting over an accessory pathway in Wolff-Parkinson-White (WPW) syndrome. Calcium channel blockers such as diltiazem, along with beta-blockers, digoxin, and adenosine, selectively block the atrioventricular (AV) node, accelerating conduction down the accessory pathway and potentially triggering fatal ventricular fibrillation. Procainamide or ibutilide are appropriate antiarrhythmic choices for hemodynamically stable patients.

4A 74-year-old man with known calcific aortic stenosis presents with exertional angina and near-syncope while walking up stairs. Transthoracic echocardiography demonstrates an aortic valve area of 0.7 cm², peak aortic velocity of 4.4 m/s, mean transvalvular gradient of 48 mmHg, and preserved left ventricular ejection fraction of 55%. What is the most appropriate management recommendation?

A.Close clinical observation with repeat echocardiography in 6 months

B.Initiation of high-dose bisoprolol and exercise stress testing

C.Balloon aortic valvuloplasty as definitive long-term therapy

D.Referral for surgical or transcatheter aortic valve replacement

Explanation: Aortic valve replacement (surgical or transcatheter) is indicated for patients with severe symptomatic aortic stenosis, defined by a valve area under 1.0 cm², mean gradient of 40 mmHg or greater, or peak velocity exceeding 4.0 m/s accompanied by cardinal symptoms (angina, syncope, or heart failure). Once symptoms develop, 2-year mortality exceeds 50% without mechanical relief of the obstruction. Medical therapy cannot halt progressive calcific stenosis.

5A 44-year-old woman is evaluated for persistent hypertension. Despite adherence to amlodipine 10 mg, valsartan 320 mg, and chlorthalidone 25 mg daily, her clinic blood pressure is 154/96 mmHg. Laboratory workup reveals serum sodium 142 mEq/L, potassium 3.1 mEq/L, and serum creatinine 0.8 mg/dL. What is the initial screening test of choice for her underlying condition?

A.Plasma aldosterone-to-renin ratio obtained in the morning

B.Twenty-four-hour urinary free cortisol excretion

C.Renal artery duplex ultrasonography

D.Computed tomography angiography of the adrenal glands

Explanation: The clinical picture of resistant hypertension accompanied by unprovoked hypokalemia is classic for primary aldosteronism. The recommended initial screening test is the morning plasma aldosterone concentration to plasma renin activity (or concentration) ratio. Cross-sectional adrenal imaging is performed only after biochemical confirmation to differentiate bilateral hyperplasia from a unilateral aldosterone-producing adenoma.

6Four days after an acute anterior wall ST-segment elevation myocardial infarction, a 62-year-old man develops sudden profound dyspnea, diaphoresis, and hypotension. On examination, blood pressure is 82/50 mmHg, a new harsh holosystolic murmur is heard best at the lower left sternal border accompanied by a palpable thrill, and bibasilar crackles are present. Oxygen saturation via a pulmonary artery catheter demonstrates a significant step-up from the right atrium to the right ventricle. What mechanical complication has occurred?

A.Acute rupture of the posteromedial papillary muscle

B.Post-infarction ventricular septal rupture

C.Free wall left ventricular rupture with hemopericardium

D.Acute expansion of a left ventricular true aneurysm

Explanation: Ventricular septal rupture is a catastrophic mechanical complication occurring 3 to 7 days post-MI, presenting with cardiogenic shock, a harsh holosystolic murmur with a thrill at the left sternal border, and an oxygen saturation step-up of 5% or greater between the right atrium and right ventricle. Papillary muscle rupture produces severe mitral regurgitation radiating to the axilla without an oxygen step-up. Urgent echocardiography, intra-aortic balloon pump stabilization, and emergency surgical repair are required.

7A 52-year-old woman with metastatic breast cancer presents with progressive dyspnea, fatigue, and lower extremity swelling. On physical examination, her blood pressure is 98/70 mmHg with a 16 mmHg decline in systolic pressure during normal inspiration. Jugular venous distension is present with loss of the y-descent, heart sounds are distant, and clear breath sounds are noted bilaterally. What is the most definitive immediate therapeutic intervention?

A.Intravenous administration of furosemide 80 mg

B.High-dose systemic corticosteroids and mediastinal radiation

C.Emergent therapeutic pericardiocentesis

D.Intravenous infusion of phenylephrine

Explanation: The clinical triad of hypotension, distant heart sounds, and elevated jugular venous pressure (Beck triad) accompanied by exaggerated pulsus paradoxus (greater than 10 mmHg fall in systolic blood pressure during quiet inspiration) confirms acute cardiac tamponade. The blunted y-descent reflects impaired early diastolic ventricular filling. Emergent pericardiocentesis relieves intrapericardial pressure, restores venous return, and reverses life-threatening cardiogenic shock.

8A 23-year-old collegiate athlete is evaluated after an episode of exertional syncope during basketball practice. His older brother died suddenly at age 19. Transthoracic echocardiography reveals asymmetric septal hypertrophy with a maximal left ventricular wall thickness of 32 mm, systolic anterior motion of the mitral valve, and a resting left ventricular outflow tract gradient of 42 mmHg. What is the primary therapy recommended to prevent sudden cardiac death in this patient?

A.Surgical septal myectomy

B.Alcohol septal ablation

C.High-dose oral verapamil therapy

D.Implantable cardioverter-defibrillator placement

Explanation: This patient has hypertrophic cardiomyopathy (HCM) with multiple high-risk features for sudden cardiac death, including extreme left ventricular hypertrophy (maximal wall thickness of 30 mm or greater), unexplained syncope, and a family history of premature sudden cardiac death. An implantable cardioverter-defibrillator (ICD) is the only proven therapy for primary prevention of sudden cardiac death in high-risk HCM. Septal reduction therapies treat refractory gradient-related symptoms but do not substitute for an ICD.

9A 64-year-old man with hypertension, hyperlipidemia, and type 2 diabetes experiences reproducible retrosternal chest tightness when climbing more than one flight of stairs, promptly relieved within 3 minutes of resting. He has no resting symptoms. Coronary angiography shows 75% stenosis in the proximal circumflex artery and preserved left ventricular function. According to landmark clinical trials (e.g., COURAGE and ISCHEMIA), what is the foundational initial management strategy?

A.Optimal guideline-directed medical therapy and cardiovascular risk factor modification

B.Immediate bare-metal stent implantation without antiplatelet loading

C.Emergent coronary artery bypass graft surgery

D.Percutaneous coronary intervention with drug-eluting stent prior to medical therapy

Explanation: In stable ischemic heart disease without left main coronary disease, severe left ventricular dysfunction, or medically refractory angina, initial optimal medical therapy (aspirin, statin, beta-blocker, and ACE inhibitor or ARB) provides equivalent survival and rates of nonfatal myocardial infarction compared to early routine revascularization. Percutaneous revascularization is reserved for patients whose symptoms persist despite maximal tolerated anti-ischemic medical therapy.

10A 28-year-old man presents with sharp pleuritic chest pain that worsens when lying flat and improves when sitting forward. Electrocardiogram reveals widespread concave-upward ST-segment elevation with PR-segment depression in leads I, II, aVL, and V2 through V6, along with reciprocal PR-segment elevation in lead aVR. What pharmacologic combination represents first-line therapy for this condition?

A.Oral prednisone and intravenous unfractionated heparin

B.High-dose nonsteroidal anti-inflammatory drugs combined with oral colchicine

C.Intravenous morphine and low-molecular-weight heparin

D.Oral azathioprine and high-dose aspirin

Explanation: The clinical presentation and classic ECG findings represent acute viral or idiopathic pericarditis. First-line therapy consists of high-dose NSAIDs (such as ibuprofen 600-800 mg three times daily or high-dose aspirin) combined with oral colchicine for 3 months. Colchicine significantly accelerates symptom resolution and halves the rate of recurrent pericarditis. Systemic corticosteroids should be avoided as initial therapy because they promote recurrence.

About the Iran Specialty Board - Internal Medicine Exam

The Iranian Specialty Board Examination in Internal Medicine (آزمون دانشنامه تخصصی بیماری‌های داخلی - Daneshnameh Takhasosi Dakheli) is the culminating national certification credential for physicians completing an accredited four-year Internal Medicine residency in the Islamic Republic of Iran. Governed by the Council for Medical and Specialized Education (شورای آموزش پزشکی و تخصصی) and administered centrally by the National Center for Health Assessment (مرکز سنجش آموزش پزشکی - Sanjesh Pezeshki), successful attainment of the Board diploma (Daneshnameh) is required for appointment to university medical faculties, fellowship subspecialty training eligibility, and senior hospital consultant status. The written board examination consists of 152 clinically nuanced, case-based multiple-choice questions administered in Persian over 240 minutes, drawn primarily from Harrison's Principles of Internal Medicine and official clinical practice guidelines. The examination encompasses seven major internal medicine domains: Cardiovascular Disorders (16%), Gastroenterology & Hepatology (16%), Pulmonary & Critical Care Medicine (14%), Endocrinology & Metabolism (14%), Nephrology, Acid-Base & Electrolyte Disorders (14%), Rheumatology & Clinical Immunology (12%), and Hematology, Medical Oncology & Infectious Diseases (14%). Candidates must secure at least 70% (105/150) with zero negative marking to qualify for the practical OSCE and oral board stations. This practice bank is an independent English-language MCQ study adaptation authored by OpenExamPrep. It provides 100 in-depth clinical vignettes with comprehensive diagnostic rationales and distractor analyses based on Harrison'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 late summer (Shahrivar / September) by the National Center for Health Assessment (Sanjesh Pezeshki) under the Council for Medical and Specialized Education. The written stage consists of 152 multiple-choice questions administered in a single continuous session of 240 minutes (95 seconds per question). There is NO negative marking (zero points for incorrect responses, no deductions). Candidates scoring at or above 70% (105/150) qualify for the subsequent multi-station structured clinical examination (OSCE / PMP) and oral viva voce examinations held across leading academic medical centers.

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.

16%

Cardiovascular Disorders

Acute coronary syndromes (STEMI, NSTEMI, unstable angina), chronic ischemic heart disease, cardiac arrhythmias (atrial fibrillation, ventricular tachycardia, heart block), acute and chronic heart failure (HFrEF, HFpEF, cardiogenic shock), valvular heart disease (aortic stenosis/regurgitation, mitral disease, endocarditis prophylaxis), aortic syndromes, pericardial diseases, and resistant hypertension.

16%

Gastroenterology & Hepatology

Upper and lower gastrointestinal bleeding, peptic ulcer disease and Helicobacter pylori, inflammatory bowel disease (ulcerative colitis, Crohn disease), acute pancreatitis and necrotizing complications, chronic pancreatitis, cirrhosis and portal hypertension (varices, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome), acute liver failure, viral hepatitis (HBV, HCV, HDV), autoimmune hepatitis, NAFLD/MASH, and biliary tract disorders.

14%

Pulmonary & Critical Care Medicine

Chronic obstructive pulmonary disease (COPD) exacerbations and stable management, severe persistent asthma, acute respiratory distress syndrome (ARDS) lung-protective ventilation, mechanical ventilation strategies (weaning, pressure vs. volume control, auto-PEEP), interstitial lung diseases (idiopathic pulmonary fibrosis, sarcoidosis, hypersensitivity pneumonitis), pulmonary arterial hypertension, venous thromboembolism (massive and submassive PE), pleural diseases, and septic shock.

14%

Endocrinology & Metabolism

Type 1 and Type 2 diabetes mellitus, diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), thyroid disorders (thyrotoxic storm, myxedema coma, Hashimoto thyroiditis, subacute thyroiditis, thyroid nodules), adrenal disorders (primary adrenal insufficiency, Cushing syndrome, primary aldosteronism, pheochromocytoma), pituitary disorders (hyperprolactinemia, acromegaly, hypopituitarism, central diabetes insipidus), and calcium and bone disorders (hypercalcemia of malignancy, primary hyperparathyroidism, hypocalcemia, osteoporosis).

14%

Nephrology, Acid-Base & Electrolyte Disorders

Acute kidney injury (prerenal, intrinsic ATN/AIN, postrenal obstruction), chronic kidney disease staging and complications, primary and secondary glomerulonephritis (nephrotic and nephritic syndromes, membranous nephropathy, FSGS, IgA nephropathy, lupus nephritis), renal tubular acidosis (Types 1, 2, 4), hyponatremia and hypernatremia, hyperkalemia and hypokalemia, complex mixed acid-base disorders, and kidney stone management.

12%

Rheumatology & Clinical Immunology

Systemic lupus erythematosus (SLE) and lupus nephritis, rheumatoid arthritis (RA) DMARD therapy, systemic vasculitides (granulomatosis with polyangiitis, eosinophilic GPA, polyarteritis nodosa, giant cell arteritis, Takayasu arteritis), spondyloarthropathies (ankylosing spondylitis, psoriatic arthritis, reactive arthritis), systemic sclerosis (diffuse and limited, scleroderma renal crisis), inflammatory myopathies (polymyositis, dermatomyositis), gout, and pseudogout.

14%

Hematology, Medical Oncology & Infectious Diseases

Microcytic, normocytic, and hemolytic anemias (autoimmune hemolytic anemia, TTP, HUS, hereditary spherocytosis), acute and chronic leukemias (AML, ALL, CML, CLL), lymphoma (Hodgkin and non-Hodgkin), plasma cell dyscrasias (multiple myeloma, MGUS), coagulopathies (DIC, heparin-induced thrombocytopenia, antiphospholipid syndrome), oncologic emergencies (neutropenic fever, tumor lysis syndrome, hypercalcemia, cord compression), and severe systemic infections (bacterial meningitis, hospital-acquired pneumonia, infective endocarditis, tuberculosis, brucellosis, and HIV complications).

Preparing for the Iran Specialty Board - Internal Medicine 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 late summer (Shahrivar / September) by the National Center for Health Assessment (Sanjesh Pezeshki) under the Council for Medical and Specialized Education. The written stage consists of 152 multiple-choice questions administered in a single continuous session of 240 minutes (95 seconds per question). There is NO negative marking (zero points for incorrect responses, no deductions). Candidates scoring at or above 70% (105/150) qualify for the subsequent multi-station structured clinical examination (OSCE / PMP) and oral viva voce examinations held across leading academic medical centers.
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

Using Our Practice Resources

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Iran Specialty Board - Internal Medicine: Suggested Study Strategy

1Thoroughly review Harrison's Principles of Internal Medicine: The Iranian specialty board exam questions are tightly mapped to Harrison's text, diagnostic algorithms, and clinical tables. Prioritize boxed guidelines, evidence summaries, and diagnostic criteria.

2Master the high-weight domains: Cardiovascular Disorders (16%) and Gastroenterology & Hepatology (16%) constitute nearly a third of the examination. Ensure deep understanding of acute coronary syndromes, acute liver failure, portal hypertension complications, and acute pancreatitis.

3Focus on complex multi-step clinical reasoning: Board-level questions often test secondary evaluations, atypical presentations, contraindications to first-line therapies, and second-line interventions rather than simple initial diagnoses.

4Practice strict pacing of 95 seconds per question: The 240-minute time limit for 152 questions requires rapid vignette interpretation, elimination of plausible distractors, and decisive answering without lingering on difficult items.

5Answer all questions without hesitation: Because there is zero negative marking, never leave any question blank; eliminate clearly incorrect distractors and make an informed choice on every item.

Frequently Asked Questions

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

The Iranian Specialty Board Examination in Internal Medicine (آزمون دانشنامه تخصصی بیماری‌های داخلی) is the supreme national certification examination administered by the National Center for Health Assessment (Sanjesh Pezeshki) under the Council for Medical and Specialized Education of the Ministry of Health. Graduating internal medicine residents who have passed their institutional exit / certificate exam (Govahi-nameh) 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 (95 seconds per question). Candidates must achieve a minimum score of 70% (105 points out of a written total of 150) to pass the written stage and qualify for the clinical OSCE and oral board examination.

Is there negative marking on the Iranian Internal Medicine Board Exam?

No. The Iranian medical specialty board examination has no negative marking. Incorrect answers receive zero points without penalty, which means candidates should answer every single question on the examination.

What is the primary reference textbook for the exam?

The official curriculum reference established by the Iranian Ministry of Health and the National Board Committee is Harrison's Principles of Internal Medicine (current edition), supplemented by recognized international clinical practice guidelines and national therapeutic protocols.

What happens after passing the written board examination?

Candidates who score 70% (105/150) or higher in the written stage advance to the clinical examination phase, which consists of structured Objective Structured Clinical Examinations (OSCE), computerized Patient Management Problems (PMP), and structured oral evaluations conducted by the National Board Examination Committee.

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 - Internal Medicine

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