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Key Facts: Iran Medical Residency Entrance Exam Exam

200

Total Questions

Sanjesh Pezeshki

200 min

Exam Duration

Sanjesh Pezeshki

+3 / -1

Scoring Formula

MOHME Secretariat

150 / 600

Min Qualifying Score

Sanjesh Pezeshki

~15-20%

Seat Match Rate

Council for Medical Education

The Iranian Medical Residency Entrance Exam (Dastyari Pezeshki) is a 200-question, 200-minute national MCQ examination administered by Sanjesh Pezeshki with +3/-1 negative marking and a 150/600 minimum qualifying threshold. It determines admission to all postgraduate medical residency programs across Iran across five distinct specialty sub-groups. This practice set provides an independent English-language MCQ study adaptation by OpenExamPrep.

Sample Iran Medical Residency Entrance Exam Practice Questions

Try these sample questions to review concepts for the Iran Medical Residency Entrance Exam 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 severe, crushing substernal chest pain of 90 minutes duration radiating to his left jaw. Electrocardiography reveals 3-mm ST-segment elevation in leads II, III, and aVF with reciprocal ST-segment depression in leads I and aVL. The facility has 24-hour primary percutaneous coronary intervention (PCI) capability. What is the recommended reperfusion strategy and target timeframe from first medical contact?

A.Primary percutaneous coronary intervention within 90 minutes of first medical contact

B.Intravenous fibrinolytic therapy with tenecteplase within 30 minutes of presentation

C.Intravenous unfractionated heparin infusion followed by elective angiography within 48 hours

D.Oral dual antiplatelet therapy alone with deferred angiography if chest pain resolves

Explanation: In patients with acute ST-elevation myocardial infarction (STEMI) presenting within 12 hours of symptom onset to a PCI-capable medical center, primary percutaneous coronary intervention is the gold standard reperfusion modality and should be performed within 90 minutes of first medical contact. Primary PCI achieves superior vessel patency rates, lower re-infarction rates, and reduced intracranial hemorrhage risk compared with fibrinolysis.

2A 64-year-old woman with chronic ischemic cardiomyopathy and a left ventricular ejection fraction (LVEF) of 32% presents for routine follow-up. She is currently asymptomatic on sacubitril/valsartan, metoprolol succinate, and spironolactone. Her blood pressure is 124/76 mmHg, heart rate is 68 bpm, and serum creatinine is 1.1 mg/dL. Which medication class should be added next to improve cardiovascular survival according to modern guideline-directed medical therapy (GDMT)?

A.Non-dihydropyridine calcium channel blocker (diltiazem)

B.Sodium-glucose cotransporter-2 (SGLT2) inhibitor (dapagliflozin or empagliflozin)

C.Digoxin for positive inotropic augmentation

D.Long-acting oral nitrate monotherapy (isosorbide mononitrate)

Explanation: Guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF) is built upon four foundational pillars: an ARNI/ACEi, an evidence-based beta-blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor. Adding dapagliflozin or empagliflozin significantly reduces cardiovascular mortality and heart failure hospitalizations regardless of diabetes status.

3A 22-year-old collegiate athlete is evaluated after an episode of lightheadedness during sprint intervals. Cardiac auscultation reveals a harsh crescendo-decrescendo systolic murmur heard best along the lower left sternal border that does not radiate to the carotids. Which bedside physical maneuver will predictably INCREASE the intensity of this murmur?

A.Sustained handgrip maneuver

B.Passive leg elevation while supine

C.Strain phase of the Valsalva maneuver

D.Rapid squatting from a standing position

Explanation: Hypertrophic cardiomyopathy produces a dynamic left ventricular outflow tract (LVOT) obstruction murmur. The strain phase of the Valsalva maneuver reduces venous return and decreases LV preload, which narrows the outflow tract and brings the anterior mitral leaflet closer to the hypertrophied septum, thereby intensifying the systolic murmur.

4A 71-year-old man with hypertension and type 2 diabetes mellitus presents with palpitations. Electrocardiography demonstrates atrial fibrillation with a ventricular response of 118 bpm. Echocardiography shows preserved left ventricular systolic function with no valvular stenosis or prosthetic valves. What is his CHA2DS2-VASc score, and what is the standard management regarding stroke prevention?

A.CHA2DS2-VASc score of 1; aspirin 81 mg daily monotherapy is sufficient

B.CHA2DS2-VASc score of 2; dual antiplatelet therapy with aspirin and clopidogrel

C.CHA2DS2-VASc score of 2; therapeutic anticoagulation is optional based on patient preference

D.CHA2DS2-VASc score of 3; oral anticoagulation with a direct oral anticoagulant (DOAC) is indicated

Explanation: The patient scores 3 points on the CHA2DS2-VASc risk assessment: Age 65-74 years (+1), Hypertension (+1), and Diabetes mellitus (+1). In male patients with non-valvular atrial fibrillation and a CHA2DS2-VASc score of 2 or greater, oral anticoagulation—preferably with a direct oral anticoagulant (DOAC) such as apixaban, rivaroxaban, or dabigatran—is strongly indicated to reduce ischemic stroke risk.

5A 68-year-old man with severe COPD (GOLD Stage 3) presents to the emergency department with worsening dyspnea, increased sputum volume, and purulence. Arterial blood gas (ABG) on 2 L/min nasal cannula reveals: pH 7.27, PaCO2 62 mmHg, PaO2 56 mmHg, and HCO3- 28 mEq/L. Despite nebulized bronchodilators and intravenous methylprednisolone, he remains tachypneic with accessory muscle use. What is the most appropriate next step in ventilatory support?

A.Initiate non-invasive positive pressure ventilation (NIV/BiPAP)

B.Perform immediate endotracheal intubation and mechanical ventilation

C.Increase oxygen flow to 10 L/min via high-flow non-rebreather mask

D.Administer intravenous theophylline infusion and continue low-flow oxygen

Explanation: Non-invasive positive pressure ventilation (NIV), typically delivered via bilevel positive airway pressure (BiPAP), is the treatment of choice for acute hypercapnic respiratory failure in COPD exacerbations presenting with respiratory acidosis (pH 7.25-7.35 and PaCO2 > 45 mmHg). NIV decreases the work of breathing, improves gas exchange, and reduces the need for endotracheal intubation, hospital length of stay, and mortality.

6A 66-year-old former smoker presents with a 9-month history of progressive exertional dyspnea and dry cough. Physical examination reveals bilateral end-inspiratory Velcro-like crackles at lung bases and digital clubbing. High-resolution computed tomography (HRCT) of the chest displays subpleural, basilar-predominant reticular opacities with honeycombing and traction bronchiectasis, without extensive ground-glass opacities. Which diagnosis is most consistent with this clinical and radiologic picture?

A.Hypersensitivity pneumonitis

B.Idiopathic pulmonary fibrosis (Usual Interstitial Pneumonia pattern)

C.Pulmonary alveolar proteinosis

D.Sarcoidosis Stage II

Explanation: The clinical presentation of progressive exertional dyspnea, basilar fine crackles, and digital clubbing in an older adult, combined with HRCT demonstrating bilateral, subpleural, basal-predominant honeycombing and traction bronchiectasis, is pathognomonic for a definitive Usual Interstitial Pneumonia (UIP) pattern, establishing the diagnosis of idiopathic pulmonary fibrosis (IPF) when other identifiable causes are excluded.

7A 74-year-old woman presents to the clinic with fever, cough productive of rust-colored sputum, and right pleuritic chest pain for 3 days. Vital signs: BP 84/52 mmHg, pulse 108 bpm, respiratory rate 34 breaths/min, temperature 38.8°C. She is fully oriented (Glasgow Coma Scale 15/15). Serum urea nitrogen is 28 mg/dL (10 mmol/L). What is her CURB-65 score, and what is the appropriate management setting?

A.CURB-65 score of 1; outpatient treatment with oral amoxicillin

B.CURB-65 score of 2; outpatient treatment with respiratory fluoroquinolone

C.CURB-65 score of 3; urgent hospital admission with consideration for intensive care monitoring

D.CURB-65 score of 4; urgent hospital admission with immediate assessment for intensive care unit support

Explanation: Four of the five CURB-65 criteria are met: urea above 7 mmol/L (hers is 10 mmol/L, or 28 mg/dL) (+1), respiratory rate of at least 30 breaths/min (hers is 34) (+1), systolic blood pressure below 90 mmHg or diastolic 60 mmHg or below (hers is 84/52) (+1), and age 65 years or older (she is 74) (+1); confusion is absent because she is fully oriented, so the total is 4. Thirty-day mortality rises steeply across the scale (roughly 0.7% at 0, 13% at 2, 17% at 3 and above 40% at 4), so a score of 4 or 5 places her in the highest-risk group: she needs urgent admission with immediate senior review for intensive care or high-dependency support rather than ward-only care.

8A 45-year-old man presents with severe epigastric abdominal pain radiating straight through to his back, accompanied by persistent vomiting following an alcohol binge. Serum amylase is 1,240 U/L and lipase is 1,880 U/L. Contrast-enhanced CT scan of the abdomen performed 4 hours after admission demonstrates diffuse pancreatic enlargement with peripancreatic fat stranding but no non-enhancing parenchyma or collection. What is the most critical initial therapeutic intervention within the first 12 to 24 hours?

A.Prophylactic intravenous imipenem-cilastatin to prevent pancreatic infection

B.Urgent endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy

C.Immediate exploratory laparotomy and necrosectomy

D.Aggressive goal-directed intravenous fluid resuscitation with balanced crystalloids (Lactated Ringer's)

Explanation: Early, aggressive goal-directed intravenous fluid resuscitation (typically 200-500 mL/hr or 20 mL/kg bolus followed by 3 mL/kg/hr of Lactated Ringer's) during the initial 12 to 24 hours is the single most important intervention in acute pancreatitis. It counteracts intravascular volume depletion from third-spacing, preserves pancreatic microcirculatory perfusion, and prevents progressive ischemic necrosis.

9A 28-year-old woman presents with a 6-week history of 6 to 8 episodes daily of bloody diarrhea, tenesmus, and cramping lower abdominal pain. Colonoscopy reveals continuous, circumferential mucosal erythema, loss of vascular pattern, and friability extending from the anal verge up to the splenic flexure, with a sharp transition to normal mucosa beyond that point. Histopathology shows mucosal inflammation limited to the mucosa and submucosa with neutrophilic crypt abscesses. Which feature, if present, would most strongly favor Crohn's disease over ulcerative colitis?

A.Transmural inflammation with non-caseating granulomas and skip lesions

B.Crypt architectural distortion and crypt atrophy

C.Pseudopolyps arising from regenerative mucosal islands

D.Diffuse mucosal friability extending continuously from the rectum

Explanation: Transmural inflammation, non-caseating epithelioid granulomas, skip areas of normal tissue (skip lesions), and cobblestone mucosal appearance are classic hallmarks of Crohn's disease. In contrast, ulcerative colitis is characterized by continuous, confluent inflammation originating in the rectum and strictly restricted to the mucosal and submucosal layers.

10A 54-year-old man with hepatitis B cirrhosis and gross ascites presents with confusion, low-grade fever (38.1°C), and mild generalized abdominal discomfort. Diagnostic paracentesis yields cloudy fluid with an absolute neutrophil count of 420 cells/mm³ (PMNs) and a total protein of 1.2 g/dL. What is the definitive initial medical therapy for this condition?

A.Oral ciprofloxacin outpatient therapy for 3 days

B.Intravenous third-generation cephalosporin (cefotaxime or ceftriaxone) plus intravenous albumin

C.Urgent surgical exploration for secondary bacterial peritonitis

D.Intravenous vancomycin and metronidazole without albumin

Explanation: An ascitic fluid polymorphonuclear (PMN) count ≥ 250 cells/mm³ establishes the diagnosis of spontaneous bacterial peritonitis (SBP). The standard first-line treatment is an intravenous third-generation cephalosporin (cefotaxime 2 g IV every 8 hours or ceftriaxone 2 g IV daily) combined with intravenous albumin (1.5 g/kg within 6 hours, followed by 1.0 g/kg on day 3) to prevent hepatorenal syndrome and reduce mortality.

About the Iran Medical Residency Entrance Exam Exam

The Iranian Medical Residency Entrance Examination (آزمون پذیرش دستیار تخصصی پزشکی), universally known as Dastyari Pezeshki, is the centralized, highly competitive national entrance examination that determines admission into all postgraduate medical residency training programs across Iran. Conducted annually in Persian by the National Center for Health Assessment (Markaz-e Sanjesh-e Amuzesh-e Pezeshki) under the Ministry of Health and Medical Education, the exam tests comprehensive clinical proficiency across internal medicine, pediatrics, general surgery, obstetrics and gynecology, and clinical/basic subspecialties based on standard international reference textbooks. Candidates must score at least 150 out of 600 raw points (25%) to qualify for specialty choice submission. Admission is strictly merit-based, computed through specialty sub-group coefficient formulas that weight subject areas differently depending on the targeted discipline (e.g., surgical specialties weigh general surgery and orthopedics more heavily). This resource represents an independent English-language MCQ study adaptation developed by OpenExamPrep to help physicians master the core clinical competencies tested in the Iranian national curriculum.

Exam sponsor: National Center for Health Assessment (Sanjesh Pezeshki) under the Secretariat of the Council for Medical and Specialized Education, Ministry of Health and Medical Education (MOHME). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Single paper of 200 four-option multiple-choice questions administered across 200 minutes. The scoring system assigns +3 points for each correct response, 0 points for unanswered questions, and -1 point for each incorrect response (one-third negative marking penalty), resulting in a raw score range of -200 to +600 points.

Time Limit

200 minutes

Passing Score

150 / 600

Exam / Certification Fees

Set for each round by Sanjesh Pezeshki and published in the official registration guide at sanjeshp.ir

Exam sponsor website

Reported exam pass rate: ~15-20%. Nationwide matching rate into residency positions across all five specialty sub-groups This describes exam candidates, not OpenExamPrep users or results from using our resources. 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.

23%

Internal Medicine

Harrison's Principles of Internal Medicine covering Cardiology, Pulmonology, Gastroenterology & Hepatology, Nephrology, Endocrinology, Rheumatology, and Hematology/Oncology.

18%

Pediatrics & Infectious Diseases

Nelson Textbook of Pediatrics and Mandell's Principles and Practice of Infectious Diseases, including neonatology, developmental milestones, pediatric emergency medicine, and regional infectious diseases (brucellosis, leishmaniasis, hydatidosis, tuberculosis, CCHF).

12%

General Surgery & Surgical Critical Care

Schwartz's Principles of Surgery focusing on acute abdominal pain, appendicitis, intestinal obstruction, hepatobiliary pathology, breast oncology, endocrine surgery, trauma resuscitation (ATLS), surgical shock, burns, and wound management.

10%

Obstetrics & Gynecology

Williams Obstetrics and Berek & Novak's Gynecology covering prenatal screening, hypertensive disorders of pregnancy, labor and delivery emergencies, postpartum hemorrhage, abnormal uterine bleeding, cervical dysplasia, and gynecologic oncology.

16%

Minor Surgical & Sensory Specialties

Orthopedic surgery (fractures, joint dislocations, pediatric orthopedics), Urology (nephrolithiasis, uro-oncology, acute scrotal emergencies), Otolaryngology/ENT (epistaxis, stridor, otitis, neck masses), Ophthalmology (glaucoma, red eye, retinal detachment), and Diagnostic Radiology (imaging modalities and chest/abdominal radiograph interpretation).

21%

Minor Medical & Basic Specialties

Psychiatry (mood disorders, psychosis, psychopharmacology), Neurology (stroke, epilepsy, neuromuscular diseases, headache syndromes), Dermatology (papulosquamous, bullous, cutaneous infections), General Pathology, Clinical Pharmacology/Toxicology, and Medical Ethics & Forensic Medicine.

Preparing for the Iran Medical Residency Entrance Exam Exam

What You Need to Know

Passing score: 150 / 600
Assessment: Single paper of 200 four-option multiple-choice questions administered across 200 minutes. The scoring system assigns +3 points for each correct response, 0 points for unanswered questions, and -1 point for each incorrect response (one-third negative marking penalty), resulting in a raw score range of -200 to +600 points.
Time limit: 200 minutes
Exam / certification fees: Set for each round by Sanjesh Pezeshki and published in the official registration guide at sanjeshp.ir Official sources

Using Our Practice Resources

Work through all 100 available questions
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Iran Medical Residency Entrance Exam: Suggested Study Strategy

1Master high-coefficient subjects first: Calculate your target specialty sub-group coefficients and allocate study hours proportionally, giving prime focus to Harrison's and Nelson if aiming for medical sub-groups, or Schwartz and Williams for surgical tracks.

2Calibrate your negative marking threshold: Because three incorrect answers erase an entire correct answer (+3 vs -1), practice disciplined elimination. Refrain from blind guessing unless you can eliminate at least two distractors with high clinical confidence.

3Focus heavily on endemic regional pathologies: Sanjesh Pezeshki consistently includes questions on brucellosis (Malta fever), cutaneous and visceral leishmaniasis, Crimean-Congo hemorrhagic fever (CCHF), hydatid cyst disease, and tuberculosis presentations.

4Review high-yield pediatric immunization and developmental milestones: Pediatric questions frequently test national vaccination schedules, neonatal hyperbilirubinemia thresholds, pediatric fluid resuscitation formulas, and neurodevelopmental red flags.

5Integrate clinical pharmacology and toxicology: Pay close attention to toxidromes common in regional emergency settings (organophosphate poisoning, aluminum phosphide / rice tablet ingestion, opioid overdose, acetaminophen toxicity, tricyclic antidepressant poisoning) and their definitive antidotes.

Frequently Asked Questions

What is the structure and scoring system of the Dastyari Pezeshki examination?

The examination consists of 200 four-option multiple-choice questions administered in a single 200-minute session. The test employs a strict negative marking formula: each correct answer awards +3 points, each unanswered question awards 0 points, and each incorrect answer deducts 1 point (-1). The raw score scale ranges from -200 to +600 points. Candidates must achieve a minimum qualifying threshold of 150 points (25%) to be eligible for specialty choice selection.

How do specialty sub-groups and coefficient weighting work in the Iranian residency matching process?

Residency specialties in Iran are classified into five distinct sub-groups (Zir-guruh). While all candidates take the exact same 200-question exam, each sub-group applies different mathematical weights (coefficients) to subject areas. For example, Sub-Group 1 (Internal Medicine, Pediatrics, Dermatology) places the highest coefficient weight on Harrison's and Nelson; Sub-Group 2 (General Surgery, Orthopedics, Urology, ENT, Ophthalmology, OB/GYN) weights Schwartz and surgical specialties more heavily; Sub-Group 3 (Cardiology); Sub-Group 4 (Neurology, Psychiatry); and Sub-Group 5 (Pathology, Radiology, Anesthesiology, Emergency Medicine, Radiation Oncology, Occupational Medicine, Community Medicine) apply specialized coefficient distributions.

Which textbooks serve as the official national reference sources for the exam?

The Secretariat of the Council for Medical and Specialized Education officially designates national reference textbooks. Major references include Harrison's Principles of Internal Medicine for Internal Medicine, Nelson Textbook of Pediatrics for Pediatrics, Schwartz's Principles of Surgery for General Surgery, Williams Obstetrics and Berek & Novak's Gynecology for OB/GYN, Mandell's Principles and Practice of Infectious Diseases, Kaplan & Sadock's Synopsis of Psychiatry, Adams and Victor's Principles of Neurology, Rook's Textbook of Dermatology, and relevant specialty syllabi issued by Sanjesh Pezeshki.

What are the eligibility requirements for participating in the exam?

Applicants must hold an accredited Doctor of Medicine (MD) degree, have completed an 18-month clinical internship, and possess valid registration with the Medical Council of Iran (I.R.I.M.C.). In addition, male physicians must have completed or received exemption/deferral from compulsory military service, and candidates must either have completed their mandatory provincial public health service (Tarh-e Khedmat-e Pezeshkan) or qualify under statutory exemption quotas (e.g., straight-through top graduates, specific military/martyr quotas).

Is this practice question bank an official Sanjesh Pezeshki release?

No. This practice question bank is an independent English-language educational adaptation authored by OpenExamPrep. It is designed to model the scope, clinical depth, question style, and negative marking constraints of the Dastyari Pezeshki exam based on the internationally recognized textbook references specified in the official Iranian syllabus.

Can foreign medical graduates (FMGs) take the Iranian Residency Entrance Exam?

Yes, graduates of foreign medical schools recognized by the Ministry of Health and Medical Education may register for the Dastyari examination after their foreign degree has been officially evaluated and credentialed by the MOHME Foreign Medical Education Assessment Council, and following successful completion of required supplementary clinical internship rotations or the national pre-internship/equivalence assessments.