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Exam Review

Key Facts: CMMI Medicina Interna Exam

600 items

Items on the official exam

CMMI temario

800 / 500–1,100

Pass mark on the ECMMI scale

CMMI ¿Qué es la ECMMI?

21 chapters

Official temario structure

CMMI temario

40/600

Diabetes mellitus items

CMMI temario

1 Aug 2026

2026 exam date

CMMI

The CMMI certification exam is the CONACEM-recognized internal medicine board exam in Mexico: an annual 600-item exam across a 21-chapter temario, passed with 800 or more on the ECMMI scale (500–1,100).

Sample CMMI Medicina Interna Practice Questions

Try these sample questions to review concepts for the CMMI Medicina Interna exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 104+ question experience with AI tutoring.

1A 54-year-old man with a 7-year history of type 2 diabetes mellitus and a prior non-ST segment elevation myocardial infarction 2 years ago presents for follow-up. Current medications include metformin 1,000 mg twice daily, atorvastatin 40 mg daily, and ramipril 10 mg daily. His BMI is 32 kg/m2, blood pressure is 128/78 mmHg, eGFR is 78 mL/min/1.73m2, and HbA1c is 8.6%. According to ADA guidelines for patients with established atherosclerotic cardiovascular disease (ASCVD), which medication should be added next to improve glycemic control and reduce cardiovascular events?
A.Sulfonylurea (glimepiride 2 mg daily)
B.GLP-1 receptor agonist with proven cardiovascular benefit (semaglutide or dulaglutide)
C.DPP-4 inhibitor (sitagliptin 100 mg daily)
D.Thiazolidinedione (pioglitazone 30 mg daily)
Explanation: In patients with type 2 diabetes mellitus and established atherosclerotic cardiovascular disease (ASCVD), guidelines from the ADA and EASD recommend adding either a GLP-1 receptor agonist (such as subcutaneous semaglutide or dulaglutide) or an SGLT2 inhibitor with demonstrated cardiovascular outcome benefits independent of baseline HbA1c or metformin use. GLP-1 receptor agonists reduce major adverse cardiovascular events (MACE), all-cause mortality, and promote weight loss.
2A 22-year-old woman is brought to the emergency department with abdominal pain, nausea, vomiting, and Kussmaul respirations. Laboratory evaluation reveals plasma glucose 420 mg/dL, arterial pH 7.18, serum bicarbonate 11 mEq/L, anion gap 22 mEq/L, serum potassium 4.8 mEq/L, and strong positive serum beta-hydroxybutyrate. Intravenous isotonic saline resuscitation and an intravenous regular insulin infusion at 0.1 units/kg/h are initiated. At what plasma glucose threshold should 5% dextrose be added to the intravenous hydration fluids while continuing insulin infusion?
A.When blood glucose drops below 300 mg/dL
B.When blood glucose reaches 150 mg/dL and the patient can tolerate oral fluids
C.When blood glucose decreases to approximately 200 to 250 mg/dL
D.Only after the serum anion gap has fully normalized to < 12 mEq/L
Explanation: In the management of diabetic ketoacidosis (DKA), once plasma glucose reaches 200 to 250 mg/dL, 5% dextrose should be added to intravenous fluids (e.g., 5% dextrose in 0.45% or 0.9% NaCl) while adjusting the regular insulin infusion to maintain blood glucose between 150 and 200 mg/dL until ketoacidosis resolves (2024 ADA/EASD/JBDS/AACE/DTS consensus: venous pH >= 7.30 or bicarbonate >= 18 mEq/L, with beta-hydroxybutyrate < 0.6 mmol/L). Adding dextrose prevents hypoglycemia and cerebral edema while permitting continued insulin suppression of ketogenesis and lipolysis.
3A 71-year-old man with a 15-year history of type 2 diabetes mellitus is admitted from an assisted living facility due to progressive lethargy, dry mucous membranes, and poor skin turgor. Laboratory findings show plasma glucose 960 mg/dL, serum sodium 138 mEq/L (corrected sodium 152 mEq/L), serum potassium 4.2 mEq/L, BUN 54 mg/dL, serum creatinine 2.4 mg/dL, arterial blood pH 7.36, serum bicarbonate 22 mEq/L, and negative urine ketones. Effective serum osmolality is calculated at 348 mOsm/kg. What is the most critical and urgent initial therapeutic step in managing this hyperosmolar hyperglycemic state (HHS)?
A.Aggressive volume resuscitation with isotonic crystalloid solution (0.9% NaCl)
B.High-dose intravenous regular insulin bolus of 0.3 units/kg without fluid hydration
C.Intravenous administration of sodium bicarbonate 100 mEq to prevent acidosis
D.Immediate administration of low-dose subcutaneous long-acting glargine insulin
Explanation: The cornerstone of therapy for Hyperosmolar Hyperglycemic State (HHS) is intravenous fluid resuscitation with isotonic saline (0.9% NaCl) or a balanced crystalloid, typically 500 to 1,000 mL/h during the first 2 to 4 hours (2024 consensus; smaller boluses in older patients or those with heart or kidney failure), to restore intravascular volume, improve renal perfusion, and reduce plasma hyperosmolality. Fluid replacement alone often lowers plasma glucose by 75 to 100 mg/dL/h through urinary glucose excretion. Insulin therapy should be withheld until adequate fluid resuscitation has begun and hypokalemia is excluded, because starting insulin before fluids shifts water into cells and can worsen circulatory collapse.
4A 32-year-old non-pregnant woman presents with a 3-month history of heat intolerance, fine hand tremors, palpitations, and unintentional 6-kg weight loss. Physical examination reveals bilateral mild proptosis, a diffusely enlarged non-tender thyroid gland with an audible systolic bruit, and resting tachycardia of 114 bpm. Laboratory tests show serum TSH < 0.01 mIU/L, free T4 3.8 ng/dL, and elevated thyrotropin receptor antibodies (TRAb). What is the preferred first-line antithyroid drug (ATD) for medical management in this non-pregnant patient?
A.Propylthiouracil (PTU) 100 mg three times daily
B.Potassium iodide (Lugol solution) 5 drops three times daily
C.Lithium carbonate 300 mg twice daily
D.Methimazole (MMI) 15 to 30 mg once daily
Explanation: Methimazole (MMI) is the preferred first-line antithyroid drug for the treatment of Graves' disease in non-pregnant adults due to its longer half-life (allowing once-daily dosing), faster normalization of thyroid hormone levels, and markedly lower risk of life-threatening severe hepatotoxicity compared to propylthiouracil (PTU). PTU is reserved for the first trimester of pregnancy, thyroid storm, or patients with adverse reactions to methimazole.
5A 40-year-old woman with known Graves disease presents to the intensive care unit 2 days after developing acute pyelonephritis. She exhibits a temperature of 39.9°C, atrial fibrillation with rapid ventricular response at 162 bpm, agitation, marked jaundice, nausea, and persistent vomiting. Her Burch-Wartofsky Point Scale score is 65, establishing a diagnosis of thyroid storm. In addition to supportive measures and systemic beta-blockade with intravenous propranolol, what is the correct therapeutic sequence regarding antithyroid thionamides and inorganic iodine?
A.Administer oral Lugol solution immediately, followed 4 hours later by oral propylthiouracil
B.Administer intravenous hydrocortisone alone, withholding thionamides until blood cultures return
C.Administer high-dose propylthiouracil first, followed at least 1 hour later by saturated solution of potassium iodide (SSKI)
D.Administer intravenous levothyroxine together with potassium iodide to saturate binding globulins
Explanation: In thyroid storm, antithyroid drug therapy (propylthiouracil 200 mg every 4 hours or methimazole) must be administered at least 1 hour before giving inorganic iodine (SSKI or Lugol's solution). Administering the thionamide first blocks de novo organification and thyroid hormone synthesis; if iodine is given before or without adequate thionamide blockade, the exogenous iodine acts as substrate for increased hormone synthesis (Jod-Basedow phenomenon), exacerbating thyrotoxicosis. High-dose hydrocortisone is also administered to block peripheral T4-to-T3 conversion and treat potential relative adrenal insufficiency.
6A 74-year-old woman is brought to the emergency department in January after being found unresponsive in her unheated apartment. Physical examination shows rectal temperature of 33.4°C, heart rate 42 bpm, blood pressure 84/50 mmHg, periorbital non-pitting edema, macroglossia, dry scaly skin, and delayed relaxation of deep tendon reflexes. Arterial blood gas indicates hypoventilation with hypercapnia. Serum TSH is 108 mIU/L, and free T4 is undetectable. Before or concurrently with the administration of intravenous thyroid hormone, which critical medication must be given intravenously to prevent catastrophic cardiovascular collapse?
A.Intravenous calcium gluconate 10% bolus
B.Intravenous stress-dose hydrocortisone (100 mg every 8 hours)
C.Intravenous dopamine infusion at 15 mcg/kg/min
D.Intravenous broad-spectrum ceftriaxone monotherapy
Explanation: In suspected myxedema coma, stress-dose intravenous hydrocortisone (100 mg IV every 8 hours) must be administered immediately prior to or concurrently with intravenous thyroid hormone replacement (levothyroxine/liothyronine). Patients with profound hypothyroidism frequently have coexisting primary or secondary adrenal insufficiency (due to autoimmune polyglandular syndrome or hypothalamic-pituitary dysfunction). Administering thyroid hormone accelerates hepatic clearance of cortisol, which in the absence of glucocorticoid replacement can precipitate fatal acute adrenal crisis and irreversible circulatory shock.
7A 29-year-old woman with a history of Hashimoto thyroiditis presents for preconception counseling. She feels well and is asymptomatic. Her physical examination is normal. Laboratory testing reveals a serum TSH of 7.8 mIU/L (reference: 0.4 to 4.0 mIU/L), free T4 of 1.2 ng/dL (reference: 0.8 to 1.8 ng/dL), and positive anti-thyroid peroxidase (anti-TPO) antibodies. What is the most appropriate management recommendation regarding her thyroid status?
A.Initiate levothyroxine therapy now with a target preconception TSH < 2.5 mIU/L
B.Reassure the patient and recheck thyroid function tests only after confirmed conception
C.Perform a fine-needle aspiration biopsy of the thyroid gland to rule out lymphoma
D.Prescribe oral liothyronine (T3) monotherapy to accelerate follicular clearance
Explanation: According to the American Thyroid Association (ATA) guidelines, women with subclinical hypothyroidism (elevated TSH with normal free T4) who are antibody-positive and actively planning pregnancy should be treated with oral levothyroxine to achieve a preconception serum TSH concentration < 2.5 mIU/L. Untreated subclinical hypothyroidism during pregnancy is associated with increased risks of spontaneous miscarriage, gestational hypertension, preeclampsia, preterm birth, and impaired fetal neurocognitive development.
8A 36-year-old man presents with progressive fatigue, anorexia, 7-kg weight loss, salt craving, and dizziness upon standing over the past 4 months. On examination, blood pressure is 92/58 mmHg supine and drops to 78/48 mmHg on standing; pulse is 96 bpm. Hyperpigmentation is evident on his palmar creases, extensor surfaces, and oral buccal mucosa. Laboratory testing demonstrates serum sodium 129 mEq/L, potassium 5.6 mEq/L, and fasting plasma glucose 68 mg/dL. Morning basal serum cortisol is 3.1 mcg/dL (reference: 5 to 25 mcg/dL) with plasma ACTH 210 pg/mL (reference: 10 to 60 pg/mL). What is the gold-standard diagnostic confirmatory test for this condition?
A.High-dose overnight 8-mg dexamethasone suppression test
B.24-hour urinary free cortisol measurement
C.Measurement of 24-hour urinary vanillylmandelic acid (VMA)
D.High-dose (250 mcg) cosyntropin (synthetic ACTH) stimulation test
Explanation: The standard diagnostic confirmatory test for primary adrenal insufficiency (Addison's disease) is the high-dose (250 mcg) cosyntropin (synthetic ACTH) stimulation test. Serum cortisol is measured at baseline, 30 minutes, and 60 minutes after intramuscular or intravenous administration. A normal response is defined by a peak serum cortisol >= 18 mcg/dL (or >= 500 nmol/L). In primary adrenal insufficiency, destruction of the adrenal cortex prevents any significant rise in cortisol despite supraphysiologic ACTH stimulation.
9A 44-year-old woman is evaluated for central adiposity, facial rounded plethora ('moon facies'), prominent violaceous abdominal striae measuring 1.5 cm in width, proximal muscle weakness, and new-onset hypertension. When initiating diagnostic evaluation for suspected Cushing syndrome, which of the following tests is NOT recommended as an initial first-line screening tool?
A.24-hour urinary free cortisol (UFC) on two consecutive collections
B.Overnight 1-mg low-dose dexamethasone suppression test (DST)
C.Late-night salivary cortisol measured on two separate evenings
D.Single random morning serum cortisol measurement
Explanation: A single random morning serum cortisol measurement is NOT recommended as a screening test for Cushing syndrome because of the normal physiologic circadian peak of cortisol secretion in the morning, which overlaps substantially with values found in patients with pathologic hypercortisolemia. Guidelines recommend at least two first-line tests: 24-hour urinary free cortisol, late-night salivary cortisol (assessing loss of the normal circadian nadir), or the overnight 1-mg dexamethasone suppression test (confirming failure to suppress cortisol < 1.8 mcg/dL).
10A 48-year-old man presents with persistent hypertension. His seated blood pressure remains 168/104 mmHg despite adherence to maximum tolerated doses of amlodipine 10 mg daily, valsartan 320 mg daily, and chlorthalidone 25 mg daily. Baseline serum potassium is 3.1 mEq/L without diuretic therapy and 2.8 mEq/L with chlorthalidone. What is the recommended initial screening test for primary aldosteronism?
A.Morning plasma aldosterone concentration to plasma renin activity (PAC/PRA) ratio
B.24-hour urinary sodium and potassium excretion
C.Computed tomography angiography of the renal arteries
D.Bilateral selective adrenal venous sampling (AVS)
Explanation: The recommended initial screening test for primary aldosteronism (PA) in patients with resistant hypertension and spontaneous or diuretic-induced hypokalemia is the morning plasma aldosterone concentration to plasma renin activity ratio (PAC/PRA ratio, or ARR). A PAC/PRA ratio >= 20 to 30 (with PAC >= 10-15 ng/dL and suppressed PRA < 1.0 ng/mL/h) indicates autonomous aldosterone secretion requiring confirmatory suppression testing.

About the CMMI Medicina Interna Exam

Independent CMMI internal medicine certification study practice by OpenExamPrep. The Consejo Mexicano de Medicina Interna, A.C., recognized by CONACEM, certifies internists with an annual 600-item multiple-choice exam built on the 21-chapter CMMI temario; the 2026 exam was held on 1 August 2026. Results are reported on the ECMMI scale (500–1,100), with certification at 800 points or more. The official exam is in Spanish; this bank is an independent English-language MCQ study adaptation built on the CMMI temario, current international guidelines, and relevant Mexican NOMs. It is not an official translation or simulation.

Exam sponsor: Consejo Mexicano de Medicina Interna, A.C. (CMMI). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Annual written certification exam of 600 multiple-choice items built on prototype clinical problems and distributed across the 21 chapters of the CMMI temario: Diabetes mellitus; endocrine and metabolic diseases; malnutrition; hypertension; heart and vessels; kidneys and urinary tract; digestive system; bronchopulmonary diseases; nervous system; psychiatric disorders; emergencies; infections and parasitic diseases; joint and connective tissue diseases; blood and lymphoid tissue; skin; eyes; ear, nose and throat; pregnancy complications and female genital tract; geriatrics; clinical epidemiology; selected topics. Items per topic reflect how often each problem is seen in practice (diabetes mellitus accounts for 40 of 600). Results are reported on the ECMMI scale (500–1,100), and certification requires 800 points or more.

Time Limit

not-published

Passing Score

800 or more on the ECMMI scale (500–1,100)

Exam / Certification Fees

Not published

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.

Official chapters 01–03 (diabetes alone is 40 of 600 items)

Diabetes, endocrinología y metabolismo

Diabetes mellitus, endocrine and metabolic diseases, and malnutrition

Official chapters 04–05 (weight not published)

Hipertensión, corazón y vasos

Hypertension, coronary disease, heart failure, arrhythmias, valvular and vascular disease

Official chapters 06–08 (weight not published)

Riñones, aparato digestivo y pulmón

Kidney and urinary tract disease, digestive and liver disease, and bronchopulmonary disease

Official chapters 11–13 (weight not published)

Infecciones, urgencias y reumatología

Emergencies, infections and parasitic diseases, and joint and connective tissue diseases

Official chapters 09–10 and 14–18 (weight not published)

Neurología, psiquiatría, hematología y otros órganos

Nervous system, psychiatry, blood and lymphoid tissue, skin, eyes, ENT, and pregnancy complications

Official chapters 19–21 (weight not published)

Geriatría, epidemiología clínica y temas selectos

Geriatric medicine, clinical epidemiology and selected topics

Preparing for the CMMI Medicina Interna Exam

What You Need to Know

  • Passing score: 800 or more on the ECMMI scale (500–1,100)
  • Assessment: Annual written certification exam of 600 multiple-choice items built on prototype clinical problems and distributed across the 21 chapters of the CMMI temario: Diabetes mellitus; endocrine and metabolic diseases; malnutrition; hypertension; heart and vessels; kidneys and urinary tract; digestive system; bronchopulmonary diseases; nervous system; psychiatric disorders; emergencies; infections and parasitic diseases; joint and connective tissue diseases; blood and lymphoid tissue; skin; eyes; ear, nose and throat; pregnancy complications and female genital tract; geriatrics; clinical epidemiology; selected topics. Items per topic reflect how often each problem is seen in practice (diabetes mellitus accounts for 40 of 600). Results are reported on the ECMMI scale (500–1,100), and certification requires 800 points or more.
  • Time limit: not-published
  • Exam / certification fees: Not published Official sources

Using Our Practice Resources

  • Work through all 104 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

CMMI Medicina Interna: Suggested Study Strategy

1Focus deeply on high-yield core topics: diabetes mellitus alone accounts for 40 of 600 items on the official temario, followed closely by ischemic heart disease, hypertension, heart failure, and sepsis.
2Understand the management algorithms for endocrine emergencies: fluid resuscitation, potassium repletion, and fixed-rate regular insulin infusion in DKA, versus aggressive rehydration in hyperosmolar hyperglycemic state (HHS).
3Master guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction: the four pillars (ARNI/ACEi, beta-blocker, MRA, SGLT2 inhibitor) and their contraindications and monitoring parameters.
4Review Mexican Norma Oficial Mexicana NOM-006-SSA2-2013 for tuberculosis: DOTS (TAES) regimen phases (rifampin, isoniazid, pyrazinamide, ethambutol), hepatotoxicity management, and extrapulmonary presentations.
5Practice multi-step clinical vignettes: differential diagnosis of acute kidney injury (prerenal vs ATN with FeNa/FeUrea), interpreting urinalysis with active urinary sediment, and classifying glomerulopathies.

Frequently Asked Questions

What is the CMMI certification exam in Internal Medicine?

The Examen de Certificación en Medicina Interna is administered by the Consejo Mexicano de Medicina Interna, A.C. (CMMI), the council recognized by CONACEM for the specialty. Certification is valid for 5 years and is renewed through recertification.

How is the CMMI examination structured and when is it held?

The exam is held annually; the 2026 exam took place on 1 August 2026. It has 600 multiple-choice items built on prototype clinical problems, distributed across the 21 chapters of the official temario.

What is the passing score and fee for the CMMI exam?

CMMI exams are criterion-referenced and reported on the ECMMI scale from 500 to 1,100 points; certification or recertification requires 800 points or more. The fee is published in each year's call.

What curriculum and guidelines form the basis of the exam questions?

The official CMMI temario has 21 chapters, from diabetes mellitus, endocrine, cardiovascular, renal, digestive and pulmonary disease to neurology, psychiatry, emergencies, infections, rheumatology, hematology, skin, eyes, ENT, pregnancy complications, geriatrics, clinical epidemiology and selected topics. The number of items per topic reflects how often it is seen in practice (diabetes is 40 of 600).

Why is this OpenExamPrep question bank provided in English?

The official CMMI exam is administered in Spanish. This bank is an independent English-language MCQ study adaptation; Mexican references such as NOM-006-SSA2-2013 for tuberculosis are kept where relevant. It is not an official translation or simulation.