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Sample CPSP IMM Medicine Practice Questions

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

1A 54-year-old male presents to the emergency department with severe crushing retrosternal chest pain lasting 90 minutes. ECG demonstrates 3 mm ST-segment elevation in leads V1–V4 with reciprocal ST depression in leads II, III, and aVF. The hospital has a cardiac catheterization laboratory available, and primary percutaneous coronary intervention (PCI) can be achieved within 45 minutes. What is the most appropriate reperfusion strategy?
A.Immediate intravenous tenecteplase followed by maintenance heparin
B.Immediate transfer to the cardiac catheterization laboratory for primary PCI
C.Initiation of intravenous unfractionated heparin and reassessment after 6 hours
D.Urgent coronary artery bypass grafting without prior coronary angiography
Explanation: This presentation requires immediate reperfusion for anterior STEMI. Primary PCI is preferred here because it can be delivered promptly within 45 minutes; fibrinolysis is considered when timely PCI cannot be provided and there are no contraindications. Diagnosis-to-reperfusion and hospital arrival-to-device targets use different starting points and should not be treated as interchangeable.
2A 62-year-old female with ischemic cardiomyopathy and an echocardiographic left ventricular ejection fraction (LVEF) of 28% remains symptomatic (NYHA class II) despite receiving optimal target doses of sacubitril/valsartan, bisoprolol, and spironolactone. Her eGFR is 52 mL/min/1.73 m² and serum potassium is 4.6 mEq/L. Which medication should be added to complete foundational guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF)?
A.Dapagliflozin
B.Digoxin
C.Verapamil
D.Amlodipine
Explanation: Sodium-glucose cotransporter-2 (SGLT2) inhibitors, such as dapagliflozin or empagliflozin, are one of the four foundational pillars of GDMT for HFrEF (alongside ARNI/ACEi, evidence-based beta-blockers, and mineralocorticoid receptor antagonists), significantly reducing cardiovascular mortality and heart failure hospitalizations regardless of whether the patient has diabetes mellitus.
3A 68-year-old male with persistent non-valvular atrial fibrillation has a history of well-controlled hypertension and type 2 diabetes mellitus, but no history of stroke, transient ischemic attack, or vascular disease. Echocardiography shows normal left ventricular systolic function. What is his CHA₂DS₂-VASc score, and what is the recommended stroke prevention strategy?
A.Score 1; aspirin 75 mg daily
B.Score 3; oral anticoagulation with a direct oral anticoagulant (DOAC)
C.Score 3; dual antiplatelet therapy with aspirin and clopidogrel
D.Score 2; clopidogrel 75 mg daily monotherapy
Explanation: His CHA₂DS₂-VASc score is 3: age 65–74 years, hypertension, and diabetes contribute one point each. Under the 2023 ACC/AHA/ACCP/HRS guideline, anticoagulation is recommended at this risk level. A DOAC is generally preferred to warfarin unless there is a mechanical heart valve or moderate-to-severe rheumatic mitral stenosis; antiplatelet therapy is not an adequate substitute.
4A 28-year-old male presents with persistent low-grade fever, night sweats, fatigue, and a new early diastolic murmur at the left lower sternal border. Three sets of blood cultures yield Streptococcus gallolyticus (formerly S. bovis). Echocardiography confirms a 9 mm mobile vegetation on the aortic valve. In addition to tailored intravenous antimicrobial therapy, which diagnostic evaluation is mandatory for this patient?
A.Total colonoscopy
B.Renal biopsy
C.Bone marrow aspirate and trephine
D.Serum protein electrophoresis
Explanation: Streptococcus gallolyticus infective endocarditis is associated with colorectal adenomas and carcinomas. Colonic evaluation, usually by complete colonoscopy when clinically safe, is recommended even without gastrointestinal symptoms. The infection does not itself establish that a colorectal neoplasm is present.
5A 32-year-old male presents with sharp retrosternal chest pain that intensifies upon lying flat and during deep inspiration, and improves when leaning forward. Physical examination reveals a three-component pericardial friction rub. 12-lead ECG demonstrates widespread concave-upward ST-segment elevation with PR-segment depression in limb and precordial leads, and reciprocal PR elevation with ST depression in lead aVR. What is the first-line pharmacotherapy?
A.High-dose aspirin or NSAID combined with colchicine
B.Intravenous unfractionated heparin and urgent cardiac catheterization
C.Immediate high-dose intravenous methylprednisolone monotherapy
D.Broad-spectrum intravenous ceftriaxone and vancomycin
Explanation: Acute pericarditis is diagnosed based on classic pleuritic/positional chest pain, pericardial friction rub, and characteristic ECG findings (widespread concave ST elevation and PR depression). The first-line therapy is high-dose NSAIDs (e.g., ibuprofen 600 mg tid) or aspirin (750–1000 mg tid) plus colchicine (0.5 mg daily or bid for 3 months), which substantially reduces recurrence rates.
6A 58-year-old female presents with a blood pressure of 220/125 mmHg, severe headache, confusion, bilateral flame hemorrhages, cotton-wool spots, and bilateral papilledema on fundoscopy. Serum creatinine is 2.4 mg/dL (baseline 0.9 mg/dL). Which principle guides the initial intravenous antihypertensive therapy?
A.Rapid reduction of blood pressure to < 120/80 mmHg within the first 60 minutes
B.Lowering mean arterial pressure (MAP) by no more than 20–25% within the first hour using titratable intravenous therapy
C.Oral administration of 10 mg short-acting sublingual nifedipine
D.Withholding antihypertensive treatment until intracranial MRI is performed
Explanation: This patient has a hypertensive emergency with malignant hypertension and acute target organ damage (encephalopathy, retinopathy, and acute kidney injury). Blood pressure must be lowered carefully using titratable IV agents (e.g., labetalol, nicardipine, or sodium nitroprusside), aiming to reduce MAP by no more than 20% to 25% over the first hour, and then toward 160/100 mmHg over the subsequent 2 to 6 hours to prevent cerebral, myocardial, or renal hypoperfusion.
7A 74-year-old male presents with exertional dyspnea, lightheadedness, and one episode of exertional syncope. Cardiac auscultation reveals a harsh, late-peaking systolic ejection murmur at the right upper sternal border radiating to the carotids, a soft second heart sound (S2), and a delayed carotid pulse upstroke (pulsus parvus et tardus). Echocardiography confirms a calcified aortic valve. Which finding on transthoracic Doppler echocardiography confirms severe aortic stenosis?
A.Aortic valve area (AVA) > 1.5 cm² and mean pressure gradient < 20 mmHg
B.Aortic valve area (AVA) ≤ 1.0 cm² and mean transvalvular gradient ≥ 40 mmHg
C.Peak aortic jet velocity of 2.2 m/s
D.Left ventricular ejection fraction > 65% with normal stroke volume index
Explanation: The combination of AVA ≤ 1.0 cm² and mean gradient ≥ 40 mmHg identifies severe high-gradient aortic stenosis. A peak velocity ≥ 4.0 m/s also supports this classification. Symptomatic severe disease warrants prompt valve-team assessment for replacement, with the intervention chosen according to anatomy, operative risk, expected benefit, and patient preferences.
8A 36-year-old woman has symptomatic rheumatic mitral stenosis with a valve area of 1.1 cm², pliable leaflets, a Wilkins score of 6, and no significant mitral regurgitation. Transesophageal echocardiography excludes left atrial thrombus. She remains symptomatic despite appropriate medical therapy. Which intervention is preferred for this favorable anatomy?
A.Percutaneous mitral balloon commissurotomy (PMBC)
B.Mechanical mitral valve replacement with lifelong warfarin
C.Bioprosthetic mitral valve replacement without anticoagulation
D.Tricuspid annuloplasty alone
Explanation: Percutaneous mitral balloon commissurotomy (PMBC) is the procedure of choice for symptomatic severe rheumatic mitral stenosis (valve area ≤ 1.5 cm²) when the valve anatomy is favorable (Wilkins score ≤ 8, indicating mobile, non-calcified leaflets without significant subvalvular apparatus disease) and in the absence of moderate-to-severe mitral regurgitation or left atrial thrombus.
9A 65-year-old male with a history of anterior myocardial infarction presents with palpitations and lightheadedness. 12-lead ECG demonstrates a regular, monomorphic wide-complex tachycardia at a rate of 170 beats per minute with atrioventricular dissociation, capture beats, and fusion beats. The patient's blood pressure is 82/50 mmHg, with diaphoresis and cool extremities. What is the immediate treatment of choice?
A.Intravenous adenosine 6 mg rapid bolus
B.Immediate synchronized direct current (DC) cardioversion
C.Intravenous verapamil 5 mg over 2 minutes
D.Intravenous amiodarone infusion over 30 minutes
Explanation: AV dissociation with capture and fusion beats strongly supports ventricular tachycardia. Hypotension and peripheral hypoperfusion indicate hemodynamic instability, requiring immediate synchronized cardioversion. Give sedation when feasible without delaying the shock.
10An 80-year-old male presents with recurrent episodes of dizziness and three syncopal events over the past month. Physical examination shows a pulse of 36 beats per minute and blood pressure of 145/60 mmHg. 12-lead ECG demonstrates regular P waves at 75/min and regular wide QRS complexes at 36/min, with complete dissociation between P waves and QRS complexes. Serum electrolytes and cardiac enzymes are normal. Which long-term management is indicated?
A.Permanent cardiac pacemaker implantation
B.Ambulatory ECG monitoring without pacing unless another syncopal episode occurs
C.An implantable cardioverter-defibrillator alone for presumed ventricular tachycardia
D.Temporary transvenous pacing as the sole long-term treatment
Explanation: AV dissociation with a slow ventricular escape rhythm indicates complete AV block. After evaluating reversible causes, acquired complete block warrants permanent pacing. Temporary pacing may be needed for immediate stabilization but does not provide the durable treatment asked for here.

About the CPSP IMM Medicine Exam

The CPSP Intermediate Module (IMM) Examination in Medicine is a formal mid-training assessment after two years of training towards FCPS. This independent English-language MCQ bank covers selected core Medicine topics. Its topic proportions are editorial practice allocations, not an official blueprint or complete current syllabus. It is a study adaptation of a written and clinical assessment, not an official translation, format simulation, or substitute for bedside, oral, procedural, communication, and TOACS practice. The permitted official assessment language or languages were not confirmed in the public sources checked.

Exam sponsor: College of Physicians and Surgeons Pakistan (CPSP). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Two computer-based theory papers containing 100 single-best-answer MCQs each (2 hours per paper). Theory success qualifies candidates for the subsequent Task-Oriented Assessment of Clinical Skills (TOACS).

Time Limit

2 hours per paper (4 hours total theory examination time, excluding breaks). Clinical TOACS timing is scheduled separately.

Passing Score

A numerical theory pass percentage was not confirmed in the current sitting notice. Qualification in theory is required for the subsequent TOACS component.

Exam / Certification Fees

Rs. 15,050 standard Pakistan fee (Rs. 15,000 examination fee plus Rs. 50 handling fee), as confirmed in official September 2026 sitting notices.

Exam sponsor website

Reported exam pass rate: Not publicly published in official CPSP sources. Exam sponsor website

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

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.

12/100 practice questions

Cardiology

Ischemic heart disease, heart failure management, arrhythmias, valvular lesions, and hypertension.

12/100 practice questions

Pulmonology

COPD, asthma, community-acquired pneumonia, tuberculosis regimens, pleural effusion, and pulmonary embolism.

10/100 practice questions

Gastroenterology and Hepatology

Upper GI bleeding, cirrhosis complications, viral hepatitis, acute pancreatitis, and peptic ulcer disease.

10/100 practice questions

Nephrology and Fluid/Electrolytes

Acute kidney injury, hyperkalemia, hyponatremia, acid-base disorders, and glomerulonephritis.

10/100 practice questions

Neurology

Acute ischemic stroke, status epilepticus, bacterial meningitis, Guillain-Barré syndrome, and headache.

10/100 practice questions

Endocrinology and Metabolic

Diabetic ketoacidosis, HHS, glycemic control, thyroid emergencies, adrenal disorders, and hypercalcemia.

12/100 practice questions

Infectious Diseases

Typhoid fever, malaria, dengue shock syndrome, sepsis bundles, tuberculosis, and HIV opportunism.

8/100 practice questions

Hematology

Microcytic and macrocytic anemias, immune thrombocytopenia, TTP, HIT, and acute leukemia emergencies.

8/100 practice questions

Rheumatology

Rheumatoid arthritis, SLE, crystal arthropathies, giant cell arteritis, and systemic sclerosis.

8/100 practice questions

Critical Care and Toxicology

Organophosphate poisoning, paracetamol toxicity, acute anaphylaxis, shock classification, and resuscitation.

Preparing for the CPSP IMM Medicine Exam

What You Need to Know

  • Passing score: A numerical theory pass percentage was not confirmed in the current sitting notice. Qualification in theory is required for the subsequent TOACS component.
  • Assessment: Two computer-based theory papers containing 100 single-best-answer MCQs each (2 hours per paper). Theory success qualifies candidates for the subsequent Task-Oriented Assessment of Clinical Skills (TOACS).
  • Time limit: 2 hours per paper (4 hours total theory examination time, excluding breaks). Clinical TOACS timing is scheduled separately.
  • Exam / certification fees: Rs. 15,050 standard Pakistan fee (Rs. 15,000 examination fee plus Rs. 50 handling fee), as confirmed in official September 2026 sitting notices. Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

CPSP IMM Medicine: Suggested Study Strategy

1Review core clinical practice guidelines for prevalent regional conditions including Dengue, XDR Typhoid, Malaria, and Tuberculosis.
2Practice interpreting investigation reports systematically: arterial blood gases, electrolyte panels, chest radiographs, and ECGs.
3Understand the pathophysiological rationale for each pharmacotherapeutic decision rather than memorizing isolated drug names.
4Read explanations for all incorrect answer choices to understand common diagnostic pitfalls and alternative clinical presentations.
5Pair multiple-choice theory revision with structured TOACS practice involving physical examination maneuvers, procedural steps, and patient communication.

Frequently Asked Questions

What is the CPSP IMM Examination?

The Intermediate Module (IMM) is a mandatory mid-point assessment administered by the College of Physicians and Surgeons Pakistan (CPSP) midway through FCPS residency training (typically after two years of core training) to evaluate competency before entering advanced specialty training.

What is the structure of the IMM Medicine theory examination?

In Pakistan, the IMM Medicine theory examination consists of two computer-based papers of 100 single-best-answer MCQs each, lasting two hours per paper (four hours total). Successful candidates advance to the clinical TOACS component.

What is the TOACS component?

The Task-Oriented Assessment of Clinical Skills (TOACS) is an objective, station-based practical examination evaluating clinical history, examination, procedural skills, data interpretation, and communication.

Can these practice MCQs substitute for clinical training?

No. This practice question bank is an independent educational study aid focusing on core clinical theory. It is not an official CPSP simulation, translation, or replacement for supervised bedside clinical practice, procedural competency, or TOACS preparation.

What are the eligibility requirements for IMM Medicine?

The September 2026 notice requires two completed training years, an appropriately signed training certificate, and mandatory workshops completed at least one month before the examination. For induction from January 2026, CPSP's revised 24-month scheme specifies 16 months of General/Internal Medicine, two months of Cardiology, two months in one of Neurology, Endocrinology, Nephrology, or Pulmonology, then four months of General/Internal Medicine. This is a training scheme, not question-weight percentages. Check the current specialty prospectus and trainee e-portal for full prior-qualification, registration, logbook, and other requirements.

What is the examination fee in Pakistan?

As confirmed in official September 2026 notices for upcoming sittings, the standard fee in Pakistan is Rs. 15,050 (Rs. 15,000 examination fee plus Rs. 50 handling fee).