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Free Practice Questions for CONAREM Primary Specialties

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Key Facts: CONAREM Primary Specialties Exam

140 questions

Written examination length for primary residency specialties

CONAREM / Instituto Nacional de Salud (INS)

60/100 scaled

Minimum for preselection; the raw-to-scaled conversion uses the median of the ten highest raw scores

Reglamento General CONAREM — Resolución S.G. N.º 885/2025

Gs. 550,000

2026 total of application and computerized marking fees

CONAREM 2026 application FAQ

5 domains

Core areas tested: Internal Medicine, Surgery, Pediatrics, OB/GYN, and Public Health

CONAREM Comisión de Selección

140 minutes

2026 primary-specialty test: 80-minute and 60-minute blocks

CONAREM 2026 primary-specialty candidate guide

Spanish

Language of the published official primary-specialty papers

CONAREM 2026 published examination papers

Annual

Single nationwide competition cycle held per fiscal year

CONAREM / MSPBS

The 2026 CONAREM primary-specialty test has 140 Spanish MCQs in 140 minutes and a scaled preselection threshold of 60/100. This independent bank offers 98 English-language study questions across its five subjects; it does not exhaust the official outlines.

Sample CONAREM Primary Specialties Practice Questions

Try these sample questions to review concepts for the CONAREM Primary Specialties exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 98+ question experience with AI tutoring.

1A 56-year-old man presents to a district emergency department with severe retrosternal chest pain radiating to his jaw for 75 minutes. The 12-lead electrocardiogram demonstrates 3-mm ST-segment elevation in leads II, III, and aVF with reciprocal ST depression in leads I and aVL. The nearest tertiary cardiac catheterization facility is located 160 minutes away by ground ambulance. The patient has no history of stroke, recent surgery, or active bleeding, and his blood pressure is 135/85 mmHg. Which initial reperfusion strategy is indicated according to international STEMI guidelines?
A.Prompt intravenous fibrinolysis after checking contraindications, followed by immediate transfer to a PCI-capable center
B.Immediate ambulance transfer for primary percutaneous coronary intervention despite the anticipated transport time exceeding 120 minutes
C.Continuous unfractionated heparin infusion alone while monitoring for spontaneous resolution of ST elevations
D.Urgent transfer for emergency coronary artery bypass graft surgery without prior pharmacological reperfusion
Explanation: This patient has an acute inferior STEMI within the reperfusion window and no stated contraindication to fibrinolysis. When timely primary PCI cannot be achieved, a pharmacoinvasive strategy uses prompt fibrinolysis followed by immediate transfer to a PCI center. Failed reperfusion requires rescue PCI; successful fibrinolysis is followed by early angiography.
2A woman with stable HFrEF and an ejection fraction of 30% takes enalapril and bisoprolol. Her blood pressure, potassium, and renal function permit additional treatment. Which pair of drug classes completes the four foundational treatment classes used to improve outcomes?
A.Mineralocorticoid receptor antagonist e.g. spironolactone and SGLT2 inhibitor e.g. dapagliflozin
B.Loop diuretic e.g. furosemide and non-dihydropyridine calcium channel blocker e.g. diltiazem
C.Digoxin and long-acting nitrate e.g. isosorbide mononitrate
D.Class Ic antiarrhythmic e.g. flecainide and alpha-1 blocker e.g. doxazosin
Explanation: Foundational HFrEF therapy includes an ARNI, ACE inhibitor, or ARB; an evidence-based beta-blocker; a mineralocorticoid receptor antagonist; and an SGLT2 inhibitor. An MRA and an SGLT2 inhibitor are the missing classes here. Assess renal function, potassium, blood pressure, and contraindications during initiation and titration. Switching an eligible patient from an ACE inhibitor to an ARNI is another consideration, with the required ACE-inhibitor washout.
3A patient with persistent atrial fibrillation and a mechanical mitral valve takes warfarin. He asks to change to apixaban to avoid INR testing. Which advice best follows the 2023 ACC/AHA atrial fibrillation guideline?
A.Continue vitamin K antagonist treatment with appropriate monitoring; a DOAC is not recommended for a mechanical valve
B.Change to apixaban because DOAC preference applies to every patient with atrial fibrillation
C.Stop anticoagulation if his usual atrial fibrillation stroke-risk score is low
D.Replace warfarin with aspirin and clopidogrel to avoid INR monitoring
Explanation: Mechanical heart valves are an exception to the usual preference for DOACs in atrial fibrillation. Vitamin K antagonist therapy remains necessary, with monitoring and an INR target appropriate to the valve and clinical circumstances. The mechanical valve creates an anticoagulation indication that cannot be dismissed using an ordinary AF risk score. Address monitoring difficulties through an individualized anticoagulation service rather than an unsupported drug substitution.
4A 48-year-old woman with a history of mitral valve prolapse presents with low-grade fever, malaise, and a new regurgitant systolic murmur at the cardiac apex. Blood cultures drawn 12 hours apart grow Streptococcus gallolyticus (formerly S. bovis) in three separate bottles. Transthoracic echocardiogram shows an oscillating 8-mm mass on the posterior mitral leaflet with moderate mitral regurgitation. Which statement regarding her diagnosis and management is correct according to the modified Duke criteria?
A.She fulfills two major Duke criteria, establishing a definite diagnosis of infective endocarditis, and requires colonoscopy due to the organism identified
B.She fulfills one major and one minor criterion, qualifying only as possible infective endocarditis pending transesophageal echocardiography
C.She requires surgical valve replacement within 24 hours regardless of hemodynamic stability or antibiotic response
D.Blood cultures positive for Streptococcus gallolyticus represent skin contamination and do not constitute a major Duke criterion
Explanation: Typical positive blood cultures and an echocardiographic vegetation provide two major criteria for definite infective endocarditis. Streptococcus gallolyticus infection also warrants evaluation for colorectal neoplasia, generally with colonoscopy. The need for valve surgery depends on complications and response to treatment, rather than vegetation detection alone.
5A 68-year-old man presents with productive cough, fever of 38.8°C, and pleuritic right-sided chest pain for 3 days. Physical examination reveals crackles and bronchial breath sounds at the right lung base. Vital signs show blood pressure 86/54 mmHg, pulse 108 bpm, respiratory rate 32 breaths/min, and oxygen saturation 91% on room air. He is alert and oriented to time, place, and person. Blood urea nitrogen (BUN) is 28 mg/dL (10 mmol/L). What is his CURB-65 score and the appropriate disposition?
A.CURB-65 score of 4; urgent hospital admission with assessment for critical care
B.CURB-65 score of 1; outpatient management with oral high-dose amoxicillin
C.CURB-65 score of 2; outpatient management with oral levofloxacin and 48-hour follow-up
D.CURB-65 score of 4; immediate invasive endotracheal intubation before obtaining laboratory confirmation
Explanation: The CURB-65 score is 4: raised urea (10 mmol/L), respiratory rate at least 30/min, systolic pressure below 90 mmHg or diastolic pressure at most 60 mmHg, and age at least 65 each contribute one point. He receives no point for confusion. Urea above 7 mmol/L corresponds to BUN above approximately 19.6 mg/dL, not serum urea above 19 mg/dL. This high-risk presentation requires urgent hospital admission and assessment for critical care; the score alone does not determine intubation.
6A patient with a COPD exacerbation initially receives monitored NIV for acute hypercapnic respiratory failure. Despite an optimized mask and settings, he develops worsening acidosis, declining consciousness, copious secretions, and inability to protect his airway. His treatment plan permits invasive ventilation. What is the best immediate escalation?
A.Arrange prompt endotracheal intubation and invasive ventilation with an experienced airway team
B.Continue the same NIV trial despite worsening airway protection
C.Substitute high-flow nasal oxygen alone and defer airway reassessment
D.Give a benzodiazepine to improve mask tolerance and wait for consciousness to improve
Explanation: NIV failure together with impaired airway protection requires prompt escalation to invasive ventilation when consistent with the treatment plan. Continuing an unsuccessful mask trial can delay a necessary airway intervention. Oxygen therapy alone does not correct inadequate ventilation or protect against aspiration. Clinical deterioration matters alongside blood gases; no isolated pH threshold replaces the overall assessment.
7A 24-year-old woman with persistent asthma presents with an acute asthma exacerbation characterized by diffuse expiratory wheezing, tachypnea (26 breaths/min), and a peak expiratory flow (PEF) of 55% of her personal best. What constitutes the cornerstone initial pharmacological therapy?
A.Repetitive inhaled short-acting beta-2 agonist (SABA) plus early administration of systemic corticosteroids
B.Inhaled long-acting beta-2 agonist (LABA) monotherapy and oral montelukast
C.Intravenous magnesium sulfate infusion alone without bronchodilators
D.Subcutaneous epinephrine injection and broad-spectrum intravenous antibiotics
Explanation: The initial pharmacotherapy for acute moderate-to-severe asthma exacerbation comprises repetitive or continuous administration of an inhaled short-acting beta-2 agonist (SABA, such as albuterol/salbutamol, often combined with ipratropium bromide) plus early administration of systemic corticosteroids (oral prednisone 40-50 mg or IV methylprednisolone). Systemic corticosteroids suppress airway inflammation, hasten resolution, and prevent relapse.
8A 21-year-old man with type 1 diabetes presents with nausea, vomiting, Kussmaul respirations, and abdominal pain. Laboratory evaluation reveals serum glucose 420 mg/dL, arterial pH 7.18, serum bicarbonate 11 mEq/L, anion gap 24 mEq/L, positive serum ketones, and serum potassium 3.1 mEq/L. Before initiating intravenous regular insulin therapy, what is the mandatory immediate step?
A.Replace potassium intravenously with monitoring and delay insulin until serum potassium is above 3.5 mEq/L
B.Administer an immediate intravenous bolus of regular insulin at 0.14 units/kg
C.Infuse 100 mL of 8.4% sodium bicarbonate intravenously to correct acidosis
D.Initiate intravenous 5% dextrose infusion to prevent sudden hypoglycemia
Explanation: Insulin shifts potassium into cells and can worsen this patient's hypokalemia. The 2024 international hyperglycemic-crises consensus recommends potassium replacement and delaying insulin when potassium is below 3.5 mmol/L, until it rises above 3.5 mmol/L. Isotonic fluid replacement proceeds alongside electrolyte monitoring, with the rate individualized to the patient's circulation and comorbidities.
9A 59-year-old man with a 7-year history of type 2 diabetes mellitus and a prior myocardial infarction 2 years ago presents for routine follow-up. His current HbA1c is 7.8% on metformin 1000 mg twice daily. His estimated GFR is 62 mL/min/1.73 m2. According to international diabetes guidelines (ADA/EASD), which class of antidiabetic agent should be added next to reduce major adverse cardiovascular events (MACE)?
A.A GLP-1 receptor agonist with proven cardiovascular benefit e.g. liraglutide or an SGLT2 inhibitor e.g. empagliflozin
B.A sulfonylurea e.g. glibenclamide / glyburide
C.A thiazolidinedione e.g. pioglitazone as first-line monotherapy
D.A DPP-4 inhibitor e.g. saxagliptin
Explanation: In patients with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD), guidelines strongly recommend adding an SGLT2 inhibitor (e.g., empagliflozin, dapagliflozin) or a GLP-1 receptor agonist (e.g., liraglutide, semaglutide, dulaglutide) with demonstrated cardiovascular benefit, independent of the baseline HbA1c level or individualized glycemic target.
10A 32-year-old woman with untreated Graves' disease is admitted with a high fever (39.6°C), severe agitation, delirium, marked tachycardia (heart rate 158 bpm, atrial fibrillation), and jaundice following an acute dental abscess. Thyroid storm is diagnosed. What is the correct sequence and rationale for pharmacological interventions?
A.Beta-blocker (propranolol) to control adrenergic hyperactivity, followed by propylthiouracil (PTU), then inorganic iodine given at least 1 hour after PTU, and systemic hydrocortisone
B.Inorganic iodine given immediately before thionamides to prevent new hormone synthesis, followed by high-dose levothyroxine
C.Radioactive iodine ablation (I-131) administered emergently followed by intravenous methimazole
D.Intravenous calcium gluconate followed by emergent total thyroidectomy within 6 hours
Explanation: Thyroid storm requires antithyroid treatment, control of adrenergic symptoms, glucocorticoids, supportive intensive care, and treatment of the precipitating infection. Thionamide treatment should precede inorganic iodine by at least one hour to avoid supplying substrate for new hormone synthesis. Beta-blocker choice requires assessment for shock or decompensated heart failure; the entire regimen should not be interpreted as a rigid sequence that delays other urgent care.

About the CONAREM Primary Specialties Exam

CONAREM's primary-specialty competition selects eligible physicians for available medical residency places in Paraguay. INS publishes the regulations, five subject outlines, and annual examination materials. The 2026 written assessment was scheduled for 7 March at Facultad Politécnica, UNA, San Lorenzo. OpenExamPrep provides independent English-language MCQ practice for selected internal medicine, surgery, pediatrics, obstetrics/gynecology, and public-health topics; the official assessment is in Spanish. Study the official bibliography and national protocols alongside this resource.

Exam sponsor: Comisión Nacional de Residencias Médicas (CONAREM) / Instituto Nacional de Salud (INS) — MSPBS. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

The primary competition comprises documentary eligibility screening, a written knowledge assessment, scaling and tie-breaks, then selection of available places in merit order. There is no separate graded oral, practical, assignment, or submitted case-study component in these primary-specialty rules. Academic grades are tie-breakers, not a weighted addition to the main primary score. Derived-specialty selection has different assessment and curricular rules.

Time Limit

2026: 140 minutes — 80 questions in 80 minutes, then 60 in 60 minutes; unused time does not carry over

Passing Score

At least 60 on the scaled 100-point score for preselection; scaling uses the median of the ten highest raw scores, not a fixed 60% raw-answer cutoff

Exam / Certification Fees

2026: Gs. 550,000 total — Gs. 400,000 INS application plus Gs. 150,000 UNA computerized marking; non-refundable

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.

21.4%

Medicina Interna (Internal Medicine)

Cardiology, pulmonology, gastroenterology, nephrology, endocrinology, infectious diseases (including dengue, tuberculosis, and Chagas disease), neurology, and rheumatology.

21.4%

Cirugía General (General Surgery)

Acute abdomen, acute appendicitis, cholecystitis, abdominal wall hernias, trauma evaluation and resuscitation (ATLS protocols), intestinal obstruction, and perioperative care.

21.4%

Pediatría (Pediatrics)

Neonatal care and resuscitation, growth and development milestones, infant nutrition, acute respiratory infections, acute diarrheal disease and dehydration rehydration plans, and pediatric infectious exanthems.

21.4%

Gineco-Obstetricia (Obstetrics and Gynecology)

Prenatal care and high-risk pregnancy, hypertensive disorders of pregnancy (preeclampsia/eclampsia), obstetric hemorrhage and postpartum hemorrhage management, labor mechanics, abnormal uterine bleeding, and cervical cancer screening.

14.3%

Salud Pública (Public Health and Primary Care)

Health systems and financing, national health policy, primary care, health promotion, maternal-child health, epidemiology and vital statistics, infection prevention, climate and food insecurity. This bank samples selected topics rather than every subtopic.

Preparing for the CONAREM Primary Specialties Exam

What You Need to Know

  • Passing score: At least 60 on the scaled 100-point score for preselection; scaling uses the median of the ten highest raw scores, not a fixed 60% raw-answer cutoff
  • Assessment: The primary competition comprises documentary eligibility screening, a written knowledge assessment, scaling and tie-breaks, then selection of available places in merit order. There is no separate graded oral, practical, assignment, or submitted case-study component in these primary-specialty rules. Academic grades are tie-breakers, not a weighted addition to the main primary score. Derived-specialty selection has different assessment and curricular rules.
  • Time limit: 2026: 140 minutes — 80 questions in 80 minutes, then 60 in 60 minutes; unused time does not carry over
  • Exam / certification fees: 2026: Gs. 550,000 total — Gs. 400,000 INS application plus Gs. 150,000 UNA computerized marking; non-refundable Official sources

Using Our Practice Resources

  • Work through all 98 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

CONAREM Primary Specialties: Suggested Study Strategy

1Use the five official primary-specialty outlines and bibliography. The published 2026 papers allocate 30 items to each clinical subject and 20 to public health.
2Focus on national epidemiology and health priorities in Paraguay, including dengue fever clinical warning signs, tuberculosis management, and Chagas disease surveillance.
3Review emergency assessment, neonatal resuscitation, postpartum hemorrhage, and preeclampsia. When a question names a guideline and year, apply that framework; current clinical guidance can differ from older editions in the official bibliography.
4Practice calculations with stated assumptions, including classic Parkland estimates, daily Holliday-Segar requirements, diagnostic-test performance, and maternal mortality ratios.
5Familiarize yourself with the Paraguay National Immunization Program (PAI) schedule and public health surveillance reporting requirements.
6Use timed English practice to develop reasoning and pace, and study the official Spanish materials separately. The bank does not reproduce the official paper or every outline subtopic.

Frequently Asked Questions

What is the CONAREM Medical Residency Admission Examination?

It is the knowledge assessment within CONAREM's residency selection process. This page covers the primary-specialty competition; derived specialties have separate examinations and curricular evaluation rules. Selection requires eligibility and a sufficient merit position for an available place.

How many questions are on the official CONAREM primary specialty exam?

The 2026 primary-specialty examination has 140 Spanish-language MCQs with four or five options. Block I contains 80 questions in 80 minutes, and Block II contains 60 questions in 60 minutes. Our four-option English practice bank is a study adaptation.

What subjects are covered on the CONAREM examination?

The published 2026 papers contain 30 questions each in Medicina Interna, Cirugía General, Pediatría, and Gineco-Obstetricia, plus 20 in Salud Pública. The five official outlines contain more subtopics than this practice bank; consult them and the specified bibliography.

What is the passing score and how are vacancies adjudicated?

Preselection requires at least 60 scaled points. The median of the ten highest raw scores corresponds to 100; lower scores are scaled proportionally and higher scores are capped at 100. Ties are resolved by raw score, subject-score priorities, then academic grades as prescribed. Places are selected in merit order subject to eligibility and vacancies.

How much is the CONAREM registration fee?

The 2026 total is Gs. 550,000: Gs. 400,000 for INS application and Gs. 150,000 for computerized marking by Facultad Politécnica, UNA. The official application FAQ states that both fees are non-refundable.

Is this practice question bank an official CONAREM product?

No. OpenExamPrep provides independent English-language MCQ study adaptations for selected primary-specialty topics. The official Spanish assessment allows four or five options; our bank uses four. It is not an official translation, format simulation, or substitute for Spanish-language study or clinical and practical preparation.