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100+ Free Dip Int Med(SA) Practice Questions

Prepare for the Diploma in Internal Medicine of the College of Physicians of South Africa: Dip Int Med(SA) exam with instant access — no signup required.

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2026 Statistics

Key Facts: Dip Int Med(SA) Exam

100 Qs

Practice MCQs

OpenExamPrep Practice Adaptation

Overall 50%

Passing Score

CMSA College of Physicians

R18 950

Exam Fee

CMSA Exam Fees SS2026/FS2027

SA STGs

Guideline Basis

NDoH Adult Hospital EML & STGs

The CMSA Dip Int Med(SA) evaluates clinical competence in adult internal medicine across district hospital settings. This practice bank provides 100 clinically accurate MCQs covering HIV/TB, cardiology, pulmonology, nephrology, endocrinology, gastroenterology, neurology, and rheumatology according to SA STGs.

Sample Dip Int Med(SA) Practice Questions

Try these sample questions to test your Dip Int Med(SA) exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 34-year-old HIV-positive man with a CD4 count of 45 cells/µL presents to a South African district hospital with a 2-week history of worsening severe headache, low-grade fever, and photophobia. On examination, he is confused with neck stiffness. Lumbar puncture shows an opening pressure of 32 cm H2O, and India ink staining of the CSF is positive for encapsulated yeast cells. According to current South African NDoH adult guidelines, what is the initial preferred induction therapy for this patient?
A.High-dose oral Fluconazole 1200 mg daily for 2 weeks
B.IV Amphotericin B deoxycholate 1 mg/kg daily plus oral Flucytosine 25 mg/kg four times daily for 1 week
C.IV Amphotericin B deoxycholate 1 mg/kg daily for 4 weeks as monotherapy
D.Oral Voriconazole 400 mg twice daily plus IV Ceftriaxone 2 g daily for 2 weeks
Explanation: According to current South African NDoH adult hospital guidelines and Southern African HIV Clinicians Society guidelines for cryptococcal meningitis, preferred induction therapy is IV Amphotericin B deoxycholate (1 mg/kg/day) plus oral Flucytosine (25 mg/kg 6-hourly) for 7 days, followed by oral Fluconazole 1200 mg daily for 7 days. This combination achieves faster CSF fungal clearance and lower 10-week mortality compared to fluconazole monotherapy or prolonged amphotericin B monotherapy.
2A 42-year-old woman presents to the outpatient clinic for initiation of antiretroviral therapy (ART) in South Africa. Baseline laboratory investigations show HIV-1 positive status, CD4 count 210 cells/µL, serum creatinine 68 µmol/L (eGFR 98 mL/min/1.73m2), and negative HBsAg. According to the South African National Department of Health guidelines, what is the standard first-line ART regimen for this adult patient?
A.Tenofovir Disoproxil Fumarate (TDF) + Lamivudine (3TC) + Dolutegravir (DTG)
B.Abacavir (ABC) + Lamivudine (3TC) + Efavirenz (EFV)
C.Zidovudine (AZT) + Lamivudine (3TC) + Nevirapine (NVP)
D.Tenofovir Disoproxil Fumarate (TDF) + Emtricitabine (FTC) + Atazanavir/ritonavir (ATV/r)
Explanation: The standard preferred first-line ART regimen for HIV-positive adults and adolescents initiating therapy in South Africa (with normal renal function) is the fixed-dose combination TLD: Tenofovir Disoproxil Fumarate (TDF 300 mg) + Lamivudine (3TC 300 mg) + Dolutegravir (DTG 50 mg) taken once daily. TLD offers high genetic barrier to resistance, rapid viral suppression, and superior tolerability compared to NNTRI-based regimens.
3A 58-year-old man with a history of long-standing hypertension presents to a district emergency unit with acute severe shortness of breath, orthopnoea, and pink frothy sputum. Blood pressure is 210/120 mmHg, heart rate 118 bpm, SpO2 82% on room air, and chest examination reveals bilateral extensive crackles to the mid-zones. What is the immediate first-line pharmacological treatment of choice?
A.IV Furosemide 40-80 mg bolus and sublingual/IV Nitroglycerin
B.IV Digoxin 0.5 mg slow bolus and IV Amiodarone 300 mg
C.Oral Amlodipine 10 mg and oral Enalapril 20 mg
D.IV Adrenaline 1 mg bolus and IV Hydrocortisone 200 mg
Explanation: This patient is presenting with acute hypertensive pulmonary edema (acute decompensated heart failure). Immediate management requires IV loop diuretics (Furosemide 40-80 mg) to reduce preload and IV/sublingual nitrates (Nitroglycerin) to reduce both preload and afterload, along with high-flow oxygen and non-invasive positive pressure ventilation (CPAP/BiPAP).
4A 28-year-old pregnant woman (26 weeks gestation) is admitted to a district hospital with a severe asthma exacerbation. SpO2 is 90% on room air, peak expiratory flow rate (PEFR) is 40% of predicted, and she has marked intercostal retractions. In addition to high-flow oxygen and frequent nebulised Salbutamol, which systemic corticosteroid regimen is indicated?
A.Systemic corticosteroids must be strictly avoided during pregnancy due to teratogenicity
B.Oral Prednisone 40-50 mg daily (or IV Hydrocortisone 100 mg 6-hourly) for 5-7 days
C.Inhaled Fluticasone high-dose monotherapy without any systemic steroids
D.Single dose of IM Dexamethasone 6 mg only for fetal lung maturation
Explanation: Severe acute asthma in pregnancy is a medical emergency that endangers both mother and fetus via maternal hypoxemia. Systemic corticosteroids (oral Prednisone 40-50 mg daily or IV Hydrocortisone) are essential and safe in acute asthma exacerbations during pregnancy to reduce airway inflammation and prevent respiratory arrest.
5A 62-year-old man with chronic kidney disease (baseline creatinine 180 µmol/L) presents with generalized muscle weakness. His ECG reveals tall, peaked T waves, broadened QRS complexes, and prolonged PR intervals. Serum potassium is reported as 7.2 mmol/L. What is the mandatory immediate first step in medical management?
A.Administer IV 10% Calcium Gluconate 10-20 mL over 5-10 minutes under ECG monitoring
B.Administer oral Sodium Polystyrene Sulfonate (Resonium) 30 g
C.Initiate IV Insulin 10 units in 50 mL 50% Dextrose over 15 minutes
D.Perform urgent emergent hemodialysis without any medical temporizing measures
Explanation: In severe hyperkalemia with ECG changes (peaked T waves, QRS widening), the critical first step is administration of IV Calcium Gluconate (or Calcium Chloride) to antagonize potassium-induced membrane excitability and stabilize cardiac myocytes, preventing lethal dysrhythmias. Shift therapies (insulin/dextrose, nebulized salbutamol) and elimination therapies follow immediately.
6A 24-year-old female presents with polyuria, polydipsia, vomiting, and abdominal pain. Laboratory results show blood glucose 24.5 mmol/L, serum sodium 132 mmol/L, serum potassium 4.8 mmol/L, arterial pH 7.15, serum bicarbonate 10 mmol/L, and urine ketones 4+. What is the primary initial resuscitation fluid according to standard DKA management protocols?
A.0.9% Sodium Chloride (Normal Saline) IV infusion 1000 mL in the first hour
B.5% Dextrose IV infusion 1000 mL in the first hour
C.0.45% Sodium Chloride with 5% Dextrose infusion
D.Ringer-Lactate IV infusion with 40 mmol/L KCl added immediately
Explanation: Initial fluid resuscitation in Diabetic Ketoacidosis (DKA) requires rapid restoration of intravascular volume using isotonic crystalloid, specifically 0.9% Sodium Chloride (Normal Saline) at 1000 mL (or 10-20 mL/kg) in the first hour. Dextrose is added to IV fluids only later when blood glucose drops below 14 mmol/L.
7A 52-year-old male presenting with coffee-ground emesis and melena has a blood pressure of 85/50 mmHg and pulse 124 bpm. What is the immediate clinical priority before performing diagnostic upper gastrointestinal endoscopy?
A.Intravascular volume resuscitation with large-bore IV access and isotonic crystalloids
B.Immediate oral administration of high-dose activated charcoal
C.Administration of oral barium swallow to localize the bleeding site
D.Barium enema examination to rule out colonic diverticular bleeding
Explanation: In acute upper gastrointestinal bleeding with hemodynamic instability (hypotension, tachycardia), the paramount immediate priority is hemodynamic stabilization via resuscitation with isotonic crystalloids (and blood products as required) using two large-bore peripheral IV lines before endoscopy.
8A 68-year-old man presents with sudden-onset right-sided hemiplegia and expressive aphasia 2 hours ago. Non-contrast CT scan of the brain shows no evidence of intracerebral hemorrhage or early infarctive changes. Blood pressure is 165/95 mmHg, and blood glucose is 6.4 mmol/L. There are no contraindications. What is the definitive hyperacute treatment?
A.Intravenous recombinant tissue plasminogen activator (rtPA / Alteplase 0.9 mg/kg)
B.Immediate IV Heparin bolus followed by therapeutic infusion
C.Oral Clopidogrel 300 mg loading dose plus oral Aspirin 300 mg
D.Intravenous Labetalol to lower blood pressure below 120/80 mmHg
Explanation: In acute ischemic stroke within the 4.5-hour therapeutic window without hemorrhage on CT and no contraindications, IV thrombolysis with recombinant tissue plasminogen activator (Alteplase 0.9 mg/kg, max 90 mg) is the definitive standard of care to restore perfusion and improve neurological outcome.
9A 45-year-old woman presents with symmetrical joint pain and morning stiffness lasting > 1 hour in her PIP, MCP, and wrist joints for the past 4 months. Examination reveals bilateral swelling and tenderness of MCP joints. Rheumatoid factor and anti-CCP antibodies are strongly positive. What is the disease-modifying antirheumatic drug (DMARD) of first choice?
A.Methotrexate
B.Oral Prednisone 30 mg daily as monotherapy
C.Infliximab monotherapy
D.Paracetamol 1 g 6-hourly as needed
Explanation: Methotrexate (with weekly folic acid supplementation) is the anchor first-line conventional synthetic DMARD of choice for newly diagnosed Rheumatoid Arthritis. Early initiation halts joint erosion and preserves functional status.
10A 30-year-old HIV-positive patient on TLD regimen presents with a 3-week history of cough, night sweats, weight loss, and fever. Chest X-ray reveals upper lobe cavitary infiltrates. Sputum GeneXpert MTB/RIF detects Mycobacterium tuberculosis without rifampicin resistance. According to SA national guidelines, what is the standard intensive phase anti-TB treatment regimen?
A.Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol (RHZE) daily for 2 months
B.Rifampicin and Isoniazid (RH) daily for 6 months
C.Moxifloxacin, Bedaquiline, Linezolid, and Pretomanid for 4 months
D.Isoniazid and Ethambutol daily for 9 months
Explanation: Standard initial treatment for drug-susceptible pulmonary tuberculosis in adults in South Africa consists of a 2-month intensive phase with four drugs: Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol (RHZE), followed by a 4-month continuation phase with Rifampicin and Isoniazid (RH).

About the Dip Int Med(SA) Exam

The Diploma in Internal Medicine Dip Int Med(SA) is awarded by the College of Physicians of South Africa. It assesses clinical diagnostic and management competence in adult internal medicine for medical practitioners working at district and regional hospital levels in South Africa.

Assessment

100 Single Best Answer (SBA) MCQs covering 8 blueprint areas (Infectious Diseases/HIV/TB, Cardiology, Pulmonology, Nephrology, Endocrinology, Gastroenterology, Neurology, Rheumatology).

Time Limit

3 hours

Passing Score

Overall 50% with written subminimum

Exam Fee

R18 950 (Colleges of Medicine of South Africa (CMSA), College of Physicians)

Dip Int Med(SA) Exam Content Outline

20%

Infectious Diseases, HIV & Tuberculosis

Adult HIV management & antiretroviral therapy (TLD regimen), opportunistic infections (Cryptococcal meningitis, PCP, CMV), pulmonary & extrapulmonary TB (GeneXpert Ultra, drug-resistant TB), malaria, sepsis, and febrile illness.

15%

Cardiology & Vascular Medicine

Hypertension management (SA Hypertension Guidelines), heart failure (reduced vs preserved EF), acute coronary syndromes, valvular heart disease (rheumatic heart disease), infective endocarditis, and dysrhythmias.

15%

Pulmonology & Critical Care

Community-acquired pneumonia, acute severe asthma, COPD exacerbations, pulmonary embolism, pleural effusion evaluation, respiratory failure, and ARDS in district hospitals.

13%

Nephrology & Fluid/Electrolyte Disorders

Acute kidney injury (KDIGO criteria), chronic kidney disease staging & referral thresholds, glomerulonephritis, diabetic nephropathy, severe hyperkalaemia, hyponatraemia, and acid-base disturbances.

12%

Endocrinology & Metabolism

Type 2 diabetes mellitus management, diabetic ketoacidosis (DKA) & hyperosmolar hyperglycaemic state (HHS), thyroid disorders (thyrotoxicosis, hypothyroidism), adrenal insufficiency, and calcium metabolism.

10%

Gastroenterology & Hepatology

Upper and lower gastrointestinal bleeding, acute liver failure, liver cirrhosis & portal hypertension complications (ascites, SBP, hepatic encephalopathy), peptic ulcer disease, and acute pancreatitis.

8%

Neurology & Stroke

Acute ischaemic & haemorrhagic stroke management, status epilepticus, meningitis/encephalitis, peripheral neuropathies (Guillain-Barré syndrome, HIV-associated neuropathy), and altered mental status.

7%

Rheumatology & Autoimmune Diseases

Rheumatoid arthritis, systemic lupus erythematosus (SLE), crystal arthropathies (gout, pseudogout), septic arthritis vs reactive arthritis, and vasculitis syndromes.

How to Pass the Dip Int Med(SA) Exam

What You Need to Know

  • Passing score: Overall 50% with written subminimum
  • Assessment: 100 Single Best Answer (SBA) MCQs covering 8 blueprint areas (Infectious Diseases/HIV/TB, Cardiology, Pulmonology, Nephrology, Endocrinology, Gastroenterology, Neurology, Rheumatology).
  • Time limit: 3 hours
  • Exam fee: R18 950

Keys to Passing

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

Dip Int Med(SA) Study Tips from Top Performers

1Focus heavily on the South African National Department of Health Adult Hospital Standard Treatment Guidelines (STGs) and EML.
2Master adult HIV protocols including first-line TLD regimen, TB co-infection management, and opportunistic infection diagnosis (cryptococcal meningitis, PCP).
3Review common emergency presentations in South African district hospitals: acute DKA/HHS, severe acute asthma, hypertensive emergencies, acute stroke, and GI bleeding.

Frequently Asked Questions

What is the format of the CMSA Dip Int Med(SA) examination?

The exit examination comprises two written papers, data interpretation, and a clinical examination. This English-language study tool provides a 100-question practice MCQ bank adapted to the syllabus — it is not the official exam format.

What is the passing score for the Dip Int Med(SA)?

The passing score is Overall 50% with written subminimum as specified by the CMSA College of Physicians.

What primary reference materials are recommended?

Primary references include the South African National Department of Health Adult Hospital Standard Treatment Guidelines (STGs) and Essential Medicines List (EML), SA HIV Clinicians Society guidelines, and standard adult internal medicine textbooks.

What is the examination fee?

The examination fee is R18 950 per the CMSA Exam Fees SS2026/FS2027 schedule.