FCPS IMM Medicine MCQs: High-Yield Practice Questions & Prep

A mixed set of FCPS IMM Medicine MCQs across cardiology, gastroenterology, endocrinology, neurology and nephrology, each with the reasoning behind the answer.

The IMM in Medicine asks clinical questions across every medical specialty, so practising within one subject at a time gives a false sense of readiness. This mixed set draws from several specialties, in the vignette style used on exam day, with an explanation after each answer.

Mixed IMM Medicine MCQs

1. A 44-year-old diabetic hypertensive lady has chest pain after a brisk walk, and ECG shows ST elevation in V1-V4. What is the diagnosis?

A) Unstable angina
B) Pericarditis
C) ST elevation myocardial infarction ✅
D) Non-ST elevation myocardial infarction

Why: ST elevation in contiguous anterior leads with ischaemic chest pain is an anterior STEMI, and needs immediate reperfusion.

2. A post-MI patient has shortness of breath and raised JVP. ECG shows atrial fibrillation with HR 140/min. What is the appropriate step in management?

A) Diuretics
B) Digoxin ✅
C) Beta blockers
D) Calcium-channel blockers

Why: In AF with acute heart failure, negatively inotropic drugs (beta blockers, verapamil) are avoided and digoxin (or amiodarone) is used for rate control.

3. A patient has epigastric pain and is unable to swallow any solid or liquid. The pain subsides on standing up. What is the diagnostic test to confirm?

A) Urea breath test
B) Serology
C) Manometry ✅
D) pH monitoring

Why: Oesophageal manometry, showing absent peristalsis and incomplete LES relaxation, is the definitive test for achalasia.

4. A 30-year-old female has itching. Her total bilirubin is 1.2, ALT 65, ALP 500. What is the diagnosis?

A) Primary biliary cirrhosis ✅
B) Primary sclerosing cholangitis
C) Autoimmune hepatitis
D) Coeliac disease

Why: Itching with a marked cholestatic pattern (raised ALP) in a woman suggests primary biliary cholangitis, which often presents with pruritus before jaundice.

5. A middle-aged lady has increased tanning of skin, generalised weakness and investigations show cortisol decreased and ACTH increased. Which of the following investigations is most likely to reveal the diagnosis?

A) Short synacthen test ✅
B) Serum glucose
C) TSH
D) Overnight dexamethasone suppression test

Why: Low cortisol with high ACTH and hyperpigmentation suggests Addison disease, which is confirmed by failure of cortisol to rise after a short synacthen (ACTH) test.

6. A 24-year-old lady with BMI 30 has facial hair growth, hirsutism and irregular menstrual periods, with BSR 200 mg/dL and BP 160/100 mmHg. What is your most probable diagnosis?

A) Addison disease
B) Metabolic syndrome
C) Cushing syndrome ✅
D) Polycystic ovarian syndrome

Why: Hypertension with significant hyperglycaemia and hirsutism favours Cushing syndrome over PCOS, in which BP is usually normal.

7. An MRI brain of a young boy shows triangular calcification in parietal lobe. What is the diagnosis?

A) Oligodendroglioma ✅
B) Healed brain abscess
C) Glioblastoma multiforme
D) Calcified cyst
E) Osteoma

Why: Oligodendrogliomas characteristically show calcification, and arise in the cerebral hemispheres, often the frontal lobe.

8. A young boy presents in OPD with dancing movement of his arms. On examination you find nodules around both elbows as well as skin rash. This dancing movement is known as:

A) Hemiballismus
B) Chorea ✅
C) Athetosis
D) Tic douloureux

Why: Rheumatic fever produces Sydenham chorea (quick, irregular, dance-like movements) together with subcutaneous nodules and erythema marginatum.

9. A patient chronic smoker and COPD presented with shortness of breath. ABGs were done which showed pH 7.05, pCO2 56, HCO3 18, SaO2 88. What is your diagnosis?

A) Respiratory acidosis
B) Mixed respiratory and metabolic acidosis ✅
C) Partially compensated respiratory acidosis
D) Respiratory alkalosis

Why: A raised PCO2 (respiratory acidosis) together with a low HCO3 (metabolic acidosis) gives a mixed disorder and a severely low pH.

10. Patient on ATT develops gum bruising, drug responsible for it?

A) Ethambutol
B) INH
C) Rifampin ✅
D) PZA

Why: Rifampicin can cause thrombocytopenia (immune-mediated), which presents as gum bleeding and bruising, especially with intermittent dosing. It should be stopped and not restarted if thrombocytopenia is confirmed.

How to Use Practice Questions Well

Cover the options, commit to an answer, then compare, so you are practising recall rather than recognition.
Read the explanation even when you were right, because it often carries a second fact the exam may ask separately.
Keep a running list of the distractors that fooled you and review that list before the exam.

The full bank is at HighYield FCPS IMM Medicine, organised by subject, with timed and tutor modes.

Keep Practising

These questions come from HighYield's FCPS IMM Medicine QBank, which holds over 2,400 clinical-vignette MCQs with an explanation for every answer. The first 20 questions are free in Tutor mode, so you can judge the explanation quality before unlocking the full bank.