Most Repeated FCPS IMM Medicine MCQs: High-Yield Topics

The topics that come up again and again in FCPS IMM Medicine papers and recalls, with sample MCQs for each, so you can prioritise revision.

Across IMM Medicine papers and recalled questions, the same topics keep returning. Building a strong base in them before you touch the rarer areas is the most efficient use of limited revision time. This list is drawn from the patterns in the HighYield IMM bank and from recall themes, not from an official CPSP syllabus, so treat it as a prioritisation aid.

Topics That Recur

Acute coronary syndromes: reperfusion choices, the first drug, complications such as Dressler syndrome, and arrhythmia after MI.
Valvular and congenital heart disease: murmur recognition, rheumatic fever criteria, endocarditis organisms.
Viral hepatitis and cholestatic disease: serology patterns, PBC and PSC, autoimmune markers.
Inflammatory bowel disease and coeliac disease: extraintestinal features, surveillance, malabsorption.
Thyroid, adrenal and pituitary disease: which test confirms which diagnosis.
Nephrotic and nephritic syndromes and renal tubular acidosis.
Epilepsy, meningitis and stroke syndromes.
Tuberculosis, pneumonia, COPD and pulmonary embolism.
Drug side effects and toxicology: a surprisingly large share of the general medicine questions.

Sample High-Yield MCQs

1. A 56-year-old obese diabetic woman has severe pain in her lower jaw and neck for 5 hours, profusely diaphoretic with vomiting. Her ECG shows new left bundle branch block, while the previous ECG was normal. Which is the best next investigation?

A) X-ray cervical spine
B) Serum troponin I ✅
C) Exercise tolerance test
D) Echocardiography
E) Random blood sugar

Why: Diabetic women often present with atypical pain (jaw, neck), and a new LBBB is treated as an STEMI equivalent. Troponin confirms myocardial necrosis, and management must not be delayed.

2. A patient has chest pain and sweating. ECG suggests unstable angina. What is the initial management?

A) Heparin
B) Aspirin ✅
C) Thrombolysis
D) PCI
E) Beta blocker

Why: Aspirin (300 mg loading) is the first drug in any acute coronary syndrome. Thrombolysis is contraindicated in unstable angina/NSTEMI.

3. A 14-year-old girl has jaundice, fever and amenorrhoea. Which test will you perform?

A) Amylase
B) Anti HAV IgM
C) Anti-mitochondrial antibodies
D) Anti-smooth muscle antibodies ✅

Why: Jaundice, fever and amenorrhoea in a young girl suggests autoimmune hepatitis, which is associated with anti-smooth muscle antibodies and raised IgG.

4. A 29-year-old male has diarrhoea and weight loss of 3 months' duration. On examination there is a palpable mass in the iliac fossa. What is the diagnosis?

A) Diverticulitis
B) Ulcerative colitis
C) Caecal carcinoma
D) Crohn disease ✅

Why: A right iliac fossa mass with chronic diarrhoea and weight loss in a young adult is Crohn disease of the terminal ileum.

5. A female has mood swings (irritable), weakness, and experienced excessive sweating. What is the diagnosis?

A) Pheochromocytoma
B) Hypothyroidism
C) Addison disease
D) Hyperthyroidism ✅

Why: Irritability, sweating and weakness point to hyperthyroidism, since the sympathetic-like effects of excess thyroid hormone cause anxiety and heat intolerance.

6. A 13-year-old child was brought to OPD. They describe that the child ceases his activity, stares and turns pale followed by eye twitching. Soon after he becomes normal. What is the diagnosis?

A) Partial seizure
B) Myoclonic seizure
C) Jacksonian seizure
D) Temporal lobe seizure
E) Petit-mal epilepsy ✅

Why: Brief staring spells with eye blinking and immediate recovery with no postictal state are absence (petit mal) seizures.

7. A patient was started on antituberculosis treatment, later presented with nephrotic syndrome. Which drug is responsible for it?

A) Pyrazinamide
B) Isoniazid
C) Amikacin
D) Rifampicin ✅

Why: Rifampicin is the antitubercular drug reported to cause immune-mediated renal injury (interstitial nephritis, occasionally minimal change disease with nephrotic syndrome).

8. A patient has fever, weight loss and cough with sputum. CXR shows bilateral apical lung shadows. What is your diagnosis?

A) TB ✅
B) Bronchiectasis
C) Aspergilloma
D) Silicosis

Why: Reactivation tuberculosis characteristically involves the upper lobes and apical segments, with constitutional symptoms and productive cough.

What to Do With This List

Do the recurring topics first, then work outwards. Track your accuracy per subject so you can see which of these you are actually strong in, rather than assuming. The FCPS IMM Medicine QBank shows a subject-level breakdown after every session.

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.