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MCPS Family Medicine Part 1 exam MCQ questions medicine surgery clinical basics Pakistan
Here is a topic-wise question bank for MCPS Family Medicine Part 1 - Medicine & Surgery (Clinical Basics). These questions are modeled on the authentic CPSP MCPS exam style (single best answer, 1-mark MCQs), covering high-yield topics tested repeatedly in the exam.
MCPS Family Medicine - Part 1
Medicine & Surgery: Topic-Wise MCQ Bank (35 Questions)
SECTION 1: CARDIOLOGY (8 Questions)
Q1. A 58-year-old hypertensive male presents with sudden tearing chest pain radiating to the back. BP in the right arm is 180/100 mmHg and in the left arm is 140/90 mmHg. The most likely diagnosis is:
- A) Acute MI
- B) Aortic dissection
- C) Pulmonary embolism
- D) Pericarditis
Answer: B - The unequal blood pressures between arms, tearing pain radiating to the back, and hypertension strongly suggest aortic dissection (Type A).
Q2. A 65-year-old diabetic male presents with exertional dyspnea, orthopnea, and bilateral basal crepitations. JVP is raised. The most appropriate initial investigation is:
- A) ECG
- B) Chest X-ray
- C) Echocardiogram
- D) BNP levels
Answer: C - Echocardiogram is the investigation of choice to confirm heart failure, assess ejection fraction, and guide management.
Q3. A patient on Digoxin develops nausea, vomiting, and visual disturbances (yellow-green halos). ECG shows heart block. The precipitating factor most likely is:
- A) Hyperkalemia
- B) Hypokalemia
- C) Hypernatremia
- D) Hypercalcemia
Answer: B - Hypokalemia potentiates digoxin toxicity by increasing digoxin binding to Na/K ATPase.
Q4. A 50-year-old male with known IHD is started on a drug that is contraindicated in reactive airway disease. Which drug is this?
- A) Amlodipine
- B) Atenolol
- C) Ramipril
- D) Isosorbide mononitrate
Answer: B - Non-selective beta-blockers and even cardioselective beta-blockers like atenolol are relatively contraindicated in asthma/COPD due to risk of bronchospasm.
Q5. Which of the following is the drug of choice for acute rate control in atrial fibrillation with rapid ventricular response in a patient with no pre-excitation?
- A) Adenosine
- B) Amiodarone
- C) Digoxin
- D) Diltiazem (IV)
Answer: D - IV diltiazem or metoprolol is preferred for acute rate control in hemodynamically stable AF without pre-excitation (WPW).
Q6. ST elevation in leads II, III, and aVF indicates infarction of which territory?
- A) Anterior wall
- B) Lateral wall
- C) Inferior wall
- D) Posterior wall
Answer: C - Leads II, III, aVF represent the inferior territory, supplied by the right coronary artery (RCA) in most patients.
Q7. A patient presents with exertional chest pain relieved by rest, lasting 5-10 minutes. The most appropriate first-line pharmacological management is:
- A) Aspirin alone
- B) Sublingual GTN + Aspirin + Beta-blocker
- C) Morphine + oxygen
- D) Thrombolysis
Answer: B - Stable angina is managed with sublingual GTN for acute relief, plus anti-anginals (beta-blocker) and antiplatelet (aspirin) as baseline therapy.
Q8. Which of the following values of blood pressure on two separate occasions defines Stage 2 hypertension according to JNC-8?
- A) ≥130/80 mmHg
- B) ≥140/90 mmHg
- C) ≥160/100 mmHg
- D) ≥150/95 mmHg
Answer: C - JNC-8 classifies Stage 2 hypertension as ≥160/100 mmHg. (Note: ACC/AHA 2017 defines Stage 2 as ≥140/90, so be aware of the guideline context used by CPSP.)
SECTION 2: RESPIRATORY MEDICINE (6 Questions)
Q9. A 45-year-old smoker presents with chronic productive cough for 3 months over the past 2 consecutive years. The most likely diagnosis is:
- A) Bronchiectasis
- B) Chronic bronchitis
- C) Emphysema
- D) Asthma
Answer: B - Chronic bronchitis is defined clinically as productive cough for at least 3 months per year for 2 consecutive years.
Q10. A patient with COPD exacerbation is started on oxygen at 40% FiO2. Thirty minutes later, he becomes drowsy. The most likely explanation is:
- A) Pulmonary embolism
- B) Hypercapnic respiratory failure with loss of hypoxic drive
- C) Pneumothorax
- D) Septic encephalopathy
Answer: B - In chronic hypercapnia (COPD), the respiratory drive becomes dependent on hypoxia. High-flow O2 removes this drive, causing CO2 retention and type II respiratory failure.
Q11. A 30-year-old asthmatic presents with severe breathlessness, unable to complete sentences, RR 30/min, SpO2 88%, silent chest on auscultation. This clinical picture represents:
- A) Moderate asthma exacerbation
- B) Severe asthma
- C) Life-threatening asthma
- D) Near-fatal asthma
Answer: C - Silent chest, SpO2 < 92%, and inability to complete sentences mark a life-threatening exacerbation.
Q12. A 60-year-old male smoker has a 3 cm solitary pulmonary nodule on CXR. The next best step is:
- A) Repeat CXR in 6 months
- B) CT chest with contrast
- C) Sputum cytology
- D) Bronchoscopy
Answer: B - Any nodule > 8 mm (especially in a smoker over 50) requires CT chest for further characterization per Fleischner Society guidelines.
Q13. Which of the following is the most sensitive test for diagnosing pulmonary embolism?
- A) D-dimer
- B) Chest X-ray
- C) CTPA (CT pulmonary angiography)
- D) V/Q scan
Answer: C - CTPA is the gold standard for diagnosis of PE with high sensitivity and specificity.
Q14. A patient with pleural effusion: aspiration shows straw-colored fluid with protein >3 g/dL, LDH > 2/3 of serum LDH, and fluid/serum LDH > 0.6. This effusion is:
- A) Transudate
- B) Exudate
- C) Chylothorax
- D) Hemothorax
Answer: B - Light's criteria: protein > 3 g/dL, fluid:serum LDH > 0.6, or fluid LDH > 2/3 upper limit of normal serum LDH = exudate.
SECTION 3: GASTROENTEROLOGY (5 Questions)
Q15. A 40-year-old male presents with epigastric pain relieved by food, occurring 1-2 hours after meals. H. pylori test is positive. The most appropriate treatment is:
- A) PPI alone for 8 weeks
- B) Triple therapy: PPI + Amoxicillin + Clarithromycin for 14 days
- C) H2 blocker + antacid
- D) Sucralfate alone
Answer: B - H. pylori-positive duodenal ulcer is treated with triple eradication therapy (PPI + two antibiotics) for 14 days as per CPSP/BSG guidelines.
Q16. A patient presents with progressive dysphagia, first to solids then to liquids, significant weight loss, and is a 65-year-old male. Most likely diagnosis:
- A) Achalasia cardia
- B) Esophageal carcinoma
- C) GERD
- D) Globus hystericus
Answer: B - Progressive dysphagia (solids → liquids) + weight loss in an elderly male = carcinoma of esophagus until proven otherwise.
Q17. Which of the following is the most common cause of upper GI bleeding in Pakistan?
- A) Esophageal varices
- B) Peptic ulcer disease
- C) Mallory-Weiss tear
- D) Gastric carcinoma
Answer: B - Peptic ulcer disease (PUD) is the most common cause of upper GI bleed globally and in Pakistan.
Q18. A 55-year-old female presents with painless jaundice, pruritus, dark urine, and pale stools. CA 19-9 is elevated. The most likely diagnosis is:
- A) Hepatitis A
- B) Choledocholithiasis
- C) Carcinoma of head of pancreas
- D) Primary biliary cirrhosis
Answer: C - Painless obstructive jaundice + elevated CA 19-9 + pale stools = carcinoma head of pancreas (Courvoisier's sign may be present).
Q19. A patient with liver cirrhosis develops confusion, asterixis, and fetor hepaticus. The most important precipitant to look for and treat first is:
- A) Constipation
- B) GI bleeding
- C) Hyponatremia
- D) Sedative use
Answer: B - GI bleeding is the most common precipitant of hepatic encephalopathy. Blood in the gut is metabolized by bacteria to ammonia.
SECTION 4: ENDOCRINOLOGY (5 Questions)
Q20. A 35-year-old female presents with weight gain, cold intolerance, constipation, dry skin, and bradycardia. TSH is markedly elevated and free T4 is low. The treatment of choice is:
- A) Carbimazole
- B) Levothyroxine
- C) Propylthiouracil
- D) Radioactive iodine
Answer: B - Primary hypothyroidism (high TSH, low T4) is treated with levothyroxine replacement.
Q21. A diabetic patient on metformin develops lactic acidosis. The most important contraindication to using metformin in this patient most likely was:
- A) Obesity
- B) Renal impairment (eGFR < 30)
- C) Hypertension
- D) Dyslipidemia
Answer: B - Metformin is contraindicated in significant renal impairment (eGFR < 30 mL/min/1.73m²) due to risk of lactic acidosis.
Q22. A patient presents with polyuria, polydipsia, and hyperglycemia. Serum glucose is 600 mg/dL with no ketones. Serum osmolality is 340 mOsm/kg. The diagnosis is:
- A) Diabetic ketoacidosis
- B) Hyperosmolar hyperglycemic state (HHS)
- C) SIADH
- D) Central diabetes insipidus
Answer: B - HHS: marked hyperglycemia (often > 600 mg/dL), hyperosmolarity (> 320), minimal or no ketosis, altered consciousness.
Q23. Which of the following is the HbA1c target for a diabetic patient with established cardiovascular disease according to current guidelines?
- A) < 6%
- B) < 6.5%
- C) < 7%
- D) < 8%
Answer: C - For most adults with T2DM including those with CVD, HbA1c target is < 7% (ADA/IDF). Less stringent targets (< 8%) apply to the elderly or those with hypoglycemia unawareness.
Q24. A patient presents with hypertension, hypokalemia, and metabolic alkalosis. 24-hour urinary aldosterone is elevated. The most likely diagnosis is:
- A) Cushing's syndrome
- B) Primary hyperaldosteronism (Conn's syndrome)
- C) Pheochromocytoma
- D) Renal artery stenosis
Answer: B - Conn's syndrome: hypertension + hypokalemia + metabolic alkalosis + elevated aldosterone with suppressed renin.
SECTION 5: NEUROLOGY (4 Questions)
Q25. A 70-year-old hypertensive patient develops sudden onset right-sided hemiplegia and expressive aphasia. CT head (plain) at 1 hour is normal. The most appropriate next step is:
- A) Start aspirin and observe
- B) MRI brain with DWI
- C) Thrombolysis with tPA immediately
- D) Carotid Doppler
Answer: B - CT is insensitive in the first few hours of ischemic stroke. MRI with diffusion-weighted imaging (DWI) detects early ischemia and confirms diagnosis before thrombolysis decision.
Q26. A patient presents with sudden severe "thunderclap" headache, described as the worst headache of their life, with neck stiffness. CT head is normal. The next investigation is:
- A) MRI brain
- B) Lumbar puncture
- C) Carotid angiogram
- D) EEG
Answer: B - Normal CT does not exclude subarachnoid hemorrhage (SAH). LP showing xanthochromia confirms the diagnosis.
Q27. A 25-year-old female presents with episodes of tingling in one arm, blurred vision that resolved spontaneously, and now has limb weakness. MRI shows periventricular white matter lesions. The most likely diagnosis is:
- A) SLE
- B) Multiple sclerosis
- C) TIA
- D) CNS vasculitis
Answer: B - Relapsing-remitting neurological episodes + periventricular plaques on MRI = classic multiple sclerosis (McDonald criteria).
Q28. The drug of choice for absence seizures in a child is:
- A) Carbamazepine
- B) Phenytoin
- C) Ethosuximide
- D) Sodium valproate
Answer: C - Ethosuximide is first-line for pure absence epilepsy. Valproate is also effective and used when generalized tonic-clonic seizures coexist.
SECTION 6: SURGERY (7 Questions)
Q29. A 30-year-old male presents with sudden onset severe pain in the right iliac fossa, nausea, and low-grade fever. On examination, there is guarding and rebound tenderness at McBurney's point. The most likely diagnosis is:
- A) Renal colic
- B) Acute appendicitis
- C) Meckel's diverticulum
- D) Right inguinal hernia
Answer: B - Classic presentation of acute appendicitis: RIF pain, nausea, fever, and positive signs at McBurney's point.
Q30. A 60-year-old male presents with a painless, palpable, pulsatile abdominal mass. USS shows an infrarenal aortic diameter of 6.5 cm. The most appropriate management is:
- A) Watchful waiting with 6-monthly USS
- B) Elective surgical repair / EVAR
- C) CT angiogram and discharge
- D) Beta-blocker therapy
Answer: B - AAA > 5.5 cm in males is an indication for elective repair (open surgery or EVAR) due to high rupture risk.
Q31. A 45-year-old female presents with right upper quadrant pain radiating to the right shoulder, especially after fatty meals, with Murphy's sign positive. Ultrasound shows gallstones. The treatment of choice is:
- A) Oral ursodeoxycholic acid
- B) Low-fat diet and antispasmodics
- C) Laparoscopic cholecystectomy
- D) ERCP
Answer: C - Symptomatic gallstones with cholecystitis are managed by laparoscopic cholecystectomy. ERCP is for common bile duct stones.
Q32. A patient is brought to A&E after a road traffic accident with hypotension, tachycardia, distended neck veins, and muffled heart sounds. The most likely diagnosis is:
- A) Tension pneumothorax
- B) Massive hemothorax
- C) Cardiac tamponade
- D) Aortic transection
Answer: C - Beck's triad: hypotension + distended neck veins + muffled heart sounds = cardiac tamponade. Treat with immediate pericardiocentesis.
Q33. A 55-year-old male presents with painless hematuria. He is a chronic smoker. The most likely diagnosis is:
- A) Renal calculi
- B) Transitional cell carcinoma of the bladder
- C) BPH
- D) UTI
Answer: B - Painless hematuria + smoking history in a male > 50 = bladder TCC until proven otherwise. Cystoscopy is the investigation of choice.
Q34. The earliest sign of compartment syndrome is:
- A) Paralysis
- B) Absent pulse
- C) Pain out of proportion to injury, especially on passive stretch
- D) Pallor and paresthesia
Answer: C - Pain on passive stretch of the muscles in the affected compartment is the earliest and most reliable sign of compartment syndrome.
Q35. A neonate presents with bile-stained vomiting on day 2 of life, abdominal distension, and failure to pass meconium in the first 48 hours. The most likely diagnosis is:
- A) Pyloric stenosis
- B) Hirschsprung's disease
- C) Duodenal atresia
- D) Intussusception
Answer: B - Hirschsprung's disease (congenital aganglionic megacolon) presents with delayed passage of meconium (> 48 hours), abdominal distension, and bile-stained vomiting in neonates.
Quick Exam Tips for MCPS Part 1
| Area | High-Yield Topics |
|---|---|
| Cardiology | ACS management, AF, heart failure, hypertension targets |
| Respiratory | COPD management, asthma severity, PE diagnosis |
| GI | H. pylori treatment, cirrhosis complications, GI bleed causes |
| Endocrine | Diabetes targets, thyroid disorders, adrenal conditions |
| Neurology | Stroke management, seizure drugs, MS criteria |
| Surgery | Appendicitis, AAA, compartment syndrome, trauma |
Exam format reminder: MCPS Written = 100 MCQs (single best answer) + 10 SAQs. Passing aggregate is 50-60% depending on the exam diet. The MCQs are scenario-based, testing clinical reasoning - not just recall.
For further authentic MCQ practice, the CIFM MCPS prep course and Interface Medical Q-Bank are the most widely used platforms in Pakistan with updated question banks aligned to the CPSP syllabus.
Want me to continue with more topics (Renal, Hematology, Rheumatology, OB/GYN, Pediatrics, Psychiatry) or provide SAQ-style questions for the written exam?
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