Internal Medicine

The MCQ Assessment




The syllabus is that used by our own medical students:

Undergraduate syllabus for internal medicine


Issued without prejudice and subject to alteration. This is a 100-mark MCQ assessment. Time: 3 hours.

The following format is planned for 2011. Should any aspects change, this website will be updated as soon as possible.

Section 1: 75 one-best-answer-of-four.

questions will assess your ability to work with clinical information and make
appropriate management decisions, for example diagnosis, investigation or
therapy. Each question consists of one or more introductory statements,
followed by a question and then a list of four options. You are required to
select one best answer from these four options. A correct answer receives one
mark; a wrong answer receives -1/3 of a mark. An answer left blank scores zero.


“A 16-year-old girl known to be asthmatic is rushed
into the emergency room. The family report that she has been becoming
increasingly wheezy for two days and has deteriorated badly in the past
few hours. On examination she is limp,unresponsive and cyanosed. Her breathing is shallow with a respiratory rate of 1 per minute. Her pulse rate is 70 and of low volume.

“The most urgent and
immediate step in her management is:

“a. Aminophylline by intravenous infusion
“b. Intubation and ventilation
“c. Oxygen by face mask
“d. Salbutamol by nebuliser”

 You are required to select the most appropriate answer (in
this case, option b) and mark this on your computer answer sheet. Note that in this example none of the options would be
wrong in the management of acute severe asthma. Clearly, however, only intubation and ventilation is lifesaving in this patient who is about to stop breathing.

Section 2: 25 extended matching item questions.

Each group of questions deals with a particular subject, for example ECG
analysis, radiographic interpretation or laboratory data interpretation. The list begins with a
large number of options. The answer for each question will be found among these


a. acute anterior myocardial infarction
b. acute inferior myocardial infarction
c. left bundle branch block
d. left ventricular hypertrophy
e. right bundle branch block
f. right ventricular hypertrophy

Q75. A 54 year old diabetic  man presents to hsopital with severe chest pain. His ECG is as follows… (ECG supplied)

Q76. A 65 year old woman is admitted with heart failure. Which ECG abnormality is shown in the following ECG? (ECG supplied)

You are required to match each  clinical description/ECG with one of the options given in the list. Note that individual options can be used more than once – e.e. one answer may apply to several questions, and some options may not be used at all. In other words, you cannot “work out” the answer based on whether an particular answer has already been used!  


This assessment is set at the same standard as the final examination for our final year students, and questions are drawn from the same bank as those we use for our own students. The
questions are marked by computer. Following an initial marking, each question
is scrutinised.  If the question itself
appears to have performed poorly (for example many candidates choosing the same wrong answer), we look carefully. IF the question appears ambiguous or inappropriate, then it is removed. All scripts are then marked again by the computer. We therefore do all that we can to
ensure that  your paper is appropriate
and is fairly marked.


You will not do well in this assessment unless you
realize that it is
NOT a theory examination
. It is actually a clinical examination, even
though it takes a written format.

All questions are built around a clinical
scenario. We do not test rote repetition of material learned by heart from textbooks. As medical educators we are guided by a useful
concept known as Bloom’s taxonomy of learning which is shown in the diagram

Though you do need to know and remember factual information, merely remembering facts is not enough. In order to be a competent doctor you have to be able to comprehend and use your factual information at these higher levels: understanding the material, applying it to patients, analying clinical presentations and laboratory information, evaluating all relevant actions in order to select the most appropriate action, and lastly , taking all the knowledge you have and putting it together in new ways to deal with new clinical situations.

Our MCQ questions are designed to test all of these levels. You will therefore not be asked to repeat facts memorised from a book. Reading and memorising is therefore insufficient preparation. You need to extend and develop your knowledge of internal medicine (epidemiology, symptoms, signs, diagnoses and illnesses, appropriate methods of investigation and treatment) in such a way that you can use all of this information to solve a patient’s problems whether a real patient or the imaginary patient we sketch in our MCQ questions.

You therefore need to learn in a problem-orientated fashion . You should prepare for the assessment by seeing patients with problems in internal medicine, and read around them in terms of the way in which they present, and how they should be investigated and treated, so that all this information becomes integrated.

Use textbooks in two ways: firstly by reading around the real patients you encounter, and secondly, by setting yourself questions and then use the books to answer them. For example, rather than just reading about acute myocardial infarction and attempting to memorise it,  ask yourself: How will I recognise that my patient has acute myocardial infarction? How would I myself set a multiple choice question such that the correct answer was myocardial infarction?


Do not read the question and then immediately look at the options and expect to recognise one of them as correct.

Our questions are carefully constructed such that it is impossible to guess the answer or to work out the answer just by looking at the options given. We choose the incorrect options such that they also look attractive to a candidate who does not possess the knowledge we are testing. Thus we make sure that all options relate to the same thing, are not obviously impossible, are of approximately the same length, and are presented in alphabetical order such that it is impossible to guess which is the right answer by tricks such as counting the number of times particular options have been used before.

The most effective way to answer the question is as follows:

  1. Read the question.
  2. Provide your own answer based on your knowledge without looking at the options.
  3. Then look at the options to see which one matches the answer you provided, and choose this as your answer.