FCPS Part 2 Medicine Exam 2027: Format, Eligibility & Fee
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FCPS Part 2 Medicine Quick Summary
FCPS Part II in Medicine is the final exit exam of the College of Physicians and Surgeons Pakistan (CPSP). It has two computer-based theory papers of 100 single best answer MCQs each, then a TOACS and clinical cases held only in Pakistan. The fee is Rs 15,050, and the next theory dates are 16 February and 17 August 2027. You need four years of completed training, the IMM, an approved synopsis and a published article.
Passing FCPS Part II in Medicine gives you the FCPS fellowship and the specialist title in Pakistan. This guide covers who can apply, the research rule that now catches many candidates out, how the theory and clinical parts are marked, what to study and how to plan the last few months, with sample questions from our QBank.
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Who can sit FCPS Part 2 Medicine
FCPS Part II in Medicine is open to trainees who have completed four years of supervised training in Medicine at a CPSP accredited unit. Before you apply you need:
- FCPS Part I passed in the relevant subject group, or a CPSP exemption.
- The Intermediate Module (IMM) passed.
- All four years of training and every required rotation completed. CPSP does not relax this for the major subjects.
- A training completion certificate from your supervisor, and your e-logbook entries up to date.
- An approved synopsis and a published article (see the next section).
Training done partly abroad must be in a unit CPSP accredits for that period. If you are not sure whether a rotation counts, ask the CPSP Department of Postgraduate Medical Education before the closing date, not after.
Research and the published article rule
Research is now a hard requirement, not something you can finish later. Under CPSP notifications issued in July and September 2025:
- Your synopsis must be approved by the CPSP Research Evaluation Unit (REU).
- You must complete the Research Methodology, Biostatistics and Academic Writing (RMB&AW) workshop before writing the synopsis.
- You need one original article based on that synopsis, with you as first author, published in an indexed journal with an impact factor or in an HEC W or X category journal.
- The article must be uploaded to your CPSP e-portal at least three months before the exam.
Journal review and publication can take six months or more, so start the synopsis early in your third year.
How to apply, step by step
CPSP publishes the exam notice with closing dates on its website. Read the eligibility section for your subject.
Make sure training records, e-logbook, IMM result, workshops and the published article are all on your CPSP e-portal account.
Apply through the e-portal and choose your theory centre in Pakistan, or one of the CPSP centres abroad that holds Part II theory.
Pay Rs 15,050 before the closing date to avoid the late fee.
Your exact date, shift and centre appear on the admit card in your e-portal account.
Theory papers
| Paper | Questions | Time |
|---|---|---|
| Paper I | 100 single best answer MCQs | 2.5 hours |
| Paper II | 100 single best answer MCQs | 2.5 hours |
Both papers are computer-based and are taken on the same day in two shifts. Questions are clinical scenarios at the level of a consultant in training: expect management decisions, interpretation of investigations and complications rather than plain recall. Only candidates who pass the theory are called for the clinical exam.
TOACS and clinical exam
The clinical exam for Medicine follows the CPSP guideline for the major subjects: a TOACS on day one, then a long case and short cases with a pair of examiners. Each part is marked out of 10 and you need 6 in each, with an overall 60%.
| Component | Format | Marks (pass) |
|---|---|---|
| TOACS | 15 to 18 stations of 4 to 8 minutes each | 10 (6) |
| Long case | 60 minutes: 30 with the patient taking a history and examining, 30 of discussion with the examiners | 10 (6) |
| Short cases | Four short cases in 40 minutes | 10 (6) |
| Total | Aggregate of all three parts | 30 (18, which is 60%) |
TOACS results are announced on the same day. A score of 55% or more lets you take the cases in that exam only; 60% or more carries forward to the next exam, so you can skip the TOACS while your theory pass is still valid.
What to study for FCPS Part 2 Medicine
CPSP does not publish a weighting for each topic. The bars below are our guide to how much time each area deserves, based on how the theory papers usually look:
A 16-week study plan
Most candidates prepare during the final months of training, so plan for about two hours on working days and more at weekends:
| Weeks | Focus | Daily target |
|---|---|---|
| 1 to 4 | Read the core text for the highest weighted areas and make short notes | 40 MCQs plus reading |
| 5 to 8 | Remaining areas, with recent guidelines for common conditions | 50 MCQs |
| 9 to 12 | Timed blocks of 100 questions, review every wrong answer | 100 MCQs on alternate days |
| 13 to 14 | Two full mock papers and weak area revision | Mock papers |
| 15 to 16 | Clinical practice: present long cases to a senior, rehearse TOACS stations | Two cases a day |
Recommended books for FCPS Part 2 Medicine
Read one core text well and use the others for reference, alongside a question bank.
| Book | Why it helps |
|---|---|
| Davidson's Principles and Practice of Medicine | The core text most Pakistani trainees know well; good for the theory papers. |
| Kumar and Clark's Clinical Medicine | Clear chapters for revision and a second explanation of hard topics. |
| Oxford Handbook of Clinical Medicine | Quick review and bedside management, useful the week before the exam. |
| Macleod's Clinical Examination | Examination technique for the long and short cases. |
| Hutchison's Clinical Methods | History taking and presentation style for the clinical. |
Sample FCPS Part 2 Medicine MCQs
These five questions come from the free trial of our FCPS Part 2 Medicine QBank, covering several medical systems. Tap a question to see the answer and explanation.
A 19-year-old woman with transfusion-dependent beta-thalassaemia started deferiprone 2 months ago. She presents with 2 days of fever 38.9 °C, sore throat and mouth ulcers. She has missed her last two weekly blood counts. Her blood pressure is 112/70 mmHg. What is the most appropriate immediate action?A. Stop deferiprone and check an urgent full blood countB. Continue deferiprone and give oral amoxicillinC. Switch deferiprone to deferasirox the same day without testsD. Give a red cell transfusionE. Halve the deferiprone dose and recheck the count in a week
Answer: A. Stop deferiprone and check an urgent full blood count
Explanation: Deferiprone causes neutropenia in about 5% and agranulocytosis in about 1% of patients, usually in the first year. For this reason the neutrophil count must be checked weekly. Any patient on deferiprone with fever, sore throat or mouth ulcers must stop the drug at once and have an urgent full blood count.
A 72-year-old man had a left middle cerebral artery stroke 3 weeks ago. Since then he coughs and chokes when drinking water, his voice becomes wet after swallowing, and fluid sometimes comes out of his nose. He has had one episode of aspiration pneumonia. Which investigation best assesses his swallowing?A. Upper gastrointestinal endoscopyB. Videofluoroscopic swallowing studyC. High-resolution oesophageal manometryD. Barium meal and follow-throughE. CT of the neck and chest
Answer: B. Videofluoroscopic swallowing study
Explanation: Coughing or choking within seconds of swallowing, a wet voice and nasal regurgitation point to oropharyngeal dysphagia, here from stroke. The best tests are a videofluoroscopic swallowing study (modified barium swallow), usually with a speech and language therapist, or fibreoptic endoscopic evaluation of swallowing (FEES). They show the oral and pharyngeal phases, detect aspiration (including silent aspiration), and test which food textures, postures and manoeuvres (e.g. chin tuck) make swallowing safe.
A 48-year-old woman accidentally swallowed drain cleaner (lye) at the age of 6 and needed oesophageal dilatations as a child. She now has 3 months of progressive dysphagia and weight loss. Endoscopy shows an ulcerated, friable stricture in the mid-oesophagus at the site of the old injury. What is the most likely histological finding on biopsy?A. AdenocarcinomaB. Gastrointestinal stromal tumourC. Squamous cell carcinomaD. Small cell carcinomaE. Leiomyoma
Answer: C. Squamous cell carcinoma
Explanation: Caustic (lye) injury raises the risk of oesophageal squamous cell carcinoma many-fold, with a latency of about 40 years; tumours arise at the site of the scar, often the mid-oesophagus (at the level of the tracheal bifurcation, where transit slows). New or changed dysphagia in a patient with a known caustic stricture must be investigated with biopsy. Other SCC risk factors are smoking, alcohol, achalasia, tylosis, Plummer-Vinson syndrome, very hot drinks and nitrosamines.
A 28-year-old woman with acute asthma has received 1 hour of maximal treatment, including continuous nebulised salbutamol, ipratropium, IV hydrocortisone and IV magnesium. She is now drowsy and difficult to rouse, with shallow breathing at 12/min and a quiet chest. SpO2 is 89% on 15 L/min oxygen. Arterial blood gas: pH 7.19, PaCO2 64 mmHg. What is the most appropriate next step?A. Rapid sequence intubation and mechanical ventilationB. Non-invasive ventilation (BiPAP)C. High-flow nasal oxygenD. Repeat nebulised salbutamol and review in 30 minutesE. Intravenous aminophylline infusion and review in 1 hour
Answer: A. Rapid sequence intubation and mechanical ventilation
Explanation: She has near-fatal asthma: altered consciousness, exhaustion, silent chest and a rising PaCO2 with acidosis despite maximal therapy. These are clear indications for intubation and mechanical ventilation. Intubation should be done by the most experienced operator, with a large endotracheal tube (to reduce resistance and allow suction), ketamine as a useful induction agent (bronchodilator effect), and fluid ready because hypotension is common after intubation.
A 44-year-old woman has been ventilated for 2 days for aspiration pneumonia after a seizure. She has no heart or lung disease and her BMI is 26 kg/m². She is alert, has a strong cough and few secretions, and passes a 30-minute spontaneous breathing trial. She was easy to intubate. She is extubated today. Which post-extubation oxygen strategy best reduces her risk of reintubation?A. Prophylactic non-invasive ventilation for 24 hoursB. Delay extubation for another 24 hoursC. Conventional oxygen by face maskD. High-flow nasal oxygenE. Extubation to a T-piece with room air
Answer: D. High-flow nasal oxygen
Explanation: She is at low risk of extubation failure: age under 65, no heart failure or COPD, BMI under 30, ventilation less than 7 days, effective cough, few secretions and an easy airway. In a randomised trial of such patients (Hernández, JAMA 2016), high-flow nasal oxygen for 24 hours after extubation reduced reintubation (4.9% vs 12.2%) compared with conventional oxygen. HFNO delivers heated, humidified gas at high flow, giving a stable FiO₂, dead-space washout, a small PEEP effect and better secretion clearance.
Want to try more FCPS Part 2 Medicine questions?
Start with 30 free questions from the same QBank, each with a full explanation, then unlock the full bank when you are ready.
Fee and 2027 dates
| Item | Details |
|---|---|
| Exam fee | Rs 15,000 plus Rs 50 handling charges (Rs 15,050) |
| Late fee | Charged after the normal closing date; see the CPSP notice |
| Withdrawal | 75% of the fee is refunded if you withdraw by the deadline |
| Theory dates 2027 | 16 February and 17 August 2027 |
| Theory centres in Pakistan | Karachi, Hyderabad, Larkana, Quetta, Multan, Lahore, Faisalabad, Islamabad, Peshawar and Abbottabad |
| Theory centres abroad | Riyadh, Kathmandu and Birmingham (Solihull) |
| Clinical exam | Pakistan only; venue announced after the theory result |
Fees and dates are those CPSP has announced for the current cycle. Always confirm them in the latest notice before paying.
Results and attempts
After you pass the theory, you can appear in three of the next four consecutive clinical exams, counting any you miss, and the first clinical attempt is mandatory. If you do not pass within these chances, you need to pass the theory again.
Once you pass, CPSP awards the FCPS fellowship. Many fellows go on to work in the Gulf, where each country has its own licensing exam; see our guides to the DHA Dubai exam, the QCHP Qatar exam and the Saudi licensing exam.
Frequently asked questions
How many MCQs are in the FCPS Part 2 Medicine exam?
The theory has two computer-based papers, each with 100 single best answer MCQs, so 200 questions in total. Each paper lasts two and a half hours.
What is the fee for FCPS Part 2 Medicine?
Rs 15,000 plus Rs 50 handling charges, so Rs 15,050. A late fee applies after the closing date.
When is the next FCPS Part 2 exam?
For Medicine, Surgery, Paediatrics, Obstetrics and Gynaecology and Ophthalmology, the 2027 theory exams are on 16 February and 17 August 2027.
Is a published article required for FCPS Part 2?
Yes. CPSP requires one original article based on your approved synopsis, with you as first author, in an indexed journal with an impact factor or an HEC W or X category journal. It must be on the e-portal at least three months before the exam.
How many attempts do I get at the clinical exam?
After you pass the theory, you can sit three of the next four consecutive clinical exams, counting any you miss, and you must take the first one.
What happens if I pass the TOACS but fail the cases?
A TOACS score of 60% or more carries forward, so you can go straight to the long and short cases next time while your theory pass is valid. A score of 55% to 59% lets you sit the cases only in the current exam.
Which book is best for FCPS Part 2 Medicine?
Most candidates use Davidson's or Kumar and Clark as the core text, the Oxford Handbook for quick review and Macleod's for examination technique, along with timed practice from a question bank.
Further reading
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