104+ Free ENARE Practice Questions

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2026 Statistics

Key Facts: ENARE Exam

100 items

Enamed objective paper, 4 alternatives each

Inep Edital nº 71/2026, item 3.1.1.1

5 hours

Duration of the Enamed paper

Inep Edital nº 71/2026, item 3.1.1.1.1

60.0 points

Nível Proficiente threshold on the Inep TRI scale

Inep Edital nº 71/2026, item 14.1.4

3 years

Validity of an Enamed proficiency score

Inep Edital nº 71/2026, item 5.4

7 areas

Areas of formation in the reference matrix

Portaria Inep nº 478/2025, Art. 3º

R$ 330,00

ENARE fee for Residência Médica

Edital ENARE 2026/2027 (HU Brasil)

R$ 220,00

ENARE fee for Multi/Uniprofissional programmes

Edital ENARE 2026/2027 (HU Brasil)

7th edition

ENARE editions held through 2026

enare2026.conhecimento.fgv.br

The ENARE is Brazil's unified national residency selection, run by HU Brasil (Ebserh) and the MEC. For direct access the objective paper is the Inep's Enamed — 100 four-option questions in 5 hours, scored by Item Response Theory, with 60.0 points marking the Proficiente level. Content follows the seven areas of the Matriz de Referência Comum (Portaria Inep nº 478/2025).

Sample ENARE Practice Questions

Try these sample questions to test your ENARE exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 104+ question experience with AI tutoring.

1A 28-year-old male driver is brought to the emergency department following a high-speed frontal motor vehicle collision. He presents with severe midface fractures, massive oral hemorrhage, and gurgling respiration. Bag-valve-mask ventilation is unsuccessful due to altered facial anatomy, and endotracheal intubation via direct laryngoscopy fails due to persistent blood obscuring the vocal cords. The patient's oxygen saturation drops to 74% and heart rate is 138 bpm. According to ATLS guidelines, what is the most appropriate next step in securing a definitive airway?

A.Immediate surgical cricothyroidotomy.

B.Repeated blind orotracheal intubation with a bougie.

C.Placement of a supraglottic laryngeal mask airway (LMA) as a permanent definitive airway.

D.Emergency bedside formal tracheostomy.

Explanation: In ATLS protocols, when a patient presents with a 'cannot intubate, cannot oxygenate' scenario due to massive facial trauma and upper airway hemorrhage, immediate surgical cricothyroidotomy is the primary emergency surgical airway of choice in adults. It provides rapid, direct subglottic access to re-establish oxygenation. Formal tracheostomy is too time-consuming in an acute emergency.

2A 32-year-old construction worker arrives at the trauma bay after sustaining a penetrating stab wound to the right hemithorax. On initial evaluation, he is in severe respiratory distress, cyanotic, and agitated. Vital signs reveal blood pressure of 72/40 mmHg, heart rate of 142 bpm, and respiratory rate of 36 bpm. Physical examination demonstrates absent breath sounds and hyperresonance on the right hemithorax, with distended jugular veins and tracheal deviation to the left. What is the immediate priority intervention?

A.Urgent chest computed tomography (CT) scan to quantify the size of the pneumothorax.

B.Immediate needle decompression in the 4th/5th intercostal space anterior to the mid-axillary line, followed by tube thoracostomy.

C.Endotracheal intubation with high positive end-expiratory pressure (PEEP).

D.Immediate pericardiocentesis under subxiphoid ultrasound guidance.

Explanation: The clinical presentation (hypotension, unilateral absent breath sounds, hyperresonance, jugular venous distension, and tracheal deviation) is classic for tension pneumothorax. Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression (recommended in the 4th/5th ICS anterior axillary line or 2nd ICS midclavicular line in adults) to relieve intrathoracic pressure and restore venous return, followed by a formal tube thoracostomy (chest drain). Diagnostic imaging must never delay treatment.

3A 45-year-old pedestrian is struck by a truck and presents in severe hemorrhagic shock with an unstable pelvic fracture and positive abdominal Focused Assessment with Sonography for Trauma (FAST). Vital signs show BP 68/38 mmHg, HR 148 bpm, cold clammy extremities, and GCS 11 (Class IV hemorrhagic shock). The trauma team initiates a massive transfusion protocol. According to current damage control resuscitation principles, what is the recommended initial resuscitation strategy?

A.Exclusive infusion of 6 units of packed red blood cells followed by reassessment of hemoglobin before giving plasma.

B.Aggressive infusion of 4 liters of normal saline 0.9% boluses before requesting blood products.

C.Balanced transfusion of packed red blood cells, fresh frozen plasma, and platelets in a 1:1:1 ratio, alongside early administration of intravenous tranexamic acid within 3 hours.

D.High-dose norepinephrine vasopressor infusion to achieve a systolic blood pressure above 140 mmHg.

Explanation: Modern damage control resuscitation in severe trauma hemorrhage prioritizes balanced hemostatic resuscitation using packed red blood cells (pRBCs), fresh frozen plasma (FFP), and platelets in a 1:1:1 ratio, minimizing crystalloids to prevent dilution coagulopathy, hypothermia, and acidosis ('lethal triad'). Intravenous tranexamic acid (TXA, 1g bolus over 10 min followed by 1g over 8 hours) should be administered within 3 hours of injury to reduce trauma-related mortality (CRASH-2 trial).

4A 22-year-old previously healthy man presents with a 24-hour history of periumbilical abdominal pain that has migrated to the right lower quadrant. He reports anorexia, nausea, and low-grade fever (37.9°C). On examination, he has localized tenderness and rebound tenderness at McBurney's point, with a positive Rovsing sign. Laboratory tests reveal leukocytosis (14,200/mm³) with 82% neutrophils. His Alvarado score is calculated as 8 points. What is the most appropriate management plan?

A.Observation in the ward without antibiotics or surgery until repeat blood counts in 48 hours.

B.Discharge home on oral ciprofloxacin and metronidazole with follow-up in one week.

C.Upper gastrointestinal endoscopy to exclude peptic ulcer perforation.

D.Surgical consultation and prompt appendectomy (laparoscopic or open).

Explanation: An Alvarado score of 8 in an adult male indicates a high clinical probability of acute appendicitis (migratory pain, anorexia, nausea, RLQ tenderness, rebound tenderness, fever, leukocytosis, and left shift). In young men with classic signs and high clinical scores, prompt appendectomy (laparoscopic preferred) is the gold standard definitive management. Unnecessary delays risk perforation and peritonitis.

5A 52-year-old female presents to the emergency department with severe, constant epigastric pain radiating band-like to her back, accompanied by persistent vomiting. Serum amylase is 1,480 U/L and lipase is 2,150 U/L (more than three times the upper limit of normal). Transabdominal ultrasound reveals multiple gallstones in the gallbladder, a normal common bile duct diameter (4 mm), and no signs of acute cholecystitis. Contrast CT performed on admission shows homogeneous pancreatic enlargement without necrosis or peripancreatic fluid collections (mild acute biliary pancreatitis). In accordance with Brazilian and international pancreatitis guidelines, what is the appropriate definitive management regarding the gallstones?

A.Index admission laparoscopic cholecystectomy prior to hospital discharge once clinical symptoms and pancreatic enzymes resolve.

B.Discharge home and perform elective outpatient cholecystectomy after 6 months.

C.Routine urgent endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy within 24 hours regardless of cholangitis status.

D.Lifelong oral ursodeoxycholic acid therapy avoiding any surgical intervention.

Explanation: In mild acute biliary pancreatitis, guidelines (IAP/APA and Brazilian College of Digestive Surgery - CBCD) recommend performing laparoscopic cholecystectomy during the same index hospital admission once the pancreatitis has clinically resolved. Delaying cholecystectomy beyond the index admission results in a high rate (20–30%) of recurrent biliary events (pancreatitis, cholecystitis, or cholangitis) within 30 to 60 days.

6A 68-year-old diabetic male is admitted with a 3-day history of right upper quadrant pain, high fever with shaking chills (39.2°C), and marked scleral icterus (total bilirubin 6.8 mg/dL, direct bilirubin 5.4 mg/dL). On physical examination, he is somnolent, disoriented, with blood pressure of 82/50 mmHg and heart rate of 124 bpm. Abdominal ultrasound shows common bile duct dilatation (14 mm) with an impacted calculus at the distal choledochus. What clinical syndrome does this patient present, and what is the definitive immediate therapeutic priority?

A.Acute alcalculous cholecystitis; requires immediate emergency bedside percutaneous cholecystostomy.

B.Acute suppurative cholangitis presenting with Reynolds' pentad; requires fluid resuscitation, broad-spectrum IV antibiotics, and urgent biliary decompression via ERCP.

C.Mirizzi syndrome type I; requires open subtotal cholecystectomy without common bile duct exploration.

D.Primary sclerosing cholangitis; requires high-dose IV corticosteroids and elective magnetic resonance cholangiography.

Explanation: The patient exhibits Reynolds' pentad: Charcot's triad (RUQ pain, fever/chills, jaundice) plus hypotension/shock and altered mental status. This represents acute suppurative (severe/toxic) cholangitis (Tokyo Guidelines Grade III). Immediate management requires aggressive crystalloid resuscitation, broad-spectrum IV antibiotics covering enteric pathogens, and urgent emergency biliary tract decompression, usually via Endoscopic Retrograde Cholangiopancreatography (ERCP) with stone extraction/stenting.

7A 60-year-old woman with a history of open hysterectomy 5 years ago presents with a 2-day history of diffuse cramping abdominal pain, obstipation, inability to pass flatus, and bilious vomiting. Abdominal examination reveals abdominal distension, surgical scar on the midline, high-pitched metallic bowel sounds with rushes, and no signs of localized peritonitis. Plain abdominal radiography shows multiple air-fluid levels in a step-ladder pattern centrally and absence of gas in the colon and rectum. What is the most likely diagnosis and the most frequent underlying etiology?

A.Colonic pseudo-obstruction (Ogilvie syndrome) caused by autonomic dysfunction.

B.Sigmoid volvulus caused by redundant sigmoid colon elongation.

C.Mechanical small bowel obstruction caused by postoperative intra-abdominal adhesions (bridles).

D.Paralytic ileus caused by hypokalemia and metabolic alkalosis.

Explanation: Postoperative peritoneal adhesions (bridas/aderências) are the most common cause of mechanical small bowel obstruction in adults with prior abdominal surgery (>60–70% of cases). The clinical triad of colicky pain, vomiting, obstipation, alongside metallic bowel sounds and central step-ladder air-fluid levels on X-ray with collapsed large bowel, is pathognomonic for mechanical small bowel obstruction.

8A 70-year-old male presents to the emergency department with acute severe left lower quadrant abdominal pain, high fever (38.8°C), and marked localized peritoneal signs (Blumberg sign positive in the left iliac fossa). Contrast-enhanced abdominal CT confirms acute diverticulitis of the sigmoid colon with a large 5.5 cm pelvic abscess and free gas bubbles adjacent to the inflamed colonic wall, but no generalized feculent peritonitis (Hinchey Stage II). The patient is hemodynamically stable. What is the most appropriate initial management?

A.Hospitalization, broad-spectrum IV antibiotics, and image-guided percutaneous drainage of the pelvic abscess.

B.Diagnostic colonoscopy with balloon dilatation of the inflamed diverticular segment.

C.Discharge home on oral ciprofloxacin and outpatient clear liquid diet.

D.Immediate emergency Hartmann's procedure (sigmoidectomy with end colostomy).

Explanation: Under the modified Hinchey classification, Hinchey II diverticulitis consists of complicated diverticulitis with a distant retroperitoneal or pelvic abscess (>3–4 cm). In a hemodynamically stable patient, the gold standard initial therapy is hospital admission, IV broad-spectrum antibiotics, and ultrasound- or CT-guided percutaneous catheter drainage of the abscess. This frequently resolves the acute sepsis and permits elective single-stage resection with primary anastomosis later.

9During a physical examination of a 55-year-old male with a right groin bulge, the physician occludes the deep inguinal ring with a fingertip. When the patient is asked to perform a Valsalva maneuver, the bulging mass protrudes directly forward against the examiner's finger pad through Hesselbach's triangle, medial to the inferior epigastric vessels. According to the Nyhus classification, how is this hernia classified, and what is the standard open tension-free surgical repair?

A.Direct inguinal hernia (Nyhus Type IIIa); Lichtenstein tension-free mesh hernioplasty.

B.Indirect inguinal hernia (Nyhus Type II); Bassini tissue approximation repair.

C.Femoral hernia (Nyhus Type IIIc); McVay cooper ligament repair.

D.Recurrent indirect hernia (Nyhus Type IVb); Shouldice anatomical repair.

Explanation: A direct inguinal hernia arises medial to the inferior epigastric vessels through the floor of Hesselbach's triangle (transversalis fascia weakness), presenting as a bulge felt against the examiner's finger pad on forward protrusion (Nyhus Type IIIa). The global gold standard open repair is the Lichtenstein tension-free hernioplasty using a flat synthetic polypropylene mesh to reinforce the inguinal floor without tissue tension.

10A 58-year-old man with a history of daily NSAID use for osteoarthritis presents with hematemesis and melena. Emergency upper endoscopy reveals a 2.0 cm duodenal bulb ulcer with a visible non-bleeding protuberant vessel in the ulcer base (Forrest Classification IIa). What is the appropriate endoscopic and pharmacological management for this lesion?

A.Monotherapy with epinephrine injection alone without thermal coagulation or clips, followed by oral antacids.

B.Dual-modality endoscopic hemostasis (e.g., epinephrine injection combined with thermal coagulation or hemoclips) followed by continuous high-dose IV proton pump inhibitor (PPI) therapy.

C.Immediate referral for emergent total gastrectomy with Roux-en-Y reconstruction without endoscopic intervention.

D.Endoscopic observation only because the ulcer is not actively spurting blood at the moment of inspection.

Explanation: Forrest IIa lesions (non-bleeding visible vessel) carry a high rebleeding risk (~50% if untreated). Guidelines mandate dual-modality endoscopic hemostasis (epinephrine injection combined with thermal coagulation, electrocautery, or mechanical hemoclips) along with high-dose intravenous PPI therapy (e.g., omeprazole 80 mg IV bolus followed by 8 mg/h infusion for 72 hours) to maintain gastric pH >6 and stabilize the fibrin clot.

About the ENARE Exam

The Exame Nacional de Residências (ENARE) is Brazil's unified national selection for Programas de Residência Médica and for Residência Multiprofissional e em Área Profissional da Saúde, run by HU Brasil — the rebranded Empresa Brasileira de Serviços Hospitalares (Ebserh) — under the Ministério da Educação. The 2026 edition is the seventh; the previous edition drew more than 138,000 registrations for over 12,000 places across 225 institutions. Since the 2026/2027 cycle the objective paper for direct-access medical residency is the Exame Nacional de Avaliação da Formação Médica (Enamed), applied by the Inep: 100 multiple-choice questions with four alternatives over five hours, built from the Banco Nacional de Itens da Educação Superior on the Matriz de Referência Comum instituted by Portaria Inep nº 478/2025, and scored on an Item Response Theory proficiency scale where 60.0 points marks the Nível Proficiente. Papers for Pré-requisito, Ano Adicional, Área de Atuação and the Multiprofissional/Uniprofissional programmes are applied by FGV Conhecimento. The official examination is written and sat in Portuguese in Brazil; this bank is an English-language multiple-choice study adaptation of the knowledge and clinical judgement the matrix describes, not an official translation or a format simulation.

Assessment

A single objective stage worth 100% of the final score. For Acesso Direto that stage is the Enamed, applied by the Inep on 13 September 2026 from 13h30 to 18h30 (Brasília), with items drawn from the Banco Nacional de Itens da Educação Superior and scored by Item Response Theory. Candidates register separately for the Enamed at the Inep and for the ENARE at FGV, then choose programmes and institutions in the ENARE system.

Time Limit

5 hours

Passing Score

No fixed admission cut score — placement is rank-based (classificatório). Acesso Direto requires the Nível Proficiente on the Enamed (60.0 or more on the Inep TRI scale); the FGV Pré-requisito and Multi/Uniprofissional papers require at least 50% correct.

Exam Fee

R$ 330,00 (Residência Médica — Acesso Direto and Pré-requisito); R$ 220,00 (Multiprofissional/Uniprofissional) (HU Brasil (Ebserh) / MEC, with the Enamed objective paper applied by the Inep and the remaining papers by FGV Conhecimento)

ENARE Exam Content Outline

Not published

Clínica Médica

Cardiology (acute coronary syndromes, heart failure GDMT, arrhythmias, hypertension), pulmonology (community-acquired pneumonia, COPD exacerbation, asthma), nephrology and fluid balance (KDIGO AKI, anion gap acidosis, hyperkalaemia), endocrinology (type 2 diabetes, DKA, thyroid disease), stroke, sepsis, cirrhosis complications and infectious disease (HIV, tuberculosis, arboviruses).

Not published

Cirurgia Geral

Trauma airway and thoracic emergencies, damage-control resuscitation, acute abdomen syndromes, appendicitis, biliary disease and cholangitis, pancreatitis, hernias, bowel obstruction, gastrointestinal bleeding, burns, mesenteric ischaemia and surgical infection.

Not published

Ginecologia e Obstetrícia

Prenatal care, pre-eclampsia and magnesium sulphate protocols, gestational diabetes, ectopic pregnancy, third-trimester bleeding, labour mechanics and the partograph, postpartum haemorrhage, PALM-COEIN abnormal uterine bleeding, contraception eligibility, the 2025 DNA-HPV cervical screening guideline and BI-RADS breast assessment.

Not published

Pediatria

Neonatal resuscitation and jaundice, congenital infection, WHO growth curves, developmental milestones, iron supplementation, the 2026 PNI immunisation schedule, gastroenteritis hydration plans, bronchiolitis, pneumonia, asthma, croup, the childhood exanthems and recognition of non-accidental injury.

Not published

Medicina da Família e Comunidade

Starfield's essential primary care attributes as adopted by the PNAB, the composition and territory of the Family Health team, the person-centred clinical method, genogram and ecomap, levels of prevention including quaternary prevention, and occupational health duties.

Not published

Saúde Mental

Diagnosis and first-line treatment of moderate depression in primary care, alcohol withdrawal and delirium tremens including thiamine sequencing, structured suicide risk assessment and safety planning, and the classification and legal duties of psychiatric admission under Lei nº 10.216/2001.

Not published

Saúde Coletiva

SUS doctrinal and organisational principles, Lei nº 8.080/1990 and Lei nº 8.142/1990, Decreto nº 7.508/2011, LC nº 141/2012 financing minimums, epidemiological study designs, relative and attributable risk, sensitivity and specificity, outbreak curves, health indicators, compulsory notification and the CFM Code of Medical Ethics.

How to Pass the ENARE Exam

What You Need to Know

Passing score: No fixed admission cut score — placement is rank-based (classificatório). Acesso Direto requires the Nível Proficiente on the Enamed (60.0 or more on the Inep TRI scale); the FGV Pré-requisito and Multi/Uniprofissional papers require at least 50% correct.
Assessment: A single objective stage worth 100% of the final score. For Acesso Direto that stage is the Enamed, applied by the Inep on 13 September 2026 from 13h30 to 18h30 (Brasília), with items drawn from the Banco Nacional de Itens da Educação Superior and scored by Item Response Theory. Candidates register separately for the Enamed at the Inep and for the ENARE at FGV, then choose programmes and institutions in the ENARE system.
Time limit: 5 hours
Exam fee: R$ 330,00 (Residência Médica — Acesso Direto and Pré-requisito); R$ 220,00 (Multiprofissional/Uniprofissional)

Keys to Passing

Work through all 104 available questions
Review every answer and explanation
Track weak areas and revisit them
Use our AI tutor for tough concepts

ENARE Study Tips from Top Performers

1Register for both exams if you want a direct-access place: the Enamed at the Inep and the ENARE at FGV are separate registrations with separate deadlines, and missing either one removes you from the selection.

2Respect the bibliographic cut-off. The 2026 Enamed limits normative and bibliographic updates to 3 July 2026, so study the guideline versions in force by that date — including the 2025 DNA-HPV cervical screening guideline and the 2026 national immunisation schedule.

3Do not assume equal weighting. The Inep publishes no percentage split across the seven matrix areas, so build coverage across all of them rather than over-investing in the four classic clinical blocks.

4Master the SUS legal framework: Lei nº 8.080/1990 and Lei nº 8.142/1990, Decreto nº 7.508/2011, LC nº 141/2012 financing minimums and the PNAB are high-yield and recur every year.

5Practise the quantitative items. Relative and attributable risk, sensitivity, specificity, predictive values and number needed to treat are routinely examined and are quick marks once the 2x2 table is second nature.

Frequently Asked Questions

What is the ENARE and how does the national selection work?

The ENARE (Exame Nacional de Residências) is Brazil's unified national selection for medical residency and for multiprofessional and health-professional residency, run by HU Brasil — the rebranded Ebserh — under the Ministério da Educação, with FGV Conhecimento operating the process. Candidates sit one objective paper, then choose programmes and institutions inside the ENARE system, where places are allocated by rank.

Does FGV still write the direct-access medical paper?

No. Since the 2026/2027 cycle the objective paper for Residência Médica de Acesso Direto is the Enamed, written and applied by the Inep. FGV continues to apply the papers for Pré-requisito, Ano Adicional, Área de Atuação and for the Multiprofissional and Uniprofissional programmes. Direct-access candidates must register for both the Enamed at the Inep and the ENARE at FGV.

How is the Enamed paper structured and scored?

Inep Edital nº 71/2026 specifies 100 multiple-choice questions with four alternatives and a single correct answer, applied over five hours on 13 September 2026. Items come from the Banco Nacional de Itens da Educação Superior and are scored on an Item Response Theory proficiency scale. A score of 60.0 or more is the Nível Proficiente, and the result is valid for three years.

What content does the exam cover?

The Enamed is built on the Matriz de Referência Comum instituted by Portaria Inep nº 478/2025, which covers seven areas of medical formation: Clínica Médica, Cirurgia Geral, Ginecologia e Obstetrícia, Pediatria, Medicina da Família e Comunidade, Saúde Mental and Saúde Coletiva. The Inep does not publish percentage weightings for these areas, so plan coverage across all seven. For the 2026 edition the normative and bibliographic cut-off date is 3 July 2026.

How much does it cost to apply?

The ENARE 2026/2027 fee is R$ 330,00 for Residência Médica, covering both Acesso Direto and Pré-requisito, and R$ 220,00 for the Multiprofissional and Uniprofissional programmes. Registration for the Enamed itself is free at the Inep; the fee is charged under the ENARE edital, and fee waivers can be requested within the period set in the edital.

Is there a passing score?

There is no fixed cut score that guarantees a place: allocation is rank-based (classificatório) and the effective cut varies by programme and institution each year. For Acesso Direto the candidate must reach the Nível Proficiente on the Enamed (60.0 or more on the Inep scale). The FGV papers for Pré-requisito and for Multi/Uniprofissional programmes require at least 50% correct answers to remain eligible.

Is this practice bank an official simulation or an English study adaptation?

It is an English-language multiple-choice study adaptation. The official examination is written and sat in Portuguese in Brazil, and the official Enamed paper uses four alternatives while the FGV papers use five. This bank teaches the clinical reasoning, protocols and Brazilian public health framework the official reference matrix describes; it is not an official translation, an item replica or a format simulation.