100+ Free ECOM-CR Medical Licensure Practice Questions
Prepare for the ECOM-CR — Examen de Conocimientos Médicos de Costa Rica (Costa Rica) exam with instant access — no signup required.
Loading practice questions...
Key Facts: ECOM-CR Medical Licensure Exam
140 cases
Total clinical case scenarios evaluated on the official electronic ECOM-CR exam
Colegio de Médicos y Cirujanos de Costa Rica — Decreto Ejecutivo 43769-S
70% / 70%
Article 23 pass rule: 70% or more of cases correct in 70% or more of the subareas evaluated that convocatoria
Reglamento del ECOM-CR, Artículo 23 — Procedimiento para Postulantes del ECOM-CR
50% weight
Proportion of exam cases devoted to Internal Medicine across 10 clinical subareas
Tabla de Especificaciones ECOM-CR — Colegio de Médicos
3 options
Answer choices per clinical case on the official exam: one correct key and two distractors, labelled A, B and C
Procedimiento para Postulantes del ECOM-CR — Colegio de Médicos y Cirujanos
5 hours
Total duration of the digital tablet-based exam session
Colegio de Médicos y Cirujanos de Costa Rica
August 2023
Date of the first mandatory official administration of the ECOM-CR in Costa Rica
Acta Médica Costarricense (SciELO 2024)
Decreto 43769-S
Executive Decree establishing and regulating the ECOM-CR licensure exam
La Gaceta N° 217 — Procuraduría General de la República
Biannual
Frequency of official ECOM-CR convocatorias conducted each year
Colegio de Médicos y Cirujanos de Costa Rica
Costa Rica's ECOM-CR is the mandatory 140-case computer-based medical licensure examination administered by the Colegio de Médicos y Cirujanos under Decreto Ejecutivo 43769-S. It runs 5 hours, is held twice a year in San José, and is passed by scoring at least 70% of cases correct in 70% or more of the evaluated subareas across 7 core areas. This 100-question English-language MCQ study adaptation provides case-based practice weighted to the official blueprint; it is a study aid, not a simulation of the Spanish three-option official exam.
Sample ECOM-CR Medical Licensure Practice Questions
Try these sample questions to test your ECOM-CR Medical Licensure exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 52-year-old male with newly diagnosed essential hypertension presents to his local primary health clinic (EBAIS) in San José. His blood pressure across three consecutive visits averages 152/94 mmHg. He has no history of diabetes, chronic kidney disease, or coronary artery disease, and baseline serum creatinine is 0.9 mg/dL with normal electrolytes. According to standard clinical practice guidelines, which of the following is the most appropriate first-line pharmacological monotherapy?
2A 61-year-old man arrives at the emergency department of a regional hospital with severe, retrosternal squeezing chest pain of 90 minutes' duration radiating to his left shoulder and jaw. An urgent 12-lead ECG demonstrates 3 mm ST-segment elevation in leads V1 through V4 with reciprocal ST depressions in leads II, III, and aVF. The hospital lacks a cardiac catheterization laboratory, and the expected transfer time to a percutaneous coronary intervention (PCI) center is 150 minutes. What is the most appropriate immediate reperfusion strategy?
3A 68-year-old woman with a history of prior myocardial infarction presents for follow-up of chronic heart failure. Transthoracic echocardiography reveals a left ventricular ejection fraction of 32%. She currently takes enalapril 10 mg twice daily and carvedilol 25 mg twice daily, and reports mild dyspnea with moderate exertion (NYHA Class II). Her blood pressure is 118/74 mmHg, heart rate is 68 bpm, serum potassium is 4.3 mEq/L, and estimated GFR is 62 mL/min/1.73 m². Which medication should be added to her regimen to reduce mortality?
4A 72-year-old female presents to the outpatient clinic with occasional palpitations. An ECG shows irregular narrow-complex tachycardia without distinct P waves, confirming non-valvular atrial fibrillation with a ventricular rate of 88 bpm. Her medical history includes well-controlled hypertension and type 2 diabetes mellitus; she has no history of stroke, thromboembolism, or vascular disease. According to the CHA2DS2-VASc score, what is her stroke risk score and what is the recommended thromboprophylaxis?
5A 45-year-old man with a prosthetic mechanical aortic valve develops a low-grade fever, anorexia, and night sweats over the past four weeks. Physical examination reveals a new regurgitant heart murmur and subungual splinter hemorrhages. Three separate sets of blood cultures drawn 12 hours apart grow Enterococcus faecalis. Transesophageal echocardiography (TEE) reveals an oscillating 8 mm intracardiac mass on the prosthetic valve ring. Which of the following modified Duke criteria classifications is fulfilled, and what is the definitive initial antimicrobial therapy?
6A 24-year-old woman presents with intensely pruritic, dry, erythematous patches with excoriations on both antecubital and popliteal fossae. She has a personal history of allergic rhinitis and asthma. Which of the following is the most appropriate initial pharmacological treatment for an acute exacerbation of this condition, alongside emollients?
7A 32-year-old agricultural laborer presents with severe nocturnal generalized pruritus that has worsened over the past three weeks. Two family members in the same household have developed similar symptoms. Physical examination demonstrates small erythematous papules, excoriations, and linear serpiginous burrows in the web spaces of the fingers, flexor wrists, and periumbilical area. What is the diagnosis and recommended treatment?
8A 54-year-old fair-skinned man presents with a pigmented cutaneous lesion on his upper back. Dermatoscopic evaluation reveals asymmetry, border irregularity, color variegation (shades of dark brown, black, and blue), and a diameter of 8 mm. An excisional biopsy is performed. Histopathology confirms cutaneous malignant melanoma. Which histopathological parameter is the single most important determinant for staging, surgical margin determination, and prognosis in primary non-metastatic melanoma?
9A 38-year-old man presents with well-demarcated, erythematous plaques covered by thick, silvery-white scales located symmetrically over his extensor elbows, knees, and presacral region. Auspitz sign is positive upon gentle scraping of a scale. Several fingernails show pitting and distal onycholysis. Which of the following systemic treatments is contraindicated as monotherapy for this condition due to the risk of triggering life-threatening generalized pustular psoriasis upon withdrawal?
10A 62-year-old woman is admitted with widespread flaccid blisters and painful denuded erosions on her trunk, scalp, and oral mucosa. Gentle lateral tangential pressure on normal-appearing perilesional epidermis induces dislodgement and epidermal detachment (positive Nikolsky sign). Direct immunofluorescence of a perilesional skin biopsy demonstrates intraepidermal intercellular IgG and C3 deposition in a 'fishnet-like' or 'chicken-wire' pattern. What is the target autoantigen in this condition?
About the ECOM-CR Medical Licensure Exam
The Examen de Conocimientos Médicos de Costa Rica (ECOM-CR) is the mandatory professional licensure examination required for all medical school graduates in Costa Rica seeking incorporation into the Colegio de Médicos y Cirujanos and entry into the public healthcare system (Caja Costarricense de Seguro Social - CCSS) through the Servicio Social Obligatorio. Established under Executive Decree N° 43769-S and Ley 9809, the exam rigorously assesses clinical decision-making across 140 cases in internal medicine, surgery, pediatrics, obstetrics and gynecology, family medicine, psychiatry, and bioethics. The official examination is administered in Spanish; this prep resource is an English-language MCQ study adaptation designed for international and bilingual medical trainees.
Assessment
The official examination consists of 140 clinical case vignettes (casos clínicos) delivered on the SABERMED-X platform via tablets at the Colegio de Médicos y Cirujanos headquarters in San José. Each case presents a clinical stem of at most 175 words, which may include images such as ECGs or radiographs, followed by a reactivo (question) in one of the four ECOM-CR dimensions — Prevención, Diagnóstico, Tratamiento, Seguimiento — with three answer options labelled A, B and C, of which one is the key and two are distractors. Candidates have 5 hours in total, which includes the reading of instructions and any time spent leaving the exam room. Under Article 23 of the Reglamento, a candidate passes by scoring at least 70% of the clinical cases correct in 70% or more of the subareas evaluated in that convocatoria (20 subareas in the 2024-2026 sittings).
Time Limit
5 hours (300 minutes), inclusive of instructions and any breaks taken
Passing Score
At least 70% of clinical cases correct in 70% or more of the evaluated subareas (Reglamento ECOM-CR, Article 23)
Exam Fee
Set per convocatoria by the Colegio and not published in the Procedimiento para Postulantes; confirm the current amount at the CMC Plataforma de Servicios (₡125,000 CRC for graduates at launch). Paid by BAC colones transfer or Sinpe Móvil (Colegio de Médicos y Cirujanos de Costa Rica (CMC))
ECOM-CR Medical Licensure Exam Content Outline
Medicina Interna (Internal Medicine)
Covers 10 clinical subareas: Cardiology, Dermatology, Endocrinology, Gastroenterology, Geriatrics, Hematology and Nephrology, Infectious Diseases, Pulmonology, Neurology, and Rheumatology.
Cirugía (General Surgery & Surgical Specialties)
Covers 4 clinical subareas: General Surgery & Emergencies, Orthopedics & Traumatology, Otolaryngology (ENT), and Urology & Peripheral Vascular Surgery.
Ginecología y Obstetricia (Gynecology & Obstetrics)
Covers normal antenatal surveillance, obstetric complications (preeclampsia, postpartum hemorrhage), labor management, contraception, and gynecological disorders.
Pediatría (General Pediatrics & Pediatric Emergencies)
Covers neonatal care, well-child developmental milestones, CCSS official vaccination schedule, acute respiratory infections, pediatric dehydration, and pediatric resuscitation.
Medicina Familiar y Salud Comunitaria (Family & Community Health Medicine)
Covers the primary health care model in Costa Rica (EBAIS / CCSS), preventive health, chronic non-communicable disease control, and epidemiology.
Psiquiatría (General Psychiatry & Psychiatric Emergencies)
Covers mood disorders, anxiety disorders, acute psychosis, substance abuse, psychiatric emergencies, and crisis intervention.
Investigación y Ética Médica (Research & Medical Ethics)
Covers biomedical research principles, epidemiological studies, diagnostic metrics, patient autonomy, informed consent, and the Código de Ética Médica del Colegio de Médicos.
How to Pass the ECOM-CR Medical Licensure Exam
What You Need to Know
- Passing score: At least 70% of clinical cases correct in 70% or more of the evaluated subareas (Reglamento ECOM-CR, Article 23)
- Assessment: The official examination consists of 140 clinical case vignettes (casos clínicos) delivered on the SABERMED-X platform via tablets at the Colegio de Médicos y Cirujanos headquarters in San José. Each case presents a clinical stem of at most 175 words, which may include images such as ECGs or radiographs, followed by a reactivo (question) in one of the four ECOM-CR dimensions — Prevención, Diagnóstico, Tratamiento, Seguimiento — with three answer options labelled A, B and C, of which one is the key and two are distractors. Candidates have 5 hours in total, which includes the reading of instructions and any time spent leaving the exam room. Under Article 23 of the Reglamento, a candidate passes by scoring at least 70% of the clinical cases correct in 70% or more of the subareas evaluated in that convocatoria (20 subareas in the 2024-2026 sittings).
- Time limit: 5 hours (300 minutes), inclusive of instructions and any breaks taken
- Exam fee: Set per convocatoria by the Colegio and not published in the Procedimiento para Postulantes; confirm the current amount at the CMC Plataforma de Servicios (₡125,000 CRC for graduates at launch). Paid by BAC colones transfer or Sinpe Móvil
Keys to Passing
- Work through all 100 available questions
- Review every answer and explanation
- Track weak areas and revisit them
- Use our AI tutor for tough concepts
ECOM-CR Medical Licensure Study Tips from Top Performers
Frequently Asked Questions
What is the ECOM-CR and who is required to take it in Costa Rica?
The ECOM-CR (Examen de Conocimientos Médicos de Costa Rica) is the mandatory national licensure examination for medical graduates wishing to incorporate into the Colegio de Médicos y Cirujanos de Costa Rica (CMC). Mandated by Ley Orgánica N° 3019 (as reformed by Ley N° 9809) and Executive Decree N° 43769-S, passing the ECOM-CR is legally required to practice medicine in Costa Rica and to qualify for the mandatory social service lottery (rifa del Servicio Social Obligatorio).
How many cases are on the official ECOM-CR and what score is needed to pass?
The official ECOM-CR consists of 140 clinical case scenarios (casos clínicos) administered electronically on tablets, each with three answer options. The pass criterion is set by Article 23 of the Reglamento del ECOM-CR: a candidate passes by obtaining a percentage of correct answers of 70% or more of the clinical cases in 70% or more of the total number of subareas evaluated in that convocatoria. Twenty subareas were evaluated in the 2024-2026 sittings, so this meant clearing the 70% bar in at least 14 of them. Anyone who does not meet the criterion is recorded as reprobado.
How is the official ECOM-CR structured across medical specialties?
The Procedimiento para Postulantes publishes an approximate percentage distribution of cases across 7 áreas troncales and their subareas: Medicina Interna 50% (10 subareas), Cirugía 20% (4 subareas), Ginecología y Obstetricia 10% (2 subareas), Pediatría 5%, Medicina Familiar y Salud Comunitaria 5%, Psiquiatría 5%, and Investigación y Ética Médica 5%. Applied to 140 cases that works out at roughly 70, 28 and 14 cases for the three largest areas and about 7 cases for each 5% area. Every case also maps to one of four dimensions — Prevención, Diagnóstico, Tratamiento, Seguimiento — and to one of the 18 professional actions in the ECOM-CR taxonomy.
What is the examination fee and how is it paid?
The Procedimiento para Postulantes does not print the amount: it says only that the candidate must pay the cost of the registration process and that the form and amount can be consulted at the CMC Plataforma de Servicios, because the Colegio sets it for each convocatoria. When the exam launched the CMC announced ₡125,000 CRC for university graduates and ₡175,000 CRC for already-incorporated physicians sitting voluntarily, so treat those as historical reference points rather than the current price. Payment is made by BAC colones bank transfer or Sinpe Móvil, and the applicant's full name and the exam date must appear in the payment description.
What are the eligibility prerequisites before taking the ECOM-CR?
Applicants must hold a Licenciatura in Medicine and Surgery (Medicina y Cirugía) from an authorized university in Costa Rica, or a foreign medical degree recognized and equiparated by CONARE. In addition, candidates must possess a valid Costa Rican identity document (cédula or DIMEX) and must complete and pass the mandatory Medical Ethics Course (Curso de Ética Médica) conducted by the Fiscalía del Colegio de Médicos.
What is the duration of the ECOM-CR exam session?
The examination is administered in a continuous 5-hour session (300 minutes), providing candidates with approximately 2 minutes per clinical case vignette. While candidates may take individual restroom or hydration breaks, the exam clock continues running and no extra time is granted.
In what language is the official ECOM-CR administered?
The official ECOM-CR is administered exclusively in Spanish using clinical cases written by certified Costa Rican medical educators in collaboration with UNAM (Mexico). This practice bank is an English-language MCQ study adaptation, designed to help candidates test core clinical decision-making, pharmacological treatments, and diagnostic guidelines in a standard question-bank format.
What happens if a candidate fails the ECOM-CR?
Every candidate receives an emailed report called Notificación y Análisis de Resultados within 30 calendar days, giving the Aprobado/Reprobado outcome, the number of cases answered correctly and incorrectly, the learning objective behind each case, the justification for the correct and incorrect options, and performance by área troncal, subárea and dimensión. A candidate who does not meet the Article 23 criterion may sit the exam as many times as needed at subsequent convocatorias, re-registering and paying the fee again; there is no statutory ceiling on attempts. A failed candidate may also file a Recurso de Revisión de Respuesta within 3 working days of notification and, subsequently, a Recurso de Apelación.