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Exam Review

Key Facts: Israel Medical Licensing Exam Exam

210

Exam Questions

Israel Medical Association — exam structure

Pass Mark (55-59 May Appeal)

Israel Medical Association — scores and appeals

658 ILS

Exam Fee

Israel Medical Association exam registration page (MOH fee)

Sittings per Year

MOH Licensing Examination Calendar

1 Year

Mandatory Internship (סטאז')

Physicians Ordinance [New Version], 5737-1976

100

Practice Questions

OpenExamPrep Practice Bank

The Israel Government Medical Licensing Examination (בחינת הרישוי הממשלתית ברפואה) tests internal medicine (60 questions), surgery (50), pediatrics (50), obstetrics & gynecology (30) and psychiatry (20). The 210-question computerized paper is sat in two 2.5-hour parts on one day, twice a year, for a 658 ILS fee, and the pass mark is 60. This 100-question set is independent English-language practice by OpenExamPrep, weighted to the same five subjects.

Sample Israel Medical Licensing Exam Practice Questions

Try these sample questions to review concepts for the Israel Medical Licensing Exam exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 58-year-old man presents to the emergency department with severe, crushing substernal chest pain of 45 minutes' duration radiating to his left jaw and diaphoresis. His ECG demonstrates 3 mm ST-segment elevation in leads V1–V4 with reciprocal depressions in leads II, III, and aVF. The hospital has a 24/7 cardiac catheterization laboratory. What is the most appropriate next step in management?

A.Immediate activation of the catheterization laboratory for primary percutaneous coronary intervention (PCI) within 90 minutes of first medical contact.

B.Administration of intravenous alteplase (tPA) followed by transfer to the coronary care unit.

C.Serial troponin measurements every 3 hours before considering invasive angiography.

D.Urgent CT angiography of the chest to rule out aortic dissection prior to antiplatelet administration.

Explanation: This patient presents with an acute anterior ST-elevation myocardial infarction (STEMI). According to international and Israeli cardiology guidelines, immediate primary percutaneous coronary intervention (PCI) is the gold standard reperfusion therapy when available, with a target first medical contact-to-device time of under 90 minutes (or under 120 minutes if transferred). Fibrinolytic therapy is reserved only for situations where primary PCI cannot be delivered within 120 minutes.

2A 64-year-old woman with ischemic cardiomyopathy and a left ventricular ejection fraction (LVEF) of 28% remains symptomatic (NYHA functional class II) despite receiving target-dose enalapril and carvedilol. Her serum potassium is 4.3 mEq/L, eGFR is 58 mL/min/1.73m², and blood pressure is 122/76 mmHg. Which therapeutic modification offers the greatest proven mortality reduction and is recommended as next-line guideline-directed medical therapy (GDMT)?

A.Add oral digoxin and increase the carvedilol dose beyond maximum recommended guidelines.

B.Switch enalapril to sacubitril-valsartan (ARNI) after a 36-hour washout period, and initiate an SGLT2 inhibitor and mineralocorticoid receptor antagonist (spironolactone).

C.Discontinue carvedilol and substitute with verapamil for better heart rate control.

D.Initiate long-term oral anticoagulation with warfarin targeting an INR of 2.5–3.5.

Explanation: Four foundational drug classes (the 'four pillars' of GDMT for HFrEF) significantly decrease all-cause mortality: an ARNI (sacubitril-valsartan, requiring a 36-hour ACE inhibitor washout to prevent angioedema), an evidence-based beta-blocker (carvedilol, metoprolol succinate, or bisoprolol), a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and an SGLT2 inhibitor (dapagliflozin or empagliflozin). Adding an MRA and SGLT2i while switching from ACEi to ARNI provides cumulative survival benefits.

3A 72-year-old man presents with acute palpitations, shortness of breath, and lightheadedness. His blood pressure is 78/48 mmHg, heart rate is 164 bpm and irregularly irregular, and oxygen saturation is 88% on room air. Auscultation reveals bilateral basal pulmonary crackles. The monitor displays atrial fibrillation with rapid ventricular response. What is the immediate treatment of choice?

A.Intravenous diltiazem bolus followed by a continuous infusion.

B.Oral amiodarone loading dose combined with apixaban.

C.Immediate synchronized electrical cardioversion.

D.Carotid sinus massage followed by intravenous adenosine.

Explanation: Any tachyarrhythmia (including atrial fibrillation with rapid ventricular response) associated with hemodynamic instability—defined by hypotension, acute altered mental status, signs of shock, ischemic chest pain, or acute pulmonary edema—mandates immediate synchronized electrical cardioversion. Pharmacologic rate or rhythm control takes time to act and carries vasodilatory or negative inotropic properties that worsen acute shock.

4A 34-year-old man with a history of intravenous drug use presents with persistent fever, night sweats, and lethargy for 2 weeks. Physical examination reveals a grade 3/6 holosystolic murmur at the left lower sternal border that increases with inspiration, painless erythematous macules on the palms (Janeway lesions), and retinal hemorrhages with pale centers (Roth spots). Three separate blood cultures grow methicillin-resistant Staphylococcus aureus (MRSA). Which echocardiographic finding and immediate empirical therapy are most expected?

A.Aortic valve bicuspid calcification; initiate intravenous ampicillin and ceftriaxone.

B.Mitral valve anterior leaflet perforation; initiate oral linezolid monotherapy.

C.Pulmonic valve stenosis; initiate intravenous gentamycin and rifampin.

D.Tricuspid valve mobile vegetation; initiate intravenous vancomycin.

Explanation: Intravenous drug use strongly predisposes to right-sided infective endocarditis, most commonly involving the tricuspid valve (frequently producing a holosystolic murmur increasing with inspiration, Rivero-Carvallo sign). Staphylococcus aureus is the predominant pathogen (>60-70% of cases). By the modified Duke criteria, two major criteria (typical organism isolated from blood cultures and echocardiographic evidence of endocardial involvement) establish a definitive diagnosis, requiring bactericidal therapy with intravenous vancomycin (or daptomycin) targeting MRSA.

5A 62-year-old man presents with sudden-onset, tearing substernal chest pain radiating to his back between the scapulae. His blood pressure is 194/110 mmHg in the right arm and 142/82 mmHg in the left arm. Contrast-enhanced chest CT confirms a Stanford type A aortic dissection originating in the ascending aorta and extending past the left subclavian artery. What is the definitive management?

A.Immediate emergent surgical replacement of the ascending aorta, alongside aggressive intravenous beta-blocker therapy (e.g., labetalol or esmolol) to lower blood pressure and heart rate.

B.Conservative medical therapy in the intensive care unit with nitroprusside monotherapy and outpatient vascular follow-up.

C.Catheter-directed thrombolysis of the false lumen followed by delayed elective stenting.

D.High-dose intravenous corticosteroid pulse therapy and bed rest for 14 days.

Explanation: Stanford type A aortic dissection involves the ascending aorta and represents a surgical emergency with a mortality rate increasing by 1-2% per hour if untreated. Immediate emergent surgical repair is required to prevent fatal complications including pericardial tamponade, aortic rupture, and acute severe aortic regurgitation. Initial medical stabilization requires reducing shear stress (dP/dt) using intravenous beta-blockers (e.g., labetalol or esmolol) to achieve a heart rate < 60 bpm and systolic blood pressure between 100-120 mmHg.

6A 68-year-old man with severe COPD presents with a 4-day history of increased shortness of breath, increased sputum volume, and sputum purulence (Anthonisen type 1 exacerbation). Physical examination reveals diffuse expiratory wheezing, tachypnea, and an oxygen saturation of 89% on room air. Arterial blood gas shows pH 7.34, PaCO2 50 mmHg, and PaO2 58 mmHg. In addition to controlled oxygen therapy and inhaled short-acting bronchodilators, which pharmacologic regimen is indicated?

A.Intravenous methylprednisolone for 21 days and long-term theophylline.

B.Oral systemic corticosteroid (prednisone 40 mg daily for 5 days) and an oral antibiotic (such as amoxicillin-clavulanate or azithromycin).

C.High-dose inhaled fluticasone monotherapy and empiric vancomycin.

D.Subcutaneous omalizumab and oral montelukast.

Explanation: According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, patients with all three cardinal symptoms (increased dyspnea, sputum volume, and sputum purulence—Anthonisen type 1) benefit significantly from antibiotic therapy (e.g., amoxicillin-clavulanate, macrolide, or fluoroquinolone). Concurrently, a short course of oral systemic corticosteroids (prednisone 40 mg daily for 5 days) shortens recovery time, improves FEV1, and decreases relapse risk without the morbidity of prolonged steroid courses.

7A 38-year-old woman presents with persistent dry cough, progressive exertional dyspnea, and painful, erythematous subcutaneous nodules on her pretibial shins (erythema nodosum). A chest radiograph demonstrates prominent bilateral symmetrical hilar lymphadenopathy without pulmonary parenchymal consolidation. Serum angiotensin-converting enzyme (ACE) is elevated. Transbronchial lung biopsy reveals non-caseating granulomas with negative fungal and acid-fast stains. What is the most likely diagnosis?

A.Idiopathic pulmonary fibrosis.

B.Pulmonary tuberculosis.

C.Sarcoidosis (Löfgren syndrome variant).

D.Small-cell lung carcinoma.

Explanation: The clinical triad of bilateral hilar lymphadenopathy, erythema nodosum, and polyarthralgias represents Löfgren syndrome, an acute, highly specific presentation of sarcoidosis that carries a favorable prognosis (>85% spontaneous resolution). The hallmark pathology of sarcoidosis is non-caseating (non-necrotizing) epithelioid granulomas with negative microbiological stains for mycobacteria and fungi.

8A 54-year-old woman who underwent total knee arthroplasty 6 days ago suddenly collapses in the orthopedic recovery ward. Upon arrival of the medical emergency team, she is cyanotic and obtunded. Her blood pressure is 68/40 mmHg, heart rate is 132 bpm, respiratory rate is 36 breaths/min, and oxygen saturation is 82% on a non-rebreather mask. Bedside echocardiography shows marked right ventricular dilation with McConnell sign and severe tricuspid regurgitation. There are no absolute contraindications to bleeding. What is the most appropriate immediate intervention?

A.Systemic intravenous thrombolysis (alteplase 100 mg over 2 hours) along with supportive resuscitation.

B.Subcutaneous low-molecular-weight heparin (enoxaparin 1 mg/kg twice daily) monotherapy.

C.Placement of an inferior vena cava (IVC) filter followed by observation.

D.Immediate oral therapeutic anticoagulation with dabigatran.

Explanation: Massive (high-risk) pulmonary embolism is defined by acute PE presenting with sustained hypotension (systolic BP < 90 mmHg for >15 minutes), obstructive shock, or cardiac arrest, accompanied by right ventricular strain. In the absence of absolute contraindications (such as recent intracranial hemorrhage or active bleeding), immediate intravenous systemic thrombolytic therapy (e.g., alteplase 100 mg over 2 hours) is the treatment of choice to rapidly dissolve the occlusive clot, reduce pulmonary vascular resistance, and restore systemic perfusion.

9A 71-year-old previously healthy man presents with a 3-day history of high fever, productive cough with rust-colored sputum, and right-sided pleuritic chest pain. His vitals are: temperature 38.8°C, blood pressure 86/54 mmHg, heart rate 108 bpm, respiratory rate 32 breaths/min, and oxygen saturation 91% on room air. He is disoriented to time and place. Laboratory tests reveal a blood urea nitrogen (BUN) of 28 mg/dL. Chest X-ray reveals right lower lobe consolidation. Based on the CURB-65 score, what is his calculated score and recommended disposition?

A.Score of 1; outpatient oral azithromycin.

B.Score of 2; outpatient close observation with amoxicillin.

C.Score of 3; general medical ward admission with oral fluoroquinolone monotherapy.

D.Score of 5; urgent inpatient hospital admission (with consideration of ICU admission) and empiric parenteral antibiotic therapy.

Explanation: The CURB-65 criteria assign 1 point each for: Confusion (disoriented), Urea (BUN > 19 mg/dL or > 7 mmol/L), Respiratory rate (>= 30/min), Blood pressure (systolic < 90 or diastolic <= 60 mmHg), and Age >= 65 years. This patient meets all 5 criteria: Confusion, BUN 28 mg/dL (10 mmol/L urea), Respiratory rate 32/min, Blood pressure 86/54 mmHg, and Age 71, giving a total score of 5. A score of 3–5 indicates severe community-acquired pneumonia requiring urgent hospital admission, intensive monitoring, and parenteral antibiotics (e.g., ceftriaxone plus azithromycin).

10A 52-year-old man with alcohol-related liver cirrhosis presents with hematemesis and melena. His blood pressure is 88/52 mmHg and heart rate is 118 bpm. Peripheral access is established, volume resuscitation is initiated, and packed red blood cells are ordered. Along with urgent esophagogastroduodenoscopy (EGD) within 12 hours, which pharmacologic combination is mandatory during the initial acute management phase?

A.Subcutaneous heparin and oral propranolol.

B.Intravenous vasoactive agent (terlipressin or octreotide) plus intravenous prophylactic ceftriaxone.

C.Oral lactulose and intravenous furosemide.

D.Intravenous tranexamic acid and high-dose hydrocortisone.

Explanation: In suspected or confirmed acute variceal bleeding in cirrhosis, standard management requires immediate initiation of an intravenous splanchnic vasoconstrictor (terlipressin, octreotide, or somatostatin) to lower portal venous pressures before endoscopy, along with prophylactic antibiotics (intravenous ceftriaxone 1 g/day for up to 7 days). Antibiotic prophylaxis dramatically reduces bacterial infections (spontaneous bacterial peritonitis, bacteremia), early rebleeding, and all-cause mortality.

About the Israel Medical Licensing Exam Exam

The Israel Government Medical Licensing Examination (בחינת הרישוי הממשלתית ברפואה) is the statutory qualifying examination under the Physicians Ordinance [New Version], 5737-1976 (פקודת הרופאים [נוסח חדש], התשל"ז-1976). Eligibility is approved by the Ministry of Health's Division of Medical Professions, and the examination itself is set and run by the Examinations Committee of the Israel Medical Association's Scientific Council. Passing it is mandatory for graduates of foreign medical schools who seek to enter the 1-year clinical internship (סטאז') or to obtain a licence to practise medicine (רישיון לעסוק ברפואה) in Israel. The examination covers five core clinical subjects - internal medicine, general surgery, pediatrics, obstetrics & gynecology and psychiatry - and is based on the published syllabus and mandatory textbooks for each subject. The Ministry of Health has announced an intention to add a clinical part (Part B) in future; until that is published the examination remains theoretical only. By regulation the examination is written in Hebrew, with translation into English, Arabic, Russian, French or Spanish at the examination committee's discretion. This question bank is an independent English-language MCQ study adaptation by OpenExamPrep; it is not an official translation, not the government examination pool, and not endorsed by the Ministry of Health.

Exam sponsor: Ministry of Health — Division of Medical Professions (משרד הבריאות, האגף לרישוי מקצועות רפואיים). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Computerized multiple-choice test divided into Part A and Part B, 2.5 hours each with no break between the parts, sat on one day at a central examination venue (Expo Tel Aviv). Approved candidates receive 45 minutes of extra time per part.

Time Limit

Two parts of 2.5 hours each with no break between them (5 hours of testing time; 45 extra minutes per part where approved)

Passing Score

60 (scores of 55-59 carry a right of appeal)

Exam / Certification Fees

658 ILS per sitting (Ministry of Health fee quoted by the Israel Medical Association exam registration page)

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

29%

Internal Medicine

Diagnosis, pathophysiology, and pharmacotherapy of cardiovascular diseases, respiratory disorders, gastrointestinal and hepatic conditions, acute and chronic renal failure, endocrine syndromes, hematologic and oncologic malignancies, infectious disease management, and systemic autoimmune diseases.

24%

General Surgery & Trauma

Evaluation of the acute abdomen, benign and malignant surgical disease, ATLS shock resuscitation, primary and secondary trauma surveys, vascular emergencies (AAA, acute limb ischemia), perioperative fluid balance, surgical infections, and wound healing.

24%

Pediatrics

Neonatal adaptation and pathology, growth curves and developmental milestones, infectious illnesses of childhood, pediatric asthma and bronchiolitis, emergency fluid and electrolyte deficits, genetic syndromes, and pediatric emergency medicine.

13%

Obstetrics & Gynecology

Antenatal screening protocols, management of normal and abnormal labor, hypertensive emergencies of pregnancy (preeclampsia/eclampsia), postpartum hemorrhage, pelvic masses, gynecologic oncology, cervical cytology screening, and contraceptive counseling.

10%

Psychiatry & Medical Jurisprudence

Diagnosis and pharmacotherapy of major depressive disorder, bipolar affective disorder, schizophrenia spectrum disorders, anxiety and acute stress disorders, delirium vs. dementia, substance abuse, and statutory procedures under the Treatment of Mentally Ill Persons Law (חוק טיפול בחולי נפש) and Patient Rights Act.

Preparing for the Israel Medical Licensing Exam Exam

What You Need to Know

Passing score: 60 (scores of 55-59 carry a right of appeal)
Assessment: Computerized multiple-choice test divided into Part A and Part B, 2.5 hours each with no break between the parts, sat on one day at a central examination venue (Expo Tel Aviv). Approved candidates receive 45 minutes of extra time per part.
Time limit: Two parts of 2.5 hours each with no break between them (5 hours of testing time; 45 extra minutes per part where approved)
Exam / certification fees: 658 ILS per sitting (Ministry of Health fee quoted by the Israel Medical Association exam registration page) Official sources

Using Our Practice Resources

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Israel Medical Licensing Exam: Suggested Study Strategy

1Prioritize Internal Medicine and General Surgery/Trauma, which together comprise over 50% of the total question pool.

2Master ATLS trauma algorithms: primary survey (ABCDE), immediate needle decompression vs. chest tube placement, and massive transfusion protocols.

3Memorize pediatric milestones and immunization schedules, as well as neonatal APGAR scoring and acute pediatric emergency resuscitation algorithms.

4Understand high-yield obstetric emergencies, particularly magnesium sulfate dosing for preeclampsia/eclampsia and first-line uterotonics for postpartum hemorrhage.

5Review the legal thresholds under Israeli law for involuntary psychiatric assessment and hospitalization (the District Psychiatrist's powers under the Treatment of Mentally Ill Persons Law).

Frequently Asked Questions

What is the passing score and format of the Israel Government Medical Licensing Examination?

The examination consists of 210 multiple-choice questions taken on computer in two parts on the same day, 2.5 hours per part with no break between them. The pass mark is 60, and candidates scoring 55-59 may appeal. The examination is written in Hebrew; candidates may request a translation into English, Arabic, Russian, French or Spanish at registration, which the examination committee approves at its discretion (normally when at least 8 candidates register in that language).

Who is required to take the Israeli Medical Licensing Exam?

Graduates of foreign medical schools recognized by the Ministry of Health who seek a license to practice medicine (רישיון לעסוק ברפואה) in Israel must pass the examination to be eligible for the mandatory 12-month clinical internship (סטאז') or to receive an Israeli medical license (subject to statutory exemption rules for certified board specialists or approved programs).

What is the statutory fee and schedule for the exam in 2026?

The examination fee is 658 ILS per sitting, paid on the Ministry of Health payments site before registering on the Israel Medical Association exam site. The examination runs twice a year; the published sittings are 06.10.2026 and 08.02.2027, both at Expo Tel Aviv, with document deadlines two months earlier.

What legal rights and hospitalization procedures are tested in Israeli medical exams?

Questions frequently touch upon Israeli medical jurisprudence, particularly the Patient Rights Act, 5756-1996 (informed consent, patient privacy, and emergency treatment mandates) and the Treatment of Mentally Ill Persons Law, 5751-1991 (criteria for urgent compulsory psychiatric examination by the District Psychiatrist — פסיכיאטר מחוזי — in cases of immediate psychotic danger to self or others).

Is this practice question bank an official Ministry of Health exam?

No. This practice question bank is an independent English-language adaptation created by OpenExamPrep based on the official Ministry of Health blueprint and syllabus. It is not an official translation, government exam pool, or endorsed by the Ministry of Health.

What happens after passing the Israeli Medical Licensing Examination?

Upon passing, candidates participate in the national lottery ('Hagrala') for placement into a 12-month rotating clinical internship (סטאז') in an accredited Israeli hospital. After successfully completing the internship and receiving hospital evaluations, candidates are issued a permanent license to practice medicine (רישיון קבוע) and can apply for residency positions (התמחות).