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Key Facts: Concorso Nazionale SSM Exam

140 questions

Number of questions on the official national SSM examination

Bando Concorso Nazionale SSM MUR

210 minutes

Official examination time limit (1.5 minutes per question)

Bando Concorso Nazionale SSM MUR

+1 / -0.25 / 0

Official scoring system: +1 correct, -0.25 wrong, 0 blank

Bando Concorso Nazionale SSM MUR

Up to 7 pts

Curriculum vitae points (degree mark and academic honors)

Bando Concorso Nazionale SSM MUR

€100

National registration fee paid during application

Bando Concorso Nazionale SSM MUR

English MCQ adaptation

Independent SSM practice by OpenExamPrep with Italian clinical terminology

OpenExamPrep

Admission to Italian medical residency contracts involves a 140-question, 210-minute national CBT test administered by MUR/CINECA with a €100 registration fee. This independent 100-question English MCQ practice bank reviews high-yield clinical medicine, surgery, diagnostics, public health, medical jurisprudence, and pediatrics/gynecology.

Sample Concorso Nazionale SSM Practice Questions

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

1A 62-year-old male arrives at the emergency department with severe substernal chest pain radiating to his left arm that started 75 minutes ago. An ECG shows 3 mm ST-segment elevation in leads V1–V4. The hospital has a 24/7 catheterization laboratory (emodinamica) with an anticipated door-to-balloon time of 45 minutes. According to the ESC guidelines for STEMI, what is the most appropriate reperfusion strategy?

A.Immediate intravenous administration of full-dose tenecteplase followed by elective coronary angiography within 48 hours

B.Immediate transfer to the catheterization laboratory for primary percutaneous coronary intervention (angioplastica primaria - PCI)

C.Continuous intravenous unfractionated heparin and nitroglycerin infusion, reassessing ECG changes after 6 hours

D.Oral dual antiplatelet therapy and sublingual nitrates alone, reserving invasive procedures only if hemodynamic shock develops

Explanation: According to the European Society of Cardiology (ESC) guidelines on ST-segment elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (angioplastica primaria - PCI) is the preferred reperfusion strategy if it can be performed within 120 minutes of STEMI diagnosis. Because a 24/7 cath lab is immediately available with a door-to-balloon time of 45 minutes, primary PCI must be performed without delay.

2A 68-year-old female with chronic heart failure and reduced ejection fraction (HFrEF, LVEF 30%, NYHA class II) is evaluated in the cardiology outpatient clinic. She is currently asymptomatic on low-dose furosemide alone. According to current ESC heart failure guidelines, which combination of drug classes constitutes the foundational four-pillar guideline-directed medical therapy (GDMT) that reduces mortality?

A.ARNI (or ACE inhibitor), Beta-blocker (bisoprolol, carvedilol, or metoprolol succinate), Mineralocorticoid receptor antagonist (spironolactone/eplerenone), and SGLT2 inhibitor (dapagliflozin/empagliflozin)

B.Loop diuretic, Digoxin, Calcium channel blocker (amlodipine), and long-acting oral nitrate

C.Direct oral anticoagulant (DOAC), Statin, Aspirin, and Thiazide diuretic

D.Alpha-1 receptor blocker (doxazosin), Ivabradine, Hydralazine, and Verapamil

Explanation: ESC guidelines establish four foundational pharmacotherapies for heart failure with reduced ejection fraction (HFrEF) with a Class I, Level A recommendation to reduce all-cause and cardiovascular mortality: (1) an ARNI (sacubitril/valsartan) or ACE inhibitor, (2) an evidence-based beta-blocker (bisoprolol, carvedilol, or metoprolol succinate), (3) a mineralocorticoid receptor antagonist (MRA: spironolactone or eplerenone), and (4) an SGLT2 inhibitor (dapagliflozin or empagliflozin).

3A 73-year-old male with a history of arterial hypertension and type 2 diabetes mellitus presents with palpitations and is diagnosed with new-onset non-valvular atrial fibrillation (fibrillazione atriale). His echocardiogram shows normal valves and an ejection fraction of 55%. What is his CHA2DS2-VASc score and what is the recommended stroke prevention strategy?

A.Score = 1; oral anticoagulation is not recommended and aspirin 100 mg daily should be initiated

B.Score = 2; lifelong antiplatelet monotherapy with clopidogrel is preferred over systemic anticoagulation

C.Score = 3; oral anticoagulation with a direct oral anticoagulant (DOAC) is strongly indicated

D.Score = 4; surgical left atrial appendage occlusion is mandatory as first-line therapy before medical therapy

Explanation: The patient's CHA2DS2-VASc score is 3: Age 65–74 years (+1), Hypertension (+1), and Diabetes mellitus (+1). In men with a CHA2DS2-VASc score >=2 (and women >=3), oral anticoagulation is strongly recommended (Class I) to prevent thromboembolic stroke. Direct oral anticoagulants (DOACs: apixaban, dabigatran, edoxaban, rivaroxaban) are preferred over vitamin K antagonists (warfarin) in non-valvular atrial fibrillation.

4A 48-year-old male with a history of bicuspid aortic valve presents with persistent low-grade fever, weight loss, night sweats, and a new regurgitant murmur over the right second intercostal space. Transesophageal echocardiography (TEE) reveals an oscillating intracardiac mass of 12 mm on the aortic valve leaflets. Blood cultures show Streptococcus viridans in 3 separate sets drawn 12 hours apart. According to the modified Duke criteria, what is the diagnostic classification for this patient?

A.Possible infective endocarditis (endocardite infettiva possibile)

B.Rejected infective endocarditis because fever duration is under 6 months

C.Non-bacterial thrombotic endocarditis (marantic endocarditis)

D.Definite infective endocarditis (endocardite infettiva certa)

Explanation: According to the modified Duke criteria, definite infective endocarditis is established by meeting either: 2 major criteria, 1 major and 3 minor criteria, or 5 minor criteria. Here, the patient exhibits two major criteria: (1) positive blood cultures with typical microorganisms (Streptococcus viridans in separate blood cultures drawn at appropriate intervals), and (2) positive echocardiographic evidence of endocardial involvement (oscillating intracardiac vegetation on the aortic valve). This fulfills the criteria for definite infective endocarditis.

5A 70-year-old male with severe chronic obstructive pulmonary disease (BPCO) is admitted with an acute exacerbation. Arterial blood gas (EGA) analysis on room air reveals: pH 7.28, PaCO2 62 mmHg, PaO2 50 mmHg, HCO3- 30 mEq/L, and SaO2 84%. He is dyspneic, tachypneic (respiratory rate 28 breaths/min), and using accessory respiratory muscles, but remains alert and cooperative. What is the most appropriate next step in respiratory management?

A.Initiate non-invasive positive pressure ventilation (NIV / BiPAP) with controlled oxygen therapy targeting SaO2 88–92%

B.Immediate endotracheal intubation and invasive mechanical ventilation

C.High-flow 100% oxygen via non-rebreather mask targeting SaO2 99–100%

D.Intravenous aminophylline infusion and observation without mechanical ventilatory support

Explanation: Non-invasive positive pressure ventilation (NIV, typically BiPAP) is the gold standard intervention for acute hypercapnic respiratory failure during COPD exacerbations with respiratory acidosis (pH 7.25–7.35 and PaCO2 >45 mmHg). It reduces the need for endotracheal intubation, hospital length of stay, and mortality. Oxygen should be titrated carefully to target an oxygen saturation of 88–92% to prevent worsening hypercapnia from ventilation-perfusion mismatch and abolition of hypoxic drive.

6A 66-year-old female presents to her general practitioner with fever (38.8°C), productive cough with purulent sputum, and right pleuritic chest pain. Chest auscultation reveals crackles and bronchial breath sounds at the right lung base. Blood pressure is 115/70 mmHg, respiratory rate is 22 breaths/min, blood urea nitrogen (BUN) is 14 mg/dL (urea 30 mg/dL), and she is fully oriented. What is her CURB-65 score and recommended initial site of care?

A.CURB-65 score = 2; mandatory admission to the intensive care unit (terapia intensiva)

B.CURB-65 score = 3; inpatient hospital admission with combined intravenous therapy

C.CURB-65 score = 1; outpatient management (trattamento a domicilio) with oral amoxicillin-clavulanate or a macrolide

D.CURB-65 score = 0; no antibiotic therapy is required because viral bronchitis is most likely

Explanation: The CURB-65 criteria score 1 point each for: Confusion (0), Urea >7 mmol/L / BUN >19 mg/dL (0), Respiratory rate >=30/min (0), Blood pressure systolic <90 or diastolic <=60 mmHg (0), and Age >=65 years (+1). The patient's score is 1 (only for age >=65). A CURB-65 score of 0 to 1 indicates low mortality risk (0.7–2.1%) suitable for outpatient management (trattamento domiciliare) with standard oral antibiotic therapy (e.g., amoxicillin or amoxicillin-clavulanic acid +/- a macrolide).

7A 55-year-old woman with a known proximal deep-vein thrombosis develops sudden-onset dyspnea, pleuritic chest pain, and presyncope. In the emergency department, her blood pressure is 75/45 mmHg, heart rate is 125 beats/min, and oxygen saturation is 86% on ambient air. Bedside echocardiography demonstrates acute right ventricular dilation with hypokinesia and interventricular septal flattening. There are no contraindications to anticoagulation or fibrinolysis. What is the immediate treatment of choice?

A.Subcutaneous low-molecular-weight heparin at standard prophylactic dose and observation

B.Systemic intravenous thrombolytic therapy (fibrinolisi sistemica, e.g., alteplase 100 mg over 2 hours) combined with unfractionated heparin

C.Emergency pulmonary surgical embolectomy without any initial medical therapy

D.Immediate insertion of an inferior vena cava filter without systemic anticoagulation

Explanation: The patient has high-risk (massive) pulmonary embolism defined by hemodynamic instability (sustained systolic BP <90 mmHg or cardiogenic shock) along with right ventricular dysfunction. According to ESC guidelines, systemic thrombolytic therapy (e.g., recombinant tissue plasminogen activator / alteplase) is the first-line reperfusion treatment for high-risk PE in the absence of absolute contraindications, accompanied by intravenous unfractionated heparin.

8According to the current Global Initiative for Asthma (GINA) guidelines, what is the preferred reliever and controller strategy for an adult patient with mild asthma presenting with symptoms fewer than two times per month and no night-time awakenings (Step 1)?

A.As-needed low-dose inhaled corticosteroid (ICS) combined with formoterol (ICS-formoterolo al bisogno)

B.Short-acting beta-2 agonist (SABA, e.g., salbutamol) monotherapy as needed without any inhaled steroid

C.Daily high-dose inhaled fluticasone plus oral montelukast

D.Continuous oral systemic prednisone 25 mg daily

Explanation: GINA guidelines no longer recommend SABA-only treatment for Step 1 asthma because regular or frequent SABA monotherapy increases the risk of severe exacerbations and asthma-related death. The preferred Track 1 reliever across all asthma severity steps (including Steps 1 and 2) is as-needed low-dose inhaled corticosteroid (ICS) combined with the rapid-onset long-acting beta-agonist formoterol (e.g., budesonide-formoterol), which treats airway inflammation simultaneously whenever symptoms arise.

9A 54-year-old male with decompensated HCV-related cirrhosis arrives at the emergency room with massive hematemesis and melena. Blood pressure is 85/50 mmHg, heart rate is 118 beats/min. Resuscitative intravenous fluid access is secured. While preparing for urgent upper gastrointestinal endoscopy, which pharmacological regimen should be initiated immediately according to the Baveno consensus?

A.Intravenous proton pump inhibitor bolus alone, delaying vasoactive drugs until endoscopic confirmation

B.High-dose intravenous tranexamic acid and oral propranolol

C.Intravenous recombinant activated factor VII and broad-spectrum antifungal therapy

D.A vasoactive agent (terlipressina or somatostatina) plus intravenous antibiotic prophylaxis with ceftriaxone

Explanation: According to the Baveno VII consensus on portal hypertension, in cirrhotic patients presenting with suspected variceal upper gastrointestinal bleeding, vasoactive drugs (terlipressin, somatostatin, or octreotide) must be initiated immediately upon admission before diagnostic endoscopy, as they reduce splanchnic blood flow and portal pressure. Short-term antibiotic prophylaxis (intravenous ceftriaxone 1 g/24h) is mandatory because it significantly reduces bacterial infections, early rebleeding rates, and overall mortality.

10A 45-year-old female presents with severe epigastric pain radiating to the back, nausea, and vomiting. Serum lipase is 980 U/L (normal: 10–60 U/L). Abdominal ultrasound demonstrates cholelithiasis, acoustic shadowing, and a dilated common bile duct (11 mm) with an impacted calculus. Total bilirubin is 4.2 mg/dL, and body temperature is 38.6°C with shivering. According to international guidelines, what is the most appropriate next step in management?

A.Immediate urgent exploratory laparotomy and bile duct resection

B.Urgent endoscopic retrograde cholangiopancreatography (ERCP / CPRE) with endoscopic sphincterotomy and stone extraction within 24 hours

C.Conservative management with oral ursodeoxycholic acid and deferred outpatient ultrasound

D.Administration of high-dose prophylactic carbapenems without any endoscopic or radiological intervention

Explanation: The patient has acute biliary pancreatitis complicated by acute cholangitis (fever, jaundice, and biliary obstruction). Guidelines from the International Association of Pancreatology (IAP) and American Pancreatic Association (APA) specify that urgent endoscopic retrograde cholangiopancreatography (ERCP / CPRE) within 24 hours is indicated in patients with acute biliary pancreatitis who have concomitant acute cholangitis or persistent biliary duct obstruction.

About the Concorso Nazionale SSM Exam

The Concorso Nazionale SSM is the single centralized examination determining access to all medical residency training contracts in Italy. This bank provides independent SSM practice by OpenExamPrep adapted into English while preserving authentic Italian clinical classifications, healthcare institution terms (SSN, ASL, AOU), and legal frameworks (Legge 219/2017, Legge 194/1978, TSO, referto). It is an independent educational resource not affiliated with MUR or CINECA.

Exam sponsor: Ministero dell'Università e della Ricerca (MUR) / CINECA. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

The official national test comprises 140 multiple-choice questions administered over 210 minutes (1.5 minutes per question) across university computer labs coordinated by CINECA on behalf of MUR. Items cover clinical scenarios across medical, surgical, diagnostic service, public health/forensic, and pediatric/obstetric disciplines. Scoring is strictly objective (+1.0 point per correct answer, -0.25 penalty per incorrect answer, 0 points for unanswered items) combined with up to 7 CV points based on degree grade and academic honors.

Time Limit

210 minutes

Passing Score

Ranked by national score (+1 correct, -0.25 wrong, 0 blank, plus up to 7 CV points)

Exam / Certification Fees

€100

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.

35 questions (internal practice set)

Area Medica (Clinical Medicine)

Comprehensive internal medicine scenarios: ischemic heart disease, heart failure, COPD, asthma, inflammatory bowel disease, cirrhosis, thyroid disorders, diabetes, glomerulonephritis, systemic autoimmune diseases, sepsis, antimicrobials, leukemias, and acute stroke management.

25 questions (internal practice set)

Area Chirurgica (Surgical Disciplines)

Acute abdomen differential diagnosis, appendicitis, cholecystitis, diverticulitis, bowel obstruction, ATLS trauma resuscitation, skeletal fractures, urolithiasis, prostate cancer, abdominal aortic aneurysms, and neurosurgical emergencies.

15 questions (internal practice set)

Servizi Clinici e Diagnostici (Diagnostic & Clinical Services)

Airway management, hemodynamic monitoring in rianimazione, diagnostic imaging choices (CT, MRI, ultrasound), biomarkers, blood transfusion guidelines, pharmacokinetics, drug interactions, and acute intoxications.

13 questions (internal practice set)

Sanità Pubblica e Medicina Legale (Public Health & Forensic Medicine)

SSN structure (ASL, Distretto Sanitario, LEA), epidemiological study designs, vaccination schedules, Legge 219/2017 (DAT and consent), compulsory psychiatric assessment (TSO), professional secrecy, mandatory disease notifications, and criminal reporting (referto e denuncia di reato).

12 questions (internal practice set)

Pediatria, Ostetricia e Ginecologia (Pediatrics, Obstetrics & Gynecology)

Neonatal APGAR scoring and resuscitation, pediatric exanthems, croup, bronchiolitis, preeclampsia, postpartum hemorrhage, ectopic pregnancy, Legge 194/1978 provisions, and cervical cancer screening.

Preparing for the Concorso Nazionale SSM Exam

What You Need to Know

Passing score: Ranked by national score (+1 correct, -0.25 wrong, 0 blank, plus up to 7 CV points)
Assessment: The official national test comprises 140 multiple-choice questions administered over 210 minutes (1.5 minutes per question) across university computer labs coordinated by CINECA on behalf of MUR. Items cover clinical scenarios across medical, surgical, diagnostic service, public health/forensic, and pediatric/obstetric disciplines. Scoring is strictly objective (+1.0 point per correct answer, -0.25 penalty per incorrect answer, 0 points for unanswered items) combined with up to 7 CV points based on degree grade and academic honors.
Time limit: 210 minutes
Exam / certification fees: €100 Official sources

Using Our Practice Resources

Work through all 100 available questions
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Concorso Nazionale SSM: Suggested Study Strategy

1Prioritize first-line diagnostic and therapeutic clinical guidelines (e.g., ESC cardiology guidelines, GOLD COPD recommendations, KDIGO nephrology criteria) that frequently feature in SSM case scenarios.

2Understand Italian medico-legal requirements thoroughly, including Legge 219/2017 (DAT, consensual relationship), Legge 194/1978, rules governing the medical record (cartella clinica), and the distinction between referto and denuncia di reato under the Italian penal code.

3Practice negative-marking strategy: with a -0.25 penalty per wrong answer, blind guessing lowers your expected score, whereas eliminating two or more distractors makes calculated answering mathematically favorable.

4Master high-yield pediatric milestones, neonatal resuscitation algorithms, and obstetric emergency protocols (postpartum hemorrhage, eclampsia).

5Consistently review clinical pharmacology, adverse drug reactions, drug-drug interactions involving cytochrome P450 enzymes, and empirical antibiotic therapy for community and nosocomial infections.

Frequently Asked Questions

What is the Concorso Nazionale SSM?

The Concorso SSM is the annual national competitive examination organized by the Italian Ministry of University and Research (MUR) and CINECA that determines the assignment of postgraduate medical residency contracts (contratti di formazione specialistica medica) across all Italian university medical faculties.

How is the official SSM examination scored?

The test consists of 140 multiple-choice questions in 210 minutes. Each correct answer awards +1.0 point, each incorrect answer incurs a penalty of -0.25 points, and blank/omitted answers award 0 points (maximum test score: 140). Candidates can also earn up to 7 academic curriculum points (titoli accademici, including graduation grade and honors), for a theoretical maximum overall score of 147 points.

Who is eligible to participate in the SSM examination?

Graduates holding an Italian single-cycle Master's degree in Medicine and Surgery (Laurea Magistrale in Medicina e Chirurgia LM-41) or a recognized equivalent foreign medical degree, who are fully licensed to practice medicine in Italy (abilitati all'esercizio della professione) or enrolled with a provincial Ordine dei Medici Chirurghi e degli Odontoiatri (OMCeO).

How does residency specialty choice work after the exam?

Once the national merit ranking (graduatoria nazionale di merito) is published by MUR/CINECA, candidates choose their preferred specialties and university locations in real-time online choice phases based strictly on their ranking position.

Does this question bank replicate official SSM exam papers?

No. This question bank provides independent SSM practice by OpenExamPrep adapted into English. It is designed to reinforce clinical decision-making, pharmacological management, diagnostic workups, and Italian medical-legal statutory frameworks. It is an independent study tool not affiliated with or endorsed by MUR or CINECA.