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Exam Review

Key Facts: PGIM MD Medicine Exam

130

Written questions across Papers 1 and 2

12

OSCE stations (5 min each)

40% / 50%

Paper 1 / Paper 2 minimum

Rs. 107k

Full fee (state sector)

The PGIM Selection Examination in MD Medicine has a written component of two 3-hour papers - Paper 1 Biomedical Sciences and Paper 2 General Medicine - and a practical 12-station OSCE. The written component needs a 50% aggregate with 40% in Paper 1 and 50% in Paper 2; the OSCE needs 40% in each domain A-G and 50% overall, both passed at the same sitting.

Sample PGIM MD Medicine Practice Questions

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

1A 56-year-old man presents to an emergency unit with 90 minutes of severe central crushing chest pain. The ECG shows 3-mm ST-segment elevation in leads V1–V4. A catheterization laboratory capable of primary percutaneous coronary intervention (PCI) is located 45 minutes away. What is the most appropriate reperfusion strategy according to current international guidelines?
A.Immediate transfer for primary percutaneous coronary intervention within 120 minutes of first medical contact
B.Immediate administration of intravenous fibrinolytic therapy within 30 minutes
C.Urgent coronary artery bypass grafting within 6 hours
D.Conservative management with dual antiplatelet therapy and deferred elective angiography
Explanation: Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for acute ST-elevation myocardial infarction provided the anticipated time from STEMI diagnosis to PCI wire crossing is within 120 minutes. Because the catheterization laboratory is only 45 minutes away, transfer for primary PCI can be accomplished well within this window. Fibrinolysis is indicated only when primary PCI cannot be delivered within 120 minutes.
2A 62-year-old woman presents with acute inferior ST-elevation myocardial infarction. Her blood pressure is 82/50 mmHg, heart rate is 56 bpm, and chest auscultation reveals clear lung fields bilaterally. Her jugular venous pulse is elevated to the angle of the jaw. A right-sided 12-lead ECG demonstrates 1.5-mm ST elevation in lead V4R. Which is the most appropriate initial management step to restore hemodynamics?
A.Intravenous glyceryl trinitrate infusion titrated to blood pressure
B.Intravenous volume expansion with isotonic saline boluses
C.Intravenous furosemide 40 mg bolus
D.Intravenous metoprolol 5 mg bolus
Explanation: Right ventricular myocardial infarction complicates up to one-third of inferior STEMIs and leads to right ventricular systolic dysfunction with profound preload dependence. Clear lungs, elevated jugular venous pressure, and hypotension form the classic triad. The cornerstone of initial hemodynamic stabilization is intravenous volume loading with isotonic saline to maintain RV filling and forward cardiac output.
3A 64-year-old man with ischemic cardiomyopathy and a left ventricular ejection fraction of 28% remains symptomatic in NYHA functional class II despite receiving target doses of enalapril and carvedilol. His serum potassium is 4.3 mmol/L and eGFR is 58 mL/min/1.73 m2. According to international guidelines for heart failure with reduced ejection fraction (HFrEF), which pharmacotherapeutic pair completes the four foundational pillars of mortality-reducing medical therapy?
A.Spironolactone and dapagliflozin
B.Digoxin and ivabradine
C.Furosemide and isosorbide dinitrate
D.Amlodipine and hydralazine
Explanation: Guideline-directed medical therapy (GDMT) for HFrEF is established on four foundational classes that improve survival: an ARNI/ACEi/ARB, an evidence-based beta-blocker, a mineralocorticoid receptor antagonist (MRA, e.g., spironolactone or eplerenone), and an SGLT2 inhibitor (dapagliflozin or empagliflozin). Spironolactone and dapagliflozin complete these four life-prolonging pillars. Digoxin, ivabradine, and loop diuretics reduce symptoms or hospitalizations but do not form the universal mortality-reducing foundation.
4A 70-year-old woman admitted with acute decompensated heart failure is cold, clammy, oliguric, and drowsy. Her blood pressure is 78/48 mmHg and heart rate is 108 bpm. Bedside echocardiography shows severe global left ventricular hypokinesis with an ejection fraction of 20% and no significant valvular disease. Which hemodynamic profile, measured by pulmonary artery catheterization, characterizes cardiogenic shock in this patient?
A.Reduced pulmonary capillary wedge pressure, reduced cardiac index, and reduced systemic vascular resistance
B.Reduced pulmonary capillary wedge pressure, elevated cardiac index, and reduced systemic vascular resistance
C.Elevated pulmonary capillary wedge pressure, elevated cardiac index, and elevated systemic vascular resistance
D.Elevated pulmonary capillary wedge pressure, reduced cardiac index, and elevated systemic vascular resistance
Explanation: Cardiogenic shock is characterized by severe primary pump failure resulting in a reduced cardiac index (typically < 2.2 L/min/m2) and elevated left ventricular filling pressures manifested as an elevated pulmonary capillary wedge pressure (> 15-18 mmHg). Compensatory sympathetic and neurohumoral vasoconstriction leads to an elevated systemic vascular resistance (SVR). In contrast, distributive shock exhibits low systemic vascular resistance and initially high cardiac output.
5A 32-year-old woman with a documented history of severe persistent bronchial asthma presents with sudden-onset palpitations. The ECG demonstrates a regular, narrow-complex tachycardia at 180 bpm without discernible P waves. Vagal maneuvers fail to terminate the arrhythmia. Her blood pressure is 118/74 mmHg and she is alert and comfortable. Which medication is the most appropriate next pharmacologic agent for acute termination?
A.Intravenous verapamil
B.Intravenous adenosine
C.Intravenous digoxin
D.Intravenous amiodarone
Explanation: While intravenous adenosine is the standard first-line agent for hemodynamically stable atrioventricular nodal re-entrant tachycardia (AVNRT), it is contraindicated in patients with active asthma or severe reactive airway disease because it can provoke bronchospasm and fatal bronchoconstriction via activation of mast-cell A2B and A3 adenosine receptors. Intravenous non-dihydropyridine calcium channel blockers, such as verapamil or diltiazem, are the recommended and safe alternatives in asthmatic patients. Digoxin has a delayed onset of action and is inappropriate for acute termination.
6A 28-year-old man with known Wolff-Parkinson-White (WPW) syndrome presents with acute lightheadedness and palpitations. His blood pressure is 112/70 mmHg. The ECG demonstrates an irregularly irregular, wide-complex tachycardia with fluctuating QRS morphology and ventricular rates varying between 180 and 260 bpm. Which is the most appropriate initial pharmacological therapy if electrical cardioversion is deferred?
A.Intravenous verapamil
B.Intravenous metoprolol
C.Intravenous procainamide
D.Intravenous digoxin
Explanation: This patient has pre-excited atrial fibrillation conducting over an accessory pathway (bundle of Kent) in WPW syndrome. First-line pharmacological management in a hemodynamically stable patient is intravenous procainamide (or ibutilide), which slows conduction and prolongs refractoriness in the accessory pathway and atrial myocardium without accelerating conduction down the bypass tract. AV nodal blocking drugs (verapamil, beta-blockers, digoxin, and adenosine) preferentially block the AV node, leaving the accessory pathway unopposed; this can precipitate degeneration into ventricular fibrillation.
7A 65-year-old man with a history of anterior myocardial infarction presents with presyncope. His ECG displays a regular, wide-complex tachycardia (QRS duration 160 ms) at a rate of 165 bpm. Which electrocardiographic finding provides the strongest diagnostic proof that this rhythm is ventricular tachycardia rather than supraventricular tachycardia with aberrant conduction?
A.QRS rate exceeding 150 beats per minute
B.Demonstration of atrioventricular dissociation with capture and fusion beats
C.Left bundle branch block pattern with an rS complex in lead V1
D.Identical QRS morphology to an ECG recorded during baseline sinus rhythm
Explanation: Atrioventricular (AV) dissociation, evidenced by independent P waves and QRS complexes, along with capture beats (sinus node transiently capturing the ventricles producing a normal narrow QRS) and fusion beats (Dressler beats, where sinus and ventricular impulses merge to produce an intermediate morphology), is pathognomonic for ventricular tachycardia. Aberrant SVT requires 1:1 ventricular conduction from the atria, so true AV dissociation does not occur. Other morphological criteria (such as Brugada criteria) offer probabilistic support, but AV dissociation provides definitive proof.
8A 72-year-old man is admitted with an extensive acute anterior ST-elevation myocardial infarction. On day 2, continuous telemetry shows third-degree (complete) atrioventricular block with a wide-complex ventricular escape rhythm at 34 bpm. He becomes lightheaded, and his blood pressure falls to 80/50 mmHg. What is the most appropriate definitive immediate management?
A.Urgent placement of a temporary transvenous pacing wire
B.Repeated doses of intravenous atropine 0.5 mg up to 3 mg
C.Watchful waiting with continuous telemetry for spontaneous recovery
D.Immediate administration of high-dose intravenous aminophylline
Explanation: Complete heart block complicating an acute anterior myocardial infarction reflects extensive transmural necrosis of the interventricular septum involving the bundle of His or both bundle branches (infranodal block). The resulting ventricular escape rhythm is slow, wide, unstable, and has a high propensity to degenerate into ventricular standstill or asystole. Atropine works on the AV node and is virtually ineffective in infranodal block. Urgent insertion of a temporary transvenous cardiac pacemaker is mandatory.
9A 78-year-old man is evaluated for progressive exertional breathlessness and two recent syncopal episodes while walking uphill. Examination reveals a slow-rising carotid pulse (pulsus parvus et tardus) and a harsh, late-peaking systolic ejection murmur heard loudest at the right second intercostal space with radiation to the carotids. Transthoracic echocardiography reveals an aortic valve area of 0.7 cm2 and a mean transvalvular gradient of 48 mmHg with preserved left ventricular function. What is the definitive treatment of choice?
A.Initiation of high-dose oral beta-blockers and annual echocardiographic follow-up
B.Initiation of high-dose ACE inhibitor therapy to alleviate left ventricular afterload
C.Balloon aortic valvuloplasty as lifelong definitive management
D.Aortic valve replacement (surgical or transcatheter based on heart team risk stratification)
Explanation: The patient has severe symptomatic aortic stenosis (aortic valve area < 1.0 cm2, mean gradient > 40 mmHg, classic symptoms of dyspnea and exertional syncope). Once symptoms develop, the prognosis without intervention is dismal, with average survival of only 2 to 3 years. Aortic valve replacement—either surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI), determined by patient age, frailty, and surgical risk—is the only definitive therapy that restores life expectancy.
10A 34-year-old woman at 24 weeks gestation presents with acute orthopnea, nocturnal cough, and pink frothy sputum. She reports a childhood history of recurrent rheumatic fever. Examination reveals a tapping apex beat, a loud first heart sound, an opening snap, and a mid-diastolic rumbling murmur at the apex. What physiological change of pregnancy is the primary trigger for this acute clinical decompensation?
A.Systemic vasoconstriction causing marked increases in afterload
B.Increased plasma volume and resting tachycardia shortening ventricular diastolic filling time
C.Decreased cardiac output leading to acute left ventricular systolic failure
D.Progesterone-mediated pulmonary arteriolar vasoconstriction causing cor pulmonale
Explanation: During normal pregnancy, plasma volume increases by 40-50% and resting heart rate increases by 10-20 bpm. In mitral stenosis, the fixed restriction of the mitral valve orifice impedes left ventricular filling. Tachycardia shortens the duration of diastole, which drastically impairs filling time and exponentially increases left atrial and pulmonary capillary wedge pressures, precipitating acute pulmonary edema.

About the PGIM MD Medicine Exam

The Selection Examination in MD Medicine is conducted by the Postgraduate Institute of Medicine, University of Colombo, to select medical officers for the MD (Medicine) training programme leading to board certification in General Medicine in Sri Lanka. It is set and sat in English under the 2016 General Medicine Prospectus and its amendments.

Exam sponsor: Postgraduate Institute of Medicine, University of Colombo. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

The written component has two papers. Paper 1 (Biomedical Sciences) is a 3-hour true/false MCQ paper of 60 stems with 5 items each. Paper 2 (General Medicine) lasts 3 hours and combines a 2-hour true/false MCQ paper of 40 stems with 5 items each and a 1-hour single-best-answer paper of 30 questions. Candidates who pass the written component sit the practical component: a 12-station OSCE of 5 minutes per station, marked across domains A to G.

Time Limit

Paper 1: 3 hours. Paper 2: 3 hours. OSCE: 12 stations of 5 minutes each on later scheduled dates.

Passing Score

Written component requires an aggregate of at least 50% with at least 40% in Paper 1 and at least 50% in Paper 2. The OSCE requires at least 40% in each domain (A-G) and an overall mark of at least 50%. Both components must be passed at the same sitting.

Exam / Certification Fees

Rs. 107,000 for state-sector candidates (Rs. 17,500 registration + Rs. 9,500 application + Rs. 80,000 examination fees); Rs. 61,500 is payable with the application and the Rs. 45,500 balance only after passing the MCQ component. Non-state-sector candidates pay 50% more.

Exam sponsor website

Reported exam pass rate: Merit-based; a maximum of 57 Ministry of Health places were offered in the October 2026 sitting.. The PGIM publishes merit lists and pass index numbers per sitting rather than percentage pass rates. This describes exam candidates, not OpenExamPrep users or results from using our resources. 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.

Paper 2 and OSCE

Cardiovascular Medicine

Acute coronary syndromes and reperfusion, heart failure therapy, tachy- and bradyarrhythmias, valvular disease, hypertension, endocarditis, pericardial disease and aortic dissection.

Paper 2 and OSCE

Respiratory Medicine & Intensive Care

Pneumonia severity scoring, asthma and COPD exacerbations, tuberculosis diagnostics, pleural disease, interstitial lung disease, pulmonary embolism, ARDS and ventilation strategies.

Paper 2 and OSCE

Neurology & Endocrinology

Stroke thrombolysis and thrombectomy, status epilepticus, CNS infection, neuromuscular disease, diabetic emergencies, thyroid and adrenal crises, pituitary and calcium disorders.

Paper 2 and OSCE

Infections, Renal, Rheumatology & Haematology

Dengue and leptospirosis under Sri Lankan national guidelines, scrub typhus, melioidosis, snakebite, acute kidney injury and CKDu, glomerular disease, connective tissue disease, vasculitis and haematological emergencies.

Paper 1 (Biomedical Sciences)

Applied Biomedical Sciences

Anatomy, physiology, biochemistry, pathology, pharmacology and microbiology as applied to internal medicine. Paper 1 carries 300 of the written responses and is examined separately from the clinical General Medicine paper.

Preparing for the PGIM MD Medicine Exam

What You Need to Know

  • Passing score: Written component requires an aggregate of at least 50% with at least 40% in Paper 1 and at least 50% in Paper 2. The OSCE requires at least 40% in each domain (A-G) and an overall mark of at least 50%. Both components must be passed at the same sitting.
  • Assessment: The written component has two papers. Paper 1 (Biomedical Sciences) is a 3-hour true/false MCQ paper of 60 stems with 5 items each. Paper 2 (General Medicine) lasts 3 hours and combines a 2-hour true/false MCQ paper of 40 stems with 5 items each and a 1-hour single-best-answer paper of 30 questions. Candidates who pass the written component sit the practical component: a 12-station OSCE of 5 minutes per station, marked across domains A to G.
  • Time limit: Paper 1: 3 hours. Paper 2: 3 hours. OSCE: 12 stations of 5 minutes each on later scheduled dates.
  • Exam / certification fees: Rs. 107,000 for state-sector candidates (Rs. 17,500 registration + Rs. 9,500 application + Rs. 80,000 examination fees); Rs. 61,500 is payable with the application and the Rs. 45,500 balance only after passing the MCQ component. Non-state-sector candidates pay 50% more. Official sources

Using Our Practice Resources

  • Work through all 100 available questions
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PGIM MD Medicine: Suggested Study Strategy

1Master the National Guidelines for the Management of Dengue Fever in Adults in Sri Lanka, especially fluid management in the critical phase.
2Review the diagnosis and treatment of leptospirosis, including early antibiotic therapy and managing pulmonary haemorrhage and acute renal failure.
3Understand the electrocardiographic criteria and emergency drug dosages for tachyarrhythmias, including adenosine, amiodarone, and DC cardioversion.
4Thoroughly review diabetic ketoacidosis and HHS fluid replacement protocols, potassium management, and insulin infusion rates.
5Practice structured interpretation of arterial blood gases, chest radiographs, cerebrospinal fluid results, and renal biopsies.

Frequently Asked Questions

What is the examination format for the PGIM MD Medicine selection exam?

A written component of two 3-hour papers - Paper 1 Biomedical Sciences (60 true/false stems) and Paper 2 General Medicine (40 true/false stems plus 30 single-best-answer questions) - followed by a practical 12-station OSCE of 5 minutes per station.

What are the passing criteria for the practical OSCE component?

The OSCE has 12 stations of 5 minutes each. A candidate must obtain at least 40% of the available marks in each domain (A to G) and an overall mark of at least 50%.

What specific clinical experience is required to apply?

An SLMC-registered medical degree, a recognised internship, one year of post-internship work in Sri Lanka, six months as an intern house officer in general medicine (or the paediatrics-plus-medical-officer alternative in the circular), completion of the COAISL one-day Advanced Life Support course, and a fitness certificate from a specialist physician.

What training follows the selection examination?

Circular Letter No. 54/2026 sets out four stages: pre-MD training appointments recommended by the Board of Study (Stage 1), success at the MD examination (Stage 2), post-MD training appointments (Stage 3) and success at the Pre-Board Certification Assessment (Stage 4). The minimum post-MD training for board certification is one year local plus one year overseas.

Are these official PGIM examination questions?

No. These are original practice questions created by OpenExamPrep to assist candidates preparing for the PGIM MD Medicine selection examination.

Does this practice bank simulate the official PGIM examination format?

No. The official selection examination uses true/false and single-best-answer papers plus a 12-station OSCE, and includes a separate Biomedical Sciences paper. This is an independent English-language, four-option MCQ study bank by OpenExamPrep weighted towards the clinical General Medicine content; it is not an official paper, a format simulation, or a substitute for OSCE practice.