Free Practice Questions for North Macedonia Physician Licensing Exam

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Key Facts: North Macedonia Physician Licensing Exam Exam

120

Official Written Exam Questions

Лекарска комора на РСМ (lkm.org.mk)

150 min

Written Test Duration

Лекарска комора на РСМ (lkm.org.mk)

60%

Written Exam Pass Threshold (72/120)

Правилник за стручен испит — ЛКМ

Core Examined Clinical Domains

Лекарска комора на РСМ (lkm.org.mk)

35,000 MKD

Official Examination Fee

Лекарска комора на РСМ — Упатство за уплата

MK / SQ

Official Test Languages

Лекарска комора на РСМ (lkm.org.mk)

The North Macedonia Physician Licensing Exam (Стручен испит за доктори на медицина) is a statutory step for medical doctors seeking independent clinical licensure. Administered by the Medical Chamber (Лекарска комора на РСМ — LKM), it consists of a 150-minute, 120-question computer-based test across six subject areas (60% pass threshold), followed by a practical clinical case study and an oral ethics examination. Candidates first complete the internship applicable to their course of study. The official materials are published in Macedonian and Albanian. This resource provides independent English-language MCQ study practice, not an official translation, examination-format simulation, or substitute for practical and oral preparation.

Sample North Macedonia Physician Licensing Exam Practice Questions

Try these sample questions to review concepts for the North Macedonia Physician 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 male presents to the emergency department with acute crushing retrosternal chest pain radiating to his left jaw and diaphoresis. An immediate 12-lead ECG demonstrates ST-segment elevation of 2.5 mm in leads V1 through V4 with reciprocal ST depression in leads II, III, and aVF. Which coronary artery is most likely occluded?

A.Left anterior descending artery (LAD)

B.Right coronary artery (RCA)

C.Left circumflex artery (LCx)

D.Left main coronary artery

Explanation: ST-segment elevation in leads V1 to V4 corresponds to an acute anteroseptal myocardial infarction, which is classically caused by occlusion of the left anterior descending (LAD) coronary artery. Reciprocal changes are characteristically seen in the inferior leads (II, III, aVF).

2A 66-year-old female with a history of ischemic heart disease is admitted with severe dyspnea, orthopnea, and pink frothy sputum. Physical examination reveals blood pressure of 175/100 mmHg, pulse of 115 bpm, bilateral diffuse pulmonary crackles extending to the upper zones, and third heart sound (S3 gallop). What is the most appropriate initial pharmacological combination in this patient?

A.Intravenous loop diuretic (furosemide) and intravenous vasodilator (nitroglycerin)

B.Intravenous beta-blocker (metoprolol) and oral ACE inhibitor (ramipril)

C.Intravenous calcium channel blocker (diltiazem) and intravenous digoxin

D.Subcutaneous low-molecular-weight heparin and intravenous aminophylline

Explanation: The clinical picture describes acute cardiogenic pulmonary edema with hypertension (Killip class III). The cornerstone of urgent management is afterload and preload reduction with intravenous vasodilators (such as nitroglycerin infusion) and rapid volume unloading with an intravenous loop diuretic (furosemide).

3According to current European hypertension guidance, what is the usual initial pharmacological strategy for most adults with confirmed hypertension who require drug treatment?

A.Initial two-drug combination in a single pill, combining an ACE inhibitor or ARB with a CCB or thiazide/thiazide-like diuretic

B.Monotherapy with a beta-blocker titrated to the maximum tolerated dose

C.High-dose loop diuretic monotherapy combined with dietary sodium restriction

D.Direct renin inhibitor combined with an aldosterone antagonist

Explanation: Current European guidance supports starting most patients who require medication with a low-dose two-drug combination, preferably as a single pill. Common pairings combine an ACE inhibitor or ARB with a dihydropyridine calcium-channel blocker or a thiazide/thiazide-like diuretic, while monotherapy remains appropriate in selected frail, very old, or lower-risk patients.

4A 71-year-old male with a history of hypertension and type 2 diabetes mellitus presents with newly detected non-valvular atrial fibrillation. He has no prior history of stroke or heart failure. What is his CHA2DS2-VASc score, and what is the recommended stroke prevention strategy?

A.Score of 3; oral anticoagulation with a direct oral anticoagulant (DOAC) is indicated

B.Score of 2; antiplatelet monotherapy with acetylsalicylic acid 100 mg daily is indicated

C.Score of 1; lifestyle modification without antithrombotic therapy is recommended

D.Score of 4; dual antiplatelet therapy (aspirin plus clopidogrel) is indicated

Explanation: Calculating the CHA2DS2-VASc score: Age 65-74 years = 1 point, Hypertension = 1 point, Diabetes mellitus = 1 point. Total score = 3 points. In men with a CHA2DS2-VASc score >=2, oral anticoagulation is strongly recommended (Class I), with direct oral anticoagulants (DOACs like apixaban, rivaroxaban, dabigatran, or edoxaban) preferred over vitamin K antagonists.

5A 68-year-old female presents to the clinic with fever, productive cough with rust-colored sputum, and right pleuritic chest pain. Vital signs: BP 100/62 mmHg, HR 102 bpm, RR 32 breaths/min, temperature 38.8 °C. Laboratory testing reveals normal serum urea of 5.8 mmol/L (urea <=7 mmol/L). She is alert and fully oriented. What is her CURB-65 score, and what is the appropriate clinical management disposition?

A.Score of 2; arrange hospital assessment, with admission or closely supervised treatment determined by the full clinical picture

B.Score of 0; safe outpatient management with oral amoxicillin

C.Score of 1; outpatient management with oral macrolide monotherapy

D.Score of 4; immediate intensive care unit (ICU) admission with invasive mechanical ventilation

Explanation: The score is 2: one point for respiratory rate at least 30 and one for age at least 65; there is no point for confusion, urea, or the stated blood pressure. A score of 2 supports hospital referral and assessment and often admission, but disposition also depends on oxygenation, comorbidity, social support, oral intake, and clinician judgment rather than the score alone.

6A 64-year-old male with severe chronic obstructive pulmonary disease (COPD) presents with increased dyspnea, increased sputum volume, and purulence. Arterial blood gas on room air shows: pH 7.33, PaCO2 56 mmHg, PaO2 54 mmHg, HCO3- 29 mmol/L. When administering oxygen therapy, what is the target oxygen saturation (SpO2) to avoid hypercapnic respiratory failure?

A.88% to 92%

B.95% to 100%

C.80% to 84%

D.Strictly 98% to 100%

Explanation: In patients with acute exacerbation of COPD at risk of hypercapnic respiratory failure, oxygen therapy should be carefully titrated using a Venturi mask or low-flow nasal cannulae to achieve a target oxygen saturation of 88% to 92%. Over-oxygenation leads to ventilation-perfusion mismatch, loss of hypoxic pulmonary vasoconstriction, and the Haldane effect, worsening hypercapnia.

7A 24-year-old female presents to the urgent care clinic with an acute severe asthma attack. She is speaking in short phrases, has a respiratory rate of 28 breaths/min, pulse of 118 bpm, and peak expiratory flow (PEF) of 45% of predicted. What is the immediate first-line pharmacological treatment?

A.Inhaled short-acting beta-2 agonist (salbutamol) combined with inhaled ipratropium bromide, plus systemic corticosteroids (oral prednisolone or IV hydrocortisone)

B.Intravenous aminophylline infusion and subcutaneous adrenaline

C.Inhaled long-acting beta-2 agonist (salmeterol) combined with oral montelukast

D.Intravenous broad-spectrum cephalosporin and high-dose intravenous furosemide

Explanation: Immediate first-line management of acute severe asthma involves frequent or continuous nebulization of a short-acting beta-2 agonist (salbutamol) combined with an inhaled anticholinergic (ipratropium bromide), accompanied by early administration of systemic corticosteroids (oral prednisolone 40-50 mg or IV hydrocortisone) to reduce airway inflammation.

8A 52-year-old woman presents 10 days after total hip replacement with sudden dyspnea and obstructive shock. Bedside echocardiography shows acute right-ventricular dilatation and hypokinesis, making high-risk pulmonary embolism the leading diagnosis. What is the appropriate immediate reperfusion approach?

A.Urgent reperfusion: systemic thrombolysis if there is no prohibitive bleeding contraindication; because of the recent major surgery, obtain immediate multidisciplinary assessment for surgical embolectomy or catheter-directed treatment if thrombolysis is unsafe

B.Therapeutic subcutaneous low-molecular-weight heparin (enoxaparin) monotherapy

C.Oral direct factor Xa inhibitor (rivaroxaban 15 mg twice daily)

D.Intravenous fluid loading with 3 liters of normal saline within 1 hour

Explanation: High-risk pulmonary embolism with shock requires urgent reperfusion, not anticoagulation alone. Systemic thrombolysis is the usual emergency reperfusion treatment when bleeding risk permits, but major surgery only 10 days earlier creates a serious bleeding concern. Surgical embolectomy or catheter-directed treatment should be mobilized promptly when thrombolysis is contraindicated or judged too hazardous.

9A 54-year-old male with a history of chronic NSAID use for osteoarthritis presents with hematemesis and melena. Vital signs show BP 95/60 mmHg and HR 110 bpm. After initial fluid resuscitation, urgent upper endoscopy reveals a 1.5 cm duodenal ulcer with an active spurting arterial bleed (Forrest Ia). What is the appropriate initial endoscopic and pharmacological intervention?

A.Dual endoscopic therapy (e.g., hemoclip application plus diluted adrenaline injection) and high-dose intravenous proton pump inhibitor infusion

B.Oral sucralfate suspension and discharge with scheduled outpatient repeat endoscopy in 1 week

C.Intravenous tranexamic acid infusion alone without endoscopic intervention

D.Immediate total gastrectomy with Roux-en-Y reconstruction

Explanation: Active peptic ulcer bleeding (Forrest Ia active spurting or Ib active oozing) requires endoscopic hemostasis using dual modality therapy (injection of dilute epinephrine combined with mechanical hemoclipping or thermal coagulation). High-dose intravenous PPI therapy (e.g., omeprazole or pantoprazole) raises intragastric pH >6 to facilitate platelet aggregation and clot stabilization.

10A 42-year-old male with a history of alcohol abuse presents with severe epigastric pain radiating to his back, accompanied by nausea and persistent vomiting. Physical examination reveals epigastric tenderness and guarding. Laboratory evaluation shows serum amylase 1,240 U/L and serum lipase 2,850 U/L (reference <60 U/L). What is the most critical initial therapeutic intervention within the first 24 hours of admission?

A.Early, moderately paced, goal-directed intravenous hydration with a balanced crystalloid such as Ringer's lactate, with frequent reassessment to avoid overload

B.Prophylactic intravenous broad-spectrum carbapenem antibiotics

C.Immediate surgical debridement of pancreatic tissue

D.Strict total parenteral nutrition and total fluid restriction

Explanation: Early intravenous hydration is important in acute pancreatitis, and a balanced crystalloid such as Ringer's lactate is generally preferred. Contemporary guidance favors moderate, goal-directed administration with repeated assessment of hemodynamics, urine output, renal function, and signs of fluid overload rather than fixed aggressive rates for every patient.

About the North Macedonia Physician Licensing Exam Exam

The Стручен испит за доктори на медицина is the professional examination administered by the Medical Chamber (LKM) after the applicable internship. Passing it is one statutory prerequisite for applying for the Basic License (Основна лиценца за работа); the license and later primary-care employment or specialization remain subject to their separate requirements.

Exam sponsor: Medical Chamber of the Republic of North Macedonia (Лекарска комора на Република Северна Македонија — LKM). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

The official licensing examination is organized into three sequential parts by the Medical Chamber of North Macedonia (LKM): (1) Written Examination: 120 multiple-choice questions administered electronically in 150 minutes covering internal medicine, surgery, pediatrics, gynecology and obstetrics, primary health care, and health legislation/ethics, requiring at least 60% (72/120) to pass; (2) Practical Examination: candidate analysis and resolution of a clinical case study demonstrating diagnostic and therapeutic decision-making; (3) Oral Examination: structured evaluation of professional medical ethics, deontology, and doctor-patient legal obligations.

Time Limit

150 minutes (2.5 hours) for the computer-based written examination

Passing Score

Minimum 60% correct answers (at least 72 of 120 questions) on the computer-based written test

Exam / Certification Fees

35,000 MKD

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.

17%

Internal Medicine (Интерна медицина)

Cardiovascular diseases, acute coronary syndromes, hypertension, heart failure, respiratory conditions (COPD, asthma, pneumonia, pulmonary embolism), gastroenterology and hepatology, nephrology and electrolyte disturbances, endocrinology (diabetes mellitus, thyroid disease), and hematology.

17%

Surgery & Surgical Emergencies (Хирургија)

Acute abdomen (appendicitis, cholecystitis, bowel obstruction, perforation), trauma evaluation and resuscitation (ATLS principles), head trauma, burns, wound healing, surgical asepsis and antisepsis, abdominal wall hernias, and postoperative complications.

17%

Pediatrics & Child Health (Педијатрија)

Neonatal care and APGAR scoring, growth and developmental milestones, infant nutrition, childhood infectious diseases and exanthems, respiratory infections (croup, bronchiolitis), pediatric dehydration and rehydration, febrile seizures, and the national immunization schedule.

17%

Gynecology & Obstetrics (Гинекологија и акушерство)

Antenatal care, physiological pregnancy and labor stages, obstetric emergencies (preeclampsia, eclampsia, postpartum hemorrhage, placental abruption, ectopic pregnancy), abnormal uterine bleeding, pelvic inflammatory disease, contraception, and cervical cancer screening.

16%

Primary Health Care & Preventive Medicine (Примарна здравствена заштита)

Role and competencies of the chosen physician (избран лекар), chronic disease management in the community, preventative checkups, triage, rational antibiotic prescription, urgent outpatient interventions, referral pathways to secondary care, and issuance of temporary sick leave.

16%

Health Legislation, Medical Ethics & Deontology (Правен дел и медицинска етика)

Law on Health Care (Закон за здравствената заштита), Law on Patients' Rights Protection (Закон за заштита на правата на пациентите), Medical Code of Deontology of LKM, professional medical secrecy (лекарска тајна), informed consent, notification of infectious diseases, and death certification.

Preparing for the North Macedonia Physician Licensing Exam Exam

What You Need to Know

Passing score: Minimum 60% correct answers (at least 72 of 120 questions) on the computer-based written test
Assessment: The official licensing examination is organized into three sequential parts by the Medical Chamber of North Macedonia (LKM): (1) Written Examination: 120 multiple-choice questions administered electronically in 150 minutes covering internal medicine, surgery, pediatrics, gynecology and obstetrics, primary health care, and health legislation/ethics, requiring at least 60% (72/120) to pass; (2) Practical Examination: candidate analysis and resolution of a clinical case study demonstrating diagnostic and therapeutic decision-making; (3) Oral Examination: structured evaluation of professional medical ethics, deontology, and doctor-patient legal obligations.
Time limit: 150 minutes (2.5 hours) for the computer-based written examination
Exam / certification fees: 35,000 MKD Official sources

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North Macedonia Physician Licensing Exam: Suggested Study Strategy

1Master the emergency management algorithms for acute coronary syndrome, anaphylaxis, status epilepticus, and diabetic ketoacidosis.

2Thoroughly review surgical acute abdomen presentations, triage priorities, and trauma resuscitation according to ATLS protocols.

3Memorize pediatric dehydration clinical signs, fluid rehydration calculations, and the mandatory national childhood immunization schedule.

4Understand the statutory duties of the chosen doctor (избран лекар) under Macedonian health insurance regulations, including the 15-day limit on self-authorized temporary sick leave.

5Study the Law on Patients' Rights Protection, specifically informed consent exceptions in emergency life-saving situations and rules governing professional medical secrecy (лекарска тајна).

Frequently Asked Questions

What is the official format and duration of the North Macedonia Physician Licensing Exam?

The examination administered by the Medical Chamber of North Macedonia (LKM) has three parts. Part 1 is a computer-based electronic test consisting of 120 multiple-choice questions across six disciplines, completed in 150 minutes (2.5 hours). Part 2 is a practical examination where the candidate analyzes a clinical case study. Part 3 is an oral examination on medical ethics, deontology, and healthcare legislation.

What is the passing score required on the written examination?

Candidates must achieve at least 60% correct answers (a minimum of 72 correct questions out of 120) on the computer-based written test. Scoring 60% or higher is a prerequisite to proceed to the practical clinical case study and oral ethics examination.

In what languages is the official medical licensing exam conducted?

The Chamber publishes the official question lists in Macedonian and Albanian. This resource offers independent English-language MCQ study practice for topics appearing in those lists; it is not an official translation or a simulation of the complete assessment.

Who is eligible to take the professional exam for medical doctors in North Macedonia?

Applicants submit the medical diploma and certified internship booklet. The Chamber describes a six-month internship for graduates of six-year medical studies and a one-year internship for graduates of five-year studies; foreign-diploma applicants also submit the recognition decision and required Macedonian translation. The current Chamber application instructions should be checked for the complete document list.