Free Practice Questions for MCM Pre-Internship Exam

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Key Facts: MCM Pre-Internship Exam Exam

50%

Pass mark in each component

MCM Pre-Internship Examinations Policy (2024)

Written + OSPE

Assessment format

MCM Pre-Internship Examinations Policy (2024)

MK400,000 / USD 750

Exam fee (Malawian / non-Malawian)

MCM media release, March 2026

6 months

Pre-internship clinical placement (may be waived or reduced)

MCM Pre-Internship Examinations Policy (2024)

Foreign-trained intern medical practitioners must pass MCM's pre-internship examinations before entering the internship register. Under the December 2024 policy, candidates first complete a mandatory clinical placement, then sit a written paper in English and an OSPE, and must score 50% in each component. The March 2026 notice set fees of MK400,000 for Malawians and USD 750 for non-Malawians. These independent MCQs help with the knowledge and judgement behind both components but do not simulate the OSPE.

Sample MCM Pre-Internship Exam Practice Questions

Try these sample questions to review concepts for the MCM Pre-Internship Exam exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 104+ question experience with AI tutoring.

1A 32-year-old male is admitted to Kamuzu Central Hospital in Lilongwe with high-grade fever, altered mental status (GCS 11/15), scleral icterus, and passage of dark cola-coloured urine. A peripheral blood film demonstrates Plasmodium falciparum ring forms with 8% parasitaemia. According to the Malawi Standard Treatment Guidelines (MSTG) and WHO recommendations, what is the first-line treatment for this patient?

A.Intravenous Artesunate 2.4 mg/kg body weight at 0, 12, and 24 hours, then once daily until oral therapy can be tolerated

B.Intravenous Quinine dihydrochloride 20 mg/kg loading dose infused over 4 hours in 5% dextrose, followed by 10 mg/kg 8-hourly

C.Oral Artemether-Lumefantrine (AL) 4 tablets twice daily for 3 days crushed and administered via nasogastric tube

D.Intramuscular Artemether 3.2 mg/kg stat, followed by 1.6 mg/kg daily for 5 days as definitive monotherapy

Explanation: Intravenous artesunate is the first-line treatment for severe falciparum malaria: 2.4 mg/kg at 0, 12 and 24 hours, then once daily until the patient can take oral medication (the Malawi Standard Treatment Guidelines and WHO use 3 mg/kg for children under 20 kg). Compared with quinine it lowers mortality, clears parasites faster and causes far less hypoglycaemia. After at least 24 hours of parenteral treatment, once the patient can swallow, a full 3-day course of oral artemether-lumefantrine completes treatment.

2A 40-year-old male presents to a district hospital outpatient department with a 4-week history of productive cough, evening fevers, profuse night sweats, and marked weight loss. Sputum testing by GeneXpert MTB/RIF detects Mycobacterium tuberculosis with no rifampicin resistance. What is the standard first-line treatment regimen for this patient under the Malawi National Tuberculosis Programme?

A.2 months of Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol (2RHZE) followed by 4 months of Rifampicin and Isoniazid (4RH)

B.2 months of Rifampicin and Isoniazid (2RH) followed by 7 months of Ethambutol and Isoniazid (7EH)

C.6 months of Rifampicin, Isoniazid, and Pyrazinamide continuous daily therapy without Ethambutol

D.3 months of Streptomycin, Isoniazid, and Rifampicin followed by 5 months of Isoniazid alone

Explanation: The standard first-line regimen for drug-susceptible pulmonary tuberculosis in Malawi consists of a 2-month intensive phase with fixed-dose combination Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol (2RHZE), followed by a 4-month continuation phase of Rifampicin and Isoniazid (4RH). Pyridoxine (vitamin B6) is routinely added to prevent isoniazid-induced peripheral neuropathy.

3A 35-year-old female living with HIV on standard first-line antiretroviral therapy (Tenofovir/Lamivudine/Dolutegravir - TLD) is diagnosed with active pulmonary tuberculosis and initiated on 2RHZE. Rifampicin is a potent inducer of hepatic CYP3A4 and UGT1A1 enzymes, markedly reducing dolutegravir plasma concentrations. According to Malawian National HIV and TB Guidelines, how should her antiretroviral regimen be adjusted during anti-TB treatment?

A.Add a supplementary standalone Dolutegravir 50 mg tablet daily, taken 12 hours after the fixed-dose TLD tablet

B.Switch Dolutegravir to ritonavir-boosted Atazanavir (ATV/r 300/100 mg) once daily while taking rifampicin

C.Discontinue Dolutegravir and substitute with Nevirapine 200 mg twice daily for the duration of TB therapy

D.Maintain standard single-dose TLD without modification as drug-drug induction has no clinical impact

Explanation: Rifampicin markedly reduces serum dolutegravir concentrations through UGT1A1 and CYP3A4 enzyme induction. To overcome this interaction, Malawian and WHO guidelines recommend adding a supplementary 50 mg tablet of Dolutegravir taken approximately 12 hours after the daily TLD dose (providing 50 mg twice daily). This supplementary dose is continued throughout rifampicin treatment and for two weeks after completing anti-TB therapy.

4A 22-year-old female with type 1 diabetes presents to the casualty department with severe nausea, recurrent vomiting, deep sighing (Kussmaul) respiration, and sweet acetone breath. Blood glucose is 26 mmol/L, urine ketones are 4+, and arterial blood gas reveals pH 7.16, HCO3 9 mmol/L, with serum potassium of 4.4 mmol/L. Following initial intravenous fluid resuscitation with 0.9% normal saline, what is the initial insulin protocol?

A.Intravenous regular (soluble) insulin infusion at 0.1 units/kg/hour, adding potassium chloride to IV fluids once urine output is confirmed

B.Subcutaneous injection of 30 units of insulin glargine with no intravenous regular insulin administration

C.High-dose intravenous regular insulin bolus of 1 unit/kg stat followed by concentrated 50% dextrose infusion

D.Withholding insulin entirely until blood glucose falls below 15 mmol/L through fluid rehydration alone

Explanation: The standard protocol for DKA management is rehydration with isotonic saline coupled with continuous regular (soluble) insulin at 0.1 units/kg/hour. Because insulin drives potassium into cells, potassium replacement (20-40 mmol/L of IV fluid) must be started as soon as serum potassium is in the normal range (3.5-5.0 mmol/L) and adequate urine output is established, avoiding life-threatening hypokalemia and cardiac arrhythmias.

5A 55-year-old male presents with severe throbbing headache, blurred vision, and a blood pressure of 220/130 mmHg. Ophthalmoscopy demonstrates bilateral papilloedema, flame-shaped retinal hemorrhages, and cotton wool spots, confirming a hypertensive emergency. What is the recommended target blood pressure reduction within the first hour of emergency management?

A.Reduce mean arterial pressure by no more than 20% to 25% (or diastolic BP to ~100-110 mmHg) using IV agents such as hydralazine or labetalol

B.Rapidly normalize blood pressure to below 120/80 mmHg within 30 minutes using sublingual bite-and-swallow nifedipine capsules

C.Administer oral furosemide 40 mg and discharge the patient home for outpatient reassessment in 48 hours

D.Give oral amlodipine 10 mg and review on the ward in 24 hours, avoiding intravenous agents

Explanation: In hypertensive emergencies, the initial goal is a controlled reduction of mean arterial pressure (MAP) by no more than 20% to 25% over the first hour, or toward 160/100-110 mmHg over 2 to 6 hours. Excessive or precipitous blood pressure reduction compromises cerebral, coronary, and renal autoregulation, risking watershed cerebral infarction or acute myocardial ischemia.

6A 68-year-old male presents with right-sided pleuritic chest pain, productive cough with rust-coloured sputum, and fever for 3 days. Physical examination reveals bronchial breathing and dullness at the right lung base. Vital signs: blood pressure 86/52 mmHg, pulse 112/min, respiratory rate 34/min, temperature 38.9°C. Blood urea is 8.8 mmol/L, and he is disoriented to time and place. What is his CURB-65 pneumonia severity score and the appropriate level of care?

A.CURB-65 score of 5; high-risk severe community-acquired pneumonia requiring urgent admission, parenteral antibiotics and consideration of high-dependency care

B.CURB-65 score of 1; low-risk pneumonia suitable for outpatient management with oral amoxicillin

C.CURB-65 score of 2; moderate-risk pneumonia manageable with short ambulatory observation and home oral therapy

D.CURB-65 score of 3; moderate-risk pneumonia manageable on a general ward with oral amoxicillin alone

Explanation: CURB-65 gives 1 point each for Confusion (present), Urea above 7 mmol/L (8.8), Respiratory rate of 30/min or more (34), low Blood pressure, meaning systolic below 90 or diastolic 60 mmHg or less (86/52), and age 65 or older (68). All five criteria are met, so the score is 5. Scores of 3 to 5 indicate severe pneumonia with high 30-day mortality, requiring urgent admission, parenteral antibiotics and consideration of high-dependency or intensive care.

7A 36-year-old male with advanced HIV disease (CD4 count 28 cells/mm³) presents with a 2-week history of worsening holocranial headache, low-grade fever, malaise, and photophobia. Lumbar puncture demonstrates an opening pressure of 34 cm H2O, clear CSF, positive India ink staining, and positive Cryptococcal antigen (CrAg). What is the preferred induction regimen according to current WHO and Malawian national guidelines?

A.Single high-dose Liposomal Amphotericin B (10 mg/kg) on day 1 combined with 14 days of oral Flucytosine (100 mg/kg/day) and Fluconazole (1200 mg/day)

B.Oral Fluconazole 400 mg daily alone as monotherapy for 10 consecutive weeks

C.Intravenous Dexamethasone 8 mg 8-hourly combined with oral Cotrimoxazole for 21 days

D.Intravenous Ceftriaxone 2g daily combined with oral Rifampicin for 14 days

Explanation: Based on the AMBITION-cm trial, WHO's 2022 guideline recommends a single high dose of liposomal amphotericin B (10 mg/kg) on day 1 with 14 days of oral flucytosine (100 mg/kg/day in four divided doses) and oral fluconazole (1200 mg/day) as the preferred induction regimen for HIV-associated cryptococcal meningitis. Raised intracranial pressure is a major cause of death: when the initial opening pressure is 25 cm H2O or more, or symptoms of raised pressure develop or recur, repeat therapeutic lumbar punctures should drain CSF to bring the pressure below 20 cm H2O.

8A 24-year-old male is brought to the outpatient emergency room with acute fever, severe headache, photophobia, neck stiffness, and a positive Kernig sign. Before performing a diagnostic lumbar puncture to confirm acute bacterial meningitis, which clinical finding mandates an urgent neuroimaging study (brain CT) first to assess the risk of brain herniation?

A.New focal neurological deficit, papilloedema, abnormal pupillary responses, or newly onset focal seizures

B.Peripheral blood leukocytosis of 15,000 /mm³ with 85% neutrophils

C.Presence of a faint petechial rash over the ankles and wrists

D.Axillary temperature of 39.5°C in a fully alert and oriented patient

Explanation: Lumbar puncture in the presence of a space-occupying lesion or obstructive hydrocephalus can precipitate fatal transtentorial or cerebellar tonsillar herniation. Indications for CT before LP include focal neurological deficits, papilloedema, new-onset seizures, moderate-to-severe impairment of consciousness, and severe immunocompromise. If imaging or LP will be delayed, blood cultures should be taken and empirical antibiotics started immediately rather than waiting for the scan.

9A 62-year-old female with long-standing poorly controlled hypertension presents to casualty in severe respiratory distress, orthopnea, and pink frothy sputum. Examination reveals bilateral coarse lung crackles extending halfway up the lung fields, elevated jugular venous pressure (JVP +6 cm), and blood pressure of 185/105 mmHg. Oxygen saturation is 84% on room air. What is the immediate pharmacological intervention?

A.High-flow supplemental oxygen, intravenous furosemide bolus (40-80 mg), and sublingual or intravenous nitrates while maintaining patient upright

B.Intravenous infusion of beta-blockers (e.g., atenolol) and aggressive intravenous normal saline fluid loading

C.Intravenous digoxin 0.5 mg stat combined with immediate oral spironolactone 100 mg as primary therapies

D.Intravenous morphine as the main therapy, withholding diuretics until an echocardiogram is available

Explanation: Acute cardiogenic pulmonary oedema requires immediate reduction of cardiac preload and afterload. First-line management includes sitting the patient upright, administering high-flow oxygen (or non-invasive positive pressure ventilation), intravenous loop diuretics (furosemide 40-80 mg IV) to promote diuresis and venodilation, and nitrates (sublingual or IV nitroglycerin) to reduce systemic vascular resistance and left ventricular filling pressure.

10A 48-year-old male with chronic hepatitis B cirrhosis presents with sudden-onset massive hematemesis and melena. On arrival, he is pale and clammy with a heart rate of 124 beats/min and blood pressure of 86/50 mmHg. While wide-bore IV access, crystalloid resuscitation, and urgent cross-matching are initiated, what medical therapies should be started before diagnostic endoscopy?

A.Intravenous vasoactive medication (e.g., Octreotide or Terlipressin) to reduce portal pressure, alongside prophylactic IV Ceftriaxone

B.Intravenous Tranexamic acid bolus alone without antimicrobial or vasoactive agents

C.High-dose subcutaneous low-molecular-weight heparin to prevent portal vein thrombosis

D.Oral non-selective beta-blockers (Propranolol 40 mg) immediately via oral route

Explanation: In suspected acute variceal hemorrhage, vasoactive agents (octreotide or terlipressin) should be initiated immediately to induce splanchnic vasoconstriction and decrease portal inflow. Prophylactic intravenous antibiotics (ceftriaxone 1g daily) are mandatory in cirrhotics with GI bleeding; they reduce bacterial infections (such as spontaneous bacterial peritonitis), rebleeding rates, and overall mortality.

About the MCM Pre-Internship Exam Exam

The Medical Council of Malawi administers pre-internship examinations for medical, dental and allied-health interns trained outside Malawi. This is independent practice by OpenExamPrep for the intern medical practitioner areas. The bank is an English-language MCQ study adaptation, not an official paper, format simulation or substitute for OSPE practice.

Exam sponsor: Medical Council of Malawi. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

The policy says MCM examinations are preferably a combination of a written examination and an OSPE, with some stations manned by an examiner for oral assessment and others answered on paper; MCM may use written examinations only for some professions. For intern medical practitioners the competency areas are internal medicine, paediatrics and child health, obstetrics and gynaecology, surgery, public health and psychiatry, and each component must include at least one ethics and professionalism question. The examinations are held in person with no online option.

Time Limit

Not published; the April 2026 sitting ran on two consecutive days starting at 7:30 am

Passing Score

50% in each component (written and practical)

Exam / Certification Fees

MK400,000 (Malawian nationals); USD 750 (non-Malawian nationals)

Exam sponsor website

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

Official sources

MCM Pre-Internship Examinations Policy (December 2024) · Source checked 2026-09-27
MCM media release: Pre-internship examinations for intern medical practitioners trained outside Malawi (March 2026) · Source checked 2026-09-27
MCM Internship page · Source checked 2026-09-27
MCM Code of Ethics and Professional Conduct (2022 edition) · Source checked 2026-09-27

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.

Not published

Internal Medicine

Adult emergencies, malaria, tuberculosis, HIV and common cardiovascular, respiratory, renal and endocrine conditions.

Not published

Paediatrics and Child Health

Neonatal resuscitation, IMCI, severe acute malnutrition, childhood infections and paediatric emergencies.

Not published

Obstetrics and Gynaecology

AMTSL and postpartum haemorrhage, pre-eclampsia and eclampsia, obstetric emergencies, PMTCT and gynaecology.

Not published

Surgery

Acute abdomen, trauma, burns, orthopaedic emergencies and perioperative infection prevention.

Not published

Public Health

Cholera response, IDSR surveillance, immunisation cold chain, TB infection control, epidemiology and Malawi's Health Benefits Package.

Not published

Psychiatry

Depression, psychosis, suicide risk, substance withdrawal, drug reactions and Malawi's Mental Health Act, 2025.

Not published

Ethics and Professionalism

Consent, confidentiality, medical errors and professional conduct under the MCM Code of Ethics and Professional Conduct (2022); required in both components.

Preparing for the MCM Pre-Internship Exam Exam

What You Need to Know

Passing score: 50% in each component (written and practical)
Assessment: The policy says MCM examinations are preferably a combination of a written examination and an OSPE, with some stations manned by an examiner for oral assessment and others answered on paper; MCM may use written examinations only for some professions. For intern medical practitioners the competency areas are internal medicine, paediatrics and child health, obstetrics and gynaecology, surgery, public health and psychiatry, and each component must include at least one ethics and professionalism question. The examinations are held in person with no online option.
Time limit: Not published; the April 2026 sitting ran on two consecutive days starting at 7:30 am
Exam / certification fees: MK400,000 (Malawian nationals); USD 750 (non-Malawian nationals) Official sources

Using Our Practice Resources

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MCM Pre-Internship Exam: Suggested Study Strategy

1Use the Malawi Standard Treatment Guidelines and national programme guidelines for malaria, tuberculosis and HIV, because the examination tests practice in the Malawian setting.

2Rehearse obstetric emergency drills: AMTSL, magnesium sulphate for eclampsia, postpartum haemorrhage and neonatal resuscitation (Helping Babies Breathe).

3Learn IMCI classifications, severe acute malnutrition protocols and WHO's 2025 guidance on fluids for children in shock.

4Read the MCM Code of Ethics and Professional Conduct (2022) on consent, confidentiality, medical errors and social media; every component includes ethics.

5Use your clinical placement to practise OSPE-style skills such as history taking, examination, procedures and explaining decisions to patients.

Frequently Asked Questions

Who must sit the Medical Council of Malawi Pre-Internship Examination?

MCM administers pre-internship examinations for practitioners trained outside Malawi who want to enter the internship register. The policy covers medical, dental and allied-health graduates; MCM's March 2026 notice was for prospective intern medical practitioners trained outside the country.

What must be completed before sitting the examination?

Candidates submit a complete MCM application with a commissioned statutory declaration, certified qualifications and any credential verification MCM requests (such as ECFMG). They must also complete the mandatory pre-internship clinical placement, six months at a Central Hospital unless Council waives or reduces it, and submit the placement report or signed logbooks at least one month before the examinations.

What is the format and pass mark?

The policy describes a written examination set in English with no negative marking and an Objective Structured Practical Examination (OSPE) with manned oral stations and unmanned paper stations. The pass mark is 50% for each component, and each component includes at least one ethics and professionalism question.

How much does the examination cost and where is it held?

MCM's March 2026 notice set the fee at MK400,000 for Malawian nationals and USD 750 for non-Malawian nationals. That sitting was held in person at the Malawi College of Health Sciences (Lilongwe Campus) on 16 and 17 April 2026, with no online option. Check MCM's current notice before applying.

Are these practice questions in the official exam format?

No. This is independent, English-language MCQ practice by OpenExamPrep covering the intern medical practitioner competency areas named in MCM's policy. It is not an official paper or simulation, and it cannot replace hands-on preparation for the OSPE.