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Key Facts: ENARM Exam

50th

Edition of the ENARM held in 2026

CIFRHS convocatoria, 50° ENARM 2026

28-30 Sep 2026

Exam dates

CIFRHS convocatoria, 50° ENARM 2026

4

Options per question: one correct answer and three distractors

CIFRHS convocatoria, 50° ENARM 2026

6 hours

Length of the exam session

CIFRHS instructivo, 50° ENARM 2026

MXN 3,300

Application fee

CIFRHS convocatoria, 50° ENARM 2026

ENARM is Mexico's national residency selection exam: Spanish clinical cases with four-option questions in the four core specialties, scored out of 100 and ranked for residency places.

Sample ENARM Practice Questions

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

1A 64-year-old man has had chest pain for 2 hours. The ECG shows ST elevation in II, III and aVF and in the right-sided lead V4R. After one sublingual nitroglycerin tablet his blood pressure falls to 78/50 mmHg, and his lungs are clear. What should be done first while reperfusion is arranged?
A.IV fluid boluses; avoid nitrates
B.Repeat sublingual nitroglycerin every 5 minutes for pain
C.IV furosemide
D.Start oral metoprolol to lower heart rate
Explanation: ST elevation in V4R with an inferior infarction indicates right ventricular involvement. The right ventricle depends on preload, so nitrates and diuretics can cause profound hypotension; cautious IV crystalloid boluses support filling while urgent reperfusion is arranged.
2A 62-year-old female is brought to the emergency department with severe acute dyspnea, orthopnea, and pink frothy sputum. Her blood pressure is 210/120 mmHg, heart rate is 112 bpm, respiratory rate is 32 breaths/min, and oxygen saturation is 84% on ambient air. Bilateral coarse crackles are auscultated across both lung fields. An arterial blood gas shows hypoxemia, and a chest radiograph confirms alveolar pulmonary edema. In accordance with Mexican GPC recommendations for hypertensive emergency with acute cardiogenic pulmonary edema, which intravenous agent is the first-line vasodilator of choice?
A.Intravenous hydralazine bolus
B.Intravenous nitroglycerin infusion
C.Intravenous metoprolol bolus
D.Oral nifedipine capsule
Explanation: Intravenous nitroglycerin is the first-line vasodilator recommended by the Mexican GPC for hypertensive emergency complicated by acute cardiogenic pulmonary edema. It acts primarily as a venodilator at lower doses, decreasing preload (left ventricular end-diastolic pressure) and pulmonary congestion, while providing arterial vasodilation at higher doses to reduce afterload without increasing myocardial oxygen demand.
3A 68-year-old male with ischemic cardiomyopathy and known heart failure with reduced ejection fraction (LVEF 28%) presents to the clinic reporting progressive lower extremity edema, 4-kg weight gain over two weeks, and dyspnea on minimal exertion. Examination reveals jugular venous distension to the angle of the jaw at 45 degrees and bilateral 3+ pitting pretibial edema. His blood pressure is 124/78 mmHg, heart rate is 74 bpm, and serum creatinine is 1.1 mg/dL. What is the most appropriate initial pharmacological intervention to achieve decongestion?
A.High-dose oral spironolactone alone
B.Oral hydrochlorothiazide monotherapy
C.Intravenous loop diuretic (furosemide)
D.Intravenous infusion of digoxin
Explanation: According to Mexican and international heart failure guidelines, loop diuretics such as intravenous furosemide are the cornerstone of therapy for restoring euvolemia in patients presenting with acute decompensated heart failure and fluid overload. They act on the thick ascending limb of the loop of Henle to produce rapid natriuresis and venodilation, relieving both systemic and pulmonary congestion.
4A 54-year-old female who underwent mechanical aortic valve replacement 8 months ago presents with 3 weeks of remittent fever, malaise, anorexia, and a new regurgitant systolic murmur at the right upper sternal border. Laboratory tests demonstrate normocytic anemia, erythrocyte sedimentation rate (ESR) of 88 mm/h, and microscopic hematuria. Transthoracic echocardiography (TTE) is inconclusive due to mechanical shadowing. Based on the modified Duke criteria and Mexican GPC for infective endocarditis, what is the next diagnostic procedure of choice?
A.CT coronary angiography
B.Serial cardiac troponin measurements
C.Exercise treadmill stress testing
D.Transesophageal echocardiography (TEE)
Explanation: Transesophageal echocardiography (TEE) is the imaging modality of choice in patients with suspected prosthetic valve endocarditis (PVE) or when transthoracic echocardiography is non-diagnostic. TEE provides superior spatial resolution of the posterior cardiac structures and prosthetic sewing ring, allowing detection of small vegetations, paravalvular abscesses, and valve dehiscence that meet major modified Duke criteria.
5A 71-year-old female with long-standing hypertension and well-controlled type 2 diabetes presents for a routine check-up. She is asymptomatic. Her pulse is irregularly irregular at 88 bpm, and blood pressure is 132/80 mmHg. An ECG confirms non-valvular atrial fibrillation. Transthoracic echocardiography reveals a normal ejection fraction (60%) and mild left atrial enlargement with no valvular lesions. Applying the CHA2DS2-VASc risk stratification system per Mexican GPC, what is the recommended long-term antithrombotic management?
A.Oral anticoagulation (DOAC or warfarin)
B.Aspirin 100 mg daily monotherapy
C.Dual antiplatelet therapy with aspirin and clopidogrel
D.Routine watchful waiting without antithrombotic therapy because she is asymptomatic
Explanation: This patient has a CHA2DS2-VASc score of 4 (Female = 1, Age 65-74 = 1, Hypertension = 1, Diabetes = 1). In females with a score >= 3 (or males >= 2), the Mexican GPC and international consensus guidelines strongly recommend oral anticoagulation to reduce stroke and systemic thromboembolism risk. Direct oral anticoagulants (apixaban, dabigatran, rivaroxaban) or vitamin K antagonists (acenocoumarol or warfarin target INR 2.0-3.0) are preferred over antiplatelet therapy.
6A 58-year-old woman with type 2 diabetes has an HbA1c of 9.4% despite maximum doses of metformin and a second oral agent. She has no weight loss or other signs of catabolism. The physician decides to start basal insulin. What is a usual starting regimen?
A.Regular insulin 20 units before each meal
B.10 units (0.1–0.2 U/kg) once daily, then titrate
C.NPH 1 U/kg twice a day
D.Sliding-scale insulin only
Explanation: Basal insulin (NPH at bedtime or a long-acting analogue) is usually started at about 10 units or 0.1 to 0.2 U/kg per day and titrated every few days according to fasting glucose, while metformin is continued.
7A 24-year-old with type 1 diabetes is treated for diabetic ketoacidosis with IV fluids and an insulin infusion. After 14 hours, glucose is 180 mg/dL, bicarbonate 17 mEq/L, venous pH 7.34 and anion gap 11 mEq/L, and the patient is eating. How should insulin be managed?
A.Stop the insulin infusion immediately and give nothing until the next meal
B.Increase the infusion rate to lower glucose to 70 mg/dL
C.Give SC basal insulin; stop the infusion 1–2 hours later
D.Continue the infusion for 48 more hours regardless of results
Explanation: Ketoacidosis has resolved when glucose is below about 200 mg/dL and at least two of these are met: bicarbonate 15 mEq/L or more, venous pH above 7.30 and anion gap 12 or less. Subcutaneous basal insulin is given and the IV infusion overlaps for 1 to 2 hours to prevent rebound ketoacidosis.
8A 70-year-old woman taking hydrochlorothiazide has chronic, asymptomatic hyponatremia with a serum sodium of 112 mEq/L. Hypertonic saline is started. What is the main safety limit for correcting her sodium?
A.Raise sodium to 140 mEq/L within 6 hours
B.No limit if she has no symptoms
C.Raise sodium by 20 mEq/L in 24 hours
D.No more than about 8–10 mEq/L in 24 hours
Explanation: In chronic hyponatremia the brain has adapted, and overly rapid correction causes osmotic demyelination syndrome. Correction is limited to about 8 to 10 mEq/L in 24 hours (less in high-risk patients such as those with alcoholism, malnutrition or hypokalemia), with frequent sodium checks.
9A 36-year-old female presents with 4 months of progressive fatigue, generalized weakness, salt cravings, anorexia, and a 6-kg weight loss. Physical examination shows generalized cutaneous hyperpigmentation, particularly prominent over palmar creases, dental gingiva, and surgical scars. Blood pressure is 88/56 mmHg with an orthostatic drop. Laboratory evaluation demonstrates: serum sodium 128 mEq/L, serum potassium 5.6 mEq/L, serum fasting glucose 68 mg/dL, morning serum cortisol 2.8 mcg/dL (low), and morning plasma ACTH 320 pg/mL (elevated). What is the underlying pathophysiology and the most appropriate confirmatory diagnostic test?
A.Addison disease; ACTH stimulation test
B.Secondary adrenal insufficiency due to pituitary adenoma; confirmed by the metyrapone test
C.Adrenocortical adenoma hypersecretion; confirmed by the high-dose dexamethasone suppression test
D.Pheochromocytoma; metanephrines
Explanation: The clinical presentation of hyperpigmentation (due to elevated ACTH and pro-opiomelanocortin cleavage products stimulating melanocortin 1 receptors), hypotension, hyponatremia, and hyperkalemia confirms primary adrenal insufficiency (Addison disease). The definitive gold-standard diagnostic test per endocrinology guidelines is the synthetic ACTH (cosyntropin) stimulation test, where a failure of serum cortisol to rise above 18-20 mcg/dL at 30-60 minutes confirms primary adrenocortical failure.
10A 52-year-old non-pregnant woman undergoes routine biochemical testing. She has mild cold intolerance and dry skin but no goiter. Her thyroid profile demonstrates: serum thyroid-stimulating hormone (TSH) 12.4 mIU/L (reference: 0.4-4.0 mIU/L) and free thyroxine (FT4) 1.2 ng/dL (reference: 0.8-1.8 ng/dL). Serum anti-thyroid peroxidase (anti-TPO) antibodies are strongly positive. According to the Mexican GPC for thyroid disorders, what is the diagnosis and recommended clinical management?
A.Overt primary hypothyroidism; initiate oral radioactive iodine (I-131) ablation
B.Subclinical hypothyroidism; initiate low-dose oral levothyroxine therapy
C.Euthyroid sick syndrome; observe without laboratory repetition
D.Secondary central hypothyroidism; order urgent pituitary magnetic resonance imaging
Explanation: Subclinical hypothyroidism is defined biochemically by an elevated serum TSH in the presence of normal circulating free T4 levels. According to Mexican GPC recommendations, levothyroxine replacement therapy is indicated when serum TSH is >= 10 mIU/L (even in asymptomatic patients), or when TSH is between 5 and 10 mIU/L in the presence of high anti-TPO titers, symptomatic clinical disease, or high cardiovascular risk, to prevent progression to overt hypothyroidism and reduce atherogenic dyslipidemia.

About the ENARM Exam

Independent ENARM practice by OpenExamPrep. The official 50th ENARM (28 to 30 September 2026) is a Spanish-language exam of clinical cases, each with two or three four-option questions, covering internal medicine, pediatrics, obstetrics-gynecology and general surgery with a focus on public health, emergencies and family medicine. This bank is an English-language study adaptation, not an official translation or a simulation of the full exam. Mexican terms such as GPC, NOM, Vida Suero Oral and Código Mater are kept in Spanish.

Exam sponsor: Comisión Interinstitucional para la Formación de Recursos Humanos para la Salud (CIFRHS). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Clinical cases in Spanish focused on public health, emergencies and family medicine across the four core specialties (internal medicine, pediatrics, obstetrics-gynecology and general surgery). Each case has two or three questions with one correct answer and three distractors. The total number of items is not published in the convocatoria.

Time Limit

One 6-hour session (for example 08:00-14:00 or 16:00-22:00, local time, depending on the assigned shift and venue)

Passing Score

No fixed pass mark: places are assigned by descending 'Puntaje total sobre 100' within each specialty's available places. Foreign candidates need at least the same minimum total score as the Mexican category for the specialty. Community social service in high-marginalization areas adds 1 point

Exam / Certification Fees

MXN 3,300 for the 50th ENARM (2026)

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.

Core specialty (weight not published)

Medicina Interna

Cardiology, endocrinology, infectious disease, nephrology, pulmonology, gastroenterology and rheumatology

Core specialty (weight not published)

Pediatría

Neonatology, development, pediatric infections and emergencies, nephrology and vaccination

Core specialty (weight not published)

Ginecología y Obstetricia

Prenatal care, hypertensive disorders, hemorrhage, preterm labor, contraception, infections and screening

Core specialty (weight not published)

Cirugía General

Acute abdomen, hernias, biliary disease, trauma, burns and surgical infections

Preparing for the ENARM Exam

What You Need to Know

  • Passing score: No fixed pass mark: places are assigned by descending 'Puntaje total sobre 100' within each specialty's available places. Foreign candidates need at least the same minimum total score as the Mexican category for the specialty. Community social service in high-marginalization areas adds 1 point
  • Assessment: Clinical cases in Spanish focused on public health, emergencies and family medicine across the four core specialties (internal medicine, pediatrics, obstetrics-gynecology and general surgery). Each case has two or three questions with one correct answer and three distractors. The total number of items is not published in the convocatoria.
  • Time limit: One 6-hour session (for example 08:00-14:00 or 16:00-22:00, local time, depending on the assigned shift and venue)
  • Exam / certification fees: MXN 3,300 for the 50th ENARM (2026) Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

ENARM: Suggested Study Strategy

1Study by clinical decision points in the four core specialties: diagnosis, first-line treatment and emergency management, as ENARM cases test them.
2Prioritize emergencies and primary care: shock, trauma (ABCDE), sepsis, obstetric hemorrhage, eclampsia, pediatric resuscitation and dehydration plans.
3Review Mexican norms and programs that appear in clinical cases, such as NOM-006 on tuberculosis, NOM-007 on pregnancy care, NOM-034 on neonatal screening and the 2026 vaccination protocol.
4Practice long clinical cases under time pressure to build reading speed and stamina for a 6-hour session.
5Rehearse in Spanish as well, since the official exam is in Spanish.

Frequently Asked Questions

What is the ENARM?

The Examen Nacional para Aspirantes a Residencias Médicas is the first stage of admission to the Sistema Nacional de Residencias Médicas. It is organized by the CIFRHS for Mexican and foreign general physicians who want to enter a specialty residency for the first time.

How is the 2026 ENARM structured?

According to the convocatoria for the 50th ENARM, the exam assesses clinical reasoning through clinical cases focused on public health, emergencies and family medicine across internal medicine, pediatrics, obstetrics-gynecology and general surgery. Each case has two or three questions, each with one correct answer and three distractors. The total number of items is not published.

When is the 2026 ENARM and how much does it cost?

The 50th ENARM is held on 28, 29 and 30 September 2026, in a 6-hour session at the venue, date and shift assigned to each candidate. The fee is MXN 3,300, and payment closed on 5 June 2026.

How are results used?

Each candidate receives a score out of 100 at the end of the exam. There is no fixed pass mark: residency places are assigned in descending score order within each specialty's available places. Community social service in high-marginalization areas adds 1 point, and foreign candidates must reach the same minimum score as the Mexican category for the specialty.

Why is this practice bank in English if the ENARM is in Spanish?

The current ENARM convocatoria describes a Spanish-language exam. This bank is an independent English-language study adaptation with four-option clinical questions, like the official format, but it is not an official translation or a full simulation. Mexican terms such as GPC, NOM and Código Mater are kept in Spanish.