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Free Practice Questions for PNA (Internato Médico)

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Key Facts: PNA (Internato Médico) Exam

150 items

Single-best-answer clinical vignettes, one point each, no deduction for errors

Regulamento da PNA 2025, Article 4

240 minutes

Two 120-minute parts sat on the same day

Regulamento da PNA 2025, Article 4

25 November 2026

Date of PNA 2026 for the IM 2027 competition

Aviso n.º 20582/2026/2, point 9.2

€90

PNA comparticipação, paid by Documento Único de Cobrança

Aviso n.º 20582/2026/2, point 9.5

50% Medicina

Largest indicative domain; Cirurgia and Pediatria 15% each, Ginecologia/Obstetrícia and Psiquiatria 10% each

ACSS, Perguntas Frequentes PNA 2025

80% / 20%

Weight of the PNA and of the normalized degree grade in specialty placement

Decreto-Lei n.º 13/2018, Article 38

Portuguese

Language of the official exam papers

ACSS published PNA papers

The PNA is Portugal's paper-based national exam for access to specialty training: 150 single-best-answer clinical vignettes (up to five options each) in two 120-minute parts, scored 0–150 with no pass mark. It is sat in Portuguese, costs €90, and runs on 25 November 2026. This bank is an independent English-language MCQ study adaptation, not an official translation.

Sample PNA (Internato Médico) Practice Questions

Try these sample questions to review concepts for the PNA (Internato Médico) exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 102+ question experience with AI tutoring.

1A 58-year-old man with hypertension who smokes presents to the emergency department with 2 hours of crushing retrosternal chest pain radiating to the left arm, with diaphoresis. The ECG obtained within 10 minutes shows 3 mm ST-segment elevation in V1–V4 with reciprocal ST depression in II, III and aVF. The nearest PCI-capable hospital is 30 minutes away by ambulance. What is the most appropriate next step?
A.Intravenous tenecteplase now, followed by transfer for angiography within 2–24 hours
B.Urgent CT coronary angiography to define the culprit lesion before choosing a reperfusion strategy
C.Immediate transfer for primary percutaneous coronary intervention (PCI)
D.Sublingual nitrate and observation until the high-sensitivity troponin result is available
Explanation: This is an anterior ST-elevation myocardial infarction. ESC guidelines recommend primary PCI as the reperfusion strategy whenever the expected time from STEMI diagnosis to wire crossing is 120 minutes or less. With a PCI centre 30 minutes away, the patient should be transferred directly for primary PCI; fibrinolysis is reserved for cases where that 120-minute target cannot be met.
2A 66-year-old woman with ischemic cardiomyopathy and a left ventricular ejection fraction of 32% has NYHA class II dyspnea. She takes enalapril 10 mg twice daily, bisoprolol 5 mg daily and furosemide 40 mg as needed. Blood pressure is 124/76 mmHg, heart rate 68 bpm, potassium 4.3 mmol/L and eGFR 58 mL/min/1.73 m². According to current ESC heart failure guidelines, which change best optimizes her prognostic therapy?
A.Add digoxin and double the furosemide dose to 80 mg daily to improve symptoms and survival
B.Replace enalapril with sacubitril/valsartan after a 36-hour washout, and add an MRA and an SGLT2 inhibitor
C.Replace bisoprolol with atenolol and add verapamil to lower the heart rate further
D.Stop enalapril and switch to hydralazine with isosorbide dinitrate as first-line vasodilator therapy for HFrEF
Explanation: For heart failure with reduced ejection fraction, ESC guidelines recommend four disease-modifying drug classes: an ACE inhibitor or ARNI, an evidence-based beta-blocker, a mineralocorticoid receptor antagonist and an SGLT2 inhibitor. She already takes an ACE inhibitor and bisoprolol. Sacubitril/valsartan is recommended as a replacement for an ACE inhibitor, with a 36-hour washout to reduce the risk of angioedema. Her potassium and eGFR allow an MRA such as spironolactone, and dapagliflozin or empagliflozin can be added.
3A 71-year-old woman with long-standing hypertension and type 2 diabetes presents with palpitations. The ECG shows atrial fibrillation at 114 bpm. She has no history of stroke, transient ischemic attack, heart failure or vascular disease, and echocardiography shows no significant valve disease with an LVEF of 55%. Using the CHA2DS2-VA score adopted in the 2024 ESC atrial fibrillation guidelines, what is her score and the recommended stroke prevention?
A.Score of 2; aspirin 100 mg daily as long-term stroke prevention
B.Score of 4; long-term warfarin with a target INR of 2.5–3.5
C.Score of 1; no antithrombotic therapy, with reassessment in one year
D.Score of 3; long-term oral anticoagulation, preferably with a DOAC
Explanation: The 2024 ESC guidelines replaced CHA2DS2-VASc with CHA2DS2-VA, which drops the point for female sex. She scores 1 for age 65–74, 1 for hypertension and 1 for diabetes, a total of 3. Oral anticoagulation is recommended for a score of 2 or more, and a direct oral anticoagulant is preferred over a vitamin K antagonist in atrial fibrillation without a mechanical valve or moderate-to-severe mitral stenosis.
4A 52-year-old man presents with severe headache, blurred vision and confusion. His blood pressure is 224/132 mmHg. Fundoscopy shows bilateral flame-shaped hemorrhages and papilledema, and serum creatinine is 2.4 mg/dL (baseline 1.0 mg/dL). What is the diagnosis and the initial treatment goal?
A.Hypertensive emergency; titratable IV therapy to lower mean arterial pressure by about 20–25% in the first hour
B.Hypertensive urgency; sublingual nifedipine to bring the pressure below 120/80 mmHg
C.Hypertensive emergency; IV furosemide to bring systolic pressure below 100 mmHg within 15 minutes
D.Hypertensive urgency; oral amlodipine, discharge and outpatient review within 24 hours
Explanation: Severe hypertension with acute target-organ damage (encephalopathy, papilledema and acute kidney injury) is a hypertensive emergency. Treatment is in a monitored setting with titratable intravenous agents such as labetalol, nicardipine or nitroprusside. Mean arterial pressure is lowered by about 20–25% initially, because a faster fall risks cerebral, coronary and renal hypoperfusion when autoregulation is shifted to higher pressures.
5A 78-year-old man has had two syncopal episodes on exertion in the past month. He has a harsh, late-peaking crescendo-decrescendo systolic murmur at the right second intercostal space radiating to the carotids, a soft S2 and a slow-rising carotid pulse. Echocardiography shows a calcified aortic valve with peak velocity 4.3 m/s, mean gradient 48 mmHg and valve area 0.7 cm². What is the diagnosis and the definitive management?
A.Moderate aortic stenosis; repeat echocardiography in 12 months
B.Hypertrophic obstructive cardiomyopathy; high-dose beta-blocker and septal myectomy
C.Severe symptomatic aortic stenosis; aortic valve replacement (SAVR or TAVI after Heart Team review)
D.Severe mitral regurgitation; transcatheter edge-to-edge mitral valve repair (TEER) after Heart Team review
Explanation: A peak velocity of at least 4.0 m/s, a mean gradient of at least 40 mmHg and a valve area below 1.0 cm² define severe aortic stenosis. Exertional syncope, angina or heart failure in severe aortic stenosis carries a poor prognosis without intervention. Aortic valve replacement is indicated, and the Heart Team chooses surgical replacement or transcatheter implantation (TAVI) based on age, surgical risk and anatomy.
6A 28-year-old man has had sharp substernal chest pain for 24 hours that worsens lying flat and on deep inspiration and eases when he sits forward. He had an upper respiratory infection a week ago. There is a pericardial friction rub, and the ECG shows diffuse concave ST elevation with PR depression and ST depression in aVR. Echocardiography shows no effusion. What is the first-line treatment?
A.Intravenous unfractionated heparin and urgent coronary angiography
B.Oral prednisone 1 mg/kg/day as first-line monotherapy
C.Intravenous vancomycin plus ceftriaxone for presumed purulent pericarditis
D.A high-dose NSAID or aspirin combined with colchicine
Explanation: Pleuritic, positional chest pain with a friction rub and diffuse ST elevation with PR depression after a viral illness is acute pericarditis. ESC guidelines recommend a high-dose NSAID (for example ibuprofen 600 mg every 8 hours) or aspirin, with gastroprotection, combined with colchicine for about 3 months. Colchicine speeds recovery and halves the risk of recurrence.
7A 65-year-old man with a 40 pack-year smoking history has chronic dyspnea and a productive cough. Post-bronchodilator spirometry shows FEV1/FVC 0.58 and FEV1 62% predicted. In the past year he had one moderate exacerbation treated at home with oral antibiotics, and his mMRC dyspnea grade is 2. According to the current GOLD report, what are his spirometric grade, his group and the recommended initial maintenance therapy?
A.GOLD 1, group A; a short-acting bronchodilator as needed only
B.GOLD 2, group B; a LABA plus a LAMA, preferably in a single inhaler
C.GOLD 3, group E; triple ICS/LABA/LAMA therapy from the start
D.GOLD 2, group E; a LABA plus an inhaled corticosteroid because of the exacerbation
Explanation: A post-bronchodilator FEV1/FVC below 0.70 confirms airflow obstruction, and an FEV1 of 50–79% predicted is GOLD 2. With no more than one moderate exacerbation not leading to admission and an mMRC grade of 2 or more, he is in group B. Since the 2023 report, GOLD recommends starting group B on a LABA plus a LAMA, preferably in a single inhaler.
8A 24-year-old woman with asthma uses low-dose budesonide/formoterol as maintenance and reliever therapy (MART). Her inhaler technique and adherence are good, but she has daytime symptoms 4 days a week, wakes with cough once a week and limits her activity. Her FEV1 is 78% predicted. According to GINA Track 1, what is the next step?
A.Increase to medium-dose ICS-formoterol as maintenance and reliever therapy
B.Stop inhaled therapy and start daily oral prednisolone 20 mg
C.Switch the reliever to salbutamol and reduce the inhaled corticosteroid dose
D.Add theophylline and a LAMA while keeping the same low ICS dose
Explanation: In GINA Track 1, ICS-formoterol is used as the reliever at every step. Asthma that remains uncontrolled on low-dose ICS-formoterol MART (Step 3), after checking technique, adherence and comorbidities, is stepped up to Step 4: medium-dose ICS-formoterol maintenance with ICS-formoterol as needed.
9A 68-year-old man has 3 days of productive cough with rust-colored sputum, right pleuritic pain and high fever. He is alert and oriented. Respiratory rate is 32/min, blood pressure 86/54 mmHg and pulse 110 bpm, with bronchial breathing at the right base. Urea is 10 mmol/L (BUN 28 mg/dL), and the chest radiograph shows right lower lobe consolidation. What is his CURB-65 score and the appropriate site of care?
A.CURB-65 of 2; a short hospital stay or hospital-supervised outpatient treatment
B.CURB-65 of 1; home treatment with oral amoxicillin
C.CURB-65 of 3; admission to a general ward without intensive care review
D.CURB-65 of 4; urgent admission with assessment for intensive care
Explanation: CURB-65 gives one point each for confusion, urea above 7 mmol/L, respiratory rate of 30/min or more, systolic pressure below 90 mmHg or diastolic 60 mmHg or less, and age 65 or over. He scores for urea (10 mmol/L), respiratory rate (32/min), blood pressure (86/54 mmHg) and age (68), but not confusion, a total of 4. A score of 3–5 indicates severe pneumonia needing hospital care, and scores of 4–5 should prompt intensive care assessment, especially with hypotension.
10A 45-year-old woman who had a right total hip replacement 10 days ago develops sudden dyspnea and right pleuritic chest pain. Blood pressure is 118/72 mmHg, heart rate 108 bpm, respiratory rate 24/min and SpO2 93% on air. Her right calf is swollen and tender. She has no hemoptysis and PE is the most likely diagnosis, giving a Wells score of 9. What is the most appropriate diagnostic test?
A.High-sensitivity D-dimer, proceeding to imaging only if it is raised
B.Transthoracic echocardiography to look for a patent foramen ovale
C.CT pulmonary angiography (CTPA)
D.Bilateral lower-limb arterial duplex ultrasound
Explanation: Her Wells score is 9: clinical signs of DVT (3), PE as the most likely diagnosis (3), heart rate above 100 (1.5) and surgery within 4 weeks (1.5). With a high or 'likely' clinical probability, D-dimer is skipped because a normal value cannot safely exclude PE. In a hemodynamically stable patient, CT pulmonary angiography is the diagnostic test, and anticoagulation is started while it is awaited unless contraindicated.

About the PNA (Internato Médico) Exam

Independent practice questions by OpenExamPrep for Portugal's Prova Nacional de Acesso (PNA), the national exam that ranks doctors for Formação Especializada places in the Internato Médico. The PNA has 150 clinical-vignette single-best-answer items in two 120-minute parts. The bank follows the five domains of the official matriz de conteúdos: Medicina, Cirurgia, Pediatria, Ginecologia/Obstetrícia and Psiquiatria.

Exam sponsor: ACSS, I.P., with the Gabinete para a Prova Nacional de Acesso (GPNA). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Two 120-minute parts on one day (Parte I, items 1–75; Parte II, items 76–150; in 2025 they started at 10:30 and 15:30, mainland time). The matriz de conteúdos (Annex II of Despacho n.º 4412/2018, revised by Despachos n.º 5495-A/2021 and 3029/2024) lists contents by domain and knowledge area, rated A to C for relevance and tagged for disease mechanisms, diagnosis, prevention and patient management. ACSS's indicative proportions are Medicina 50%, Cirurgia 15%, Pediatria 15%, Ginecologia/Obstetrícia 10% and Psiquiatria 10%; general practice is treated as cross-cutting.

Time Limit

240 minutes (two 120-minute parts)

Passing Score

No pass mark; ranking score from 0 to 150, weighted 80% with 20% for the normalized degree grade (100% PNA for candidates who began medical school before Decreto-Lei n.º 13/2018)

Exam / Certification Fees

€90 comparticipação (Aviso n.º 20582/2026/2)

Exam sponsor website

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

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.

50% (indicative)

Medicina

Chest pain, dyspnea, ACS, AF, heart failure, VTE, COPD, asthma, pneumonia, GI bleeding, pancreatitis, cirrhosis, AKI and CKD, electrolytes and acid-base, glomerular disease, oncologic emergencies, anemias and hematologic malignancy, sepsis, CNS infection, HIV, rheumatology, stroke, seizures, Parkinson's disease, diabetes, thyroid, adrenal and calcium disorders

15% (indicative)

Cirurgia

Acute abdomen, biliary disease, diverticulitis, bowel obstruction and volvulus, perforated ulcer, hernias, limb ischemia and aortic aneurysm, colorectal, gastric and breast cancer, trauma, burns, wounds, and sense-organ emergencies

15% (indicative)

Pediatria

Neonatal jaundice and resuscitation, respiratory distress, bronchiolitis, croup, febrile seizures, exanthems, otitis media, fluids, anaphylaxis, development, faltering growth, nephrotic syndrome and urinary tract infection

10% (indicative)

Ginecologia/Obstetrícia

First-trimester screening, preeclampsia and HELLP, third-trimester bleeding, postpartum hemorrhage, gestational diabetes, intrapartum fetal monitoring, ectopic pregnancy, cervical screening, abnormal uterine bleeding and pelvic inflammatory disease

10% (indicative)

Psiquiatria

Depression, bipolar disorder, schizophrenia, anxiety and OCD, suicide risk, alcohol withdrawal, opioid overdose, lithium toxicity, neuroleptic malignant syndrome and anorexia nervosa

Preparing for the PNA (Internato Médico) Exam

What You Need to Know

  • Passing score: No pass mark; ranking score from 0 to 150, weighted 80% with 20% for the normalized degree grade (100% PNA for candidates who began medical school before Decreto-Lei n.º 13/2018)
  • Assessment: Two 120-minute parts on one day (Parte I, items 1–75; Parte II, items 76–150; in 2025 they started at 10:30 and 15:30, mainland time). The matriz de conteúdos (Annex II of Despacho n.º 4412/2018, revised by Despachos n.º 5495-A/2021 and 3029/2024) lists contents by domain and knowledge area, rated A to C for relevance and tagged for disease mechanisms, diagnosis, prevention and patient management. ACSS's indicative proportions are Medicina 50%, Cirurgia 15%, Pediatria 15%, Ginecologia/Obstetrícia 10% and Psiquiatria 10%; general practice is treated as cross-cutting.
  • Time limit: 240 minutes (two 120-minute parts)
  • Exam / certification fees: €90 comparticipação (Aviso n.º 20582/2026/2) Official sources

Using Our Practice Resources

  • Work through all 102 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

PNA (Internato Médico): Suggested Study Strategy

1Weight your study by the indicative proportions: half of the exam is Medicina, so prioritize the A* approach-to-the-patient contents (chest pain, dyspnea, fever, jaundice, GI bleeding, urinary changes, electrolytes)
2Practise reading long clinical vignettes and choosing the single best next step, diagnosis or test, because every PNA item starts from a clinical case
3Use the official reference books listed in the matriz (Harrison's for A* contents) and current national norms such as the Programa Nacional de Vacinação where they apply
4Work through the released PNA papers and answer keys on the ACSS website under timed conditions of 75 items in 120 minutes
5Learn the laboratory reference-value table format, because a table is supplied in the exam instead of values in each vignette

Frequently Asked Questions

What is the Prova Nacional de Acesso (PNA)?

The PNA is the national exam that ranks candidates for Formação Especializada (specialty training) places in Portugal's Internato Médico. GPNA prepares it and ACSS runs it within the annual procedimento concursal. It is mandatory for candidates seeking a specialty place or a change of specialty or training site, and not required for candidates applying only for Formação Geral.

How is the PNA structured?

The Regulamento da PNA sets 150 single-best-answer items, each built on a clinical vignette, with up to five options per item. The exam lasts 240 minutes in two 120-minute parts sat on the same day, in three paper versions. Answers are marked on answer sheets, and candidates receive a table of laboratory reference values.

What does the PNA cover?

The matriz de conteúdos (Despacho n.º 4412/2018, revised by Despachos n.º 5495-A/2021 and 3029/2024) organizes contents by domain and knowledge area, with A to C relevance ratings. ACSS's FAQ gives indicative, non-binding proportions: Medicina 50%, Cirurgia 15%, Pediatria 15%, Ginecologia/Obstetrícia 10% and Psiquiatria 10%.

How is the PNA scored and how does it affect placement?

Each correct answer scores one point, with no deduction for wrong or blank answers, giving a score from 0 to 150; there is no pass mark. Under Decreto-Lei n.º 13/2018, Article 38, placement uses 80% of the PNA score and 20% of the normalized medical-degree grade (100% PNA for candidates who began medical school before the decree), with ties broken by the PNA score and then a public draw.

When is PNA 2026 and how much does it cost?

ACSS scheduled PNA 2026 for 25 November 2026 in the Norte, Centro, Lisboa e Vale do Tejo, Açores and Madeira regions. Applications to the IM 2027 competition ran from 31 August to 18 September 2026, and the €90 comparticipação is paid by Documento Único de Cobrança (Aviso n.º 20582/2026/2).

Is this practice bank an official PNA simulation?

No. The PNA is sat in Portuguese, on paper, with items that have up to five options. This bank is an independent English-language MCQ study adaptation by OpenExamPrep with four options per question. It is not an official translation, a reproduction of GPNA items, or endorsed by ACSS or GPNA.