The preclinical curriculum of the Medical Faculty, University Kebangsaan Malaysia (UKM), underwent radical change in 1987 from traditional, subject-based system to integration of the preclinical disciplines into organ-system modules. To enhance integration, a hybrid-type of problem-based learning (PBL) was also introduced, to complement traditional teaching. Topics covered in PBL were to be dropped from lectures. Unfortunately, the mode of student assessment in the first year of implementation remained purely traditional via essays and multiple choice questions (MCQs), until the introduction of Problem-Based Questions (PBQ) the following year. This paper outlines the strategies adopted by the faculty to maintain the quality of the PBQ with respect to its planning, construction, implementation, and marking. The PBQ Report generated from student feedback surveys and analyses of question-items and student performance are given as a routine feedback process to the various departments involved. The heavy logistics mandated the “blood, sweat and tears” of a PBQ Coordinator who plays a central role in the PBQ Examination Committee to ensure quality assessment and the smooth implementation of this integrated examination via inter-departmental collaboration. For PBL and PBQ to flourish, the reward system must be more education-friendly.