Background: Stress affects medical students in various ways, such as academic performance, substance abuse, and burnout. To deal with this stress, students apply different coping strategies or mechanisms. This study aims to evaluate the level of perceived stress and the coping strategies used by students during exams. Aims: (a) To assess the level of perceived stress among undergraduate medical students, and (b) to identify the various coping strategies used by students to handle stress. Materials and methods: The current study was done among Bachelor of Medicine, Bachelor of Surgery (MBBS) students in a government medical college. After obtaining informed consent, all the students belonging to the 2nd and final years were included. A self-administered questionnaire was used to gather data on social factors, perceived stress, and coping strategies. Results: The study with 423 medical students showed that final-year students faced more moderate to severe stress (70 and 11%) compared to 2nd-year students (60.7 and 6.1%) 3 months before exams, with similar patterns just before exams. Female students reported higher severe stress levels (15.4%) than males (5.1%) 3 months prior (p = 0.001), but not before exams (p = 0.305). Active coping (p = 0.011) and planning (p = 0.001) correlated with lower perceived stress, while distraction (p = 0.001), denial (p = 0.009), and self-blame (p = 0.001) were linked to higher stress. Conclusions: As exams approached, stress levels increased, particularly among final-year students, who initially used problem-focused strategies but later shifted to dysfunctional coping strategies (distraction, venting, self-blame). In contrast, mildly stressed 2nd-year students consistently employed adaptive coping strategies such as planning and seeking emotional support. Clinical significance: Screening students with a stress scale early on allows us to effectively help them manage stress through peer-support groups, incorporating mindfulness, physical activities, and counseling.