I digged a little bit more on how and when to do the medical exam, here is what I found:Doing it upfront has nothing to do with it. If everything is alright during the medical exam, then they have no reason to ask for a second one unless some new information came into light! Call IRCC! This might have been mistake on their end as well! But for clarity it's better to connect with an agent and ask!
As of October 1, 2023, you no longer need to get an upfront medical examination before you submit your application for permanent residence through Express Entry.
After you submit your complete application for permanent residence, we’ll send you instructions on how to get your medical exam done. Please wait for our instructions before going for a medical exam.
It make sens now.
I'll keep you guys updated, hopefully I am close to the goal.