MM RX IB Exit Opportunities?

Big difference between Gugg RX and the rest. That being said, if you grind hard during your analyst years, learn a ton, network a lot, then achieving UMM or a good distressed HF is totally doable. 

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I would not consider going to one of the MM RX firms unless it is your only option. You would be better on the M&A side if you get to pick. The problem with these firms, is even though a firm like Jefferies is on some large cases, they are typically not in a leadership position (not advising the fulcrum or the company). Jefferies for instance often advises the unsecured creditor committee, and in that position, you are not as involved and just won't get close to the deal experience that you get advising the fulcrum or the company. As you mentioned, it will also be a lot of pitching for a leadership role in the deal, only to lose to a top firm than settling to advise the UCC or for some other less involved role. And when it come to recruiting for UMM distressed PE, you just won't get the looks that a top RX firm would get. In terms of exposure and deal experience, it would just be difficult to compete against analyst from the top shops or even mid-tier shops like Gugg, Ducera, and PWP because they are getting great exposure from a leadership position, and all these analyst are competing for relatively few positions. If you do end up at one of these shops and want UMM PE/HF then lateraling to a mid or top tier firm would be your best best (which is tough because rx is slow right now).