1 | Page
100 FREE MCCQE1 2025 100% PASS
ASSURED UPDATED EXAM SOLUTIONS.
An 80-year-old woman comes to the urgent care
clinic with dyspnoea on exertion. On physical
examination, her blood pressure is 100/70, and
her pulse is 75. She has no pulsus paradoxus.
Her jugular veins are distended, and she has
distant heart sounds. In addition, she has
extra third and fourth heart sounds. Her liver
is enlarged, and she has pedal oedema. She has
occasional premature ventricular contractions
on her electrocardiogram. A chest x-ray
reveals clear lung fields with a dilated
cardiac silhouette. Her echocardiogram reveals
ventricular walls with a "speckled pattern".
Which of the following is the most likely
diagnosis?
- Alcoholic cardiomyopathy
- Amyloidosis
- Haemochromatosis
- Tuberculosis
- Viral myocarditis - correct answer-
Amyloidosis
Restrictive cardiomyopathy with 'speckled'
left ventricular wall
Primary cardiac amyloidosis usually develops
into diastolic dysfunction
,2 | Page
Alcoholic cardiomyopathy: biventricular
dilated cardiomyopathy
A 92-year-old man with a 45-year history of
chronic obstructive pulmonary disease is
intubated in the ICU because of a bout of
viral pneumonia that fails to improve after 72
hours of antibiotics. Although the inspired
fraction of oxygen is 100%, the patient's pO2
remains at 57 mmHg. Positive-end expiratory
pressure (PEEP) is added to allow the inspired
fraction of oxygen. Twelve hours after the
introduction of PEEP the patient suddenly
become hypotensive. At the same time, his
oxygen saturation drops from 92% to 61%. On
physical examination, his BP is 80/50 mmHg and
his pulse is 124/min. He has distended neck
veins and distant heart sounds. Which of the
following would also most likely be seen on
this patient's physical examination?
- Absence of breath sounds in the right
hemithorax
- High amplitude carotid artery upstroke
- A pleural friction rub
- Pulsus alternans
- Splenomegaly - correct answer- Absence of
breath sounds in the right hemithorax
,3 | Page
Patient has developed a tension pneumothorax,
characterised by PEEP followed by sudden
hypotension and decreased oxygenation
Jugular venous distention occurs because
venous return to the right side of the heart
is being compressed
Rx: immediate needle/tube thoracostomy
A 46-year-old man with a history of
hypertension and hypercholesterolemia visits
the physician for a routine followup. The
patient's job involves a lot of travelling,
and he admits to occasionally forgetting to
take his medications with him when he travels.
He complains of several episodes of chest pain
in the past few months. The pain is sharp in
nature, mainly over his lower chest and
epigastrium, and tends to come on when
walking. He believes these episodes are due to
indigestion and has been taking antacids.
There is a family history of heart disease,
and his father died of a heart attack at age
48. On physical examination, his blood
pressure is 150/80 mmHg and heart rate is
86/min. His lungs are clear to auscultation.
Cardiac auscultation reveals normal rate and
rhythm, without rubs, gallops, or murmurs.
There is no pedal oedema. He is sent for an
exercise stress test. Five minutes into the
test, he develops ST - correct answer-
Coronary angiography
, 4 | Page
Multiple risk factors for atherosclerotic
coronary artery disease
A stress test is considered positive when
there are ST depression of >1mm for longer
than 0.08 seconds
Positive stress test = coronary angiography
A 74-year-old woman, who has been followed for
the past 25 years for chronic obstructive
pulmonary disease comes to the ED complaining
of 48 hours of temperature to 38.6 C and
worsening shortness of breath. She has a
chronic productive cough, which has become
more copious. On physical examination, she has
rhonchi and increased fremitus in the
posterior mid-lung field. A Gram's stain
reveals many epithelial cells and multiple
gram-positive and gram-negative organisms; no
neutrophils are seen. Which of the following
is the most likely organism causing the
symptoms?
- Escherichia coli
- Haemophilus influenzae
- Klebsiella pneumoniae
- Mycobacterium tuberculosis
- Mycoplasma pneumoniae - correct answer-
Haemophilus influenzae
Evidence of community-acquired pneumonia and
common organisms in patients with COPD are
100 FREE MCCQE1 2025 100% PASS
ASSURED UPDATED EXAM SOLUTIONS.
An 80-year-old woman comes to the urgent care
clinic with dyspnoea on exertion. On physical
examination, her blood pressure is 100/70, and
her pulse is 75. She has no pulsus paradoxus.
Her jugular veins are distended, and she has
distant heart sounds. In addition, she has
extra third and fourth heart sounds. Her liver
is enlarged, and she has pedal oedema. She has
occasional premature ventricular contractions
on her electrocardiogram. A chest x-ray
reveals clear lung fields with a dilated
cardiac silhouette. Her echocardiogram reveals
ventricular walls with a "speckled pattern".
Which of the following is the most likely
diagnosis?
- Alcoholic cardiomyopathy
- Amyloidosis
- Haemochromatosis
- Tuberculosis
- Viral myocarditis - correct answer-
Amyloidosis
Restrictive cardiomyopathy with 'speckled'
left ventricular wall
Primary cardiac amyloidosis usually develops
into diastolic dysfunction
,2 | Page
Alcoholic cardiomyopathy: biventricular
dilated cardiomyopathy
A 92-year-old man with a 45-year history of
chronic obstructive pulmonary disease is
intubated in the ICU because of a bout of
viral pneumonia that fails to improve after 72
hours of antibiotics. Although the inspired
fraction of oxygen is 100%, the patient's pO2
remains at 57 mmHg. Positive-end expiratory
pressure (PEEP) is added to allow the inspired
fraction of oxygen. Twelve hours after the
introduction of PEEP the patient suddenly
become hypotensive. At the same time, his
oxygen saturation drops from 92% to 61%. On
physical examination, his BP is 80/50 mmHg and
his pulse is 124/min. He has distended neck
veins and distant heart sounds. Which of the
following would also most likely be seen on
this patient's physical examination?
- Absence of breath sounds in the right
hemithorax
- High amplitude carotid artery upstroke
- A pleural friction rub
- Pulsus alternans
- Splenomegaly - correct answer- Absence of
breath sounds in the right hemithorax
,3 | Page
Patient has developed a tension pneumothorax,
characterised by PEEP followed by sudden
hypotension and decreased oxygenation
Jugular venous distention occurs because
venous return to the right side of the heart
is being compressed
Rx: immediate needle/tube thoracostomy
A 46-year-old man with a history of
hypertension and hypercholesterolemia visits
the physician for a routine followup. The
patient's job involves a lot of travelling,
and he admits to occasionally forgetting to
take his medications with him when he travels.
He complains of several episodes of chest pain
in the past few months. The pain is sharp in
nature, mainly over his lower chest and
epigastrium, and tends to come on when
walking. He believes these episodes are due to
indigestion and has been taking antacids.
There is a family history of heart disease,
and his father died of a heart attack at age
48. On physical examination, his blood
pressure is 150/80 mmHg and heart rate is
86/min. His lungs are clear to auscultation.
Cardiac auscultation reveals normal rate and
rhythm, without rubs, gallops, or murmurs.
There is no pedal oedema. He is sent for an
exercise stress test. Five minutes into the
test, he develops ST - correct answer-
Coronary angiography
, 4 | Page
Multiple risk factors for atherosclerotic
coronary artery disease
A stress test is considered positive when
there are ST depression of >1mm for longer
than 0.08 seconds
Positive stress test = coronary angiography
A 74-year-old woman, who has been followed for
the past 25 years for chronic obstructive
pulmonary disease comes to the ED complaining
of 48 hours of temperature to 38.6 C and
worsening shortness of breath. She has a
chronic productive cough, which has become
more copious. On physical examination, she has
rhonchi and increased fremitus in the
posterior mid-lung field. A Gram's stain
reveals many epithelial cells and multiple
gram-positive and gram-negative organisms; no
neutrophils are seen. Which of the following
is the most likely organism causing the
symptoms?
- Escherichia coli
- Haemophilus influenzae
- Klebsiella pneumoniae
- Mycobacterium tuberculosis
- Mycoplasma pneumoniae - correct answer-
Haemophilus influenzae
Evidence of community-acquired pneumonia and
common organisms in patients with COPD are
