MCCQE1 (MEDICAL COUNCIL OF CANADA
QUALIFYING EXAMINATION PART 1) Actual Exam
Complete Questions and Answers Detailed Rationales
Pass Guaranteed - A+ Graded
Total Questions: 100 | Time: 120 min | Pass: 75% (scaled)
TABLE OF CONTENTS
Section 1 | Internal Medicine & Family Medicine | Q1 – Q25
Section 2 | Pediatrics & Obstetrics/Gynecology | Q26 – Q45
Section 3 | Psychiatry, Ethics & Legal Issues | Q46 – Q60
Section 4 | Surgery, Anesthesia & Emergency Medicine | Q61 – Q80
Section 5 | Public Health & Preventive Medicine | Q81 – Q100
Instructions: Choose the single best answer. Pass: 75% scaled score.
══════════════════════════════════════
SECTION 1: INTERNAL MEDICINE & FAMILY MEDICINE Q1 – Q25
══════════════════════════════════════
Question 1 of 100
A 68-year-old man presents to the emergency department with 45 minutes of crushing
substernal chest pain radiating to his left arm. He is diaphoretic and nauseated. Vital
signs show blood pressure 88/52 mmHg, heart rate 110 bpm, and oxygen saturation
92% on room air. The 12-lead ECG reveals 3 mm ST-segment elevation in leads V1
through V4.
A. Administer sublingual nitroglycerin and obtain a chest x-ray
B. Start heparin infusion and await cardiac enzyme results
C. Activate the cardiac catheterization lab for primary percutaneous coronary
intervention ✓ CORRECT
D. Administer thrombolytics and transfer to a monitored bed
,Correct Answer: C
Rationale: An anterior STEMI with cardiogenic shock requires emergent
revascularization via primary PCI, which offers superior outcomes to thrombolysis in
shock. Sublingual nitroglycerin is contraindicated with hypotension because it can
worsen coronary perfusion and cause cardiovascular collapse. Door-to-balloon time
targets remain under 90 minutes even when transfer to a PCI-capable centre is required.
Question 2 of 100
A 45-year-old woman presents to her family physician with 6 months of progressive
fatigue, pallor, and brittle nails. She reports heavy menstrual bleeding for the past year.
Laboratory studies show hemoglobin 92 g/L, MCV 68 fL, ferritin 8 mcg/L, and transferrin
saturation 12%.
A. Start oral vitamin B12 1000 mcg daily
B. Prescribe oral ferrous sulfate 300 mg twice daily and investigate menorrhagia ✓
CORRECT
C. Arrange urgent blood transfusion and admit for observation
D. Begin intravenous iron sucrose weekly for 8 weeks
Correct Answer: B
Rationale: Iron deficiency anemia with low ferritin and microcytic indices is best treated
with oral iron replacement while investigating the source of blood loss. Vitamin B12
treats macrocytic anemia, and transfusion is unnecessary unless the patient is
hemodynamically unstable or symptomatic with angina. Oral iron should be tried first
unless malabsorption or intolerance is present.
Question 3 of 100
A 55-year-old man with type 2 diabetes presents for a routine follow-up. He reports
burning pain in both feet that worsens at night and occasional numbness in his toes.
,Monofilament testing reveals loss of protective sensation bilaterally. His most recent
HbA1c is 8.2%.
A. Start gabapentin 100 mg at bedtime for pain control
B. Prescribe amitriptyline 25 mg nightly as first-line therapy
C. Optimize glycemic control and consider duloxetine for painful diabetic neuropathy ✓
CORRECT
D. Recommend capsaicin cream as the sole treatment for neuropathic pain
Correct Answer: C
Rationale: Tight glycemic control is the foundation of diabetic neuropathy management,
and duloxetine is a first-line agent for painful neuropathy with additional benefits for
mood and sleep. Amitriptyline is effective but often poorly tolerated due to
anticholinergic side effects in older adults, and capsaicin alone is insufficient for
moderate to severe symptoms. Gabapentin is reasonable but should be titrated
carefully and is not a substitute for glucose optimization.
Question 4 of 100
A 72-year-old woman is brought to clinic after a fall from standing height. She has no
loss of consciousness but sustained a right wrist fracture. Dual-energy x-ray
absorptiometry shows a T-score of -3.2 at the lumbar spine and -2.8 at the femoral neck.
Her serum calcium and vitamin D levels are normal.
A. Recommend weight-bearing exercise and calcium supplementation alone
B. Start raloxifene 60 mg daily for osteoporosis prevention
C. Prescribe vitamin D 2000 IU daily and repeat bone density in 2 years
D. Initiate alendronate 70 mg weekly with calcium and vitamin D supplementation ✓
CORRECT
Correct Answer: D
Rationale: A fragility fracture with T-scores in the osteoporotic range meets criteria for
pharmacologic therapy, and alendronate is a first-line bisphosphonate that reduces
, vertebral and hip fracture risk. Raloxifene prevents vertebral fractures but not hip
fractures, and calcium or vitamin D alone are insufficient after a fragility fracture.
Treatment should begin promptly because the risk of subsequent fracture is highest in
the first 2 years.
Question 5 of 100
A 34-year-old man presents with 3 weeks of dry cough, wheeze, and chest tightness that
is worse at night and with exercise. He has no fever and a normal chest x-ray.
Spirometry shows an FEV1/FVC ratio of 0.68 with a 15% improvement in FEV1 after
bronchodilator.
A. Prescribe a low-dose inhaled corticosteroid and a short-acting bronchodilator as
needed ✓ CORRECT
B. Start a long-acting beta-agonist alone for maintenance therapy
C. Begin a 5-day course of oral prednisone 40 mg daily
D. Order a high-resolution CT scan of the chest to rule out interstitial lung disease
Correct Answer: A
Rationale: Mild persistent asthma with reversible airflow obstruction is best managed
with daily low-dose inhaled corticosteroids plus a reliever bronchodilator, which reduces
exacerbations and improves control. Starting a LABA without an inhaled steroid is not
recommended for safety reasons, and oral steroids are reserved for acute
exacerbations. HRCT is unnecessary when the presentation is classic for asthma and
the chest x-ray is normal.
Question 6 of 100
A 58-year-old woman presents with 6 hours of severe right upper quadrant pain
radiating to her right scapula, nausea, and vomiting. She is febrile at 38.1°C.
Examination reveals Murphy's sign. Laboratory studies show leukocytosis and normal
liver enzymes.
QUALIFYING EXAMINATION PART 1) Actual Exam
Complete Questions and Answers Detailed Rationales
Pass Guaranteed - A+ Graded
Total Questions: 100 | Time: 120 min | Pass: 75% (scaled)
TABLE OF CONTENTS
Section 1 | Internal Medicine & Family Medicine | Q1 – Q25
Section 2 | Pediatrics & Obstetrics/Gynecology | Q26 – Q45
Section 3 | Psychiatry, Ethics & Legal Issues | Q46 – Q60
Section 4 | Surgery, Anesthesia & Emergency Medicine | Q61 – Q80
Section 5 | Public Health & Preventive Medicine | Q81 – Q100
Instructions: Choose the single best answer. Pass: 75% scaled score.
══════════════════════════════════════
SECTION 1: INTERNAL MEDICINE & FAMILY MEDICINE Q1 – Q25
══════════════════════════════════════
Question 1 of 100
A 68-year-old man presents to the emergency department with 45 minutes of crushing
substernal chest pain radiating to his left arm. He is diaphoretic and nauseated. Vital
signs show blood pressure 88/52 mmHg, heart rate 110 bpm, and oxygen saturation
92% on room air. The 12-lead ECG reveals 3 mm ST-segment elevation in leads V1
through V4.
A. Administer sublingual nitroglycerin and obtain a chest x-ray
B. Start heparin infusion and await cardiac enzyme results
C. Activate the cardiac catheterization lab for primary percutaneous coronary
intervention ✓ CORRECT
D. Administer thrombolytics and transfer to a monitored bed
,Correct Answer: C
Rationale: An anterior STEMI with cardiogenic shock requires emergent
revascularization via primary PCI, which offers superior outcomes to thrombolysis in
shock. Sublingual nitroglycerin is contraindicated with hypotension because it can
worsen coronary perfusion and cause cardiovascular collapse. Door-to-balloon time
targets remain under 90 minutes even when transfer to a PCI-capable centre is required.
Question 2 of 100
A 45-year-old woman presents to her family physician with 6 months of progressive
fatigue, pallor, and brittle nails. She reports heavy menstrual bleeding for the past year.
Laboratory studies show hemoglobin 92 g/L, MCV 68 fL, ferritin 8 mcg/L, and transferrin
saturation 12%.
A. Start oral vitamin B12 1000 mcg daily
B. Prescribe oral ferrous sulfate 300 mg twice daily and investigate menorrhagia ✓
CORRECT
C. Arrange urgent blood transfusion and admit for observation
D. Begin intravenous iron sucrose weekly for 8 weeks
Correct Answer: B
Rationale: Iron deficiency anemia with low ferritin and microcytic indices is best treated
with oral iron replacement while investigating the source of blood loss. Vitamin B12
treats macrocytic anemia, and transfusion is unnecessary unless the patient is
hemodynamically unstable or symptomatic with angina. Oral iron should be tried first
unless malabsorption or intolerance is present.
Question 3 of 100
A 55-year-old man with type 2 diabetes presents for a routine follow-up. He reports
burning pain in both feet that worsens at night and occasional numbness in his toes.
,Monofilament testing reveals loss of protective sensation bilaterally. His most recent
HbA1c is 8.2%.
A. Start gabapentin 100 mg at bedtime for pain control
B. Prescribe amitriptyline 25 mg nightly as first-line therapy
C. Optimize glycemic control and consider duloxetine for painful diabetic neuropathy ✓
CORRECT
D. Recommend capsaicin cream as the sole treatment for neuropathic pain
Correct Answer: C
Rationale: Tight glycemic control is the foundation of diabetic neuropathy management,
and duloxetine is a first-line agent for painful neuropathy with additional benefits for
mood and sleep. Amitriptyline is effective but often poorly tolerated due to
anticholinergic side effects in older adults, and capsaicin alone is insufficient for
moderate to severe symptoms. Gabapentin is reasonable but should be titrated
carefully and is not a substitute for glucose optimization.
Question 4 of 100
A 72-year-old woman is brought to clinic after a fall from standing height. She has no
loss of consciousness but sustained a right wrist fracture. Dual-energy x-ray
absorptiometry shows a T-score of -3.2 at the lumbar spine and -2.8 at the femoral neck.
Her serum calcium and vitamin D levels are normal.
A. Recommend weight-bearing exercise and calcium supplementation alone
B. Start raloxifene 60 mg daily for osteoporosis prevention
C. Prescribe vitamin D 2000 IU daily and repeat bone density in 2 years
D. Initiate alendronate 70 mg weekly with calcium and vitamin D supplementation ✓
CORRECT
Correct Answer: D
Rationale: A fragility fracture with T-scores in the osteoporotic range meets criteria for
pharmacologic therapy, and alendronate is a first-line bisphosphonate that reduces
, vertebral and hip fracture risk. Raloxifene prevents vertebral fractures but not hip
fractures, and calcium or vitamin D alone are insufficient after a fragility fracture.
Treatment should begin promptly because the risk of subsequent fracture is highest in
the first 2 years.
Question 5 of 100
A 34-year-old man presents with 3 weeks of dry cough, wheeze, and chest tightness that
is worse at night and with exercise. He has no fever and a normal chest x-ray.
Spirometry shows an FEV1/FVC ratio of 0.68 with a 15% improvement in FEV1 after
bronchodilator.
A. Prescribe a low-dose inhaled corticosteroid and a short-acting bronchodilator as
needed ✓ CORRECT
B. Start a long-acting beta-agonist alone for maintenance therapy
C. Begin a 5-day course of oral prednisone 40 mg daily
D. Order a high-resolution CT scan of the chest to rule out interstitial lung disease
Correct Answer: A
Rationale: Mild persistent asthma with reversible airflow obstruction is best managed
with daily low-dose inhaled corticosteroids plus a reliever bronchodilator, which reduces
exacerbations and improves control. Starting a LABA without an inhaled steroid is not
recommended for safety reasons, and oral steroids are reserved for acute
exacerbations. HRCT is unnecessary when the presentation is classic for asthma and
the chest x-ray is normal.
Question 6 of 100
A 58-year-old woman presents with 6 hours of severe right upper quadrant pain
radiating to her right scapula, nausea, and vomiting. She is febrile at 38.1°C.
Examination reveals Murphy's sign. Laboratory studies show leukocytosis and normal
liver enzymes.
