MCCQE1 Exam
MCCQE1 EXAM NEWEST 2025/2026 COMPLETE ALL 100
QUESTIONS AND CORRECT DETAILED ANSWERS |ALREADY
GRADED A+||ALREADY GRADED A+
A 62-year-old man is being treated for an acute myocardial infarction. He originally
came to the ED with substernal chest pain and diaphoresis. Given his risk factors
of hypertension, diabetes, tobacco use, and family history, he is considered high
risk. An ECG in the ED reveals a left-bundle branch pattern, and cardiac enzymes
are elevated slightly. After a focused evaluation in the ED, the patient receives IV
thrombolytics. Although his bundle branch pattern never resolves, the patient is
chest pain-free and haemodynamically stable after thrombolysis. Two days later,
however, the patient reports episodes of recurrent chest discomfort and shortness
of breath overnight. In evaluating for potential myocardial reinfarction, which of
the following is the most appropriate diagnostic test?
- Creatinine kinase
- Dynamic ECG changes
- Lactate dehydrogenase
- Myoglobin levels
- Troponin I level
Creatinine kinase
CK, total levels and specific MB fraction, are elevated as early as 3 hours after
onset of chest pain and have a duration of no more than 2 days, peaking within
18-24 hours
Myoglobin is the first enzyme elevated and lasts no more than 1 day, but is
nonspecific to AMI
Troponin levels increase in 3-12 hours, peak in approximately 1 day, and gradually
taper over the next 10 days
A 41-year-old man comes to the clinic complaining of a chronic cough over the
past 4 months, which has now been accompanied by haemoptysis. He denies
1|Page
, MCCQE1 Exam
smoking or any past medical history. On physical examination, his head and neck
examination is normal. His lungs have diffuse bilateral rales. Cardiac examination
is normal. Laboratory findings reveal Na 142 mEq/L, K 4.2 mEq/L, Cl 110 mEq/L,
HCO3 24 mEq/L, BUN (blood urea nitrogen) 39 mg/dL, creatinine 2.9 mg/dL.
Urinalysis reveals microscopic haematuria and 4+ proteinuria. Which of the
following serologic blood tests would most help confirm the suspected diagnosis?
- Anti-glomerular basement membrane antibodies
- Anti-mitochondrial antibodies
- Anti-neutrophilic antibodies
- Anti-parietal cell antibodies
- Anti-smooth muscle antibodies
Anti-glomerular basement membrane antibodies
Haematuria + haemoptysis raises possibility of Goodpasture syndrome
Anti-mitochondrial = primary biliary cirrhosis
Anti-neutrophilic cytoplasmic = Wegener granulomatosisn (similar but + URTI sx)
Anti-parietal cell: pernicious anaemia
Anti-smooth muscle: autoimmune hepatitis
The parents of a 9-year-old girl bring their daughter to the ED. For the last 12
hours, the child has suffered severe nausea and vomiting, as well as diarrhoea and
abdominal cramps. Further discussion with the child indicates that she suffers
from blurred vision and headache. The parents originally were worried about
bringing the child to the ED because they feared deportation since the family are
illegal immigrants employed to pick strawberries on a nearby farm. On direct
questionning, the parents admit that the child was assisting with spraying crops
with pesticides the previous day. None of the family members was wearing any
protecting clothing. Her BP is 88/48 mmHg, pulse is 90/min, RR 33/min, Temp 38
C. The child appears sweaty and confused. Auscultation of the lungs reveals a
diffuse wheeze bilaterally. Pupils are miotic and the child has diffuse muscle
weakness. Which of the following interventions is the most
2|Page
, MCCQE1 Exam
Pralidoxime
Pesticide exposure: consider organophosphate poisoning, which inhibits
cholinesterase and results in accumulation of ACh in both muscarinic and nicotinic
sites. Pralidoxime activates ACh
Atropine competes with ACh only at muscarinic receptors, but will not reverse
nicotinic effects
Charcoal = gastric decontamination
Glucagon = reverse beta-blocker overdose
Naloxone = reverse effects of opioids
A 5-year-old boy suddenly begins coughing while eating peanuts. He is choking
and gagging. When he is brought to the ED, but he is awake and is able to give his
name. On physical examination, his vital signs are stable. On examination of the
chest, inspiratory stridor and intercostal and suprasternal retractions are
apparent. Which of the following is the most appropriate initial step in
management?
- Allow patient to clear foreign object by spontaneous coughing
- Clear oropharynx with multiple blind sweeps with finger
- Position patient and perform back blows
- Stand behind patient and perform abdominal thrusts
- Perform emergency tracheostomy and take to surgery
Allow patient to clear foreign object by spontaneous coughing
If patient can cough and breathe it is best to initially observe and allow
spontaneous resolution, since intervention may actually be damaging
A 35-year-old woman arrives on the floor after an uneventful hysteroscopy to
evaluate her long history of uterine fibroids. About 30 minutes after her arrival,
she begins to complain of nausea and has two episodes of vomiting. The physical
administers 0.625 mg of droperidol and 400 mg of acetaminophen by mouth. On
follow-up evaluation, the patient's neck is involuntarily flexed to one side. She is
3|Page
, MCCQE1 Exam
alert, oriented, and conversation and has an otherwise normal neurological
examination. Which of the following is the most likely diagnosis?
- Cerebral vascular accident
- Conversion disorder
- Dystonic reaction to droperidol
- Munchausen syndrome
- Seizure
Dystonic reaction to droperidol
Droperidol antagnosies dopaminergic receptors in the vomiting centre, which can
produce torticollic or other dystonias
Munchausen syndrome: mental disorder in which a person fakes illness to gain
attention and sympathy
Conversion disorder: neurological sx without a definable organic cause
A 35-year-old woman comes to the ED complaining of chest pressure. She has had
such episodes intermittently over the last 5 years, usually when sleeping, but over
the last year she has had more frequent severe symptoms that are occasionally
associated with severe migraine headaches. The pain is midsternal and is
described as pressure that extends as a band around her chest. The ED physician
is initially dubious that the pain is cardiac in origin, because the woman has no
coronary disease risk factors. An ECG, however, shows 2mm ST-segment elevation
and inverted T waves in leads V1 through V5 and 1mm ST-segment depression in
leads II, III, and aVF. Before the cardiologist arrives in the ED, the patient's ECG has
returned to normal. This repeat normal ECG is obtained after the administration of
aspirin, nitroglycerin, morphine, and oxygen. Which of the following is most likely
for these findings?
- Diffuse intimal thic
Transiently increased coronary vascular tone in the right coronary artery
Classic presentation of variant angina, caused by coronary vasospasm that induces
transient ischaemia and ST-segment elevations
Raynaud phenomenon or migraines are common clues to the diagnosis
4|Page
MCCQE1 EXAM NEWEST 2025/2026 COMPLETE ALL 100
QUESTIONS AND CORRECT DETAILED ANSWERS |ALREADY
GRADED A+||ALREADY GRADED A+
A 62-year-old man is being treated for an acute myocardial infarction. He originally
came to the ED with substernal chest pain and diaphoresis. Given his risk factors
of hypertension, diabetes, tobacco use, and family history, he is considered high
risk. An ECG in the ED reveals a left-bundle branch pattern, and cardiac enzymes
are elevated slightly. After a focused evaluation in the ED, the patient receives IV
thrombolytics. Although his bundle branch pattern never resolves, the patient is
chest pain-free and haemodynamically stable after thrombolysis. Two days later,
however, the patient reports episodes of recurrent chest discomfort and shortness
of breath overnight. In evaluating for potential myocardial reinfarction, which of
the following is the most appropriate diagnostic test?
- Creatinine kinase
- Dynamic ECG changes
- Lactate dehydrogenase
- Myoglobin levels
- Troponin I level
Creatinine kinase
CK, total levels and specific MB fraction, are elevated as early as 3 hours after
onset of chest pain and have a duration of no more than 2 days, peaking within
18-24 hours
Myoglobin is the first enzyme elevated and lasts no more than 1 day, but is
nonspecific to AMI
Troponin levels increase in 3-12 hours, peak in approximately 1 day, and gradually
taper over the next 10 days
A 41-year-old man comes to the clinic complaining of a chronic cough over the
past 4 months, which has now been accompanied by haemoptysis. He denies
1|Page
, MCCQE1 Exam
smoking or any past medical history. On physical examination, his head and neck
examination is normal. His lungs have diffuse bilateral rales. Cardiac examination
is normal. Laboratory findings reveal Na 142 mEq/L, K 4.2 mEq/L, Cl 110 mEq/L,
HCO3 24 mEq/L, BUN (blood urea nitrogen) 39 mg/dL, creatinine 2.9 mg/dL.
Urinalysis reveals microscopic haematuria and 4+ proteinuria. Which of the
following serologic blood tests would most help confirm the suspected diagnosis?
- Anti-glomerular basement membrane antibodies
- Anti-mitochondrial antibodies
- Anti-neutrophilic antibodies
- Anti-parietal cell antibodies
- Anti-smooth muscle antibodies
Anti-glomerular basement membrane antibodies
Haematuria + haemoptysis raises possibility of Goodpasture syndrome
Anti-mitochondrial = primary biliary cirrhosis
Anti-neutrophilic cytoplasmic = Wegener granulomatosisn (similar but + URTI sx)
Anti-parietal cell: pernicious anaemia
Anti-smooth muscle: autoimmune hepatitis
The parents of a 9-year-old girl bring their daughter to the ED. For the last 12
hours, the child has suffered severe nausea and vomiting, as well as diarrhoea and
abdominal cramps. Further discussion with the child indicates that she suffers
from blurred vision and headache. The parents originally were worried about
bringing the child to the ED because they feared deportation since the family are
illegal immigrants employed to pick strawberries on a nearby farm. On direct
questionning, the parents admit that the child was assisting with spraying crops
with pesticides the previous day. None of the family members was wearing any
protecting clothing. Her BP is 88/48 mmHg, pulse is 90/min, RR 33/min, Temp 38
C. The child appears sweaty and confused. Auscultation of the lungs reveals a
diffuse wheeze bilaterally. Pupils are miotic and the child has diffuse muscle
weakness. Which of the following interventions is the most
2|Page
, MCCQE1 Exam
Pralidoxime
Pesticide exposure: consider organophosphate poisoning, which inhibits
cholinesterase and results in accumulation of ACh in both muscarinic and nicotinic
sites. Pralidoxime activates ACh
Atropine competes with ACh only at muscarinic receptors, but will not reverse
nicotinic effects
Charcoal = gastric decontamination
Glucagon = reverse beta-blocker overdose
Naloxone = reverse effects of opioids
A 5-year-old boy suddenly begins coughing while eating peanuts. He is choking
and gagging. When he is brought to the ED, but he is awake and is able to give his
name. On physical examination, his vital signs are stable. On examination of the
chest, inspiratory stridor and intercostal and suprasternal retractions are
apparent. Which of the following is the most appropriate initial step in
management?
- Allow patient to clear foreign object by spontaneous coughing
- Clear oropharynx with multiple blind sweeps with finger
- Position patient and perform back blows
- Stand behind patient and perform abdominal thrusts
- Perform emergency tracheostomy and take to surgery
Allow patient to clear foreign object by spontaneous coughing
If patient can cough and breathe it is best to initially observe and allow
spontaneous resolution, since intervention may actually be damaging
A 35-year-old woman arrives on the floor after an uneventful hysteroscopy to
evaluate her long history of uterine fibroids. About 30 minutes after her arrival,
she begins to complain of nausea and has two episodes of vomiting. The physical
administers 0.625 mg of droperidol and 400 mg of acetaminophen by mouth. On
follow-up evaluation, the patient's neck is involuntarily flexed to one side. She is
3|Page
, MCCQE1 Exam
alert, oriented, and conversation and has an otherwise normal neurological
examination. Which of the following is the most likely diagnosis?
- Cerebral vascular accident
- Conversion disorder
- Dystonic reaction to droperidol
- Munchausen syndrome
- Seizure
Dystonic reaction to droperidol
Droperidol antagnosies dopaminergic receptors in the vomiting centre, which can
produce torticollic or other dystonias
Munchausen syndrome: mental disorder in which a person fakes illness to gain
attention and sympathy
Conversion disorder: neurological sx without a definable organic cause
A 35-year-old woman comes to the ED complaining of chest pressure. She has had
such episodes intermittently over the last 5 years, usually when sleeping, but over
the last year she has had more frequent severe symptoms that are occasionally
associated with severe migraine headaches. The pain is midsternal and is
described as pressure that extends as a band around her chest. The ED physician
is initially dubious that the pain is cardiac in origin, because the woman has no
coronary disease risk factors. An ECG, however, shows 2mm ST-segment elevation
and inverted T waves in leads V1 through V5 and 1mm ST-segment depression in
leads II, III, and aVF. Before the cardiologist arrives in the ED, the patient's ECG has
returned to normal. This repeat normal ECG is obtained after the administration of
aspirin, nitroglycerin, morphine, and oxygen. Which of the following is most likely
for these findings?
- Diffuse intimal thic
Transiently increased coronary vascular tone in the right coronary artery
Classic presentation of variant angina, caused by coronary vasospasm that induces
transient ischaemia and ST-segment elevations
Raynaud phenomenon or migraines are common clues to the diagnosis
4|Page
