MCCQE1 Questions Actual Exam Complete Q&A |
Medical Council of Canada Qualifying Exam | Pass
Guaranteed - A+ Graded
Core Clinical Medicine & Medical Knowledge
Q1. A 68-year-old man with hypertension and type 2 diabetes presents with progressive
dyspnea on exertion, orthopnea, and bilateral ankle edema. His JVP is elevated, and an
echocardiogram from last month shows an ejection fraction of 30%. He is already on
ramipril, metoprolol, and spironolactone. According to current Canadian heart failure
guidelines, which medication should be added to reduce mortality?
A. Digoxin
B. Hydralazine-isosorbide dinitrate
C. Dapagliflozin [CORRECT]
D. Amlodipine
Correct Answer: C
,Rationale: The correct answer is dapagliflozin. For MCCQE1, remember that SGLT2
inhibitors are now foundational therapy for HFrEF alongside ACE inhibitors/ARBs,
beta-blockers, and MRAs—they have robust evidence for reducing both mortality and
heart failure hospitalizations. Digoxin can help with symptoms but does not improve
survival, hydralazine-ISDN is reserved for specific populations or ACE-inhibitor
intolerance, and amlodipine has neutral effects in heart failure.
Q2. A 55-year-old woman develops crushing substernal chest pain radiating to her left
arm while at work. The pain started 90 minutes ago. Her vital signs are stable, but she
appears diaphoretic. ECG shows ST-segment elevation in leads V1 through V4. What is
the most appropriate next step in management?
A. Administer thrombolytics and arrange transfer
B. Arrange for immediate primary percutaneous coronary intervention [CORRECT]
C. Start heparin infusion and admit for medical management
D. Schedule a stress test for the following day
Correct Answer: B
Rationale: The correct answer is primary PCI. For STEMI with symptom onset within 12
hours, immediate percutaneous coronary intervention is the reperfusion strategy of
choice in Canada when it can be performed within 90 minutes. Thrombolytics are
,reserved for situations where PCI cannot be achieved within 120 minutes, and stress
testing is absolutely contraindicated in the setting of acute STEMI.
Q3. A 42-year-old man is found to have blood pressure readings of 148/94 mmHg and
152/96 mmHg on two separate office visits. He has no diabetes, chronic kidney disease,
or known cardiovascular disease. According to Hypertension Canada guidelines, what is
the threshold for initiating pharmacologic therapy in this patient?
A. SBP ≥ 140 or DBP ≥ 90 mmHg [CORRECT]
B. SBP ≥ 130 or DBP ≥ 80 mmHg
C. SBP ≥ 160 or DBP ≥ 100 mmHg
D. SBP ≥ 150 or DBP ≥ 95 mmHg
Correct Answer: A
Rationale: The correct answer is A. For adults without compelling indications like
diabetes or CKD, Hypertension Canada recommends starting pharmacologic therapy
when blood pressure is persistently at or above 140/90 mmHg after an appropriate trial
of lifestyle modification. The threshold drops to 130/80 for patients with diabetes, CKD,
or established cardiovascular disease.
, Q4. A 70-year-old woman with non-valvular atrial fibrillation has a CHA₂DS₂-VASc score
of 4. She has no history of major bleeding. Which strategy is recommended for stroke
prevention?
A. Aspirin 81 mg daily
B. Warfarin with target INR 2.0–3.0
C. Apixaban 5 mg twice daily [CORRECT]
D. Clopidogrel 75 mg daily
Correct Answer: C
Rationale: The correct answer is apixaban. For non-valvular atrial fibrillation with a
CHA₂DS₂-VASc score of 2 or greater in men or 3 or greater in women, oral
anticoagulation is indicated, and DOACs like apixaban are preferred over warfarin for
most patients because they have fewer drug interactions, no monitoring requirements,
and lower intracranial bleeding risk. Aspirin and clopidogrel are insufficient for stroke
prevention in AF.
Q5. A 45-year-old woman presents with acute severe headache, neck stiffness, and
fever. She is confused and photophobic. What is the most appropriate next step?
A. Start empiric antibiotics and perform lumbar puncture [CORRECT]
Medical Council of Canada Qualifying Exam | Pass
Guaranteed - A+ Graded
Core Clinical Medicine & Medical Knowledge
Q1. A 68-year-old man with hypertension and type 2 diabetes presents with progressive
dyspnea on exertion, orthopnea, and bilateral ankle edema. His JVP is elevated, and an
echocardiogram from last month shows an ejection fraction of 30%. He is already on
ramipril, metoprolol, and spironolactone. According to current Canadian heart failure
guidelines, which medication should be added to reduce mortality?
A. Digoxin
B. Hydralazine-isosorbide dinitrate
C. Dapagliflozin [CORRECT]
D. Amlodipine
Correct Answer: C
,Rationale: The correct answer is dapagliflozin. For MCCQE1, remember that SGLT2
inhibitors are now foundational therapy for HFrEF alongside ACE inhibitors/ARBs,
beta-blockers, and MRAs—they have robust evidence for reducing both mortality and
heart failure hospitalizations. Digoxin can help with symptoms but does not improve
survival, hydralazine-ISDN is reserved for specific populations or ACE-inhibitor
intolerance, and amlodipine has neutral effects in heart failure.
Q2. A 55-year-old woman develops crushing substernal chest pain radiating to her left
arm while at work. The pain started 90 minutes ago. Her vital signs are stable, but she
appears diaphoretic. ECG shows ST-segment elevation in leads V1 through V4. What is
the most appropriate next step in management?
A. Administer thrombolytics and arrange transfer
B. Arrange for immediate primary percutaneous coronary intervention [CORRECT]
C. Start heparin infusion and admit for medical management
D. Schedule a stress test for the following day
Correct Answer: B
Rationale: The correct answer is primary PCI. For STEMI with symptom onset within 12
hours, immediate percutaneous coronary intervention is the reperfusion strategy of
choice in Canada when it can be performed within 90 minutes. Thrombolytics are
,reserved for situations where PCI cannot be achieved within 120 minutes, and stress
testing is absolutely contraindicated in the setting of acute STEMI.
Q3. A 42-year-old man is found to have blood pressure readings of 148/94 mmHg and
152/96 mmHg on two separate office visits. He has no diabetes, chronic kidney disease,
or known cardiovascular disease. According to Hypertension Canada guidelines, what is
the threshold for initiating pharmacologic therapy in this patient?
A. SBP ≥ 140 or DBP ≥ 90 mmHg [CORRECT]
B. SBP ≥ 130 or DBP ≥ 80 mmHg
C. SBP ≥ 160 or DBP ≥ 100 mmHg
D. SBP ≥ 150 or DBP ≥ 95 mmHg
Correct Answer: A
Rationale: The correct answer is A. For adults without compelling indications like
diabetes or CKD, Hypertension Canada recommends starting pharmacologic therapy
when blood pressure is persistently at or above 140/90 mmHg after an appropriate trial
of lifestyle modification. The threshold drops to 130/80 for patients with diabetes, CKD,
or established cardiovascular disease.
, Q4. A 70-year-old woman with non-valvular atrial fibrillation has a CHA₂DS₂-VASc score
of 4. She has no history of major bleeding. Which strategy is recommended for stroke
prevention?
A. Aspirin 81 mg daily
B. Warfarin with target INR 2.0–3.0
C. Apixaban 5 mg twice daily [CORRECT]
D. Clopidogrel 75 mg daily
Correct Answer: C
Rationale: The correct answer is apixaban. For non-valvular atrial fibrillation with a
CHA₂DS₂-VASc score of 2 or greater in men or 3 or greater in women, oral
anticoagulation is indicated, and DOACs like apixaban are preferred over warfarin for
most patients because they have fewer drug interactions, no monitoring requirements,
and lower intracranial bleeding risk. Aspirin and clopidogrel are insufficient for stroke
prevention in AF.
Q5. A 45-year-old woman presents with acute severe headache, neck stiffness, and
fever. She is confused and photophobic. What is the most appropriate next step?
A. Start empiric antibiotics and perform lumbar puncture [CORRECT]
