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MCCQE MEDICAL LICENSING EXAM –
PRACTICE QUESTIONS | LATEST UPDATE
2026/2027 | STUDY GUIDE | EXAM PREP.
Table of Contents
1. Internal Medicine
2. Surgery
3. Pediatrics
4. Obstetrics and Gynecology
5. Psychiatry
6. Public Health, Preventive Medicine, and Ethics
7. Emergency Medicine and Critical Care
8. Family Medicine and Primary Care
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Question 1: A 68-year-old man presents to the emergency department with crushing chest
pain radiating to his jaw, associated with diaphoresis and nausea. His ECG shows ST-segment
elevation in leads V1–V4. Which one of the following is the most appropriate immediate
management?
A) Administer sublingual nitroglycerin and observe.
B) Administer aspirin, initiate reperfusion therapy, and provide supportive care.
C) Obtain a chest X-ray and await troponin results before any intervention.
D) Administer a beta-blocker and schedule an outpatient stress test.
E) Start broad-spectrum antibiotics for presumed pericarditis.
Correct Answer: B) Administer aspirin, initiate reperfusion therapy, and provide
supportive care.
This presentation is consistent with an acute ST-elevation myocardial infarction (STEMI).
Immediate management includes aspirin, activation of the cardiac catheterization laboratory
for primary percutaneous coronary intervention (PCI), or fibrinolytic therapy if PCI is
unavailable within the recommended time window. Delay for further diagnostics is
inappropriate and increases myocardial damage.
Question 2: A 25-year-old man presents with a 2-month history of knee swelling, pain, and
inflammation. He reports low back pain and morning stiffness for 2 years. Which one of the
following is most likely to confirm the diagnosis?
A) Uric acid level
B) Antinuclear antibodies test
C) Radiography of the sacroiliac joints
D) Rheumatoid factor level
E) Synovial fluid analysis
Correct Answer: C) Radiography of the sacroiliac joints
The combination of peripheral arthritis and inflammatory back pain in a young man suggests
ankylosing spondylitis, a seronegative spondyloarthropathy. Sacroiliitis on plain radiography
of the sacroiliac joints is a hallmark finding. Uric acid would evaluate gout, rheumatoid
factor and antinuclear antibodies are less specific, and synovial fluid analysis is more
relevant for septic or crystal arthritis.
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Question 3: A 78-year-old woman is found to have a 2-cm hypoechoic thyroid nodule. She is
asymptomatic, has no history of head or neck radiation, and has no family history of thyroid
cancer. Her TSH is 0.10 mIU/L (suppressed). Which one of the following is the best next
step?
A) Computed tomography of the neck
B) Thyroid antibody levels
C) Fine-needle aspiration of the thyroid
D) Repeat thyroid ultrasonography in 6 months
E) Thyroid uptake and scan
Correct Answer: E) Thyroid uptake and scan
A suppressed TSH in the setting of a thyroid nodule suggests a hyperfunctioning (toxic)
nodule. Thyroid uptake and scan should be performed to confirm whether the nodule is
hyperfunctioning; if so, malignancy risk is very low and fine-needle aspiration is not
required. FNA is indicated for non-functioning nodules with suspicious features.
Question 4: A 77-year-old man presents with urinary incontinence for 2 months. He reports a
constant feeling of bladder fullness and frequent loss of control during the day and night. He
has a 1-year history of urinary frequency and nocturia. Which one of the following is the
most likely diagnosis?
A) Interstitial cystitis
B) Prostate cancer
C) Neurogenic bladder
D) Chronic cystitis
E) Overflow incontinence
Correct Answer: E) Overflow incontinence
Overflow incontinence occurs when the bladder does not empty completely, leading to
constant dribbling and a sensation of fullness. In an older man, benign prostatic hyperplasia
or other causes of bladder outlet obstruction are common culprits. The chronic history of
frequency and nocturia supports this diagnosis.
Question 5: An 8-year-old boy is brought by his mother for a 6-month history of persistent
cough. He has single bark-like coughs about 20 times daily but does not cough at night. His
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mother notes he has been shaking his head and blinking more frequently. Which one of the
following in the history would be most important to consider?
A) Frequent vomiting
B) Family history of epilepsy
C) Academic performance
D) Exposure to allergens
E) Recent weight loss
Correct Answer: C) Academic performance
The combination of a chronic, daytime-predominant bark-like cough and motor tics (head
shaking, blinking) in a school-aged child suggests Tourette syndrome or a tic disorder. Tics
often worsen with stress and can affect social and academic functioning. Assessing academic
performance and psychosocial impact is essential for management.
Question 6: A 42-year-old woman discloses that her husband is physically abusing her. A few
days later, a police officer calls requesting medical information for an investigation. Which
one of the following is the best next step?
A) Call the police officer after reviewing the patient's file.
B) Contact the patient to discuss the request.
C) Send the police officer a medicolegal report.
D) Refuse to speak with the police officer.
E) Provide the information verbally over the phone.
Correct Answer: B) Contact the patient to discuss the request.
Patient confidentiality must be maintained unless the patient provides consent or a legal
obligation requires disclosure. The physician should first discuss the request with the patient
to obtain informed consent or clarify her wishes. Releasing information without consent may
violate privacy legislation and the therapeutic relationship.
Question 7: A 36-year-old woman, gravida 2, para 1, presents for a first prenatal visit at 14
weeks' gestation. Which one of the following screening tests is recommended at this stage of
pregnancy?
A) Glucose tolerance test
B) First-trimester combined screening for aneuploidy
C) Group B Streptococcus culture
MCCQE MEDICAL LICENSING EXAM –
PRACTICE QUESTIONS | LATEST UPDATE
2026/2027 | STUDY GUIDE | EXAM PREP.
Table of Contents
1. Internal Medicine
2. Surgery
3. Pediatrics
4. Obstetrics and Gynecology
5. Psychiatry
6. Public Health, Preventive Medicine, and Ethics
7. Emergency Medicine and Critical Care
8. Family Medicine and Primary Care
,2|Page
Question 1: A 68-year-old man presents to the emergency department with crushing chest
pain radiating to his jaw, associated with diaphoresis and nausea. His ECG shows ST-segment
elevation in leads V1–V4. Which one of the following is the most appropriate immediate
management?
A) Administer sublingual nitroglycerin and observe.
B) Administer aspirin, initiate reperfusion therapy, and provide supportive care.
C) Obtain a chest X-ray and await troponin results before any intervention.
D) Administer a beta-blocker and schedule an outpatient stress test.
E) Start broad-spectrum antibiotics for presumed pericarditis.
Correct Answer: B) Administer aspirin, initiate reperfusion therapy, and provide
supportive care.
This presentation is consistent with an acute ST-elevation myocardial infarction (STEMI).
Immediate management includes aspirin, activation of the cardiac catheterization laboratory
for primary percutaneous coronary intervention (PCI), or fibrinolytic therapy if PCI is
unavailable within the recommended time window. Delay for further diagnostics is
inappropriate and increases myocardial damage.
Question 2: A 25-year-old man presents with a 2-month history of knee swelling, pain, and
inflammation. He reports low back pain and morning stiffness for 2 years. Which one of the
following is most likely to confirm the diagnosis?
A) Uric acid level
B) Antinuclear antibodies test
C) Radiography of the sacroiliac joints
D) Rheumatoid factor level
E) Synovial fluid analysis
Correct Answer: C) Radiography of the sacroiliac joints
The combination of peripheral arthritis and inflammatory back pain in a young man suggests
ankylosing spondylitis, a seronegative spondyloarthropathy. Sacroiliitis on plain radiography
of the sacroiliac joints is a hallmark finding. Uric acid would evaluate gout, rheumatoid
factor and antinuclear antibodies are less specific, and synovial fluid analysis is more
relevant for septic or crystal arthritis.
,3|Page
Question 3: A 78-year-old woman is found to have a 2-cm hypoechoic thyroid nodule. She is
asymptomatic, has no history of head or neck radiation, and has no family history of thyroid
cancer. Her TSH is 0.10 mIU/L (suppressed). Which one of the following is the best next
step?
A) Computed tomography of the neck
B) Thyroid antibody levels
C) Fine-needle aspiration of the thyroid
D) Repeat thyroid ultrasonography in 6 months
E) Thyroid uptake and scan
Correct Answer: E) Thyroid uptake and scan
A suppressed TSH in the setting of a thyroid nodule suggests a hyperfunctioning (toxic)
nodule. Thyroid uptake and scan should be performed to confirm whether the nodule is
hyperfunctioning; if so, malignancy risk is very low and fine-needle aspiration is not
required. FNA is indicated for non-functioning nodules with suspicious features.
Question 4: A 77-year-old man presents with urinary incontinence for 2 months. He reports a
constant feeling of bladder fullness and frequent loss of control during the day and night. He
has a 1-year history of urinary frequency and nocturia. Which one of the following is the
most likely diagnosis?
A) Interstitial cystitis
B) Prostate cancer
C) Neurogenic bladder
D) Chronic cystitis
E) Overflow incontinence
Correct Answer: E) Overflow incontinence
Overflow incontinence occurs when the bladder does not empty completely, leading to
constant dribbling and a sensation of fullness. In an older man, benign prostatic hyperplasia
or other causes of bladder outlet obstruction are common culprits. The chronic history of
frequency and nocturia supports this diagnosis.
Question 5: An 8-year-old boy is brought by his mother for a 6-month history of persistent
cough. He has single bark-like coughs about 20 times daily but does not cough at night. His
, 4|Page
mother notes he has been shaking his head and blinking more frequently. Which one of the
following in the history would be most important to consider?
A) Frequent vomiting
B) Family history of epilepsy
C) Academic performance
D) Exposure to allergens
E) Recent weight loss
Correct Answer: C) Academic performance
The combination of a chronic, daytime-predominant bark-like cough and motor tics (head
shaking, blinking) in a school-aged child suggests Tourette syndrome or a tic disorder. Tics
often worsen with stress and can affect social and academic functioning. Assessing academic
performance and psychosocial impact is essential for management.
Question 6: A 42-year-old woman discloses that her husband is physically abusing her. A few
days later, a police officer calls requesting medical information for an investigation. Which
one of the following is the best next step?
A) Call the police officer after reviewing the patient's file.
B) Contact the patient to discuss the request.
C) Send the police officer a medicolegal report.
D) Refuse to speak with the police officer.
E) Provide the information verbally over the phone.
Correct Answer: B) Contact the patient to discuss the request.
Patient confidentiality must be maintained unless the patient provides consent or a legal
obligation requires disclosure. The physician should first discuss the request with the patient
to obtain informed consent or clarify her wishes. Releasing information without consent may
violate privacy legislation and the therapeutic relationship.
Question 7: A 36-year-old woman, gravida 2, para 1, presents for a first prenatal visit at 14
weeks' gestation. Which one of the following screening tests is recommended at this stage of
pregnancy?
A) Glucose tolerance test
B) First-trimester combined screening for aneuploidy
C) Group B Streptococcus culture
