MCCQE1 7/2025 UPDATED ACTUAL
Exam Questions and CORRECT Answers
*Types of Tremors* & Cause - CORRECT ANSWER - *Resting tremor = Parkinson's
disease:*
-"Pill-rolling"; Suppressed with activity.
*Intention tremor = Cerebellar disease:*
-It appears with action and worsens as goal is reached.
*Postural (or action) tremor = Hyperadrenergic state:*
-Evident with action; Severe anxiety, hyperthyroidism, sympathomimetic drugs of abuse (e.g.
amphetamine), alcohol and drug withdrawal, and essential tremor.
*Functional tremor = Anxiety*
-Psychogenic tremor, extinction with distraction
Long term use of PPIs can increase risk for? - CORRECT ANSWER - Osteoporosis
C diff
What finding most reliably indicates a diagnosis of iron deficiency anemia? - CORRECT
ANSWER - Low serum ferritin
HPV test is indicated in patients >=30 years of age with ASCUS on PAP test - CORRECT
ANSWER -
What causes the typical flow murmur in pregnancy?
(systolic ejection murmur over aortic valve) - CORRECT ANSWER - Maternal blood
volume is up 40-50% by start of 3rd trimester. Maternal stroke volume and cardiac volume are
,UP which increases turbulent flow with ventricular emptying giving rise to a flow murmur at the
aortic valve.
Hematocrit DECREASES since red cell mass only goes up by 30% (physiologic anemia of
pregnancy). There is a relative increase in plasma to red cell mass.
28 y/o male with fever, cough, hemoptysis, knee joint pain and edema, changes in urine color.
Had a respi tract infxn 4 weeks ago. No paranasal sinus tenderness, nasal lesions and skin
granulomas noted. What does this patient have and what should we be testing for? - CORRECT
ANSWER - Goodpasture's disease
Test for anti-glomerular basement membrane Ab
Diagnostic Criteria for Schizophrenia - CORRECT ANSWER - Two or more during a 1-
month period:
Delusions
Hallucinations
Disorganized speech
Grossly disorganized
Negative symptoms (diminished emotional expression or avolition)
If episode lasts <30 days, would be considered an acute psychotic episode. If >30 days to 6
months, then schizophreniform disorder.
Prevention of tinea versicolor - CORRECT ANSWER - Topical preventative therapy
includes once-monthly topical selenium sulphide or ketoconazole shampoo
Why does hair loss occur in the first few weeks postpartum? *(HIGH YIELD)* - CORRECT
ANSWER - The decrease in estrogen and progesterone levels after pregnancy can cause
postpartum alopecia, and usually resolves within 6 months
Oxycodone is 1.5x stronger than morphine and 15x more potent than codeine. Hydromorphone
(Dilaudid) is 5-10x more potent than morphine. - CORRECT ANSWER -
,Patient with beta-hCG, hx of PID and sudden onset pelvic pain
Endovaginal U/S shows nothing in uterus, 2cm simple left ovarian cyst and moderate free fluid
in cul-de-sac. Most likely diagnosis? - CORRECT ANSWER - Ectopic pregnancy
Beta-hCG >2000 mIU/mL
You see an obese female child in your office. Her mother and brother are obese as well. What
would be the most appropriate next step? - CORRECT ANSWER - Recommend a
behaviour-oriented treatment program (e.g. diet program, physical activity, behaviour
modification techniques and parental role modeling)
(NOT giving a written diet or referral to endo)
What is the most ominous sign on CT head of a patient with an epidural hemorrhage? -
CORRECT ANSWER - *Swirl sign*: hyperdense focus within the hyperdense epidural
hematoma which occurs because fresh blood has lower density on CT compared to clotted blood.
Swirl sign is considered a sign of active hemorrhage.
Lhermitte sign can be seen in both MS and cervical spondylotic myelopathy so MRI brain AND
cervical spine should be done - CORRECT ANSWER -
Canada guidelines: every 5 years a lipid panel should be checked - CORRECT
ANSWER -
What type of wound is low risk for tetanus? - CORRECT ANSWER - Bacteria is only
dangerous if in wound tissue that is cut off from good oxygen supply. A *facial wound* would
be the cleanest wound and lowest risk for tetanus.
Tetanus spores can penetrate the body through a wound that is contaminated with soil, dust. or
animal waste. Usually enters through wounds or cuts (e.g. nails, knives, skin burns or sites of
illicit drug injection).
, Patient who is going for a hysterectomy takes aspirin 325mg daily due to previous TIA. What is
the most appropriate management pre-op to prevent perioperative bleeding? *(HIGH YIELD)* -
CORRECT ANSWER - Stop ASA *5-7 days* before surgery *if non-cardiac*.
You would continue normal ASA regimen prior to a CABG.
What diagnostic test has the highest negative predictive value for septic arthritis? - CORRECT
ANSWER - ESR and CRP (NPV of 90%)
Also synovial fluid WBC counts > 50,000 cells/uL with predominance of PMNs indicates
greater likelihood of having septic arthritis, however neither sensitive nor specific for septic
arthritis
CTFPHC's recommends regarding AAA screening - CORRECT ANSWER - Men 65-80
y/o who have ever smoked
Surgical repair for AAA >5.5cm
Treatment for epiglottitis - CORRECT ANSWER - Immediate tracheotomy or
endotracheal intubation and oxygen to prevent hypoxia, brain damage, and death
IV ceftriaxone or other 3rd gen cephalosporin (to treat H. influenzae (gram negative) but ALSO
other causes including Strep pneumo, GAS, Staph aureus (gram positive))
IV corticosteroids
Facts about Parkinson's Disease (*HIGH YIELD*) - CORRECT ANSWER - 1. Affects
males and females equally
2. Onset in persons <40 y/o is uncommon (10%)
3. 0.3% of general population and 3% above age of 65 have idiopathic PD diagnosed clinically
4. Average age of onset is ~60 y/o
5. Prevalence rises EXPONENTIONALLY with AGE after 65 y/o
Exam Questions and CORRECT Answers
*Types of Tremors* & Cause - CORRECT ANSWER - *Resting tremor = Parkinson's
disease:*
-"Pill-rolling"; Suppressed with activity.
*Intention tremor = Cerebellar disease:*
-It appears with action and worsens as goal is reached.
*Postural (or action) tremor = Hyperadrenergic state:*
-Evident with action; Severe anxiety, hyperthyroidism, sympathomimetic drugs of abuse (e.g.
amphetamine), alcohol and drug withdrawal, and essential tremor.
*Functional tremor = Anxiety*
-Psychogenic tremor, extinction with distraction
Long term use of PPIs can increase risk for? - CORRECT ANSWER - Osteoporosis
C diff
What finding most reliably indicates a diagnosis of iron deficiency anemia? - CORRECT
ANSWER - Low serum ferritin
HPV test is indicated in patients >=30 years of age with ASCUS on PAP test - CORRECT
ANSWER -
What causes the typical flow murmur in pregnancy?
(systolic ejection murmur over aortic valve) - CORRECT ANSWER - Maternal blood
volume is up 40-50% by start of 3rd trimester. Maternal stroke volume and cardiac volume are
,UP which increases turbulent flow with ventricular emptying giving rise to a flow murmur at the
aortic valve.
Hematocrit DECREASES since red cell mass only goes up by 30% (physiologic anemia of
pregnancy). There is a relative increase in plasma to red cell mass.
28 y/o male with fever, cough, hemoptysis, knee joint pain and edema, changes in urine color.
Had a respi tract infxn 4 weeks ago. No paranasal sinus tenderness, nasal lesions and skin
granulomas noted. What does this patient have and what should we be testing for? - CORRECT
ANSWER - Goodpasture's disease
Test for anti-glomerular basement membrane Ab
Diagnostic Criteria for Schizophrenia - CORRECT ANSWER - Two or more during a 1-
month period:
Delusions
Hallucinations
Disorganized speech
Grossly disorganized
Negative symptoms (diminished emotional expression or avolition)
If episode lasts <30 days, would be considered an acute psychotic episode. If >30 days to 6
months, then schizophreniform disorder.
Prevention of tinea versicolor - CORRECT ANSWER - Topical preventative therapy
includes once-monthly topical selenium sulphide or ketoconazole shampoo
Why does hair loss occur in the first few weeks postpartum? *(HIGH YIELD)* - CORRECT
ANSWER - The decrease in estrogen and progesterone levels after pregnancy can cause
postpartum alopecia, and usually resolves within 6 months
Oxycodone is 1.5x stronger than morphine and 15x more potent than codeine. Hydromorphone
(Dilaudid) is 5-10x more potent than morphine. - CORRECT ANSWER -
,Patient with beta-hCG, hx of PID and sudden onset pelvic pain
Endovaginal U/S shows nothing in uterus, 2cm simple left ovarian cyst and moderate free fluid
in cul-de-sac. Most likely diagnosis? - CORRECT ANSWER - Ectopic pregnancy
Beta-hCG >2000 mIU/mL
You see an obese female child in your office. Her mother and brother are obese as well. What
would be the most appropriate next step? - CORRECT ANSWER - Recommend a
behaviour-oriented treatment program (e.g. diet program, physical activity, behaviour
modification techniques and parental role modeling)
(NOT giving a written diet or referral to endo)
What is the most ominous sign on CT head of a patient with an epidural hemorrhage? -
CORRECT ANSWER - *Swirl sign*: hyperdense focus within the hyperdense epidural
hematoma which occurs because fresh blood has lower density on CT compared to clotted blood.
Swirl sign is considered a sign of active hemorrhage.
Lhermitte sign can be seen in both MS and cervical spondylotic myelopathy so MRI brain AND
cervical spine should be done - CORRECT ANSWER -
Canada guidelines: every 5 years a lipid panel should be checked - CORRECT
ANSWER -
What type of wound is low risk for tetanus? - CORRECT ANSWER - Bacteria is only
dangerous if in wound tissue that is cut off from good oxygen supply. A *facial wound* would
be the cleanest wound and lowest risk for tetanus.
Tetanus spores can penetrate the body through a wound that is contaminated with soil, dust. or
animal waste. Usually enters through wounds or cuts (e.g. nails, knives, skin burns or sites of
illicit drug injection).
, Patient who is going for a hysterectomy takes aspirin 325mg daily due to previous TIA. What is
the most appropriate management pre-op to prevent perioperative bleeding? *(HIGH YIELD)* -
CORRECT ANSWER - Stop ASA *5-7 days* before surgery *if non-cardiac*.
You would continue normal ASA regimen prior to a CABG.
What diagnostic test has the highest negative predictive value for septic arthritis? - CORRECT
ANSWER - ESR and CRP (NPV of 90%)
Also synovial fluid WBC counts > 50,000 cells/uL with predominance of PMNs indicates
greater likelihood of having septic arthritis, however neither sensitive nor specific for septic
arthritis
CTFPHC's recommends regarding AAA screening - CORRECT ANSWER - Men 65-80
y/o who have ever smoked
Surgical repair for AAA >5.5cm
Treatment for epiglottitis - CORRECT ANSWER - Immediate tracheotomy or
endotracheal intubation and oxygen to prevent hypoxia, brain damage, and death
IV ceftriaxone or other 3rd gen cephalosporin (to treat H. influenzae (gram negative) but ALSO
other causes including Strep pneumo, GAS, Staph aureus (gram positive))
IV corticosteroids
Facts about Parkinson's Disease (*HIGH YIELD*) - CORRECT ANSWER - 1. Affects
males and females equally
2. Onset in persons <40 y/o is uncommon (10%)
3. 0.3% of general population and 3% above age of 65 have idiopathic PD diagnosed clinically
4. Average age of onset is ~60 y/o
5. Prevalence rises EXPONENTIONALLY with AGE after 65 y/o
