MCCQE1 PRACTICE EXAM QUESTIONS WITH
COMPLETE SOLUTIONS
An 80-year-old woman comes to the urgent care clinic with
dyspnoea on exertion. On physical examination, her blood
pressure is 100/70, and her pulse is 75. She has no pulsus
paradoxus. Her jugular veins are distended, and she has distant
heart sounds. In addition, she has extra third and fourth heart
sounds. Her liver is enlarged, and she has pedal oedema. She
has occasional premature ventricular contractions on her
electrocardiogram. A chest x-ray reveals clear lung fields with a
dilated cardiac silhouette. Her echocardiogram reveals
ventricular walls with a "speckled pattern". Which of the
following is the most likely diagnosis?
- Alcoholic cardiomyopathy
- Amyloidosis
- Haemochromatosis
- Tuberculosis
- Viral myocarditis correct answer: Amyloidosis
Restrictive cardiomyopathy with 'speckled' left ventricular wall
Primary cardiac amyloidosis usually develops into diastolic
dysfunction
Alcoholic cardiomyopathy: biventricular dilated
cardiomyopathy
A 92-year-old man with a 45-year history of chronic obstructive
pulmonary disease is intubated in the ICU because of a bout of
viral pneumonia that fails to improve after 72 hours of
,antibiotics. Although the inspired fraction of oxygen is 100%,
the patient's pO2 remains at 57 mmHg. Positive-end expiratory
pressure (PEEP) is added to allow the inspired fraction of
oxygen. Twelve hours after the introduction of PEEP the patient
suddenly become hypotensive. At the same time, his oxygen
saturation drops from 92% to 61%. On physical examination, his
BP is 80/50 mmHg and his pulse is 124/min. He has distended
neck veins and distant heart sounds. Which of the following
would also most likely be seen on this patient's physical
examination?
- Absence of breath sounds in the right hemithorax
- High amplitude carotid artery upstroke
- A pleural friction rub
- Pulsus alternans
- Splenomegaly correct answer: Absence of breath sounds in
the right hemithorax
Patient has developed a tension pneumothorax, characterised
by PEEP followed by sudden hypotension and decreased
oxygenation
Jugular venous distention occurs because venous return to the
right side of the heart is being compressed
Rx: immediate needle/tube thoracostomy
A 46-year-old man with a history of hypertension and
hypercholesterolemia visits the physician for a routine
followup. The patient's job involves a lot of travelling, and he
admits to occasionally forgetting to take his medications with
him when he travels. He complains of several episodes of chest
pain in the past few months. The pain is sharp in nature, mainly
,over his lower chest and epigastrium, and tends to come on
when walking. He believes these episodes are due to
indigestion and has been taking antacids. There is a family
history of heart disease, and his father died of a heart attack at
age 48. On physical examination, his blood pressure is 150/80
mmHg and heart rate is 86/min. His lungs are clear to
auscultation. Cardiac auscultation reveals normal rate and
rhythm, without rubs, gallops, or murmurs. There is no pedal
oedema. He is sent for an exercise stress test. Five minutes into
the test, he develops ST depression of 3mm in leads V1-V5. The
ST segment depression is greater than 0.12 seconds in duration
and the stress test is stopped. Which of the following is the
most appropriate next step in management?
- Coronary angiography
- Holter monitor
- No further tests are required
- Repeat stress test with thallium
- Upper gastrointestinal endoscopy correct answer: Coronary
angiography
Multiple risk factors for atherosclerotic coronary artery disease
A stress test is considered positive when there are ST
depression of >1mm for longer than 0.08 seconds
Positive stress test = coronary angiography
A 74-year-old woman, who has been followed for the past 25
years for chronic obstructive pulmonary disease comes to the
ED complaining of 48 hours of temperature to 38.6 C and
worsening shortness of breath. She has a chronic productive
cough, which has become more copious. On physical
, examination, she has rhonchi and increased fremitus in the
posterior mid-lung field. A Gram's stain reveals many epithelial
cells and multiple gram-positive and gram-negative organisms;
no neutrophils are seen. Which of the following is the most
likely organism causing the symptoms?
- Escherichia coli
- Haemophilus influenzae
- Klebsiella pneumoniae
- Mycobacterium tuberculosis
- Mycoplasma pneumoniae correct answer: Haemophilus
influenzae
Evidence of community-acquired pneumonia and common
organisms in patients with COPD are Strep. pneumoniae, Haem.
influenzae and Moraxella catarrhalis.
Klebseilla pneumonia is typically found in alcoholic patients.
Primary E. coli pneumonia is rare and there is no history of
infection elsewhere (e.g. UTI).
Mycoplasma pneumoniae does not present with a lobar
consolidation and generally occurs in younger patients - x-ray
reveals faint bilateral interstitial infiltrates.
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
COMPLETE SOLUTIONS
An 80-year-old woman comes to the urgent care clinic with
dyspnoea on exertion. On physical examination, her blood
pressure is 100/70, and her pulse is 75. She has no pulsus
paradoxus. Her jugular veins are distended, and she has distant
heart sounds. In addition, she has extra third and fourth heart
sounds. Her liver is enlarged, and she has pedal oedema. She
has occasional premature ventricular contractions on her
electrocardiogram. A chest x-ray reveals clear lung fields with a
dilated cardiac silhouette. Her echocardiogram reveals
ventricular walls with a "speckled pattern". Which of the
following is the most likely diagnosis?
- Alcoholic cardiomyopathy
- Amyloidosis
- Haemochromatosis
- Tuberculosis
- Viral myocarditis correct answer: Amyloidosis
Restrictive cardiomyopathy with 'speckled' left ventricular wall
Primary cardiac amyloidosis usually develops into diastolic
dysfunction
Alcoholic cardiomyopathy: biventricular dilated
cardiomyopathy
A 92-year-old man with a 45-year history of chronic obstructive
pulmonary disease is intubated in the ICU because of a bout of
viral pneumonia that fails to improve after 72 hours of
,antibiotics. Although the inspired fraction of oxygen is 100%,
the patient's pO2 remains at 57 mmHg. Positive-end expiratory
pressure (PEEP) is added to allow the inspired fraction of
oxygen. Twelve hours after the introduction of PEEP the patient
suddenly become hypotensive. At the same time, his oxygen
saturation drops from 92% to 61%. On physical examination, his
BP is 80/50 mmHg and his pulse is 124/min. He has distended
neck veins and distant heart sounds. Which of the following
would also most likely be seen on this patient's physical
examination?
- Absence of breath sounds in the right hemithorax
- High amplitude carotid artery upstroke
- A pleural friction rub
- Pulsus alternans
- Splenomegaly correct answer: Absence of breath sounds in
the right hemithorax
Patient has developed a tension pneumothorax, characterised
by PEEP followed by sudden hypotension and decreased
oxygenation
Jugular venous distention occurs because venous return to the
right side of the heart is being compressed
Rx: immediate needle/tube thoracostomy
A 46-year-old man with a history of hypertension and
hypercholesterolemia visits the physician for a routine
followup. The patient's job involves a lot of travelling, and he
admits to occasionally forgetting to take his medications with
him when he travels. He complains of several episodes of chest
pain in the past few months. The pain is sharp in nature, mainly
,over his lower chest and epigastrium, and tends to come on
when walking. He believes these episodes are due to
indigestion and has been taking antacids. There is a family
history of heart disease, and his father died of a heart attack at
age 48. On physical examination, his blood pressure is 150/80
mmHg and heart rate is 86/min. His lungs are clear to
auscultation. Cardiac auscultation reveals normal rate and
rhythm, without rubs, gallops, or murmurs. There is no pedal
oedema. He is sent for an exercise stress test. Five minutes into
the test, he develops ST depression of 3mm in leads V1-V5. The
ST segment depression is greater than 0.12 seconds in duration
and the stress test is stopped. Which of the following is the
most appropriate next step in management?
- Coronary angiography
- Holter monitor
- No further tests are required
- Repeat stress test with thallium
- Upper gastrointestinal endoscopy correct answer: Coronary
angiography
Multiple risk factors for atherosclerotic coronary artery disease
A stress test is considered positive when there are ST
depression of >1mm for longer than 0.08 seconds
Positive stress test = coronary angiography
A 74-year-old woman, who has been followed for the past 25
years for chronic obstructive pulmonary disease comes to the
ED complaining of 48 hours of temperature to 38.6 C and
worsening shortness of breath. She has a chronic productive
cough, which has become more copious. On physical
, examination, she has rhonchi and increased fremitus in the
posterior mid-lung field. A Gram's stain reveals many epithelial
cells and multiple gram-positive and gram-negative organisms;
no neutrophils are seen. Which of the following is the most
likely organism causing the symptoms?
- Escherichia coli
- Haemophilus influenzae
- Klebsiella pneumoniae
- Mycobacterium tuberculosis
- Mycoplasma pneumoniae correct answer: Haemophilus
influenzae
Evidence of community-acquired pneumonia and common
organisms in patients with COPD are Strep. pneumoniae, Haem.
influenzae and Moraxella catarrhalis.
Klebseilla pneumonia is typically found in alcoholic patients.
Primary E. coli pneumonia is rare and there is no history of
infection elsewhere (e.g. UTI).
Mycoplasma pneumoniae does not present with a lobar
consolidation and generally occurs in younger patients - x-ray
reveals faint bilateral interstitial infiltrates.
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
