MCCQE1 exam “Medical Council of Canada Qualifying
Examination Part I.” EXAM QUESTIONS AND VERIFIED
CORRECT ANSWERS LATEST 2026-2027 NEW VERSION
A previously healthy 27-year-old man comes to the physician complaining of a cough
with sputum production for the past 3 days. The cough has been keeping him up at
night and it is affecting his job performance. He has no prior history of respiratory
disease. His temperature is 37 C, BP 130/80, pulse 70, and RR 18. Physical examination
is unremarkable. Which of the following is the most appropriate next step in
management?
- Admit for medical management
- Perform chest x-ray
- Perform sputum culture
- Send home with abx
- Send home with no therapy - answer>>>Send home with no therapy
Likely dx: acute viral bronchitis
If >1 week, macrolide abx may be given
A female infant was born at 31 weeks gestational age following a spontaneous vaginal
delivery. The mother had regular prenatal care with negative serologies. Labour lasted
13 hours, and nitrous oxide was used for pain control. Apgar scores were 6 and 7 at 1
and 5 minutes, respectively, because of por respiratory effort and decreased tone. She
is transferred to the neonatal intensive care unit, where vitals are monitored
continuously and nasal CPAP is begun. Periodic changes in breathing were noted, with
absent respiration of 20s duration with each episode. Apneic episodes are associated
with a HR of 95 and PaO2 of 70. HR returns to 140 and PaO2 to 95 between episodes.
The patient's temperature is 36.8 C, RR 60, BP 90/50, and birth weight 1680g. Physical
exam and routine laboratory results are otherwise normal. Which of the following is the
most appropriate pharmacotherapy for this infant's apnoea?
- Bicarbonate
- Dex - answer>>>Theophylline
Apnoea of prematurity: cessation of air flow/exchange for >20s and often associated
with bradycardia and hypoxaemia. Occurs in ~50% of infants born at 30-31 weeks due to
immaturity of the infant's neurologic and respiratory systems. First line pharmacologic
agents: methylxanthines (caffeine, theophylline) which stimulate respiratory neurons
Bicarbonate: correct acidosis
Dextrose: correct hypoglycaemia
,Epinephrine: neonatal resuscitation when HR>80 despite effective ventilation and chest
compressions for >30 seconds
A term male infant is found to be cyanotic shortly after birth and requires endotracheal
intubation. On physical examination, his blood pressure is 68/34 (equal in all four
extremities), pulse 180, and RR 32. His precordium is dynamic, has a grade III systolic
murmur, and a single S2. Chest radiography shows a normal heart size and increased
pulmonary vascular markings. An arterial blood gas on an FiO2 of 100% shows pH 7.34;
PaCO2 47; PaO2 46. Which of the following diagnosis is most consistent with these
findings?
- ASD
- Hypoplastic left heart syndrome
- PDA
- Tetralogy of Fallot
- Total anomalous pulmonary venous return - answer>>>Total anomalous pulmonary
venous return
Characterised by pulmonary veins forming a confluence behind the left atrium and
draining into the right atrium = right-to-left shunt through foramen ovale
A 63-year-old man is admitted to the hospital for fever and a productive cough. The
patient reports that, over the past few days, he has had a worsening cough that has
become productive of greenish-crimson sputum. The patient reports temperature to
39.5 C over the past 24 hours. The patient has had nothing to eat or drink for the past
36 hours. On further questioning, the man describes a prodromal period 7 days prior to
the onset of the cough that was remarkable for rhinorrhoea and general malaise. On
physical examination, the patient appears acutely ill. His BP is 130/80 and pulse 110 and
regular. Examination is remarkable for diminished breath sounds on the right lung-base
with "a to e" egophony and whispered pectoiloquy. Which of the following is required
for diagnosis of pneumonia?
- Hypoxaemia on pulse oximetry
- Infiltrates present on chest radiograph
- Sputum Gram stain showing gram-positive diplococci
- Sputu - answer>>>Infiltrates present on chest radiograph
Hypoxaemia is one possible physical manifestation of severe pneumonia but is not
required for diagnosis
Other signs are non-specific for pneumonia
,A 27-year-old primigravid woman with type 2 diabetes mellitus comes to the ED in the
34th week of gestation because of a rapidly enlarging "stomach" and the sudden onset
of contractions. She has not had much prenatal care since the first trimester because of
a complicated family situation and lack of medical insurance. She had been feeling well
until several days earlier when she noticed that her 'stomach' was rapidly growing and
when she started having contractions that morning she decided to go to the hospital.
On examination, her abdomen is much distended and the uterus is large by palpation.
She is fully dilated and has contraction 2-3 minutes apart. She is admitted to the
delivery room and several hours later she delivers a boy who weighs 2500g and is 38cm
long. His APGAR scores are 6 and 7. Physical examination of the child reveals a scaphoid
abdomen and a palpable fullness of the epigastrium. An abdominal radi -
answer>>>Ultrasonography
Suspect duodenal atresia
Prenatal ultrasonography may reveal a dilated and fluid-filled stomach and duodenum
Scaphoid abdomen: anterior abdominal wall is sunken and presents a concave rather
than complex contour
A 9-month-old girl with Down syndrome is brought to the office for followup of a
respiratory tract infection. This is the third time in 3 months that she has been treated
for pneumonia. She has difficulty feeding and is not gaining weight. She frequently
pauses during eating and has to calm down to be able to continue. She also has
difficulty breathing when she cries. The parents have noticed that she started crawling
over the past week but gets tired easily and seems to have an aversion to activity of any
sort. Her medical history is significant for multiple respiratory tract infections,
pneumonia, and poor growth. On physical examination, the patient is below the fifth
percentile for weight and height. Her lips are mildly cyanotic. She has a hyperinflated
thorax and a bulging precordium. Auscultation of the heart reveals that the second
heart sound is widely split with no respiratory variations. There is a systolic -
answer>>>Endocardial cushion defect: occurs when an ASD and VSD are present and
contiguous, and the atrioventricular valves are also abnormal
A 72-year-old man with a 25-year history of emphysema comes to his physician after he
develops the acute onset of fevers, rigors, and a cough productive of green sputum. The
symptoms gradually worsen over 36 hours and he comes to the ED. He has been taking
a beclomethasone inhaler twice daily, an albuterol nebuliser treatment at home four
times daily, and has been taking erythromycin for a recent bronchitis. On physical
examination he is 183cm tall and weighs 85kg. His temperature is 38.3 C, BP 162/92,
pulse 94, and RR 32. His lung examination reveals diffuse bilateral coarse rhonchi. He
, uses his sternocleidomastoid muscles with each inspiration. An arterial blood gas
reveals a pH of 7.2, pCO2 60 and pO2 52. Over the next 2 hours, he becomes
increasingly tachypnoeic and his pCO2 rises to 74. The decision is made to intubate him
at that point. Which of the following settings would be most appropriate for his tidal vol
- answer>>>850 mL/breath
The tidal volume for a patient is generally estimated as 10 mL/kg of weight. Giving a
lower tidal volume will yield hypoventilation and be insufficient to eliminate pCO2. A
tidal volume > 10 mL/kg increases the risk of pneumothorax
A patient with a history of hypertension calls his physician's office for advice. He has had
longstanding heartburn and recently consulted with a gastroenterologist. He underwent
an endoscopy and was told that "Barrett's mucosa" was found by biopsy. The patient
has read in the newspaper that people with this condition will probably develop
oesophageal cancer. Which of the following is the most appropriate response to this
concern?
- "Your concerns are ungrounded"
- "It is foolish to worry because this type of cancer is unlikely to develop and would
occur many years later"
- "You should chew food very carefully to prevent the possibility of a mechanical
obstruction"
- "Only a small minority of patients with Barrett's oesophagus will develop cancer, and
you should undergo endoscopic surveillance"
- "You should consult with an oncologist regarding oesophageal cancer prevention
strategies" - answer>>>"Only a small minority of patients with Barrett's oesophagus will
develop cancer, and you should undergo endoscopic surveillance"
The significance of Barrett's oesophagus is that it may lead to the development of low-
grade dysplasia, high-grade dysplasia, or oesophageal adenocarcinoma. Endoscopic
surveillance every 1-2 years is often recommended
A previously healthy 45-year-old woman has lump in her right breast. She comes to her
primary care physician at the clinic for evaluation and undergoes a fine needle
aspiration, which shows malignant cells. She is sent for a core biopsy, which shows
invasive carcinoma of the breast. She is referred to a surgeon but refuses to go because
her religious beliefs prevent her from undergoing surgery, radiation, or chemotherapy
or from taking hormonal therapy. Her primary care physicial discusses all of the
potential outcomes of her disease, including death, and the risks and benefits of her
decision. She says that she fully understands her condition and the consequences of her
choice. A psychiatrist finds that she is competent. She is married and has a 12-year-old
Examination Part I.” EXAM QUESTIONS AND VERIFIED
CORRECT ANSWERS LATEST 2026-2027 NEW VERSION
A previously healthy 27-year-old man comes to the physician complaining of a cough
with sputum production for the past 3 days. The cough has been keeping him up at
night and it is affecting his job performance. He has no prior history of respiratory
disease. His temperature is 37 C, BP 130/80, pulse 70, and RR 18. Physical examination
is unremarkable. Which of the following is the most appropriate next step in
management?
- Admit for medical management
- Perform chest x-ray
- Perform sputum culture
- Send home with abx
- Send home with no therapy - answer>>>Send home with no therapy
Likely dx: acute viral bronchitis
If >1 week, macrolide abx may be given
A female infant was born at 31 weeks gestational age following a spontaneous vaginal
delivery. The mother had regular prenatal care with negative serologies. Labour lasted
13 hours, and nitrous oxide was used for pain control. Apgar scores were 6 and 7 at 1
and 5 minutes, respectively, because of por respiratory effort and decreased tone. She
is transferred to the neonatal intensive care unit, where vitals are monitored
continuously and nasal CPAP is begun. Periodic changes in breathing were noted, with
absent respiration of 20s duration with each episode. Apneic episodes are associated
with a HR of 95 and PaO2 of 70. HR returns to 140 and PaO2 to 95 between episodes.
The patient's temperature is 36.8 C, RR 60, BP 90/50, and birth weight 1680g. Physical
exam and routine laboratory results are otherwise normal. Which of the following is the
most appropriate pharmacotherapy for this infant's apnoea?
- Bicarbonate
- Dex - answer>>>Theophylline
Apnoea of prematurity: cessation of air flow/exchange for >20s and often associated
with bradycardia and hypoxaemia. Occurs in ~50% of infants born at 30-31 weeks due to
immaturity of the infant's neurologic and respiratory systems. First line pharmacologic
agents: methylxanthines (caffeine, theophylline) which stimulate respiratory neurons
Bicarbonate: correct acidosis
Dextrose: correct hypoglycaemia
,Epinephrine: neonatal resuscitation when HR>80 despite effective ventilation and chest
compressions for >30 seconds
A term male infant is found to be cyanotic shortly after birth and requires endotracheal
intubation. On physical examination, his blood pressure is 68/34 (equal in all four
extremities), pulse 180, and RR 32. His precordium is dynamic, has a grade III systolic
murmur, and a single S2. Chest radiography shows a normal heart size and increased
pulmonary vascular markings. An arterial blood gas on an FiO2 of 100% shows pH 7.34;
PaCO2 47; PaO2 46. Which of the following diagnosis is most consistent with these
findings?
- ASD
- Hypoplastic left heart syndrome
- PDA
- Tetralogy of Fallot
- Total anomalous pulmonary venous return - answer>>>Total anomalous pulmonary
venous return
Characterised by pulmonary veins forming a confluence behind the left atrium and
draining into the right atrium = right-to-left shunt through foramen ovale
A 63-year-old man is admitted to the hospital for fever and a productive cough. The
patient reports that, over the past few days, he has had a worsening cough that has
become productive of greenish-crimson sputum. The patient reports temperature to
39.5 C over the past 24 hours. The patient has had nothing to eat or drink for the past
36 hours. On further questioning, the man describes a prodromal period 7 days prior to
the onset of the cough that was remarkable for rhinorrhoea and general malaise. On
physical examination, the patient appears acutely ill. His BP is 130/80 and pulse 110 and
regular. Examination is remarkable for diminished breath sounds on the right lung-base
with "a to e" egophony and whispered pectoiloquy. Which of the following is required
for diagnosis of pneumonia?
- Hypoxaemia on pulse oximetry
- Infiltrates present on chest radiograph
- Sputum Gram stain showing gram-positive diplococci
- Sputu - answer>>>Infiltrates present on chest radiograph
Hypoxaemia is one possible physical manifestation of severe pneumonia but is not
required for diagnosis
Other signs are non-specific for pneumonia
,A 27-year-old primigravid woman with type 2 diabetes mellitus comes to the ED in the
34th week of gestation because of a rapidly enlarging "stomach" and the sudden onset
of contractions. She has not had much prenatal care since the first trimester because of
a complicated family situation and lack of medical insurance. She had been feeling well
until several days earlier when she noticed that her 'stomach' was rapidly growing and
when she started having contractions that morning she decided to go to the hospital.
On examination, her abdomen is much distended and the uterus is large by palpation.
She is fully dilated and has contraction 2-3 minutes apart. She is admitted to the
delivery room and several hours later she delivers a boy who weighs 2500g and is 38cm
long. His APGAR scores are 6 and 7. Physical examination of the child reveals a scaphoid
abdomen and a palpable fullness of the epigastrium. An abdominal radi -
answer>>>Ultrasonography
Suspect duodenal atresia
Prenatal ultrasonography may reveal a dilated and fluid-filled stomach and duodenum
Scaphoid abdomen: anterior abdominal wall is sunken and presents a concave rather
than complex contour
A 9-month-old girl with Down syndrome is brought to the office for followup of a
respiratory tract infection. This is the third time in 3 months that she has been treated
for pneumonia. She has difficulty feeding and is not gaining weight. She frequently
pauses during eating and has to calm down to be able to continue. She also has
difficulty breathing when she cries. The parents have noticed that she started crawling
over the past week but gets tired easily and seems to have an aversion to activity of any
sort. Her medical history is significant for multiple respiratory tract infections,
pneumonia, and poor growth. On physical examination, the patient is below the fifth
percentile for weight and height. Her lips are mildly cyanotic. She has a hyperinflated
thorax and a bulging precordium. Auscultation of the heart reveals that the second
heart sound is widely split with no respiratory variations. There is a systolic -
answer>>>Endocardial cushion defect: occurs when an ASD and VSD are present and
contiguous, and the atrioventricular valves are also abnormal
A 72-year-old man with a 25-year history of emphysema comes to his physician after he
develops the acute onset of fevers, rigors, and a cough productive of green sputum. The
symptoms gradually worsen over 36 hours and he comes to the ED. He has been taking
a beclomethasone inhaler twice daily, an albuterol nebuliser treatment at home four
times daily, and has been taking erythromycin for a recent bronchitis. On physical
examination he is 183cm tall and weighs 85kg. His temperature is 38.3 C, BP 162/92,
pulse 94, and RR 32. His lung examination reveals diffuse bilateral coarse rhonchi. He
, uses his sternocleidomastoid muscles with each inspiration. An arterial blood gas
reveals a pH of 7.2, pCO2 60 and pO2 52. Over the next 2 hours, he becomes
increasingly tachypnoeic and his pCO2 rises to 74. The decision is made to intubate him
at that point. Which of the following settings would be most appropriate for his tidal vol
- answer>>>850 mL/breath
The tidal volume for a patient is generally estimated as 10 mL/kg of weight. Giving a
lower tidal volume will yield hypoventilation and be insufficient to eliminate pCO2. A
tidal volume > 10 mL/kg increases the risk of pneumothorax
A patient with a history of hypertension calls his physician's office for advice. He has had
longstanding heartburn and recently consulted with a gastroenterologist. He underwent
an endoscopy and was told that "Barrett's mucosa" was found by biopsy. The patient
has read in the newspaper that people with this condition will probably develop
oesophageal cancer. Which of the following is the most appropriate response to this
concern?
- "Your concerns are ungrounded"
- "It is foolish to worry because this type of cancer is unlikely to develop and would
occur many years later"
- "You should chew food very carefully to prevent the possibility of a mechanical
obstruction"
- "Only a small minority of patients with Barrett's oesophagus will develop cancer, and
you should undergo endoscopic surveillance"
- "You should consult with an oncologist regarding oesophageal cancer prevention
strategies" - answer>>>"Only a small minority of patients with Barrett's oesophagus will
develop cancer, and you should undergo endoscopic surveillance"
The significance of Barrett's oesophagus is that it may lead to the development of low-
grade dysplasia, high-grade dysplasia, or oesophageal adenocarcinoma. Endoscopic
surveillance every 1-2 years is often recommended
A previously healthy 45-year-old woman has lump in her right breast. She comes to her
primary care physician at the clinic for evaluation and undergoes a fine needle
aspiration, which shows malignant cells. She is sent for a core biopsy, which shows
invasive carcinoma of the breast. She is referred to a surgeon but refuses to go because
her religious beliefs prevent her from undergoing surgery, radiation, or chemotherapy
or from taking hormonal therapy. Her primary care physicial discusses all of the
potential outcomes of her disease, including death, and the risks and benefits of her
decision. She says that she fully understands her condition and the consequences of her
choice. A psychiatrist finds that she is competent. She is married and has a 12-year-old
