1
MCCQE1 exam “Medical Council of Canada Qualifying
Examination Part I.” EXAM LATEST VERSION QUESTIONS
AND VERIFIED CORRECT ANSWERS JUST RELEASED
Section 1: Cardiology – High-Yield Practice Questions
Question 1: Syncope Risk Stratification
A 72-year-old man presents to the emergency department after a distinct episode of loss of
consciousness. He was sitting in his armchair watching television when he suddenly "blacked out"
without any warning symptoms. His wife witnessed the event; she states he was unresponsive for
about 30 seconds and then woke up spontaneously. He was not confused upon awakening. He has a
history of previous myocardial infarction (5 years ago) and hypertension. His current medications
include Ramipril, Metoprolol, and Aspirin. Physical examination reveals a blood pressure of 135/85
mmHg, heart rate of 64 bpm and regular, and an unremarkable cardiac exam with no murmurs. His
12-lead ECG shows sinus rhythm with a Q wave in lead III and aVF but is otherwise unchanged from
previous tracings.
Which one of the following investigations is most appropriate to establish the diagnosis?
A) 24-hour Holter monitoring
B) Tilt table testing
C) Electroencephalogram (EEG)
D) CT scan of the head
E) Reassurance and discharge
✔✔ Answer✔✔ A. 24-hour Holter monitoring
Rationale: This patient presents with features concerning for cardiac syncope :
• Age >65
• Syncope while sitting (reflex syncope typically occurs while standing)
• Sudden onset without prodrome
• History of structural heart disease (previous MI)
Even though the resting ECG is non-diagnostic, the risk profile strongly points toward a transient
arrhythmia (e.g., ventricular tachycardia or intermittent AV block). Ambulatory ECG monitoring (Holter)
is the most appropriate next step .
Why other options are incorrect:
,2
• B. Tilt table testing: Used for diagnosing neurally mediated (reflex) syncope, not indicated for
suspected cardiac syncope.
• C. EEG: The clinical picture (rapid recovery, no post-ictal confusion) fits syncope, not seizure.
• D. CT head: No focal neurological deficits or trauma; syncope is a perfusion problem, not
structural brain problem.
• E. Reassurance: Given high risk of cardiac arrhythmia and sudden death in a post-MI patient,
discharging without investigation is unsafe.
Question 2: The CHESS Mnemonic for Syncope Risk
Which of the following is NOT a component of the CHESS mnemonic (San Francisco Syncope Rule) for
identifying high-risk syncope patients requiring admission?
A) Congestive heart failure history
B) Hematocrit <30%
C) Chest pain
D) ECG abnormal (new changes or non-sinus rhythm)
E) Shortness of breath
F) Systolic BP <90 mmHg at triage
✔✔ Answer✔✔ C. Chest pain
Rationale: The CHESS mnemonic for syncope risk stratification is :
• C – CHF history
• H – Hematocrit <30%
• E – ECG abnormal
• S – Shortness of breath
• S – Systolic BP <90 mmHg
Chest pain is a concerning symptom that warrants evaluation, but it is not part of the CHESS rule.
Question 3: Aortic Dissection
A 62-year-old male presents to the Emergency Department with a sudden onset of severe, "tearing"
chest pain radiating to his interscapular region. He has a history of poorly controlled hypertension and
smoking. On examination, he appears anxious and diaphoretic. His blood pressure is 180/100 mmHg
in the right arm and 150/90 mmHg in the left arm. Heart rate is 105 bpm. Auscultation reveals a new
diastolic decrescendo murmur at the right upper sternal border. An ECG shows sinus tachycardia with
left ventricular hypertrophy but no ST-segment changes. A portable chest X-ray shows a widened
mediastinum.
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Which one of the following is the most appropriate next step in the diagnostic management of this
patient?
A) Transthoracic Echocardiogram (TTE)
B) Measurement of serum D-dimer
C) CT Angiography of the chest
D) Coronary Angiography
E) Magnetic Resonance Imaging (MRI) of the chest
✔✔ Answer✔✔ C. CT Angiography of the chest
Rationale: The clinical presentation is highly suggestive of Acute Aortic Dissection . Key features
include:
• Risk factors: Older male, uncontrolled hypertension, smoking
• Symptoms: Sudden onset, "tearing" pain radiating to the back (interscapular)
• Signs: Blood pressure differential >20 mmHg between arms, new aortic regurgitation murmur,
widened mediastinum on CXR
CT Angiography (CTA) is the gold standard diagnostic test for stable patients with suspected aortic
dissection in the acute setting .
Canadian Management Note: In aortic dissection, initial management includes IV beta-
blockers (labetalol or esmolol) to reduce heart rate <60 and systolic BP <120, reducing aortic wall shear
stress .
Question 4: Acute Coronary Syndrome – Canadian Guidelines
Which of the following statements regarding management of Acute Coronary Syndrome (ACS) is most
consistent with Canadian Cardiovascular Society (CCS) guidelines?
A) Routine oxygen should be administered to all patients with suspected ACS
B) Aspirin 160–325 mg chewed immediately
C) Beta-blockers should be avoided in all ACS patients
D) Clopidogrel is preferred over ticagrelor for all ACS patients
✔✔ Answer✔✔ B. Aspirin 160–325 mg chewed immediately
Rationale: Canadian guidelines recommend :
• ASA: 160–325 mg chewed immediately (stat)
• Oxygen: Only if SpO₂ <90% (routine oxygen is no longer recommended)
• P2Y12 Inhibitor: Ticagrelor is often preferred over clopidogrel in ACS
• Beta-blockers: Used in stable patients post-MI but not given in acute phase for cocaine-
associated chest pain
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Question 5: Pulmonary Embolism – Canadian Approach
A 45-year-old woman presents with sudden dyspnea, pleuritic chest pain, and tachycardia after a
long-haul flight. She has no prior history of DVT or PE. Her Wells score for PE is 2. What is the most
appropriate next step according to Thrombosis Canada guidelines?
A) Immediate CT Pulmonary Angiogram (CTPA)
B) D-dimer testing
C) Therapeutic anticoagulation
D) Ventilation-perfusion (V/Q) scan
✔✔ Answer✔✔ B. D-dimer testing
Rationale: Thrombosis Canada guidelines for PE evaluation :
• Low pre-test probability (Wells <2): Use PERC rule. If PERC positive or intermediate probability,
proceed with D-dimer.
• High pre-test probability (Wells ≥2): Proceed directly to CTPA (CT Pulmonary Angiogram).
This patient has intermediate probability; D-dimer is appropriate. A negative D-dimer effectively rules
out PE; a positive result warrants CTPA.
Section 2: Neurology & Musculoskeletal
Question 6: Antiepileptic Medications – Renal Excretion
Which of the following antiepileptic medications is excreted unchanged in the urine and requires dose
adjustment in renal impairment?
A) Phenytoin
B) Valproic acid
C) Gabapentin
D) Carbamazepine
✔✔ Answer✔✔ C. Gabapentin
Rationale: Gabapentin and pregabalin are renally excreted unchanged and require dose adjustment in
renal impairment . Phenytoin, valproic acid, and carbamazepine are hepatically metabolized.
Question 7: Cervical Spine Biomechanics
A 58-year-old male undergoes occiput to C2 fusion. How will this surgery affect his cervical range of
motion?
A) Complete loss of cervical flexion/extension
B) Approximately 50% loss of cervical rotation
MCCQE1 exam “Medical Council of Canada Qualifying
Examination Part I.” EXAM LATEST VERSION QUESTIONS
AND VERIFIED CORRECT ANSWERS JUST RELEASED
Section 1: Cardiology – High-Yield Practice Questions
Question 1: Syncope Risk Stratification
A 72-year-old man presents to the emergency department after a distinct episode of loss of
consciousness. He was sitting in his armchair watching television when he suddenly "blacked out"
without any warning symptoms. His wife witnessed the event; she states he was unresponsive for
about 30 seconds and then woke up spontaneously. He was not confused upon awakening. He has a
history of previous myocardial infarction (5 years ago) and hypertension. His current medications
include Ramipril, Metoprolol, and Aspirin. Physical examination reveals a blood pressure of 135/85
mmHg, heart rate of 64 bpm and regular, and an unremarkable cardiac exam with no murmurs. His
12-lead ECG shows sinus rhythm with a Q wave in lead III and aVF but is otherwise unchanged from
previous tracings.
Which one of the following investigations is most appropriate to establish the diagnosis?
A) 24-hour Holter monitoring
B) Tilt table testing
C) Electroencephalogram (EEG)
D) CT scan of the head
E) Reassurance and discharge
✔✔ Answer✔✔ A. 24-hour Holter monitoring
Rationale: This patient presents with features concerning for cardiac syncope :
• Age >65
• Syncope while sitting (reflex syncope typically occurs while standing)
• Sudden onset without prodrome
• History of structural heart disease (previous MI)
Even though the resting ECG is non-diagnostic, the risk profile strongly points toward a transient
arrhythmia (e.g., ventricular tachycardia or intermittent AV block). Ambulatory ECG monitoring (Holter)
is the most appropriate next step .
Why other options are incorrect:
,2
• B. Tilt table testing: Used for diagnosing neurally mediated (reflex) syncope, not indicated for
suspected cardiac syncope.
• C. EEG: The clinical picture (rapid recovery, no post-ictal confusion) fits syncope, not seizure.
• D. CT head: No focal neurological deficits or trauma; syncope is a perfusion problem, not
structural brain problem.
• E. Reassurance: Given high risk of cardiac arrhythmia and sudden death in a post-MI patient,
discharging without investigation is unsafe.
Question 2: The CHESS Mnemonic for Syncope Risk
Which of the following is NOT a component of the CHESS mnemonic (San Francisco Syncope Rule) for
identifying high-risk syncope patients requiring admission?
A) Congestive heart failure history
B) Hematocrit <30%
C) Chest pain
D) ECG abnormal (new changes or non-sinus rhythm)
E) Shortness of breath
F) Systolic BP <90 mmHg at triage
✔✔ Answer✔✔ C. Chest pain
Rationale: The CHESS mnemonic for syncope risk stratification is :
• C – CHF history
• H – Hematocrit <30%
• E – ECG abnormal
• S – Shortness of breath
• S – Systolic BP <90 mmHg
Chest pain is a concerning symptom that warrants evaluation, but it is not part of the CHESS rule.
Question 3: Aortic Dissection
A 62-year-old male presents to the Emergency Department with a sudden onset of severe, "tearing"
chest pain radiating to his interscapular region. He has a history of poorly controlled hypertension and
smoking. On examination, he appears anxious and diaphoretic. His blood pressure is 180/100 mmHg
in the right arm and 150/90 mmHg in the left arm. Heart rate is 105 bpm. Auscultation reveals a new
diastolic decrescendo murmur at the right upper sternal border. An ECG shows sinus tachycardia with
left ventricular hypertrophy but no ST-segment changes. A portable chest X-ray shows a widened
mediastinum.
,3
Which one of the following is the most appropriate next step in the diagnostic management of this
patient?
A) Transthoracic Echocardiogram (TTE)
B) Measurement of serum D-dimer
C) CT Angiography of the chest
D) Coronary Angiography
E) Magnetic Resonance Imaging (MRI) of the chest
✔✔ Answer✔✔ C. CT Angiography of the chest
Rationale: The clinical presentation is highly suggestive of Acute Aortic Dissection . Key features
include:
• Risk factors: Older male, uncontrolled hypertension, smoking
• Symptoms: Sudden onset, "tearing" pain radiating to the back (interscapular)
• Signs: Blood pressure differential >20 mmHg between arms, new aortic regurgitation murmur,
widened mediastinum on CXR
CT Angiography (CTA) is the gold standard diagnostic test for stable patients with suspected aortic
dissection in the acute setting .
Canadian Management Note: In aortic dissection, initial management includes IV beta-
blockers (labetalol or esmolol) to reduce heart rate <60 and systolic BP <120, reducing aortic wall shear
stress .
Question 4: Acute Coronary Syndrome – Canadian Guidelines
Which of the following statements regarding management of Acute Coronary Syndrome (ACS) is most
consistent with Canadian Cardiovascular Society (CCS) guidelines?
A) Routine oxygen should be administered to all patients with suspected ACS
B) Aspirin 160–325 mg chewed immediately
C) Beta-blockers should be avoided in all ACS patients
D) Clopidogrel is preferred over ticagrelor for all ACS patients
✔✔ Answer✔✔ B. Aspirin 160–325 mg chewed immediately
Rationale: Canadian guidelines recommend :
• ASA: 160–325 mg chewed immediately (stat)
• Oxygen: Only if SpO₂ <90% (routine oxygen is no longer recommended)
• P2Y12 Inhibitor: Ticagrelor is often preferred over clopidogrel in ACS
• Beta-blockers: Used in stable patients post-MI but not given in acute phase for cocaine-
associated chest pain
, 4
Question 5: Pulmonary Embolism – Canadian Approach
A 45-year-old woman presents with sudden dyspnea, pleuritic chest pain, and tachycardia after a
long-haul flight. She has no prior history of DVT or PE. Her Wells score for PE is 2. What is the most
appropriate next step according to Thrombosis Canada guidelines?
A) Immediate CT Pulmonary Angiogram (CTPA)
B) D-dimer testing
C) Therapeutic anticoagulation
D) Ventilation-perfusion (V/Q) scan
✔✔ Answer✔✔ B. D-dimer testing
Rationale: Thrombosis Canada guidelines for PE evaluation :
• Low pre-test probability (Wells <2): Use PERC rule. If PERC positive or intermediate probability,
proceed with D-dimer.
• High pre-test probability (Wells ≥2): Proceed directly to CTPA (CT Pulmonary Angiogram).
This patient has intermediate probability; D-dimer is appropriate. A negative D-dimer effectively rules
out PE; a positive result warrants CTPA.
Section 2: Neurology & Musculoskeletal
Question 6: Antiepileptic Medications – Renal Excretion
Which of the following antiepileptic medications is excreted unchanged in the urine and requires dose
adjustment in renal impairment?
A) Phenytoin
B) Valproic acid
C) Gabapentin
D) Carbamazepine
✔✔ Answer✔✔ C. Gabapentin
Rationale: Gabapentin and pregabalin are renally excreted unchanged and require dose adjustment in
renal impairment . Phenytoin, valproic acid, and carbamazepine are hepatically metabolized.
Question 7: Cervical Spine Biomechanics
A 58-year-old male undergoes occiput to C2 fusion. How will this surgery affect his cervical range of
motion?
A) Complete loss of cervical flexion/extension
B) Approximately 50% loss of cervical rotation
