MCCQE1 Exam Questions & Answers) |
Updated | CDM & MCQ Format | Medical
Council of Canada Qualifying Exam
Question 1
A 62-year-old man with hypertension and angina has severe retrosternal chest pain
radiating to the left shoulder on awakening, accompanied by diaphoresis and nausea.
The pain is not relieved by sublingual nitroglycerin. An ECG is consistent with an
evolving anterior wall myocardial infarction. Two days later, the patient develops
severe shortness of breath. His temperature is 36.7 C, BP 100/60, pulse 105, and RR
29. Physical examination reveals bilateral wet crackles in the lungs and a holosystolic
murmur heard at the apex radiating to the left axilla. A review of his medical records
indicates that no murmur was heard during an examination 4 months earlier. Which
of the following complications has most likely occurred?
- Aortic dissection
- Cardiac rupture
- Papillary muscle rupture
- Septal perforation
- Ventricular aneurysm formation
Correct Answer
Papillary muscle rupture
Occurs in <5% of patients with AMI - usually presents with acute onset of CCF 1-7
days after infarction. A loud systolic murmur is heard at the left sternal border and
ECG shows flail mitral valve. Rx: surgical repair/replacement
Aortic dissection: sudden onset of severe chest pain radiating to the abdomen and
back. Auscultation is significant for murmur of aortic insufficiency, pulses may be
absent or asymmetric.
Cardiac rupture: usually rapidly fatal
Septal perforation: <1% of patients following AMI. Holosystolic murmur along the
left sternal border, commonly accompanied by thrill.
Ventricular aneurysm formation: may gradually enlarge over several weeks
Page 1 of 137
,Question 2
A 29-year-old man is brought to the ED in a comatose state a few hours after
complaining of sudden onset of excruciating headache. His friend does not know if
the patient has any underlying medical conditions. Neurological examination reveals
dilated pupils poorly responsive to light. A CT scan of the head without contrast
demonstrates hyperdensity within the suprasellar cistern, while MRI is unremarkable.
Lumbar puncture shows haemorrhagic CSF. Which of the following is the most likely
diagnosis?
- Amyloid angiopathy-related haemorrhage
- Caverous sinus thrombosis
- Haemorrhagic infarction
- Pituitary apoplexy
- Ruptured berry aneurysm
Correct Answer
Ruptured berry aneurysm
Rupture of berry aneurysm is most common cause of subarachnoid bleeding
Suprasellar cistern: CSF-filled space located above sella turcica, under the
hypothalamus - contains optic chiasma, infundibular stalk and polygone of Willis.
Question 3
A 54-year-old woman comes to the physician for an annual examination. She has no
complaints. For the past year, she has been taking tamoxifen for the prevention of
breast cancer. She was started on this drug after her physician determined her to be
at high risk on the basis of her strong family history, nullipariety, and early age at
menarche. She takes no other medications. Examination is within normal limits. Before
she leaves the exam room she expresses concern about the longterm effects of
tamoxifen. Which of the following is this patient most likely to develop while taking
tamoxifen?
- Breast cancer
- Elevated LDL cholesterol
- Endometrial changes
- Myocardial infarction
- Osteoporosis
Correct Answer
Endometrial changes (polyp formation, hyperplasia, frank invasive carcinoma)
Tamoxifen: NSAID with pro- and antioestrogenic properties (antioestrogenic at the
breast, but proestrogenic at the endometrium)
Page 2 of 137
,Question 4
A 42-year-old man comes to the physician for his annual physical examination. He
was last seen 2 years ago for a periodic health examination and was in god health. He
is on no medications. His past medical history is significant for a cholecystectomy 2
years ago and rheumatic fever at age 15. He has been smoking approximately 10
cigarettes daily for the past 23 years. On physical examination, his BP is 154/56
mmHg, pulse 68/min, RR 14/min. He is afebrile. A head and neck examination is
normal. His lungs are clear. He has a regular heart rhythm with a II/VI blowing
decrescendo diastolic murmur heard at the aortic area. His abdominal and rectal
examinations are normal. Complete blood count, electrolytes, and thyroid function
tests are normal. Which of the following is the most appropriate advice for this man
regarding future preventive health maintenance?
- Antibiotic prophylaxis before dental work
- Annual chest x-ray
Correct Answer
Antibiotic prophylaxis before undergoing dental work
Physical examination is consistent with asymptomatic aortic insufficiency as a result
of childhood rheumatic fever. Patients with any significant cardiac valvular disease
should be instructed to have abx prophylaxis before dental work to reduce the risk
of subacute bacterial endocarditis.
Sigmoidoscopy and PSA testing would be recommended when >50 years
Page 3 of 137
, Question 5
A 22-year-old woman, gravida 2, para 0, at 8 weeks' gestation comes to the physician
for a prenatal visit. She has no complaints. Her first pregnancy resulted in a 22-week
loss when she presented to her physician with bleeding from the vagina, was found to
be fully dilated, and delivered the fetus. Examination of the patient today is
unremarkable. She declines to have a cerclage placed. When should this patient begin
having regular cervical examinations?
- 10 weeks
- 16 weeks
- 22 weeks
- 28 weeks
Correct Answer
16 weeks
Obstetrical history is consistent with cervical incompetence, which is a cause of
second-trimester miscarriage/preterm. Increased risk in those who have had
previous trauma to the cervix (e.g. dilation of cervic, cervical conisation, obstetric
trauma), women with mullerian anomalies, or history of in-utero exposure to
diethylstilbestrol. Rx: cerclage (suture at the level of internal os) between 12-16
weeks gestation.
Question 6
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
Correct Answer
Endocardial cushion defect: occurs when an ASD and VSD are present and
contiguous, and the atrioventricular valves are also abnormal
Page 4 of 137
Updated | CDM & MCQ Format | Medical
Council of Canada Qualifying Exam
Question 1
A 62-year-old man with hypertension and angina has severe retrosternal chest pain
radiating to the left shoulder on awakening, accompanied by diaphoresis and nausea.
The pain is not relieved by sublingual nitroglycerin. An ECG is consistent with an
evolving anterior wall myocardial infarction. Two days later, the patient develops
severe shortness of breath. His temperature is 36.7 C, BP 100/60, pulse 105, and RR
29. Physical examination reveals bilateral wet crackles in the lungs and a holosystolic
murmur heard at the apex radiating to the left axilla. A review of his medical records
indicates that no murmur was heard during an examination 4 months earlier. Which
of the following complications has most likely occurred?
- Aortic dissection
- Cardiac rupture
- Papillary muscle rupture
- Septal perforation
- Ventricular aneurysm formation
Correct Answer
Papillary muscle rupture
Occurs in <5% of patients with AMI - usually presents with acute onset of CCF 1-7
days after infarction. A loud systolic murmur is heard at the left sternal border and
ECG shows flail mitral valve. Rx: surgical repair/replacement
Aortic dissection: sudden onset of severe chest pain radiating to the abdomen and
back. Auscultation is significant for murmur of aortic insufficiency, pulses may be
absent or asymmetric.
Cardiac rupture: usually rapidly fatal
Septal perforation: <1% of patients following AMI. Holosystolic murmur along the
left sternal border, commonly accompanied by thrill.
Ventricular aneurysm formation: may gradually enlarge over several weeks
Page 1 of 137
,Question 2
A 29-year-old man is brought to the ED in a comatose state a few hours after
complaining of sudden onset of excruciating headache. His friend does not know if
the patient has any underlying medical conditions. Neurological examination reveals
dilated pupils poorly responsive to light. A CT scan of the head without contrast
demonstrates hyperdensity within the suprasellar cistern, while MRI is unremarkable.
Lumbar puncture shows haemorrhagic CSF. Which of the following is the most likely
diagnosis?
- Amyloid angiopathy-related haemorrhage
- Caverous sinus thrombosis
- Haemorrhagic infarction
- Pituitary apoplexy
- Ruptured berry aneurysm
Correct Answer
Ruptured berry aneurysm
Rupture of berry aneurysm is most common cause of subarachnoid bleeding
Suprasellar cistern: CSF-filled space located above sella turcica, under the
hypothalamus - contains optic chiasma, infundibular stalk and polygone of Willis.
Question 3
A 54-year-old woman comes to the physician for an annual examination. She has no
complaints. For the past year, she has been taking tamoxifen for the prevention of
breast cancer. She was started on this drug after her physician determined her to be
at high risk on the basis of her strong family history, nullipariety, and early age at
menarche. She takes no other medications. Examination is within normal limits. Before
she leaves the exam room she expresses concern about the longterm effects of
tamoxifen. Which of the following is this patient most likely to develop while taking
tamoxifen?
- Breast cancer
- Elevated LDL cholesterol
- Endometrial changes
- Myocardial infarction
- Osteoporosis
Correct Answer
Endometrial changes (polyp formation, hyperplasia, frank invasive carcinoma)
Tamoxifen: NSAID with pro- and antioestrogenic properties (antioestrogenic at the
breast, but proestrogenic at the endometrium)
Page 2 of 137
,Question 4
A 42-year-old man comes to the physician for his annual physical examination. He
was last seen 2 years ago for a periodic health examination and was in god health. He
is on no medications. His past medical history is significant for a cholecystectomy 2
years ago and rheumatic fever at age 15. He has been smoking approximately 10
cigarettes daily for the past 23 years. On physical examination, his BP is 154/56
mmHg, pulse 68/min, RR 14/min. He is afebrile. A head and neck examination is
normal. His lungs are clear. He has a regular heart rhythm with a II/VI blowing
decrescendo diastolic murmur heard at the aortic area. His abdominal and rectal
examinations are normal. Complete blood count, electrolytes, and thyroid function
tests are normal. Which of the following is the most appropriate advice for this man
regarding future preventive health maintenance?
- Antibiotic prophylaxis before dental work
- Annual chest x-ray
Correct Answer
Antibiotic prophylaxis before undergoing dental work
Physical examination is consistent with asymptomatic aortic insufficiency as a result
of childhood rheumatic fever. Patients with any significant cardiac valvular disease
should be instructed to have abx prophylaxis before dental work to reduce the risk
of subacute bacterial endocarditis.
Sigmoidoscopy and PSA testing would be recommended when >50 years
Page 3 of 137
, Question 5
A 22-year-old woman, gravida 2, para 0, at 8 weeks' gestation comes to the physician
for a prenatal visit. She has no complaints. Her first pregnancy resulted in a 22-week
loss when she presented to her physician with bleeding from the vagina, was found to
be fully dilated, and delivered the fetus. Examination of the patient today is
unremarkable. She declines to have a cerclage placed. When should this patient begin
having regular cervical examinations?
- 10 weeks
- 16 weeks
- 22 weeks
- 28 weeks
Correct Answer
16 weeks
Obstetrical history is consistent with cervical incompetence, which is a cause of
second-trimester miscarriage/preterm. Increased risk in those who have had
previous trauma to the cervix (e.g. dilation of cervic, cervical conisation, obstetric
trauma), women with mullerian anomalies, or history of in-utero exposure to
diethylstilbestrol. Rx: cerclage (suture at the level of internal os) between 12-16
weeks gestation.
Question 6
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
Correct Answer
Endocardial cushion defect: occurs when an ASD and VSD are present and
contiguous, and the atrioventricular valves are also abnormal
Page 4 of 137
