Medical Council of Canada Qualifying Examination Part
I MCCQE1 COMPLETE EXAM LATEST VERSION 2026-2027
QUESTIONS AND ANSWERS
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 - 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.
A 64-year-old man smokes one or two cigarettes a day sporadically on weekends and he has been
diagnosed with severe emphysema. His pulmonologist, on examining his routine blood work, finds
elevated serum transaminases. Hepatitis serologies reveal no evidence of viral hepatitis A, B, or C. A
younger brother died of emphysema at age 50 and has no smoking history. Which of the following
diseases should most likely be considered to explain this patient's liver abnormalities AND his lung
disease?
- Alpha-1-antitrypsin deficiency
- Primary haemochromatosis
Primary sclerosing cholangitis
Secondary haemachromatosis
Wilson disease - answer>>Alpha-1-antitrypsin deficiency
Decreased A1AT activity in blood and lungs, and deposition in the liver
,-
-
-
Primary haemochromatosis: autosomal recessive, leaves iron deposition in liver, heart, and pancreas,
and leads to bronze hyperpigmentation of the skin.
Primary sclerosing cholangitis: occurs in patients with ulcerative colitis and does not affect the lungs.
Secondary haemochromatosis: occurs in patients who have received massive amounts of blood
transfusion over the years.
Wilson disease: familial genetic liver disease and also involves the eye (Kayser-Fleischer ring) and causes
neuropsychiatric disorders.
A 28-year-old man who recently emigrated from Italy returns to the physician's office for a follow up
visit to evaluate his anaemia. Four days ago, he presented with fatigue and dyspnoea on exertion and
was found to have a haemocrit of 22%.
At the time he was admitted to the local hospital for evaluation. Laboratory analysis shows: haematocrit
23%; MCV 59 microm3; reticulocyte count 4.3%; serum iron 160 microg/dL; total iron binding capacity
(TIBC) 230 microg/mL; serum ferritin 80 nanog/mL; haemaglobin electrophoresis shows absent beta
bands.
Which of the following is the most likely diagnosis?
- Alpha-thalassaemia
- Beta- thalassaemia
- Iron deficiency anaemia
- Megaloblastic anaemia - answer>>Beta-thalassaemia
Key words: microcytic anaemia, Mediterranean descent, absent beta bands
A worried 19-year-old single mother calls the physician because her 5-day-old son has developed red
eyes, tearing, and a yellow, sticky discharge that prevents him from opening his eyes after sleeping until
she cleans it off. The baby was born at full term by vaginal delivery and scored 9 and 9 on the Apgar
scale. The physical examination at the time of birth was within normal limits. Mother and son were
discharged after 24 hours and everything was going well until this happened. This is her first child and
she does not know whether specific treatment is required or the condition will resolve on its own. The
physician advises the mother to bring the newborn in and a couple of hours later they arrive at the
office. On physical examination, the neonate does not seem to be in distress. He has bilateral
prominent tearing, conjunctival injection, substantial lid oedema, and a purulent discharge. A Gram
stain of the purule - answer>>Systemic ceftriaxone + frequently irrigate eyes with saline
,Dx: gonococcal conjunctivitis. Can occur at birth or after 5 days of age if the patient has received topical
antibiotic prophylaxis at birth.
Neisseria gonorrhea and chlamydia trachomatis are common infectious causes acquired by passage
through the birth canal. Chlamydia is the most common cause of infectious ophthalmia neonatorum.
Chlamydia conjunctivitis: appears 5-23 days after birth
Bacteria, such as haemophilus, streptococcus, staphylococcus, or pneumococcus usually cause acute
purulent conjunctivitis.
Viruses (adenovirus, enterovirus) may cause an isolated conjunctivitis.
Allergic conjunctivitis usually develops after the neonatal period.
A 50-year-old man is admitted secondary to respiratory failure and tachycardia. His temperature is 38.9
C, BP 110/60, and RR 30. His ECG shows P waves preceding the QRS complex. No two P waves have the
same morphology. Which of the following is the most appropriate next step in management? -
Administration of digitalis (digoxin)
- Administration of warfarin
- Electrical cardioversion
- Mechanical ventilation
- Placement of a defibrillator - answer>>Mechnical ventilation
Dx: multifocal atrial tachycardia: variable P wave morphology and PR and RR intervals. Control of this
tachycardia comes with improved ventilation and oxygenation. Caused by multiple sites of competing
atrial activity and assoc. with severe pulmonary disease.
Digitalis/digoxin: enhances myocardial contractility in heart failure and rate control in AF
Warfarin: chronic AF
Electrical cardioversion: AF (must be first adequately anticoagulated)
Defibrillation: arrhythmia and haemodynamically unstable (ventricular fibrillation and tachycardia)
A 54-year-old heavy smoker comes to the ED because of a mild cough, chest pain, diarrhoea, fatigue,
headache, and fever for 3 days. He has a scant amount of nonpurulent sputum. Several of his coworkers
are experiencing similar symptoms. His temperature is 39.8 C, BP 120/80, and pulse 50. Rales are heard
of auscultation. Diffuse abdominal tenderness is present. A chest x-ray film reveals bilateral infiltrates. A
Gram stain of his sputum shows numerous neutrophils, but no organisms. A sputum culture on buffered
, charcoal yeast extract (BYCE) agar grows gram-negative bacilli. Which of the following is the most likely
pathogen?
- Chlamydia trachomatis
- Legionella pneumophila
- Moraxella carrhalis
- Mycoplasma pneumoniae
- Pneumocystis carinii - answer>>Legionella pneumoniae (Legionnaire's disease)
Often acquired from a contaminated water supply (air conditioning systems) and can lead to outbreaks.
Rx: erythromycin
Chlamydia trachomatis: obligate intracellular parasite with features similar to gram-negative bacteria
Moraxella catarrhalis: gram-negative coccus that causes pneumonia in elderly patients with COPD
Mycoplasma pneumoniae: CAP that occurs in young adults; CXR shows interstitial infiltrates
Pneumocystis carinii: opportunistic pathogen that causes pneumonia in immunocompromised patients;
CXR shows diffuse interstitial infiltrates
A 63-year-old man with a history of noninsulin-dependent diabetes and hypertension comes to the
physician after being awakened from sleep by severe pain in his right first toe. He reports the sudden
onset of acute pain in the toe, rapidly followed by erythema, swelling, tenderness, and warmth. His
temperature is 37 C, BP 170/60, pulse 97, and RR 19. Physical examination is normal except for swelling
and severe tenderness over his metatarsophalangeal joint on the right foot. Which of the following is
the most appropriate first-line treatment for this patient's condition?
- Allopurinol
- Dietary modifications
- Indomethacin
- Prednisone - answer>>Indomethacin (NSAID)
Dx: gout
Allopurinol: prevent gout recurrences by decreasing uric acid levels
Dietary modifications: long-term prevention of recurrences
Prednisone: effective medication in treatment of acute gout, but is not first-line due to side effects
I MCCQE1 COMPLETE EXAM LATEST VERSION 2026-2027
QUESTIONS AND ANSWERS
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 - 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.
A 64-year-old man smokes one or two cigarettes a day sporadically on weekends and he has been
diagnosed with severe emphysema. His pulmonologist, on examining his routine blood work, finds
elevated serum transaminases. Hepatitis serologies reveal no evidence of viral hepatitis A, B, or C. A
younger brother died of emphysema at age 50 and has no smoking history. Which of the following
diseases should most likely be considered to explain this patient's liver abnormalities AND his lung
disease?
- Alpha-1-antitrypsin deficiency
- Primary haemochromatosis
Primary sclerosing cholangitis
Secondary haemachromatosis
Wilson disease - answer>>Alpha-1-antitrypsin deficiency
Decreased A1AT activity in blood and lungs, and deposition in the liver
,-
-
-
Primary haemochromatosis: autosomal recessive, leaves iron deposition in liver, heart, and pancreas,
and leads to bronze hyperpigmentation of the skin.
Primary sclerosing cholangitis: occurs in patients with ulcerative colitis and does not affect the lungs.
Secondary haemochromatosis: occurs in patients who have received massive amounts of blood
transfusion over the years.
Wilson disease: familial genetic liver disease and also involves the eye (Kayser-Fleischer ring) and causes
neuropsychiatric disorders.
A 28-year-old man who recently emigrated from Italy returns to the physician's office for a follow up
visit to evaluate his anaemia. Four days ago, he presented with fatigue and dyspnoea on exertion and
was found to have a haemocrit of 22%.
At the time he was admitted to the local hospital for evaluation. Laboratory analysis shows: haematocrit
23%; MCV 59 microm3; reticulocyte count 4.3%; serum iron 160 microg/dL; total iron binding capacity
(TIBC) 230 microg/mL; serum ferritin 80 nanog/mL; haemaglobin electrophoresis shows absent beta
bands.
Which of the following is the most likely diagnosis?
- Alpha-thalassaemia
- Beta- thalassaemia
- Iron deficiency anaemia
- Megaloblastic anaemia - answer>>Beta-thalassaemia
Key words: microcytic anaemia, Mediterranean descent, absent beta bands
A worried 19-year-old single mother calls the physician because her 5-day-old son has developed red
eyes, tearing, and a yellow, sticky discharge that prevents him from opening his eyes after sleeping until
she cleans it off. The baby was born at full term by vaginal delivery and scored 9 and 9 on the Apgar
scale. The physical examination at the time of birth was within normal limits. Mother and son were
discharged after 24 hours and everything was going well until this happened. This is her first child and
she does not know whether specific treatment is required or the condition will resolve on its own. The
physician advises the mother to bring the newborn in and a couple of hours later they arrive at the
office. On physical examination, the neonate does not seem to be in distress. He has bilateral
prominent tearing, conjunctival injection, substantial lid oedema, and a purulent discharge. A Gram
stain of the purule - answer>>Systemic ceftriaxone + frequently irrigate eyes with saline
,Dx: gonococcal conjunctivitis. Can occur at birth or after 5 days of age if the patient has received topical
antibiotic prophylaxis at birth.
Neisseria gonorrhea and chlamydia trachomatis are common infectious causes acquired by passage
through the birth canal. Chlamydia is the most common cause of infectious ophthalmia neonatorum.
Chlamydia conjunctivitis: appears 5-23 days after birth
Bacteria, such as haemophilus, streptococcus, staphylococcus, or pneumococcus usually cause acute
purulent conjunctivitis.
Viruses (adenovirus, enterovirus) may cause an isolated conjunctivitis.
Allergic conjunctivitis usually develops after the neonatal period.
A 50-year-old man is admitted secondary to respiratory failure and tachycardia. His temperature is 38.9
C, BP 110/60, and RR 30. His ECG shows P waves preceding the QRS complex. No two P waves have the
same morphology. Which of the following is the most appropriate next step in management? -
Administration of digitalis (digoxin)
- Administration of warfarin
- Electrical cardioversion
- Mechanical ventilation
- Placement of a defibrillator - answer>>Mechnical ventilation
Dx: multifocal atrial tachycardia: variable P wave morphology and PR and RR intervals. Control of this
tachycardia comes with improved ventilation and oxygenation. Caused by multiple sites of competing
atrial activity and assoc. with severe pulmonary disease.
Digitalis/digoxin: enhances myocardial contractility in heart failure and rate control in AF
Warfarin: chronic AF
Electrical cardioversion: AF (must be first adequately anticoagulated)
Defibrillation: arrhythmia and haemodynamically unstable (ventricular fibrillation and tachycardia)
A 54-year-old heavy smoker comes to the ED because of a mild cough, chest pain, diarrhoea, fatigue,
headache, and fever for 3 days. He has a scant amount of nonpurulent sputum. Several of his coworkers
are experiencing similar symptoms. His temperature is 39.8 C, BP 120/80, and pulse 50. Rales are heard
of auscultation. Diffuse abdominal tenderness is present. A chest x-ray film reveals bilateral infiltrates. A
Gram stain of his sputum shows numerous neutrophils, but no organisms. A sputum culture on buffered
, charcoal yeast extract (BYCE) agar grows gram-negative bacilli. Which of the following is the most likely
pathogen?
- Chlamydia trachomatis
- Legionella pneumophila
- Moraxella carrhalis
- Mycoplasma pneumoniae
- Pneumocystis carinii - answer>>Legionella pneumoniae (Legionnaire's disease)
Often acquired from a contaminated water supply (air conditioning systems) and can lead to outbreaks.
Rx: erythromycin
Chlamydia trachomatis: obligate intracellular parasite with features similar to gram-negative bacteria
Moraxella catarrhalis: gram-negative coccus that causes pneumonia in elderly patients with COPD
Mycoplasma pneumoniae: CAP that occurs in young adults; CXR shows interstitial infiltrates
Pneumocystis carinii: opportunistic pathogen that causes pneumonia in immunocompromised patients;
CXR shows diffuse interstitial infiltrates
A 63-year-old man with a history of noninsulin-dependent diabetes and hypertension comes to the
physician after being awakened from sleep by severe pain in his right first toe. He reports the sudden
onset of acute pain in the toe, rapidly followed by erythema, swelling, tenderness, and warmth. His
temperature is 37 C, BP 170/60, pulse 97, and RR 19. Physical examination is normal except for swelling
and severe tenderness over his metatarsophalangeal joint on the right foot. Which of the following is
the most appropriate first-line treatment for this patient's condition?
- Allopurinol
- Dietary modifications
- Indomethacin
- Prednisone - answer>>Indomethacin (NSAID)
Dx: gout
Allopurinol: prevent gout recurrences by decreasing uric acid levels
Dietary modifications: long-term prevention of recurrences
Prednisone: effective medication in treatment of acute gout, but is not first-line due to side effects
