1
MEDICAL COUNCIL OF CANADA QUALIFYING
EXAMINATION (MCCQE) PART I STUDY GUIDE |
LATEST UPDATE 2026/2027 | 100 PRACTICE
QUESTIONS AND ANSWERS | EXAM REVIEW | 100%
CORRECT ANSWERS | VERIFIED SOLUTIONS
This comprehensive practice examination is designed for candidates preparing for
the Medical Council of Canada Qualifying Examination (MCCQE) Part I. It serves
as a complete study guide and exam review, reflecting the latest update for
2026/2027. The questions are meticulously crafted to mirror the difficulty, clinical
scenario-based style, and scope of the assessment, covering all essential domains
including internal medicine, surgery, pediatrics, obstetrics and gynecology,
psychiatry, public health and preventive medicine, and emergency medicine. By
engaging with these practice questions and answers, candidates can assess
readiness, identify knowledge gaps, and reinforce critical clinical reasoning and
medical knowledge concepts. The detailed rationales provide verified solutions,
ensuring deep comprehension and enhancing preparation for this national
licensing examination.
Table of Contents
1. Internal Medicine
2. Surgery
3. Pediatrics
4. Obstetrics and Gynecology
5. Psychiatry
6. Public Health and Preventive Medicine
7. Emergency Medicine
, 2
SECTION 1: INTERNAL MEDICINE
Question 1: A 58-year-old male presents with crushing substernal chest pain
radiating to the left arm, diaphoresis, and nausea. ECG shows ST-segment
elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A) Left anterior descending artery
B) Left circumflex artery
C) Right coronary artery
D) Left main coronary artery
Correct Answer: C
ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which is most commonly caused by occlusion of the right
coronary artery (RCA) in approximately 80% of cases. The left anterior
descending artery supplies the anterior wall (leads V1-V4). The left circumflex
artery supplies the lateral wall (leads I, aVL, V5-V6). The left main coronary
artery supplies a large territory and would typically present with widespread
changes.
Question 2: A 45-year-old female presents with fatigue, weight gain, cold
intolerance, and constipation. TSH is elevated and free T4 is low. What is the most
likely diagnosis?
A) Hyperthyroidism
B) Hypothyroidism
C) Subclinical hypothyroidism
D) Thyroid storm
, 3
Correct Answer: B
Elevated TSH with low free T4 confirms primary hypothyroidism. The symptoms of
fatigue, weight gain, cold intolerance, and constipation are classic for
hypothyroidism. Hyperthyroidism would present with low TSH and elevated free
T4. Subclinical hypothyroidism has elevated TSH with normal free T4. Thyroid
storm is a severe form of hyperthyroidism.
Question 3: A 62-year-old male with a 40-pack-year smoking history presents
with progressive dyspnea, chronic cough, and weight loss. Chest X-ray shows a
right hilar mass. What is the most likely diagnosis?
A) Small cell lung cancer
B) Squamous cell carcinoma
C) Adenocarcinoma
D) Large cell carcinoma
Correct Answer: B
Squamous cell carcinoma is strongly associated with smoking and typically
presents as a central (hilar) mass. Small cell lung cancer is also smoking-related
but often presents with mediastinal involvement. Adenocarcinoma is the most
common lung cancer overall but is typically peripheral. Large cell carcinoma is
usually peripheral.
Question 4: A 34-year-old female presents with malar rash, photosensitivity, oral
ulcers, and arthritis. ANA is positive. What is the most likely diagnosis?
, 4
A) Rheumatoid arthritis
B) Systemic lupus erythematosus
C) Scleroderma
D) Dermatomyositis
Correct Answer: B
The combination of malar rash, photosensitivity, oral ulcers, and arthritis in a
young female with a positive ANA is highly suggestive of systemic lupus
erythematosus (SLE). Rheumatoid arthritis typically presents with symmetric small
joint involvement and positive RF/anti-CCP. Scleroderma presents with skin
thickening and Raynaud's. Dermatomyositis presents with proximal muscle
weakness and Gottron's papules.
Question 5: A 55-year-old male with a history of alcohol use presents with
hematemesis and melena. BP is 85/50, HR is 120. What is the most appropriate
initial step?
A) Immediate endoscopy
B) IV access and fluid resuscitation
C) Transfusion of packed red blood cells
D) Administration of proton pump inhibitor
Correct Answer: B
The patient is hemodynamically unstable, indicating hemorrhagic shock. The most
appropriate initial step is to establish IV access and begin fluid resuscitation to
stabilize the patient. Endoscopy is both diagnostic and therapeutic but should be
performed after initial stabilization. Transfusion may be necessary but requires IV
access first. PPI administration is important but not the immediate priority.
MEDICAL COUNCIL OF CANADA QUALIFYING
EXAMINATION (MCCQE) PART I STUDY GUIDE |
LATEST UPDATE 2026/2027 | 100 PRACTICE
QUESTIONS AND ANSWERS | EXAM REVIEW | 100%
CORRECT ANSWERS | VERIFIED SOLUTIONS
This comprehensive practice examination is designed for candidates preparing for
the Medical Council of Canada Qualifying Examination (MCCQE) Part I. It serves
as a complete study guide and exam review, reflecting the latest update for
2026/2027. The questions are meticulously crafted to mirror the difficulty, clinical
scenario-based style, and scope of the assessment, covering all essential domains
including internal medicine, surgery, pediatrics, obstetrics and gynecology,
psychiatry, public health and preventive medicine, and emergency medicine. By
engaging with these practice questions and answers, candidates can assess
readiness, identify knowledge gaps, and reinforce critical clinical reasoning and
medical knowledge concepts. The detailed rationales provide verified solutions,
ensuring deep comprehension and enhancing preparation for this national
licensing examination.
Table of Contents
1. Internal Medicine
2. Surgery
3. Pediatrics
4. Obstetrics and Gynecology
5. Psychiatry
6. Public Health and Preventive Medicine
7. Emergency Medicine
, 2
SECTION 1: INTERNAL MEDICINE
Question 1: A 58-year-old male presents with crushing substernal chest pain
radiating to the left arm, diaphoresis, and nausea. ECG shows ST-segment
elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A) Left anterior descending artery
B) Left circumflex artery
C) Right coronary artery
D) Left main coronary artery
Correct Answer: C
ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which is most commonly caused by occlusion of the right
coronary artery (RCA) in approximately 80% of cases. The left anterior
descending artery supplies the anterior wall (leads V1-V4). The left circumflex
artery supplies the lateral wall (leads I, aVL, V5-V6). The left main coronary
artery supplies a large territory and would typically present with widespread
changes.
Question 2: A 45-year-old female presents with fatigue, weight gain, cold
intolerance, and constipation. TSH is elevated and free T4 is low. What is the most
likely diagnosis?
A) Hyperthyroidism
B) Hypothyroidism
C) Subclinical hypothyroidism
D) Thyroid storm
, 3
Correct Answer: B
Elevated TSH with low free T4 confirms primary hypothyroidism. The symptoms of
fatigue, weight gain, cold intolerance, and constipation are classic for
hypothyroidism. Hyperthyroidism would present with low TSH and elevated free
T4. Subclinical hypothyroidism has elevated TSH with normal free T4. Thyroid
storm is a severe form of hyperthyroidism.
Question 3: A 62-year-old male with a 40-pack-year smoking history presents
with progressive dyspnea, chronic cough, and weight loss. Chest X-ray shows a
right hilar mass. What is the most likely diagnosis?
A) Small cell lung cancer
B) Squamous cell carcinoma
C) Adenocarcinoma
D) Large cell carcinoma
Correct Answer: B
Squamous cell carcinoma is strongly associated with smoking and typically
presents as a central (hilar) mass. Small cell lung cancer is also smoking-related
but often presents with mediastinal involvement. Adenocarcinoma is the most
common lung cancer overall but is typically peripheral. Large cell carcinoma is
usually peripheral.
Question 4: A 34-year-old female presents with malar rash, photosensitivity, oral
ulcers, and arthritis. ANA is positive. What is the most likely diagnosis?
, 4
A) Rheumatoid arthritis
B) Systemic lupus erythematosus
C) Scleroderma
D) Dermatomyositis
Correct Answer: B
The combination of malar rash, photosensitivity, oral ulcers, and arthritis in a
young female with a positive ANA is highly suggestive of systemic lupus
erythematosus (SLE). Rheumatoid arthritis typically presents with symmetric small
joint involvement and positive RF/anti-CCP. Scleroderma presents with skin
thickening and Raynaud's. Dermatomyositis presents with proximal muscle
weakness and Gottron's papules.
Question 5: A 55-year-old male with a history of alcohol use presents with
hematemesis and melena. BP is 85/50, HR is 120. What is the most appropriate
initial step?
A) Immediate endoscopy
B) IV access and fluid resuscitation
C) Transfusion of packed red blood cells
D) Administration of proton pump inhibitor
Correct Answer: B
The patient is hemodynamically unstable, indicating hemorrhagic shock. The most
appropriate initial step is to establish IV access and begin fluid resuscitation to
stabilize the patient. Endoscopy is both diagnostic and therapeutic but should be
performed after initial stabilization. Transfusion may be necessary but requires IV
access first. PPI administration is important but not the immediate priority.
