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An 80-year-old woman comes to the urgent care clinic with
dyspnoea on exertion. On physical examination, her blood
pressure is 100/70, and her pulse is 75. She has no pulsus
paradoxus. Her jugular veins are distended, and she has
distant heart sounds. In addition, she has extra third and
fourth heart sounds. Her liver is enlarged, and she has pedal
oedema. She has occasional premature ventricular
contractions on her electrocardiogram. A chest x-ray reveals
clear lung fields with a dilated cardiac silhouette. Her
echocardiogram reveals ventricular walls with a "speckled
pattern". Which of the following is the most likely diagnosis?
- Alcoholic cardiomyopathy
- Amyloidosis
- Haemochromatosis
- Tuberculosis
- Viral myocarditis - Correct Answers ✅Amyloidosis
Restrictive cardiomyopathy with 'speckled' left ventricular
wall
Primary cardiac amyloidosis usually develops into diastolic
dysfunction
Alcoholic cardiomyopathy: biventricular dilated
cardiomyopathy
A 92-year-old man with a 45-year history of chronic
obstructive pulmonary disease is intubated in the ICU
because of a bout of viral pneumonia that fails to improve
,100 Free MCCQE1 Questions and Verified
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after 72 hours of antibiotics. Although the inspired fraction of
oxygen is 100%, the patient's pO2 remains at 57 mmHg.
Positive-end expiratory pressure (PEEP) is added to allow the
inspired fraction of oxygen. Twelve hours after the
introduction of PEEP the patient suddenly become
hypotensive. At the same time, his oxygen saturation drops
from 92% to 61%. On physical examination, his BP is 80/50
mmHg and his pulse is 124/min. He has distended neck veins
and distant heart sounds. Which of the following would also
most likely be seen on this patient's physical examination?
- Absence of breath sounds in the right hemithorax
- High amplitude carotid artery upstroke
- A pleural friction rub
- Pulsus alternans
- Splenomegaly - Correct Answers ✅Absence of breath
sounds in the right hemithorax
Patient has developed a tension pneumothorax, characterised
by PEEP followed by sudden hypotension and decreased
oxygenation
Jugular venous distention occurs because venous return to
the right side of the heart is being compressed
Rx: immediate needle/tube thoracostomy
A 46-year-old man with a history of hypertension and
hypercholesterolemia visits the physician for a routine
followup. The patient's job involves a lot of travelling, and he
,100 Free MCCQE1 Questions and Verified
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admits to occasionally forgetting to take his medications with
him when he travels. He complains of several episodes of
chest pain in the past few months. The pain is sharp in
nature, mainly over his lower chest and epigastrium, and
tends to come on when walking. He believes these episodes
are due to indigestion and has been taking antacids. There is
a family history of heart disease, and his father died of a
heart attack at age 48. On physical examination, his blood
pressure is 150/80 mmHg and heart rate is 86/min. His lungs
are clear to auscultation. Cardiac auscultation reveals normal
rate and rhythm, without rubs, gallops, or murmurs. There is
no pedal oedema. He is sent for an exercise stress test. Five
minutes into the test, he develops ST - Correct Answers
✅Coronary angiography
Multiple risk factors for atherosclerotic coronary artery
disease
A stress test is considered positive when there are ST
depression of >1mm for longer than 0.08 seconds
Positive stress test = coronary angiography
A 74-year-old woman, who has been followed for the past 25
years for chronic obstructive pulmonary disease comes to the
ED complaining of 48 hours of temperature to 38.6 C and
worsening shortness of breath. She has a chronic productive
cough, which has become more copious. On physical
examination, she has rhonchi and increased fremitus in the
posterior mid-lung field. A Gram's stain reveals many
epithelial cells and multiple gram-positive and gram-negative
, 100 Free MCCQE1 Questions and Verified
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organisms; no neutrophils are seen. Which of the following is
the most likely organism causing the symptoms?
- Escherichia coli
- Haemophilus influenzae
- Klebsiella pneumoniae
- Mycobacterium tuberculosis
- Mycoplasma pneumoniae - Correct Answers
✅Haemophilus influenzae
Evidence of community-acquired pneumonia and common
organisms in patients with COPD are Strep. pneumoniae,
Haem. influenzae and Moraxella catarrhalis.
Klebseilla pneumonia is typically found in alcoholic patients.
Primary E. coli pneumonia is rare and there is no history of
infection elsewhere (e.g. UTI).
Mycoplasma pneumoniae does not present with a lobar
consolidation and generally occurs in younger patients - x-ray
reveals faint bilateral interstitial infiltrates.
A 62-year-old man is being treated for an acute myocardial
infarction. He originally came to the ED with substernal chest
pain and diaphoresis. Given his risk factors of hypertension,
diabetes, tobacco use, and family history, he is considered
high risk. An ECG in the ED reveals a left-bundle branch
pattern, and cardiac enzymes are elevated slightly. After a
focused evaluation in the ED, the patient receives IV
thrombolytics. Although his bundle branch pattern never
Answers, 100% Score Guarantee Pass
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An 80-year-old woman comes to the urgent care clinic with
dyspnoea on exertion. On physical examination, her blood
pressure is 100/70, and her pulse is 75. She has no pulsus
paradoxus. Her jugular veins are distended, and she has
distant heart sounds. In addition, she has extra third and
fourth heart sounds. Her liver is enlarged, and she has pedal
oedema. She has occasional premature ventricular
contractions on her electrocardiogram. A chest x-ray reveals
clear lung fields with a dilated cardiac silhouette. Her
echocardiogram reveals ventricular walls with a "speckled
pattern". Which of the following is the most likely diagnosis?
- Alcoholic cardiomyopathy
- Amyloidosis
- Haemochromatosis
- Tuberculosis
- Viral myocarditis - Correct Answers ✅Amyloidosis
Restrictive cardiomyopathy with 'speckled' left ventricular
wall
Primary cardiac amyloidosis usually develops into diastolic
dysfunction
Alcoholic cardiomyopathy: biventricular dilated
cardiomyopathy
A 92-year-old man with a 45-year history of chronic
obstructive pulmonary disease is intubated in the ICU
because of a bout of viral pneumonia that fails to improve
,100 Free MCCQE1 Questions and Verified
Answers, 100% Score Guarantee Pass
(Latest 2025)
after 72 hours of antibiotics. Although the inspired fraction of
oxygen is 100%, the patient's pO2 remains at 57 mmHg.
Positive-end expiratory pressure (PEEP) is added to allow the
inspired fraction of oxygen. Twelve hours after the
introduction of PEEP the patient suddenly become
hypotensive. At the same time, his oxygen saturation drops
from 92% to 61%. On physical examination, his BP is 80/50
mmHg and his pulse is 124/min. He has distended neck veins
and distant heart sounds. Which of the following would also
most likely be seen on this patient's physical examination?
- Absence of breath sounds in the right hemithorax
- High amplitude carotid artery upstroke
- A pleural friction rub
- Pulsus alternans
- Splenomegaly - Correct Answers ✅Absence of breath
sounds in the right hemithorax
Patient has developed a tension pneumothorax, characterised
by PEEP followed by sudden hypotension and decreased
oxygenation
Jugular venous distention occurs because venous return to
the right side of the heart is being compressed
Rx: immediate needle/tube thoracostomy
A 46-year-old man with a history of hypertension and
hypercholesterolemia visits the physician for a routine
followup. The patient's job involves a lot of travelling, and he
,100 Free MCCQE1 Questions and Verified
Answers, 100% Score Guarantee Pass
(Latest 2025)
admits to occasionally forgetting to take his medications with
him when he travels. He complains of several episodes of
chest pain in the past few months. The pain is sharp in
nature, mainly over his lower chest and epigastrium, and
tends to come on when walking. He believes these episodes
are due to indigestion and has been taking antacids. There is
a family history of heart disease, and his father died of a
heart attack at age 48. On physical examination, his blood
pressure is 150/80 mmHg and heart rate is 86/min. His lungs
are clear to auscultation. Cardiac auscultation reveals normal
rate and rhythm, without rubs, gallops, or murmurs. There is
no pedal oedema. He is sent for an exercise stress test. Five
minutes into the test, he develops ST - Correct Answers
✅Coronary angiography
Multiple risk factors for atherosclerotic coronary artery
disease
A stress test is considered positive when there are ST
depression of >1mm for longer than 0.08 seconds
Positive stress test = coronary angiography
A 74-year-old woman, who has been followed for the past 25
years for chronic obstructive pulmonary disease comes to the
ED complaining of 48 hours of temperature to 38.6 C and
worsening shortness of breath. She has a chronic productive
cough, which has become more copious. On physical
examination, she has rhonchi and increased fremitus in the
posterior mid-lung field. A Gram's stain reveals many
epithelial cells and multiple gram-positive and gram-negative
, 100 Free MCCQE1 Questions and Verified
Answers, 100% Score Guarantee Pass
(Latest 2025)
organisms; no neutrophils are seen. Which of the following is
the most likely organism causing the symptoms?
- Escherichia coli
- Haemophilus influenzae
- Klebsiella pneumoniae
- Mycobacterium tuberculosis
- Mycoplasma pneumoniae - Correct Answers
✅Haemophilus influenzae
Evidence of community-acquired pneumonia and common
organisms in patients with COPD are Strep. pneumoniae,
Haem. influenzae and Moraxella catarrhalis.
Klebseilla pneumonia is typically found in alcoholic patients.
Primary E. coli pneumonia is rare and there is no history of
infection elsewhere (e.g. UTI).
Mycoplasma pneumoniae does not present with a lobar
consolidation and generally occurs in younger patients - x-ray
reveals faint bilateral interstitial infiltrates.
A 62-year-old man is being treated for an acute myocardial
infarction. He originally came to the ED with substernal chest
pain and diaphoresis. Given his risk factors of hypertension,
diabetes, tobacco use, and family history, he is considered
high risk. An ECG in the ED reveals a left-bundle branch
pattern, and cardiac enzymes are elevated slightly. After a
focused evaluation in the ED, the patient receives IV
thrombolytics. Although his bundle branch pattern never
