MCCQE Medical Council of Canada Qualifying Examination Part 1 Exam Free Practice Exam Questions (2026 Updated)

Comprehensive and Detailed Explanation:

For small renal masses ( < 4 cm), partial nephrectomy (nephron-sparing surgery) is the standard of care in patients who are surgical candidates. It preserves renal function and provides oncologic control.

Toronto Notes 2023 – Urology / Oncology:

“Small renal tumors < 4 cm should be treated with partial nephrectomy. Active surveillance or ablation may be alternatives in poor surgical candidates.”

MCCQE1 Objectives (Urology > 59-2: Renal Masses):

“Candidates must manage small renal tumors with nephron-sparing surgery when feasible.”

MRI (A) is unnecessary after CT confirmation. Radiation (B) is not first-line. Surveillance (D) may be appropriate for elderly or frail patients, not this one. Ablation (E) is for high-risk surgical patients.

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During an outbreak in a long-term care facility, prompt control measures include keeping symptomatic staff at home to prevent spread. Staff are often vectors of infection, and exclusion is a key public health intervention.

Toronto Notes 2023 – Infectious Diseases, “Infection Control and Prevention”:

“During influenza outbreaks in institutional settings, exclusion of symptomatic staff is critical to controlling spread.”

MCCQE1 Objectives (Population Health > 63-2: Outbreak Management):

“Candidates must understand outbreak control, including staff exclusion, cohorting, and surveillance in congregate settings.”

Vaccination (B) is preventive but not immediately effective during an outbreak. Masking and visitor vaccination are supportive but secondary measures.

Comprehensive and Detailed Explanation:

Physicians must be transparent and honest in documentation. If a previous abnormality was missed, it must be acknowledged. The correct action is to comment on both the previous and current findings in your report and follow institutional disclosure policies.

Toronto Notes 2023 – ELOM, “Medical Error and Disclosure”:

“Physicians must report and document prior missed findings honestly and provide full disclosure when reviewing comparative studies.”

MCCQE1 Objectives (ELOM > 90-2: Accountability and Communication):

“Candidates must accurately document previous findings when reviewing comparative data, even if it reveals past oversight.”

Delaying reporting (C–E) or omitting prior findings (A) is unethical.

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This presentation is characteristic of a non–rapid eye movement (NREM) sleep arousal disorder (sleep terror) . MCCQE objectives highlight that sleep terrors typically occur in children aged 3–7 years and arise during the first third of the night , shortly after sleep onset, during deep NREM (slow-wave) sleep. Children abruptly awaken screaming, appear terrified, flushed, and autonomically aroused, and are inconsolable and minimally responsive to caregivers. Episodes usually last 10–20 minutes and resolve spontaneously, with the child returning to sleep and having no memory of the event the next morning.

Nightmares, in contrast, occur during REM sleep (later in the night); the child is awake, alert, consolable, and can recall the dream. Nocturnal seizures are typically brief, stereotyped, and may include tonic–clonic activity or a postictal state. Panic disorder occurs during wakefulness. Temper tantrums occur while awake and are behaviorally triggered.

Management is reassurance and ensuring safety; most children outgrow sleep terrors without intervention.

This patient has classic acute pericarditis : pleuritic chest pain relieved by sitting forward, a pericardial friction rub, diffuse ST-segment elevation with PR depression on ECG, and a small pericardial effusion on echocardiogram. MCCQE objectives emphasize recognizing the characteristic clinical and ECG features that distinguish pericarditis from myocardial infarction (diffuse ST elevation rather than territorial changes).

First-line treatment for uncomplicated acute pericarditis is high-dose nonsteroidal anti-inflammatory therapy , such as acetylsalicylic acid (ASA) or ibuprofen, often combined with colchicine to reduce recurrence risk. ASA is particularly appropriate when ischemia is in the differential diagnosis.

Apixaban (anticoagulation) is not indicated and may worsen effusion. Pericardiocentesis is reserved for large effusions or cardiac tamponade. Levofloxacin is unnecessary without evidence of bacterial infection. Beta-blockers such as metoprolol do not treat pericardial inflammation.

Thus, high-dose acetylsalicylic acid is the most appropriate initial management for uncomplicated acute pericarditis.

Comprehensive and Detailed Explanation:

Postmenopausal women with abdominal distension, bloating, a complex pelvic mass, and elevated CA-125 are highly suggestive of epithelial ovarian cancer, especially serous cystadenocarcinoma—the most common type.

Toronto Notes 2023 – Gynecology / Oncology:

“Serous epithelial ovarian carcinoma presents with vague abdominal symptoms, ascites, complex pelvic mass, and elevated CA-125.”

MCCQE1 Objectives (Gynecology > 82-5: Ovarian Masses):

“Candidates must recognize signs and investigations of ovarian cancer, including elevated tumor markers and imaging findings.”

Ovarian hyperstimulation (A) occurs in fertility treatments. Colorectal cancer (C) may mimic these symptoms but typically causes rectal bleeding and has lower CA-125 levels. Uterine adenocarcinoma (D) usually causes bleeding. Hematosalpinx (E) presents with pelvic pain, not ascites.

A varicocele is a dilatation of the pampiniform plexus that presents with a “bag of worms” appearance, worsens with standing, and improves when lying down. It is most common on the left side due to anatomical drainage differences.

Toronto Notes 2023 – Urology, Scrotal Disorders:

“Varicoceles often present with a dull, aching pain and scrotal swelling that worsens when upright and disappears when supine.”

MCCQE1 Objectives – Internal Medicine > Urology:

“Candidates must recognize and diagnose varicocele by physical exam findings and typical symptom history.”

Cryptorchidism (A) refers to undescended testes. Torsion (B) presents acutely with severe pain. Hydrocele (C) transilluminates and is not posture-dependent. " Spermatocyte " (D) is not a clinical diagnosis.

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Polyhydramnios is the most likely diagnosis given the rapid increase in abdominal girth , maternal shortness of breath , and a symphysis-fundal height (45 cm) significantly greater than expected for 27 weeks’ gestation. MCCQE objectives emphasize that fundal height should approximately correspond (±2–3 cm) to gestational age in weeks after 20 weeks. A discrepancy this large suggests excessive amniotic fluid volume. Polyhydramnios leads to uterine overdistension, which explains dyspnea and rapid abdominal enlargement. Twin pregnancy can cause a large fundal height, but early ultrasound confirmation of gestational age would likely have identified multiple gestation. Partial mole is typically associated with abnormal bleeding and abnormal fetal findings. Fetal macrosomia increases fundal height but usually not to this degree at 27 weeks and is more gradual. Ovarian tumor with ascites is less likely in a confirmed intrauterine pregnancy with normal fetal heart rate. Polyhydramnios is commonly associated with maternal diabetes or fetal anomalies affecting swallowing and requires further evaluation with ultrasound and glucose screening.

Comprehensive and Detailed Explanation:

Cognitive behavioral therapy (CBT) is the most effective first-line treatment for somatic symptom disorder. It helps patients reframe dysfunctional thoughts and improve coping strategies for perceived physical symptoms.

Toronto Notes 2023 – Psychiatry, “Somatic Symptom and Related Disorders”:

“CBT is first-line for somatic symptom disorder. Antidepressants may be considered if comorbid depression or anxiety is present.”

MCCQE1 Objectives (Psychiatry > 71-2: Somatic Symptom Disorders):

“Candidates must manage somatic symptom disorder with appropriate psychosocial interventions.”

Citalopram (B) or amitriptyline (E) may be used adjunctively if mood symptoms are prominent. Risperidone (C) and ERP (D) are not indicated.

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Radiation proctitis is a well-known complication of pelvic radiation therapy (e.g., for prostate cancer). It presents months to years after treatment with rectal bleeding, tenesmus, and mucosal ulceration on colonoscopy.

Toronto Notes 2023 – Gastroenterology, “Radiation-Induced GI Injury”:

“Radiation proctitis presents with rectal bleeding, tenesmus, urgency. Colonoscopy shows pale, friable mucosa, ulcerations, and telangiectasia.”

MCCQE1 Objectives (Gastroenterology > 47-2: GI Bleeding and Complications):

“Candidates must recognize radiation proctitis based on history of radiation and characteristic endoscopic findings.”

Ulcerative colitis (B) usually starts younger and is more diffuse. Diverticulosis (C) affects the left colon and causes painless bleeding. Recurrent prostate cancer (D) and rectal cancer (E) would show mass or infiltration.

This child likely has infectious mononucleosis caused by Epstein-Barr virus (EBV), characterized by fever, sore throat, cervical lymphadenopathy, fatigue, and splenomegaly. A palpable spleen is a hallmark of EBV in children.

Toronto Notes 2023 – Pediatrics, “Infectious Mononucleosis”:

“Key features include fever, pharyngitis, lymphadenopathy, and splenomegaly. Children may have milder symptoms but often exhibit palpable spleen.”

MCCQE1 Objectives (Pediatrics > 75-2: Infectious Disease):

“Candidates should recognize common viral syndromes such as EBV and identify complications including splenomegaly.”

Other options (renal mass, ascites, etc.) are inconsistent with this viral presentation.

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Comprehensive and Detailed Explanation:

This patient is pregnant and febrile with a new headache, photophobia, and clonus — all features concerning for preeclampsia with neurologic involvement. Clonus is a key finding suggestive of central nervous system irritability. Urine protein/creatinine ratio helps confirm the diagnosis of preeclampsia.

Toronto Notes 2023 – Obstetrics, Hypertensive Disorders in Pregnancy:

“Headache, clonus, and visual disturbances are concerning for severe preeclampsia. A urine protein/creatinine ratio or 24-hour urine collection confirms diagnosis.”

MCCQE1 Objectives – Obstetrics > Hypertension in Pregnancy:

“Candidates must recognize signs of preeclampsia and assess with appropriate biochemical testing.”

CT (A) or LP (B) are not indicated unless focal neurologic signs or seizures are present. Fetal imaging and amniocentesis (C, D) do not address maternal symptoms.

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This is a classic presentation of acute acetaminophen (paracetamol) overdose. The most serious consequence, especially with delayed treatment, is fulminant hepatic failure.

Toronto Notes 2023 – Toxicology, Acetaminophen Toxicity:

“Acetaminophen overdose is the most common cause of acute liver failure. Delayed presentation leads to jaundice, coagulopathy, encephalopathy, and possible death.”

MCCQE1 Objectives – Internal Medicine > Toxicology:

“Candidates must identify acetaminophen overdose by clinical history and recognize fulminant hepatic failure as a primary complication.”

Cerebral edema (C) may occur secondarily, but fulminant hepatic failure is the most direct and expected outcome. Renal failure (B), arrhythmias (E), and seizures (A) are not typical with acetaminophen.

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In pediatric trauma, inability to void with perineal bruising raises concern for urethral injury or urinary retention due to soft tissue swelling. The most immediate step is to attempt bladder catheterization. If unsuccessful, consult gynecology or urology urgently to avoid bladder overdistension.

Toronto Notes 2023 – Pediatrics, Genitourinary Trauma:

“In females, perineal trauma can lead to urinary retention due to labial hematomas or urethral injury. If catheterization is difficult, consult gynecology or urology for assistance.”

MCCQE1 Objectives – Pediatrics > Trauma and Emergency Care:

“Candidates must recognize when specialist consultation is required in pediatric genitourinary trauma, especially in cases of failed catheterization.”

Options B and D delay necessary care. Coagulation studies (C) may be considered if bleeding is unexplained. Abuse assessment (E) may be necessary later but does not address immediate retention.

In Canada and other high-resource settings where safe alternatives are readily available, women living with HIV are advised to exclusively formula-feed their infants to eliminate the risk of postnatal HIV transmission through breast milk. HIV can be transmitted during pregnancy, delivery, and breastfeeding. While effective maternal combination antiretroviral therapy and neonatal prophylaxis significantly reduce perinatal transmission risk, breastfeeding still carries a residual risk because HIV is present in breast milk. Boiling expressed breast milk is not recommended as a standard preventive strategy in high-resource settings. Avoiding kissing is unnecessary, as casual contact does not transmit HIV. Breastfeeding only during the colostrum period does not eliminate transmission risk. According to MCCQE objectives, physicians must provide evidence-based counseling regarding prevention of vertical transmission, including maternal antiretroviral therapy, appropriate mode of delivery when indicated, neonatal prophylaxis, and avoidance of breastfeeding when safe formula feeding is accessible. Clear counseling supports informed decision-making and optimal neonatal outcomes.

In an interdisciplinary hospital team, sharing relevant clinical information with other regulated health professionals involved in the patient’s care is generally appropriate under the “circle of care” principle. The physiotherapist’s concern about medication is clinically relevant because medications can affect mobility, cognition, balance, blood pressure, sedation, and rehabilitation safety—issues directly within the physiotherapist’s role. Requiring written consent (A) is unnecessarily restrictive in routine team-based care; implied consent is typically sufficient when information sharing is for the patient’s ongoing treatment and limited to what is necessary. Refusing to discuss because the physiotherapist does not prescribe (B) misunderstands collaborative care: team members must understand medication effects to plan safe therapy. Contacting the patient each time (C) is usually not required for routine care communication and may delay addressing a potential safety issue. Even if you are not the physician most responsible, you should respond within your knowledge, clarify uncertainties, and coordinate with the most responsible physician as needed, ensuring timely, patient-centered care.

This presentation is most consistent with acute bronchiolitis, which classically affects infants under 2 years (peak 2–6 months) and begins with upper respiratory symptoms (coryza, cough, low-grade fever) followed by increased work of breathing, tachypnea, and wheeze. The most common causative agent is respiratory syncytial virus (RSV), making it the best answer. Parainfluenza virus is more strongly associated with croup (barking cough, inspiratory stridor, hoarseness). Chlamydia trachomatis pneumonia typically occurs in young infants with a staccato cough, afebrile course, and may be associated with conjunctivitis rather than acute wheezing after coryza. Human metapneumovirus can cause bronchiolitis-like illness but is less common than RSV. Influenza A often produces higher fever and systemic symptoms and is not the leading cause of bronchiolitis in this age group. MCCQE objectives emphasize recognizing bronchiolitis clinically and identifying RSV as the predominant pathogen in infants with this classic progression of symptoms.

A febrile neonate (≤28 days old) requires a full sepsis evaluation (e.g., blood cultures, urine testing, lumbar puncture) because of the high risk of serious bacterial infection despite a well appearance. MCCQE objectives emphasize both appropriate medical management and effective communication with parents. When caregivers are distressed about painful procedures, the best approach is empathetic communication and reassurance that adequate analgesia and comfort measures (e.g., topical anesthetic, oral sucrose, swaddling) will be provided.

Threatening child protection involvement is inappropriate unless there is clear refusal of life-saving care after thorough discussion. Saying the infant “will not remember” dismisses parental concerns and undermines trust. Proceeding without addressing concerns violates principles of shared decision-making. Excluding parents from procedures may increase anxiety and is not routinely recommended.

The physician should acknowledge concerns, explain the rationale for testing (risk of occult sepsis), outline pain-control strategies, and invite questions. This maintains trust while ensuring timely, evidence-based care.

Comprehensive and Detailed Explanation:

This patient demonstrates excellent exercise tolerance (17 METs) and no ischemic changes or exertional symptoms, which makes cardiac ischemia unlikely. However, the hypertensive response to exercise (BP > 190 systolic) indicates masked or latent hypertension. This should be managed proactively, typically starting with a thiazide.

Toronto Notes 2023 – Cardiology:

“An exaggerated hypertensive response during exercise is predictive of future hypertension. Treatment with antihypertensive agents such as thiazides may be warranted.”

MCCQE1 Objectives (Internal Medicine > 31-1: Hypertension and Risk Management):

“Candidates must identify abnormal BP responses to exercise and initiate appropriate treatment.”

Reassurance alone (A) ignores the hypertensive response. Catheterization (C) and beta-blockers (D) are unnecessary without ischemia. Advising against exercise (B) is counterproductive in a young, otherwise healthy patient.

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