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

This patient exhibits classic symptoms of a major depressive episode (MDE): anhedonia, low mood, social withdrawal, feelings of worthlessness, hypersomnia, and loss of appetite. These symptoms are persistent and pervasive beyond what is typical in grief.

Toronto Notes 2023 – Psychiatry, “Depressive Disorders” Section:

“MDE is characterized by ≥5 symptoms present nearly every day for ≥2 weeks including low mood, anhedonia, sleep/appetite disturbances, low energy, feelings of worthlessness, and suicidal ideation. It must cause significant impairment in functioning.”

MCCQE1 Objectives (Psychiatry > 79-1: Mood Disorders):

“Candidates must distinguish between grief, adjustment disorders, and major depression in patients with chronic illness and initiate appropriate management.”

Normal grief (A) may involve sadness and crying but does not involve pervasive hopelessness or worthlessness. Side effects of chemotherapy (C) and hepatic encephalopathy (E) have other specific physical signs. Brain metastasis (D) would more likely present with focal neurologic symptoms or cognitive impairment.

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Comprehensive and Detailed Explanation:

Travel to rural Cambodia poses a high risk of malaria, which can be life-threatening in pregnancy. Antimalarial prophylaxis is strongly recommended for pregnant women traveling to endemic regions. Chloroquine or mefloquine (depending on resistance patterns) may be used in pregnancy under specialist guidance.

Toronto Notes 2023 – Infectious Disease / Travel Medicine:

“Malaria prophylaxis is indicated in pregnant women traveling to endemic regions. The risk of severe malaria and poor fetal outcomes is high.”

MCCQE1 Objectives (Public Health > 65-3: Travel Medicine and Pregnancy):

“Candidates must provide preventive care to pregnant travelers including vaccination and malaria prophylaxis.”

Tetanus boosters (D) are given every 10 years. Hep B Ig (B) is for acute post-exposure prophylaxis. Ciprofloxacin (C) is contraindicated in pregnancy.

According to Canadian guidelines, women aged 50 to 74 at average risk for breast cancer should undergo routine screening mammography every 2 to 3 years. A great-aunt with breast cancer does not raise this patient ' s risk to high. Mammography is appropriate as she is now due for the next screen.

Toronto Notes 2023 – Population Health, “Screening Guidelines” Section:

“Routine mammography is recommended every 2 years for average-risk women aged 50 to 74. Family history in second-degree or more distant relatives (e.g., great-aunt) does not qualify for high-risk screening or MRI.”

MCCQE1 Objectives (Population Health > 97-5: Screening and Prevention):

“Candidates should apply Canadian screening recommendations including mammography for average-risk women ≥50 years old.”

Self-breast exams (C) are not recommended for screening. PET scan (D) and MRI (E) are reserved for high-risk populations or diagnostic clarification.

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Her presentation at 6 weeks after a spouse’s death is most consistent with acute/normal grief : intense sadness, crying, social withdrawal, reduced appetite, and waves of distress triggered by reminders of the deceased. MCCQE objectives stress distinguishing grief from major depressive disorder by the fluctuating nature of symptoms , grief “pangs,” and the link to thoughts of the deceased. Although she expresses wishing to “join” her husband, this can occur in normal bereavement; the key clinical duty is to assess safety (suicidal intent, plan, means, past attempts, protective factors). In the absence of imminent risk or psychosis, inpatient/day-hospital admission is not the default. “Reassurance” alone is insufficient because she is significantly impaired and needs structured support. The best next step is referral for bereavement-focused support (often via social work), which can provide grief counseling, coping strategies, mobilization of supports, and monitoring, and can facilitate escalation if complicated grief or major depression emerges. Family systems therapy may help later, but immediate practical and grief-specific support plus safety assessment is the priority.

This child presents with “red flag” features for malignancy: a firm, fixed, nontender supraclavicular lymph node > 2 cm in size, with associated hepatosplenomegaly and night sweats. These features are most concerning for lymphoma.

Toronto Notes 2023 – Pediatrics, “Lymphadenopathy in Children”:

“Malignant lymphadenopathy tends to be firm, fixed, painless, and located in supraclavicular areas. Systemic signs (fever, weight loss, hepatosplenomegaly, night sweats) are concerning for lymphoma.”

MCCQE1 Objectives (Pediatrics > 78-3: Hematology/Oncology):

“Candidates should differentiate between benign and malignant lymphadenopathy and recognize features suggestive of lymphoma.”

Cat-scratch disease (B) is usually tender and associated with cat exposure. Kawasaki disease (C) presents with fever and mucocutaneous findings. Acute bacterial lymphadenitis (D) is painful, warm, and rapid in onset. Viral lymphadenopathy (E) is often bilateral, small, and tender.

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When a competent patient declines dialysis, the next step is to support shared decision-making and explore options that align with their lifestyle. Peritoneal dialysis may allow more flexibility and autonomy compared to hemodialysis, making it more acceptable to patients with demanding schedules.

Toronto Notes 2023 – Nephrology, Chronic Kidney Disease Section:

“Peritoneal dialysis offers the advantage of home-based treatment and flexible scheduling. Patient education and peer support can improve acceptance and adherence to dialysis initiation.”

MCCQE1 Objectives – Internal Medicine > Nephrology:

“The candidate should explore treatment alternatives collaboratively, emphasizing patient autonomy, while addressing misconceptions and lifestyle concerns related to dialysis.”

Simply warning the patient or withdrawing engagement (Options B and C) may undermine rapport. Access to medical records (D) is a right, but does not actively address treatment planning. Exploring new employment (E) is inappropriate at this stage.

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In a patient with a pelvic fracture and blood at the urethral meatus, urethral injury must be strongly suspected. Other signs may include perineal hematoma, high-riding prostate, or inability to void. The key principle is do not insert a Foley catheter until urethral integrity is confirmed, as blind catheterization may worsen a partial tear into a complete disruption. The appropriate next diagnostic step is retrograde urethrography (RUG), which evaluates the urethra for extravasation of contrast and identifies the site and extent of injury.

Voiding cystography evaluates bladder injury and is performed after urethral integrity is confirmed or via suprapubic access. Transrectal ultrasound and penile sonography are not appropriate in acute trauma assessment of suspected urethral disruption. Continuous bladder irrigation is contraindicated until urethral injury is excluded.

MCCQE objectives emphasize recognition of urethral injury in pelvic trauma and adherence to trauma principles: stabilize first, suspect urethral injury when blood is present at the meatus, and perform retrograde urethrography prior to catheterization.

Visible rectal bleeding, even in the absence of systemic symptoms, warrants diagnostic colonoscopy to rule out colorectal cancer, polyps, or IBD—especially in adults over 40. FIT is for asymptomatic screening only.

Toronto Notes 2023 – Gastroenterology, “Approach to Lower GI Bleeding”:

“In patients with overt rectal bleeding, colonoscopy is the investigation of choice regardless of age or FIT status.”

MCCQE1 Objectives (Internal Medicine > Gastroenterology > 47-1):

“Candidates must evaluate rectal bleeding with colonoscopy, even in the presence of minor findings on physical exam (e.g., skin tag).”

FIT (A) is not appropriate for symptomatic patients. CEA (D) is a tumor marker for surveillance, not diagnosis. CT colonography (C) is less sensitive for lesions than colonoscopy.

This patient is experiencing mild hypothermia (32–35°C), evidenced by shivering, ataxia, and tachycardia. First-line management includes passive external rewarming — removing wet clothing, providing warm blankets, and ensuring a warm environment (ambient temperature ~28°C).

Toronto Notes 2023 – Emergency Medicine, Environmental Injuries:

“Mild hypothermia (32–35°C): Treatment includes passive rewarming (warm blankets, warm environment). Avoid active rewarming methods to extremities due to risk of afterdrop.”

MCCQE1 Objectives – Internal Medicine > Environmental Exposure:

“Candidates must recognize appropriate levels of hypothermia and select evidence-based rewarming strategies based on severity.”

Options A, C, and D are used in moderate to severe hypothermia ( < 32°C or unconscious patients). Heating pads (B) may cause tissue damage, especially with frostbite.

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A tension pneumothorax occurs when air enters the pleural space and cannot escape, creating progressively rising intrathoracic pressure. MCCQE objectives emphasize rapid recognition of life-threatening causes of respiratory distress based on bedside findings. As pressure builds, the affected hemithorax compresses the lung and pushes the mediastinum to the opposite side, producing tracheal deviation away from the affected side —a classic, high-specificity sign of tension physiology (often accompanied by severe dyspnea, tachycardia, unilateral absent breath sounds, hyperresonance, distended neck veins, and hypotension from impaired venous return).

The other options do not specifically support tension pneumothorax: ecchymoses suggest trauma; bilateral wheezing suggests asthma or bronchiolitis; abdominal distension is nonspecific; inspiratory stridor indicates upper airway obstruction (e.g., croup, foreign body). Because tension pneumothorax is a clinical diagnosis, MCCQE priorities are immediate decompression (needle thoracostomy) followed by chest tube placement—without waiting for imaging if the child is unstable.

The first step in any MAID request is to explore the patient ' s motivations, psychosocial concerns, and mental health status. The request should be taken seriously and approached with compassion. Exploring the reasons is essential to determine eligibility and to distinguish suffering from other potentially treatable issues (e.g., depression, loss of hope).

Toronto Notes 2023 – ELOM, " Medical Assistance in Dying " :

“Upon receiving a request for MAID, the physician must first explore the patient’s motivations, ensure understanding of their condition, and assess for coercion, depression, or other treatable factors.”

MCCQE1 Objectives (ELOM > Ethical Dilemmas > End-of-Life Care):

“Candidates must demonstrate understanding of the ethical and legal framework surrounding MAID and respond appropriately to requests by exploring reasons and providing necessary support and referrals.”

MAID is available to mature minors in some jurisdictions but not uniformly. Assuming the patient is ineligible or redirecting to other treatments without discussion is inappropriate.

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Anaphylaxis requires immediate administration of epinephrine via the intramuscular (IM) route, typically in the lateral thigh. This route provides the fastest and most reliable absorption for emergency treatment.

Toronto Notes 2023 – Pediatrics, Anaphylaxis:

“Epinephrine 0.01 mg/kg IM is the first-line treatment for anaphylaxis. The intramuscular route provides the most rapid and safe absorption in emergencies.”

MCCQE1 Objectives – Pediatrics > Allergy and Immunology:

“Candidates must know the emergency management of anaphylaxis, including proper dosage and intramuscular administration of epinephrine.”

IV administration (A) is reserved for critical care settings. Subcutaneous (C) and intranasal/inhaled routes (D, E) are ineffective in anaphylaxis.

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This patient had a single spontaneous abortion and is planning another pregnancy. MCCQE objectives emphasize modifiable risk factor reduction and evidence-based preconception counseling. Smoking is a well-established risk factor for miscarriage, placental complications, fetal growth restriction, and preterm birth. Therefore, smoking cessation is the most effective intervention among the options listed to improve the likelihood of a healthy term pregnancy.

A 2-cm subserosal fibroid does not distort the uterine cavity and is unlikely to contribute to miscarriage; surgical removal is not indicated. There is no evidence that abstaining from intercourse in the first trimester prevents miscarriage. After a single early pregnancy loss, there is no need to delay conception for 6 months; couples may attempt pregnancy once emotionally and physically ready.

While folic acid supplementation is recommended preconceptionally, the standard dose for low-risk women is 0.4–1 mg daily, not 5 mg (which is reserved for high-risk patients). Thus, smoking cessation is the most important advice.

Mumps is a contagious viral illness spread by respiratory droplets, with transmission occurring from shortly before symptom onset through the early symptomatic period. MCCQE objectives in outbreak management emphasize using effective, feasible source control measures that reduce onward transmission. The most effective intervention listed is exclusion (isolation) of symptomatic clinical cases from school and workplace during the infectious period, because symptomatic individuals are the main identifiable sources of spread and removal from congregate settings directly reduces contact rates and secondary cases.

Antivirals are not standard, effective therapy for mumps and do not control outbreaks. Excluding asymptomatic contacts before symptoms develop is generally less effective and often impractical, because many contacts will never become ill and transmission may already occur before recognition; blanket exclusion can also cause major disruption with limited incremental benefit. Closing an entire post-secondary institution is a high-impact measure with uncertain added benefit compared with targeted case exclusion and is typically reserved for extreme circumstances. Immunoglobulin is not an effective post-exposure prophylaxis for mumps. Therefore, isolating/excluding clinical cases is the best and most effective intervention among the options.

In Canada and in most jurisdictions internationally, physicians have a professional and in some cases legal obligation to provide emergency assistance. Documentation should be done in your own records afterward. Aviation laws and Good Samaritan protections offer liability coverage for health professionals acting in good faith.

Toronto Notes 2023 – ELOM, “Physician Obligations and Medical-Legal Responsibility”:

“Physicians should respond to in-flight or public emergencies when capable. Documentation should be completed after the event, and liability is protected under Good Samaritan laws.”

MCCQE1 Objectives (ELOM > Professionalism > 90-1):

“Candidates must demonstrate appropriate professional behavior, including willingness to assist in emergencies and understanding of legal protections.”

Avoiding assistance (A), or placing conditional barriers (D), is unethical and inappropriate.

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Delirium is the most likely diagnosis because the change is acute (3 days) with fluctuating level of activity (quiet at times, agitated at others) and prominent inattention (does not finish answers, “drifts off” during conversation). MCCQE objectives emphasize distinguishing delirium from dementia: dementia is typically chronic and progressive , whereas delirium is a sudden, reversible syndrome characterized by disturbed attention and awareness, often with altered sleep–wake cycle, perceptual disturbances, and psychomotor changes (hyperactive, hypoactive, or mixed). This patient’s new aggression, confusion, and variable behavior strongly suggest delirium superimposed on existing vascular dementia—a common and high-risk scenario in LTC residents. Major depressive disorder can cause apathy and reduced concentration but does not typically cause a fluctuating course with acute confusion. Lewy body dementia is associated with chronic cognitive fluctuations and visual hallucinations/parkinsonism, not a sudden 3-day deterioration. Late-onset delusional disorder would feature fixed delusions with otherwise clearer consciousness. The next clinical priority is to search for and treat underlying causes (infection, medications, metabolic disturbance, pain, dehydration) while ensuring safety and supportive care.

When an error in the system is identified (e.g., test result not properly followed up), the most responsible approach is to analyze and improve internal clinic processes. Patient safety depends on reliable result tracking systems.

Toronto Notes 2023 – ELOM, “Medical Errors and Quality Improvement” Section:

“When an error or near miss is identified, root cause analysis and system-level interventions are required to prevent recurrence. Blaming the patient or others without review of internal processes is inappropriate.”

MCCQE1 Objectives (ELOM > 99-1: Medical Error and Disclosure):

“Candidates must recognize the importance of continuous quality improvement in health care. System-level changes should be implemented when safety lapses occur.”

Option A shifts responsibility improperly onto the patient. Option C deflects blame without assessing one’s own clinic. Option D minimizes the error and does not lead to improvement.

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At the end of life, decreasing consciousness and unresponsiveness are common and expected physiologic changes. MCCQE ELOM objectives emphasize prioritizing patient comfort, respecting goals of care, and communicating clearly with families about prognosis and the dying process. The best next step is to explain that her reduced level of consciousness is most consistent with imminent dying and that she is unlikely to have the decision-making capacity required to execute legal documents (capacity requires understanding and appreciation of the decision and its consequences).

Withholding morphine to attempt to increase alertness risks causing pain and dyspnea, violating the duty to relieve suffering. Administering naloxone is inappropriate because it may precipitate acute pain and distress and is not indicated when opioids are being used appropriately for symptom control. A legal opinion or ethics consult may be considered later if conflict persists, but the immediate priority is compassionate communication, clarifying that “waking her to sign” is unlikely feasible or ethically justified, and supporting the son through anticipatory grief while continuing comfort-focused care.

In a euthyroid patient with an asymptomatic goiter or thyroid enlargement, the next step is a thyroid ultrasound to evaluate nodule size, composition, and features suggestive of malignancy.

Toronto Notes 2023 – Endocrinology, Thyroid Nodules and Goiter:

“TSH should be obtained first. If normal and there is a palpable mass or enlargement, ultrasound is indicated to evaluate for nodules and guide further testing (e.g., FNA).”

MCCQE1 Objectives – Internal Medicine > Endocrinology:

“Candidates must use thyroid ultrasound as the initial imaging study in the evaluation of thyroid enlargement or palpable nodules.”

T3/T4 (A) are not needed with normal TSH. FNA (D) is done if nodules are identified. CT (C) is used for retrosternal goiters or compressive symptoms. Calcium (E) is irrelevant here.

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