MCCQE Medical Council of Canada MCCQE Part 1 Exam Free Practice Exam Questions (2025 Updated)

Postoperative fever on day 1–2 is commonly caused by atelectasis, particularly in patients who are immobile. It is considered a self-limited cause of early fever after surgery and often resolves with mobilization and pulmonary exercises.

Toronto Notes 2023 – Surgery, Postoperative Complications:

“The ‘5 W’s’ of postoperative fever: Wind (atelectasis), Water (UTI), Wound (infection), Walking (DVT), and Wonder drugs. Atelectasis typically occurs in the first 48 hours and is due to hypoventilation or pain-limited breathing.”

MCCQE1 Objectives – Surgery > Postoperative Management:

“Candidates must recognize timing-specific causes of postoperative fever. Atelectasis is the most likely cause within the first 48 hours.”

PE (B) can cause fever but is less likely without respiratory compromise. Wound infection (C) and bowel trauma (D) typically present later or with more specific symptoms. Septic pelvic thrombophlebitis (A) usually presents later and with more systemic signs.

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Comprehensive and Detailed Explanation:

The patient presents with classic symptoms of schizophrenia: delusions, hallucinations, social withdrawal, and disorganized appearance. The first-line treatment is antipsychotic medication—risperidone is a well-tolerated option among second-generation antipsychotics.

Toronto Notes 2023 – Psychiatry, “Schizophrenia”:

“Schizophrenia is treated with second-generation antipsychotics such as risperidone. These reduce positive symptoms like delusions and hallucinations.”

MCCQE1 Objectives (Psychiatry > 71-3: Psychotic Disorders):

“Candidates must recognize and manage schizophrenia with antipsychotics and distinguish from other mood or personality disorders.”

CBT (E) is supportive but not first-line. ECT (A) is used for severe depression or catatonia. Valproic acid (C) and carbamazepine (D) are mood stabilizers, not first-line for schizophrenia.

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Comprehensive and Detailed Explanation:

This patient has end-stage heart failure with frequent hospitalizations, progressive symptoms, and functional decline. The most appropriate next step is to initiate a goals-of-care conversation, including acknowledgment of the prognosis.

Toronto Notes 2023 – Cardiology / Palliative Care:

“In advanced heart failure with recurrent admissions and functional decline, a goals-of-care discussion should be initiated to align treatment with patient values.”

MCCQE1 Objectives (Cardiology > 34-4 / ELOM > 90-2):

“Candidates must recognize end-stage illness and provide appropriate communication and palliative care planning.”

Deactivating the defibrillator (B) may be appropriate later but should follow a goals-of-care conversation. Reassuring (C) ignores the true clinical trajectory.

A tender, mobile lymph node following a recent localized infection (e.g., dental infection) is most likely reactive. In a young, otherwise well patient with no systemic symptoms or concerning features, observation is appropriate.

Toronto Notes 2023 – Internal Medicine, Lymphadenopathy:

“In patients with localized lymphadenopathy and a recent infection, observation for 4–8 weeks is often appropriate before further investigation.”

MCCQE1 Objectives – Internal Medicine > Hematology:

“Candidates should recognize benign features of lymphadenopathy (tender, mobile, <2 cm, localized) and manage conservatively unless red flags are present.”

Biopsy (B) and imaging (C, E) are premature. Bone marrow biopsy (D) is not relevant.

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This ABG reveals primary respiratory acidosis (↓pH, ↑PaCO₂, normal HCO₃), likely from hypoventilation due to postoperative pain, sedation, or narcotics. PaO₂ is also low, suggesting inadequate oxygenation.

Toronto Notes 2023 – Respiratory, “Postoperative Respiratory Complications”:

“Postoperative respiratory acidosis results from hypoventilation, often due to pain, sedatives, or poor respiratory effort. Assess airway, breathing, and support oxygenation.”

MCCQE1 Objectives (Internal Medicine > 44-3: Acid-Base Disturbances):

“Candidates must recognize respiratory acidosis on ABG and relate findings to common postoperative complications.”

Metabolic acidosis (C) would show ↓HCO₃. Compensated alkalosis (D) would show opposite ABG changes. Hypermetabolic states increase respiratory drive, not decrease it.

In a patient with known diverticular bleeding and no red flags (e.g., weight loss, anemia, family history), repeating colonoscopy is not required. Diverticular bleeding is typically self-limited. Colonoscopy within the past few years with clear findings suffices.

Toronto Notes 2023 – Gastroenterology, Lower GI Bleed:

“Patients with known diverticulosis and self-limited bleeding who have had prior complete colonoscopy do not require repeat endoscopy unless symptoms recur or persist.”

MCCQE1 Objectives – Internal Medicine > Gastroenterology:

“Candidates must recognize when no further invasive investigation is necessary in elderly patients with known benign findings and resolved symptoms.”

Option E is considerate but not clinically necessary for independent patients. Options A, B, and D are not indicated in resolved, low-risk cases.

This patient has secondary amenorrhea, infertility, and a history of multiple uterine curettages, which strongly points toward Asherman syndrome (intrauterine adhesions or synechiae). The hysterosalpingogram shows an obliterated uterine cavity and no tubal dye spill—classic for intrauterine synechiae. Her midluteal progesterone level is normal, indicating ovulation.

Toronto Notes 2023 – Gynecology, “Infertility” section:

“Asherman syndrome results from intrauterine adhesions due to curettage, leading to amenorrhea and infertility. HSG shows an obliterated or irregular uterine cavity.”

MCCQE1 Objectives (Gynecology > 82-1: Infertility):

“Candidates should evaluate secondary amenorrhea and interpret imaging such as hysterosalpingogram in the diagnosis of intrauterine abnormalities.”

Other options are ruled out by the presence of normal ovulation (rules out hypothalamic and PCOS) and by imaging (not suggestive of fibroids or perimenopause).

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In situations involving potential oversight, the appropriate next step is to contact the other physician directly. This supports collegial communication, continuity of care, and provides an opportunity to clarify the clinical situation. It avoids premature judgment while allowing the primary provider to respond and address concerns.

Toronto Notes 2023 – ELOM, “Professionalism and Interprofessional Communication”:

“When concerns arise about another provider’s care, direct communication is preferred before considering formal reporting. This maintains collaboration and fairness.”

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

“Candidates must demonstrate collegiality and appropriate methods for addressing concerns regarding another physician’s care.”

Empathizing (D) and validating blame is unprofessional. Reporting (B) is premature. Offering another provider (C) could undermine continuity. (E) is incorrect since the glucose should have been checked based on the presenting symptoms.

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A mood journal is a structured tool that allows the patient to record mood fluctuations, triggers, and timing. It is particularly helpful in identifying mood disorders such as premenstrual dysphoric disorder, bipolar disorder, or cyclothymia.

Toronto Notes 2023 – Psychiatry, Mood Disorders:

“Mood diaries are useful in identifying temporal patterns, such as menstrual cycle–linked mood changes, and in distinguishing between affective disorders.”

MCCQE1 Objectives – Psychiatry > Diagnostic Evaluation:

“Candidates should use clinical tools such as symptom diaries to assist in establishing the pattern and nature of psychiatric symptoms.”

Personality testing (A) is not first-line. Urine drug screen (B) is only indicated with suspicion of substance use. Lorazepam (D) treats symptoms, not diagnosis. Interviewing the boyfriend (E) may help, but only as a supplement to direct observation and self-report.

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Orchiopexy is the treatment of choice for cryptorchidism and should be performed between 6–18 months of age. Early surgery improves fertility outcomes and reduces malignancy risk.

Toronto Notes 2023 – Pediatrics, Urology:

“Undescended testes should be referred for orchiopexy ideally before 18 months of age. Observation beyond 6 months is not recommended.”

MCCQE1 Objectives – Pediatrics > Genitourinary Disorders:

“Candidates must recognize and refer for cryptorchidism early to optimize testicular function and reduce cancer risk.”

Hormonal therapies (C, D) are not recommended due to limited efficacy. Observation (A) is too late beyond

This patient presents with fever, confusion, anemia with schistocytes, thrombocytopenia, and renal impairment — fulfilling the classic pentad of thrombotic thrombocytopenic purpura (TTP). TTP is a hematologic emergency requiring plasma exchange.

Toronto Notes 2023 – Hematology, “Microangiopathic Hemolytic Anemia” Section:

“TTP is a medical emergency. Features include MAHA, thrombocytopenia, renal failure, neurologic symptoms, and fever. Schistocytes on blood film are diagnostic.”

MCCQE1 Objectives (Internal Medicine > 76-7: Hematologic Disorders):

“Candidates must urgently recognize TTP and initiate emergent plasma exchange therapy.”

AML (B) does not present with schistocytes. HIV (C) can cause thrombocytopenia but not MAHA. ITP (D) causes isolated thrombocytopenia without anemia or schistocytes.

This infant likely has infantile colic, defined by the “rule of 3s”: crying >3 hours per day, >3 days per week, for >3 weeks, usually starting in the first few months of life. It is benign and self-limited, typically resolving by 3–4 months of age.

Toronto Notes 2023 – Pediatrics, “Common Concerns in Infancy”:

“Colic is self-limited. No routine testing is required in healthy, thriving infants. Reassurance and support for parents are key.”

MCCQE1 Objectives (Pediatrics > 78-1: Behavioral Pediatrics):

“Candidates must recognize normal variations such as colic and avoid unnecessary interventions. Counseling and reassurance are essential.”

Sedatives (D) are contraindicated. Investigations (C) are unnecessary without red flags. Resolution (B) usually occurs by 3–4 months, not as late as 12 months.

In discussions about end-of-life care, it is critical to shift the focus from the substitute decision-maker’s own feelings to what the patient would have wanted. This approach promotes ethically sound and patient-centered decisions. It is respectful, supportive, and maintains trust.

Toronto Notes 2023 – ELOM, “Advance Care Planning and End-of-Life Decisions”:

“When a patient cannot express wishes, decisions must be based on known prior wishes or substituted judgment—what the patient would have wanted.”

MCCQE1 Objectives (ELOM > 90-2: Capacity, Consent, and End-of-Life Care):

“Candidates must guide surrogate decision-makers toward reflecting on the patient’s values and previously expressed wishes.”

Options A and B are inappropriate—waiting without engagement or unilateral withdrawal is unethical. C does not address the wife’s emotional or ethical concerns. E is premature unless the wife is clearly unable or unfit to act as decision-maker.

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This presentation suggests hereditary hemochromatosis. Common features include hyperpigmentation ("bronze diabetes"), hepatomegaly, diabetes, fatigue, and elevated liver enzymes. Serum ferritin is a screening test for iron overload, and elevated levels support the diagnosis.

Toronto Notes 2023 – Endocrinology / Gastroenterology:

“Hemochromatosis presents with skin hyperpigmentation, hepatomegaly, diabetes, fatigue. Diagnosis begins with serum ferritin and transferrin saturation.”

MCCQE1 Objectives (Internal Medicine > Metabolic and Endocrine > 37-1):

“Candidates must investigate iron overload syndromes using ferritin and transferrin saturation.”

Cortisol (B) is for adrenal insufficiency. A1AT (C) is a liver disease cause but not typical here. Amylase (E) is for pancreatitis. A1c (A) would confirm diabetes but not the underlying cause.

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The presentation is consistent with cervical spondylosis — a degenerative condition. In the absence of neurologic findings, further imaging beyond plain radiography is not warranted. Management includes conservative measures such as physiotherapy and analgesia.

Toronto Notes 2023 – Rheumatology, Cervical Spondylosis:

“Patients with typical cervical spondylosis and no red flags (e.g., neurologic deficits) do not require MRI. Treatment is conservative. Radiographs showing disc space narrowing and osteophytes confirm diagnosis.”

MCCQE1 Objectives – Internal Medicine > Musculoskeletal Disorders:

“Candidates must recognize typical degenerative spine disorders and avoid unnecessary investigations when clinical findings are straightforward.”

MRI (B) is useful if myelopathy or radiculopathy is suspected. CT (A), EMG (C), and LP (D) are not indicated here.

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The symptoms described — haloes at night, monocular diplopia, and improved near vision (second sight) — are classic signs of nuclear sclerosis-type cataracts. On exam, the most consistent finding would be an altered red reflex due to lens opacification.

Toronto Notes 2023 – Ophthalmology, Cataracts:

“Cataracts can cause glare, monocular diplopia, and improved near vision. A diminished or irregular red reflex is commonly seen on direct ophthalmoscopy.”

MCCQE1 Objectives – Internal Medicine > Ophthalmologic Disorders:

“The candidate must recognize symptoms and physical findings of cataracts, including changes in red reflex and visual acuity.”

Options A and B are associated with lipid deposition and Wilson’s disease, respectively. Retinal exudates (D) suggest diabetic or hypertensive retinopathy. Increased intraocular pressure (E) suggests glaucoma but is not supported by this clinical picture.

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Comprehensive and Detailed Explanation:

Ginger is a first-line, evidence-based non-pharmacologic treatment for nausea and vomiting in pregnancy. It's well tolerated and effective. Addressing nausea will help her resume vitamin use and reduce distress.

Toronto Notes 2023 – Obstetrics, “Nausea and Vomiting in Pregnancy”:

“Ginger 250 mg four times daily is safe and effective for mild to moderate nausea.”

MCCQE1 Objectives (Obstetrics > 80-1: Early Pregnancy Management):

“Candidates must treat nausea and vomiting in pregnancy using safe and effective options.”

Folic acid alone (A) is less effective than a full prenatal vitamin. B may help, but nausea should be addressed first. C lacks empathy for her symptoms. D (cannabinoids) is not recommended in pregnancy.

Respecting patient autonomy requires understanding their perspective before offering persuasion or incentives. The best next step is to explore the reason for non-compliance. This builds rapport and informs a shared decision-making process.

Toronto Notes 2023 – ELOM, Patient-Centered Communication:

“When a patient refuses recommended treatment, explore the reason behind the refusal before proceeding. Shared decision-making is crucial.”

MCCQE1 Objectives – ELOM > Communication and Consent:

“Candidates must demonstrate an ability to explore reasons for treatment refusal before counseling or modifying management.”

Options B and C may follow later. Options D and E can undermine appropriate pharmacologic care or violate ethics if not consented.

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