Free MCCQE1 Practice Test: 20 Questions With Answers

How should you take this MCCQE practice test?

The MCCQE (formerly MCCQE Part I) has 230 multiple-choice questions in two sections of 115, with up to two hours and forty minutes for each section. MCC’s exam-day guidance is to allow 1 minute and 23 seconds per question on average.

At that pace, 20 questions take just under 28 minutes. Set a 28-minute timer, answer every question before you check any answers, then mark yourself. In the real exam, unanswered questions are marked incorrect, so practise answering all of them.

The questions come from the TopQbank MCCQE question bank, reviewed by licensed doctors. They cover medicine, surgery, paediatrics, obstetrics and gynaecology, psychiatry, emergency medicine, population health, epidemiology, and geriatrics and palliative care. They are not real MCCQE questions, and they are different from the four in our MCCQE Part 1 sample questions guide.

Question 1 · Medicine

An 82-year-old woman living in a long-term care home has a urine culture obtained during routine assessment before facility transfer. The culture grows a single gram-negative organism, and urinalysis shows pyuria. She has no dysuria, urgency, suprapubic pain, flank pain, fever or hemodynamic instability. Her cognition, appetite and mobility are at baseline, and she has no planned urologic procedure. She is not pregnant and has not recently undergone urinary tract instrumentation. What is the most appropriate next step?

A) Do not prescribe antibiotics and do not obtain surveillance cultures

B) Prescribe oral nitrofurantoin because pyuria indicates lower urinary infection

C) Prescribe oral trimethoprim-sulfamethoxazole based on culture susceptibility

D) Repeat the urine culture and treat if the same organism is isolated

E) Give one dose of intravenous ceftriaxone before transfer

Correct answer: A) Do not prescribe antibiotics and do not obtain surveillance cultures. This is asymptomatic bacteriuria, which should not be treated in a nonpregnant long-term care resident without an upcoming invasive urologic procedure. Pyuria does not distinguish asymptomatic bacteriuria from symptomatic infection.

Question 2 · Medicine

A 52-year-old transport truck driver has hypertension despite maximally tolerated therapy with four agents, including a diuretic. His spouse reports loud snoring, witnessed pauses in breathing and gasping during sleep. He has morning headaches, a body mass index of 36 kg/m² and an increased neck circumference. He has twice nearly fallen asleep while driving, and his Epworth Sleepiness Scale score is markedly elevated. Medication adherence and blood pressure measurement technique have been verified, and primary aldosteronism has been excluded. Which intervention is most appropriate to evaluate this potential secondary cause of hypertension?

A) Overnight pulse oximetry as the definitive diagnostic test

B) Computed tomography of the upper airway

C) Daytime arterial blood gas analysis

D) Repeat ambulatory blood pressure monitoring during a work shift

E) Formal sleep assessment with diagnostic sleep testing

Correct answer: E) Formal sleep assessment with diagnostic sleep testing. Resistant hypertension, obesity, loud snoring, witnessed apneas and severe daytime sleepiness create a high probability of obstructive sleep apnea. Diagnostic sleep testing is required to characterize respiratory events and guide treatment; his safety-sensitive occupation also makes prompt assessment essential.

Question 3 · Medicine

A 62-year-old man with a 40-pack-year smoking history reports three episodes of coughing up small amounts of bright-red blood over one week. He is hemodynamically stable, has normal oxygen saturation and has no ongoing bleeding in the emergency department. Examination of the nose and oropharynx identifies no source, and he denies hematemesis. Chest radiography is normal, but he has had unintentional weight loss and a persistent cough for two months. He is not anticoagulated and has no findings suggesting active pulmonary infection. What is the most appropriate next investigation?

A) Repeat chest radiography in six weeks

B) Flexible bronchoscopy as the initial investigation

C) Ventilation-perfusion lung scanning

D) Sputum cytology on three consecutive mornings

E) Contrast-enhanced computed tomography of the chest

Correct answer: E) Contrast-enhanced computed tomography of the chest. A normal chest radiograph does not exclude malignancy in an older smoker with recurrent hemoptysis, weight loss and persistent cough. Contrast-enhanced CT is the preferred next test to identify a parenchymal, airway or vascular lesion and guide subsequent bronchoscopy.

Question 4 · Medicine

A 51-year-old man has biochemically confirmed pheochromocytoma and CT demonstrates a localized 4-cm adrenal mass. Elective adrenalectomy is planned. Blood pressure remains intermittently elevated and he has frequent palpitations. The surgical team discusses preoperative pharmacologic preparation. Which one of the following is the most appropriate strategy before surgery?

A) Establish adequate alpha-adrenergic blockade before adding a beta-blocker if persistent tachycardia requires it

B) Use a thiazide diuretic as the sole preparation

C) Proceed directly to surgery without blood-pressure preparation

D) Begin high-dose levothyroxine

E) Start propranolol alone before alpha blockade

Correct answer: A) Establish adequate alpha-adrenergic blockade before adding a beta-blocker if persistent tachycardia requires it. Preoperative alpha blockade reduces the risk of severe catecholamine-mediated hypertension during surgery. If beta blockade is required for tachycardia, it should be introduced only after adequate alpha blockade because unopposed alpha stimulation can precipitate a hypertensive crisis.

Question 5 · Medicine

A 39-year-old woman with hypertension reports progressive weight gain, easy bruising, proximal muscle weakness, and irregular menses. Examination shows facial rounding, wide violaceous abdominal striae, and blood pressure of 166/100 mm Hg. Which one of the following is the most appropriate initial test for the suspected secondary cause of hypertension?

A) Overnight dexamethasone suppression testing

B) Plasma renin activity alone

C) Exercise stress testing

D) Serum calcitonin

E) Urine culture

Correct answer: A) Overnight dexamethasone suppression testing. The clinical findings suggest Cushing syndrome. Initial screening can be performed with an accepted test such as an overnight dexamethasone suppression test, late-night salivary cortisol, or 24-hour urinary free cortisol.

Question 6 · Surgery

A 22-year-old soccer player plants his right foot and pivots suddenly. He hears a pop, develops immediate swelling, and cannot continue playing. Examination 2 hours later shows a large effusion and increased anterior translation of the tibia with a soft endpoint when the knee is flexed about 20–30 degrees. Plain radiographs show no fracture. He wants to return to competitive pivoting sports. Which examination maneuver is most sensitive for the suspected ligament injury?

A) Lachman test

B) Posterior drawer test

C) Patellar apprehension test

D) McMurray test

E) Varus stress test

Correct answer: A) Lachman test. The mechanism, rapid hemarthrosis, and anterior instability suggest ACL rupture. The Lachman test is generally the most sensitive physical examination maneuver for ACL injury. MRI can confirm associated internal derangement when clinically indicated.

Question 7 · Surgery

A 30-year-old man is brought after a diving accident. He has neck pain, weakness in all four limbs, and reduced sensation below the shoulders. He is hypotensive but warm with relative bradycardia. Cervical spinal cord injury is suspected. Which immediate management principle is most important?

A) Encourage early walking

B) Maintain spinal immobilization and support airway, breathing, and perfusion

C) Perform lumbar puncture

D) Start anticoagulation before imaging

E) Remove cervical immobilization to improve comfort

Correct answer: B) Maintain spinal immobilization and support airway, breathing, and perfusion. Acute cervical cord injury management begins with spinal motion restriction and ABC stabilization. Hypotension should be treated promptly to preserve spinal cord perfusion.

Question 8 · Paediatrics

An 18-month-old child has a generalized tonic-clonic seizure during a febrile viral illness. The seizure lasts 4 minutes and stops spontaneously before arrival. There has been no previous seizure, and no further event occurs over the next 24 hours. The child returns rapidly to baseline and has normal development and neurologic examination. Immunizations are current, and there are no meningeal signs. Which prognostic statement is most appropriate?

A) Long-term antiseizure therapy is indicated because recurrence is almost certain

B) The event substantially increases the likelihood of intellectual disability

C) A structural brain lesion is likely despite the normal neurologic examination

D) The risk of epilepsy is equivalent to that after an unprovoked afebrile seizure

E) Another febrile seizure may occur, but long-term neurologic prognosis is generally favourable

Correct answer: E) Another febrile seizure may occur, but long-term neurologic prognosis is generally favourable. This was a simple febrile seizure: generalized, brief, occurring once within 24 hours, with rapid recovery and no neurologic abnormality. Recurrence is possible, but simple febrile seizures do not usually impair cognition and only modestly alter future epilepsy risk.

Question 9 · Paediatrics

A 7-month-old boy born at term has a right testis that has never been palpable in the scrotum; the left testis is normal. The right testis is palpable in the inguinal canal but cannot be maintained in the scrotum after gentle manipulation, and there is no associated hernia. The family was initially told to wait because spontaneous descent can occur during early infancy, but there has been no change. The clinician is deciding whether hormonal therapy, imaging or surgical referral is now most appropriate. Which next step is most appropriate?

A) Continue observation until puberty because most palpable undescended testes descend after the first year

B) Order ultrasound to locate the testis precisely before any referral because imaging is required for all cryptorchidism

C) Begin hCG therapy because hormonal treatment has better fertility outcomes than early orchiopexy

D) Refer for orchiopexy within the recommended early-childhood window because spontaneous descent after about 6 months is unlikely

E) Perform orchiectomy now because an inguinal testis present at 7 months has an unacceptable malignancy risk

Correct answer: D) Refer for orchiopexy within the recommended early-childhood window because spontaneous descent after about 6 months is unlikely. Spontaneous descent after about 6 months is unlikely. Persistent cryptorchidism warrants timely surgical referral for orchiopexy, generally during infancy/early childhood; routine ultrasound is not needed for a clinically palpable undescended testis.

Question 10 · Obstetrics and gynaecology

A 22-year-old varsity distance runner has had no menstrual periods for 7 months. Her cycles were previously regular, but she recently increased her training and adopted a restrictive diet. She has lost 8 kg, and her body mass index is now below the healthy range. Pregnancy has been excluded, and thyroid and prolactin testing are normal. Estradiol is low with low-normal gonadotropin concentrations; she has no hirsutism or galactorrhea. What is the most likely diagnosis?

A) Primary ovarian insufficiency

B) Polycystic ovary syndrome

C) Nonclassic congenital adrenal hyperplasia

D) Functional hypothalamic amenorrhea

E) Asherman syndrome

Correct answer: D) Functional hypothalamic amenorrhea. Weight loss, low energy availability and intense exercise suppress pulsatile gonadotropin-releasing hormone secretion, producing low estradiol with inappropriately low or normal gonadotropins.

Question 11 · Obstetrics and gynaecology

A 25-year-old primigravida at 11 weeks' gestation presents after 3 weeks of persistent vomiting and minimal oral intake. She has lost 7% of her prepregnancy weight and is orthostatic with dry mucous membranes. She has no abdominal tenderness, fever, diarrhea, goitre or focal neurologic deficit. Intravenous rehydration is started, and the team is considering dextrose-containing fluid because of prolonged starvation. She has not taken prenatal vitamins or other vitamin supplements during this illness. Which medication should be administered before dextrose?

A) Pyridoxine

B) Ondansetron

C) Thiamine

D) Metoclopramide

E) Dimenhydrinate

Correct answer: C) Thiamine. Prolonged vomiting and starvation deplete thiamine stores; giving dextrose first can precipitate or worsen Wernicke encephalopathy. Thiamine should precede dextrose-containing therapy.

Question 12 · Psychiatry

A 45-year-old accountant is referred by his spouse because he is rigid, perfectionistic, preoccupied with rules and schedules, reluctant to delegate, and so focused on details that he frequently misses deadlines. He views his standards as appropriate and does not experience intrusive unwanted thoughts or perform rituals to neutralize anxiety. His pattern has been stable since early adulthood and affects both work and relationships. Which diagnosis is most likely?

A) Autism spectrum disorder

B) Obsessive-compulsive personality disorder

C) Obsessive-compulsive disorder

D) Narcissistic personality disorder

E) Generalized anxiety disorder

Correct answer: B) Obsessive-compulsive personality disorder. OCPD is an ego-syntonic pattern of perfectionism, control, rigidity, and preoccupation with order. Unlike OCD, it does not require intrusive obsessions or compulsions performed to relieve anxiety.

Question 13 · Psychiatry

A 45-year-old man develops tearfulness, insomnia, reduced concentration, and anxiety after unexpectedly losing his job 6 weeks ago. He remains able to care for himself and has begun searching for work, but his distress is disproportionate and is affecting his marriage. He does not meet full criteria for major depressive disorder or generalized anxiety disorder. There is no suicidal intent, psychosis, mania, or substance-related explanation. Which diagnosis is most likely?

A) Post-traumatic stress disorder

B) Major depressive disorder

C) Adjustment disorder

D) Persistent depressive disorder

E) Bipolar II disorder

Correct answer: C) Adjustment disorder. Adjustment disorder consists of clinically significant emotional or behavioural symptoms arising in response to an identifiable stressor when criteria for another psychiatric disorder are not met.

Question 14 · Emergency medicine

A 76-year-old man with atrial fibrillation develops abrupt severe diffuse abdominal pain. The abdomen is initially soft with only mild tenderness despite his marked distress. Lactate is 4.8 mmol/L and metabolic acidosis is present. He is not taking anticoagulation and CT angiography is rapidly available. There is no free intraperitoneal air or obvious mechanical obstruction. Which diagnostic test should be obtained urgently?

A) Upper GI endoscopy

B) Routine abdominal ultrasound

C) CT angiography of the mesenteric vessels

D) Plain abdominal radiograph only

E) Elective colonoscopy

Correct answer: C) CT angiography of the mesenteric vessels. Acute mesenteric ischemia classically causes severe pain out of proportion to examination. CT angiography is the preferred rapid diagnostic test in most stable enough patients.

Question 15 · Emergency medicine

A 65-year-old man with diabetes is treated with IV dextrose for severe hypoglycemia. He awakens promptly, but review of medications shows glyburide use and chronic kidney disease. His glucose falls again 45 minutes later despite eating a meal. There is no evidence of insulin overdose or sepsis. The team is concerned about recurrent sulfonylurea-induced hypoglycemia. Which medication can reduce recurrent insulin release in this setting?

A) Naloxone

B) Octreotide

C) Insulin infusion

D) Metoclopramide

E) Glucagon infusion as the preferred definitive antidote

Correct answer: B) Octreotide. Octreotide suppresses pancreatic insulin secretion and is useful for recurrent sulfonylurea-associated hypoglycemia, typically alongside dextrose and monitoring.

Question 16 · Population health

A 3-year-old child lives in a house built before 1960 that is undergoing renovation. His parent reports frequent hand-to-mouth behaviour and ingestion of paint chips. He has mild irritability but no encephalopathy, seizures, or abdominal emergency. A sibling previously had evidence of lead exposure while living in the same home. The physical examination is otherwise unremarkable. What is the most appropriate initial investigation?

A) Abdominal radiography as the sole screening test

B) Urinary lead concentration

C) Hair mineral analysis

D) Zinc protoporphyrin concentration alone

E) Venous blood lead level

Correct answer: E) Venous blood lead level. His age, pica, renovation of older housing, and affected sibling create a strong indication for definitive blood lead testing alongside environmental source control.

Question 17 · Population health

A 68-year-old man attends a periodic health examination and has never been screened for abdominal aortic aneurysm. He stopped smoking 25 years ago after accumulating a 10-pack-year history. He has no abdominal symptoms, known aneurysm, or family history of aneurysm. Which screening strategy is most consistent with Canadian preventive guidance?

A) Offer one-time abdominal ultrasonography

B) Perform annual abdominal ultrasonography until age 80

C) Screen only if abdominal palpation suggests an aneurysm

D) Do not screen because his smoking exposure was below 20 pack-years

E) Order one-time contrast-enhanced computed tomography of the abdomen

Correct answer: A) Offer one-time abdominal ultrasonography. Canadian preventive guidance supports offering one-time abdominal ultrasonography to men 65 to 80 years of age. Eligibility is not restricted to those with a specified minimum smoking exposure, although smoking increases risk. Ultrasonography is noninvasive and is preferred for screening; repeated imaging is determined by the initial aortic diameter rather than performed annually after a normal result.

Question 18 · Epidemiology

A wedding reception in Ontario is attended by 240 guests. Within 48 hours, 60 guests develop vomiting and diarrhea meeting the outbreak case definition. Public health confirms that all guests had comparable opportunities for exposure. Three affected guests die, while no deaths occur among guests who remained well. Investigators want to summarize both transmission during the event and disease severity. Which pair of measures is calculated correctly?

A) Attack rate 20%; case-fatality rate 1.25%

B) Attack rate 25%; case-fatality rate 1.25%

C) Attack rate 20%; case-fatality rate 5%

D) Attack rate 26.3%; case-fatality rate 5%

E) Attack rate 25%; case-fatality rate 5%

Correct answer: E) Attack rate 25%; case-fatality rate 5%. The attack rate is 60/240 = 25%. The case-fatality rate uses affected cases as its denominator and is 3/60 = 5%.

Question 19 · Geriatrics and palliative care

A 74-year-old man with metastatic lung cancer is hospitalized with progressive respiratory failure. He is alert and has decision-making capacity; disease-directed therapy is no longer likely to reverse his decline. His daughter asks the team to pursue every possible intervention, while he says he mainly wants to avoid suffering. No prior conversation has clarified what outcomes he considers acceptable. He is comfortable enough to participate in an unhurried discussion. What is the most appropriate way to begin the goals-of-care discussion?

A) Ask permission to discuss prognosis, assess his understanding, and explore his values and acceptable outcomes

B) Ask his daughter to select a resuscitation status before discussing prognosis with him

C) Recommend comfort measures only before eliciting his priorities

D) Present cardiopulmonary resuscitation as an isolated choice without broader context

E) Defer discussion until he loses capacity so that the family can decide

Correct answer: A) Ask permission to discuss prognosis, assess his understanding, and explore his values and acceptable outcomes. A patient-centred goals-of-care discussion begins by establishing readiness and understanding, then eliciting values before making a medically appropriate recommendation.

Question 20 · Geriatrics and palliative care

An 87-year-old woman is actively dying from advanced ovarian cancer in a hospice. She is unconscious and comfortable but has developed loud gurgling upper-airway secretions. Her respiratory rate is irregular, and there is no grimacing, accessory muscle use, or agitation. Her family is distressed by the sound and asks whether she is choking. She is receiving clinically assisted hydration that is no longer providing symptomatic benefit. What is the most appropriate immediate treatment?

A) Deep oropharyngeal suctioning at frequent intervals

B) Intravenous furosemide for presumed pulmonary edema

C) Nebulized salbutamol for terminal bronchospasm

D) Repositioning, reduction of nonbeneficial fluids, and an antisecretory medication

E) Escalation of oxygen until the respiratory sounds disappear

Correct answer: D) Repositioning, reduction of nonbeneficial fluids, and an antisecretory medication. Terminal secretions result from loss of the ability to clear saliva and airway fluid. Repositioning and an antimuscarinic such as glycopyrrolate can reduce the sound, while family reassurance is essential because the unconscious patient is not necessarily distressed.

Official MCC practice

MCC sells a Preparatory Examination (PE) form for $1 with 230 multiple-choice questions, the same length as the MCCQE. MCC says there are no repeated questions across its four forms (the $1 form, the PE form and two PE-Lite forms) or its set of 55 free MCCQE questions, giving up to 745 questions for practice. More in MCC’s $1 official practice exam.

For more free questions, download the free MCCQE sample questions PDF. For timed, full-length practice, try the TopQbank MCCQE question bank. And before the day itself, read what to expect on MCCQE exam day.