MCCQE Part 1 Sample Questions Guide

The MCCQE consists of 230 multiple-choice questions, split into two sections of 115 items each, with up to 2 hours 40 minutes allowed per section. It's a one-day, computer-based exam administered at Prometric test centres across Canada and in over 70 countries, offered four times a year. Content is organized under two evaluation categories — Dimensions of Care and Physician Activities — each with four weighted domains, built from MCC's own Examination Objectives, which are themselves organized under the CanMEDS roles.

Below are four practice questions in that same MCQ format — TopQbank's own original items, not real retired MCCQE questions (MCC does not publish a retired-question bank).

Question 1

A 71-year-old man presents with acute-onset confusion over the past 24 hours. He has a background of mild dementia, and his daughter reports he was at his baseline 2 days ago. On examination he is afebrile, and urinalysis shows leukocytes and nitrites. What is the most likely diagnosis?

A) Progression of his underlying dementia

B) Delirium secondary to a urinary tract infection

C) Acute ischemic stroke

D) Normal pressure hydrocephalus

Correct answer: B) Delirium secondary to a urinary tract infection. The acute onset (over 24 hours, from a known baseline) is the key distinguishing feature between delirium and dementia — dementia progresses gradually over months to years, not days. Combined with a positive urinalysis, this points to delirium precipitated by a UTI, a very common cause of acute confusion in older adults, rather than dementia progression, stroke, or NPH, none of which fit the acute, reversible-precipitant picture described.

Question 2

A 6-month-old infant presents with a 3-day history of cough, rhinorrhea, and low-grade fever, now with wheeze and mild subcostal indrawing. She is feeding well and oxygen saturation is 96% on room air. What is the most likely diagnosis?

A) Bacterial pneumonia

B) Bronchiolitis

C) Asthma exacerbation

D) Foreign body aspiration

Correct answer: B) Bronchiolitis. Bronchiolitis, typically caused by respiratory syncytial virus, classically presents in infants under 12 months with a preceding upper respiratory prodrome (cough, rhinorrhea, low-grade fever) followed by wheeze and increased work of breathing. This infant is well-appearing with good feeding and saturations, consistent with mild bronchiolitis rather than bacterial pneumonia (which would more typically show focal findings and higher fever) or a sudden-onset presentation as would be expected with foreign body aspiration.

Question 3

A 35-year-old woman at 28 weeks gestation is found to have a random glucose of 9.8 mmol/L on routine screening. A confirmatory oral glucose tolerance test meets diagnostic criteria for gestational diabetes. She has no prior history of diabetes. What is the most appropriate first-line management?

A) Immediate initiation of insulin therapy

B) Nutritional counselling and lifestyle modification, with reassessment

C) Oral metformin as first-line therapy

D) Elective delivery at 34 weeks

Correct answer: B) Nutritional counselling and lifestyle modification, with reassessment. For most patients newly diagnosed with gestational diabetes, first-line management is nutritional counselling and lifestyle/dietary modification, with blood glucose monitoring to reassess whether glycemic targets are met. Pharmacologic therapy (insulin or metformin) is added only if lifestyle measures fail to achieve target glucose control — it is not the default first step, and elective preterm delivery is not indicated based on the diagnosis alone.

Question 4

A 45-year-old man presents with sudden-onset severe, tearing chest pain radiating to the back, with a blood pressure of 190/110 mmHg in the right arm and 150/90 mmHg in the left arm. What is the most appropriate immediate investigation?

A) Exercise stress test

B) CT angiography of the chest

C) Troponin only, with discharge if negative

D) Outpatient echocardiogram in one week

Correct answer: B) CT angiography of the chest. Tearing chest pain radiating to the back with a significant blood pressure differential between arms is a classic presentation of aortic dissection — a surgical emergency. CT angiography is the appropriate immediate investigation to confirm the diagnosis and characterize the dissection. A stress test is contraindicated in this acute setting, and relying on troponin alone or delaying to an outpatient echocardiogram risks missing a rapidly fatal diagnosis.