Free clinical case practice with answers
A complete, original clinical case with answers: one patient, a history and findings, then linked questions that move from assessment to diagnosis to management.
Why practise whole cases?
Since April 2025 the MCCQE has had no separate clinical decision-making (CDM) section — it is 230 multiple-choice questions. But most of those questions are clinical vignettes, and the MCC's test specifications put about 45% of the exam on assessment and diagnosis and 35% on management. Working one patient from first visit to plan trains exactly that reasoning. PassMCCQE groups its cases by the MCC's four dimensions of care.
Case: Periodic health review at 52
Patient: 52-year-old woman
Presenting complaint: “I haven’t had a check-up in years and I want to know what I’m due for.”
| Medical history | No chronic illness. No medications. Menopause at 50. Chickenpox as a child. |
|---|---|
| Family history | Father had a myocardial infarction at 71. No known cancers in the family. |
| Social history | Accountant. Smokes 10 cigarettes a day (15 pack-years). About 4 alcoholic drinks a week. |
| Vital signs | Blood pressure 142/92 mmHg (average of three readings), heart rate 76, BMI 27. |
| Examination | Unremarkable cardiovascular, respiratory, breast and abdominal examinations. |
1. She is at average risk for colorectal cancer. Which screening strategy is most appropriate?
- A. Fecal immunochemical test (FIT) every 2 years
- B. CT colonography every year from age 50
- C. Screening colonoscopy every 3 years
- D. No screening until she reaches age 60
- E. Serum carcinoembryonic antigen (CEA) every year
Show answer and explanation
Answer: A. Fecal immunochemical test (FIT) every 2 years
For average-risk adults aged 50 to 74, Canadian guidance favours a stool test (FIT, or guaiac FOBT) every 2 years, or flexible sigmoidoscopy every 10 years. A positive FIT is followed by colonoscopy. CEA is a tumour marker for follow-up, not a screening test, and colonoscopy every 3 years is neither the recommended primary test nor interval for average risk.
2. Which vaccine should she be offered at this visit, based on her age?
- A. Live attenuated zoster vaccine, one dose
- B. Recombinant zoster vaccine, two doses
- C. Varicella vaccine, two doses 6 weeks apart
- D. Pneumococcal conjugate vaccine, one dose
- E. Hepatitis A vaccine, two doses
Show answer and explanation
Answer: B. Recombinant zoster vaccine, two doses
NACI recommends the adjuvanted recombinant zoster vaccine (two doses, 2 to 6 months apart) for adults 50 and older, including those who had chickenpox or previous shingles. It has replaced the live vaccine, which is less effective and wanes. Varicella vaccine is for non-immune people; routine pneumococcal vaccination starts at 65 unless there is a risk condition.
3. She adds that her brother was diagnosed with colorectal cancer last month at age 48. How should her screening change?
- A. Genetic testing before any screening is offered
- B. Flexible sigmoidoscopy every 10 years instead
- C. Colonoscopy now and every 5 years if normal
- D. No change: FIT every 2 years is still appropriate
- E. FIT every year instead of every 2 years
Show answer and explanation
Answer: C. Colonoscopy now and every 5 years if normal
A first-degree relative diagnosed before 60 puts her at increased risk. Colonoscopy is recommended, starting at 40 or 10 years before the relative’s age at diagnosis (whichever is earlier), and repeated every 5 years. A stool test or sigmoidoscopy is not adequate for this risk group. Genetic counselling may be considered if the family history suggests a hereditary syndrome, but it should not delay colonoscopy.
4. What is the most appropriate next step for her office blood pressure of 142/92 mmHg?
- A. Confirm with home or ambulatory monitoring
- B. Start amlodipine 5 mg daily now
- C. Repeat the office reading in one year
- D. Order an echocardiogram before deciding
- E. Diagnose hypertension and start lifestyle care only
Show answer and explanation
Answer: A. Confirm with home or ambulatory monitoring
Hypertension Canada recommends confirming an elevated office reading with out-of-office measurement (ambulatory monitoring or a standardized home series) before making the diagnosis, because white-coat hypertension is common. Waiting a year is too long, and drug treatment is not started on a single office visit at this level without target-organ damage.
5. She says she would like to quit smoking. Which approach is most effective?
- A. Give written information and review next year
- B. Varenicline together with behavioural support
- C. Refer her for hypnotherapy as the first step
- D. Advise her to cut down gradually over a year
- E. Recommend switching to e-cigarettes long term
Show answer and explanation
Answer: B. Varenicline together with behavioural support
Combining pharmacotherapy with behavioural counselling gives the highest quit rates. Varenicline is among the most effective agents; combination nicotine replacement is an alternative. Set a quit date, arrange follow-up and use provincial quit-line or pharmacy supports. Written advice alone or gradual reduction without support is much less effective, and hypnotherapy lacks good evidence.
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PassMCCQE has 12 original cases with 53 linked questions across the four dimensions of care.
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Last reviewed 2026-09-30
Frequently asked questions
Does the MCCQE still have clinical decision-making (CDM) cases?
No. The CDM component was removed as of April 2025; the MCCQE is now 230 multiple-choice questions. Case practice still helps because most MCCQE questions are clinical vignettes.
How are PassMCCQE cases organized?
By the MCC’s four dimensions of care — health promotion and illness prevention, acute, chronic, and psychosocial aspects — each weighted as in the MCC test specifications.