Free MCCQE practice questions with answers
12 free, original MCCQE-style practice questions — from each of the 6 disciplines — each with the answer and an explanation.
The real MCCQE has 230 multiple-choice questions with one best answer and 3–5 options, in two sections of 160 minutes. Most are short clinical vignettes. These samples use the same one-best-answer format. Try each one before opening the answer.
Internal medicine
1. A 58-year-old man has had 40 minutes of crushing retrosternal pain with diaphoresis. His ECG shows 3-mm ST elevation in leads II, III and aVF. BP is 128/80 mmHg and he is alert. The nearest PCI-capable hospital is a 60-minute transfer away. Besides aspirin, what is the most appropriate next step?
- A. Give fibrinolysis only once the troponin result is positive
- B. Immediate transfer for primary percutaneous coronary intervention
- C. CT pulmonary angiography before giving any other therapy
- D. Arrange an outpatient exercise stress test within the week
- E. Admit locally and repeat troponin and ECG in 3 hours
Show answer and explanation
Answer: B. Immediate transfer for primary percutaneous coronary intervention
This is an inferior STEMI, and reperfusion should not wait for troponin. Primary PCI is preferred when it can be done within about 120 minutes of first medical contact, which a 60-minute transfer allows. If PCI could not be reached in time, fibrinolysis within 30 minutes of arrival would be the alternative. Serial enzymes and stress testing are for suspected non-ST-elevation syndromes or stable pain.
2. A 52-year-old woman has an office blood pressure of 148/92 mmHg on one visit. She has no diabetes, kidney disease or target-organ damage, and her cardiovascular risk is low. What is the most appropriate next step?
- A. Confirm with ambulatory or home blood pressure monitoring
- B. Order a renal artery Doppler to exclude a secondary cause
- C. Start amlodipine 5 mg daily and recheck in one month
- D. Advise lifestyle change and discharge her from follow-up
- E. Recheck office readings once a year until above 160/100
Show answer and explanation
Answer: A. Confirm with ambulatory or home blood pressure monitoring
A single elevated office reading below 180/110 mmHg does not establish hypertension. Canadian guidance recommends out-of-office measurement, with ambulatory monitoring preferred and home monitoring as an alternative, to confirm the diagnosis and exclude white-coat effect. Treatment decisions follow confirmation and overall risk. Secondary causes are sought only when clinical clues are present.
Surgery & emergency
3. A 22-year-old man has periumbilical pain that moved to the right lower quadrant, with anorexia and a temperature of 38.2 °C. WBC is 14 × 10⁹/L. CT shows a 12-mm non-perforated appendix with surrounding fat stranding. What is the most appropriate management?
- A. IV antibiotics and laparoscopic appendectomy
- B. Discharge on oral antibiotics without surgical follow-up
- C. Interval appendectomy in six weeks after recovery
- D. Percutaneous drainage of the inflamed appendix
- E. Colonoscopy within 24 hours to exclude a tumour
Show answer and explanation
Answer: A. IV antibiotics and laparoscopic appendectomy
Uncomplicated acute appendicitis is treated with preoperative IV antibiotics and appendectomy, usually laparoscopic. Percutaneous drainage and interval appendectomy are for a contained abscess or phlegmon. Discharging without surgical follow-up risks perforation. Colonoscopy has no role in the acute setting of a young patient.
4. A 30-year-old man is brought in after a motorcycle crash. RR is 34, SpO2 84%, BP 78/50 mmHg and his neck veins are distended. Breath sounds are absent on the right and the trachea is deviated to the left. What is the most appropriate immediate step?
- A. A portable chest radiograph to confirm the diagnosis
- B. Immediate needle or finger decompression on the right
- C. CT of the chest with contrast before any procedure
- D. Rapid-sequence intubation and positive-pressure ventilation
- E. Pericardiocentesis for suspected cardiac tamponade
Show answer and explanation
Answer: B. Immediate needle or finger decompression on the right
Hypotension, distended neck veins, absent breath sounds and tracheal deviation away from the affected side indicate a tension pneumothorax, a clinical diagnosis that must be treated before imaging. Decompression (needle at the 4th–5th intercostal space in the mid-axillary line in adults, or finger thoracostomy) is followed by a chest tube. Positive-pressure ventilation first can worsen the tension.
Pediatrics
5. A 4-month-old boy has had 3 days of runny nose and cough, and now has wheeze and fine crackles. RR is 48, SpO2 94% on room air, mild subcostal indrawing, and he is feeding well. What is the most appropriate management?
- A. Chest radiograph and oral amoxicillin
- B. Supportive care with nasal suctioning and feeding
- C. Salbutamol by inhaler with a spacer every 4 hours
- D. Nebulized epinephrine given regularly at home
- E. Oral dexamethasone once daily for 3 days
Show answer and explanation
Answer: B. Supportive care with nasal suctioning and feeding
This is mild bronchiolitis, a viral illness managed with supportive care: nasal suctioning, maintaining hydration and feeding, and clear advice on when to return. Bronchodilators, corticosteroids, routine radiographs and antibiotics do not improve outcomes. Admission is considered for poor feeding, significant respiratory distress, apnea or persistent SpO2 below about 90%.
6. A 2-week-old girl born at term has a rectal temperature of 38.4 °C. She is feeding a little less than usual but looks well. What is the most appropriate management?
- A. Blood, urine and CSF cultures, then IV antibiotics
- B. Acetaminophen and reassessment in 24 hours
- C. Urinalysis alone, discharging her if normal
- D. Oral amoxicillin with family doctor follow-up
- E. A chest radiograph and observation for 4 hours
Show answer and explanation
Answer: A. Blood, urine and CSF cultures, then IV antibiotics
In an infant under about 3 weeks, fever carries a significant risk of serious bacterial infection (bacteremia, meningitis, UTI), and a well appearance does not reliably exclude it. Full sepsis evaluation with blood, urine and CSF cultures, admission and empiric IV antibiotics is standard. Antipyretic response and a normal urinalysis do not rule out bacteremia or meningitis.
Obstetrics & gynecology
7. A 28-year-old woman has a positive pregnancy test; her last menstrual period was 6 weeks ago. She has had lower abdominal pain and spotting since yesterday. She is hemodynamically stable. What is the most appropriate next step?
- A. Intramuscular methotrexate given in the department today
- B. Reassurance, since spotting is common in early pregnancy
- C. Transvaginal ultrasound and a quantitative β-hCG
- D. Diagnostic laparoscopy performed without imaging
- E. Urine culture and a course of oral antibiotics
Show answer and explanation
Answer: C. Transvaginal ultrasound and a quantitative β-hCG
Pain and bleeding in early pregnancy require exclusion of ectopic pregnancy. Transvaginal ultrasound locates the pregnancy, and the quantitative β-hCG is interpreted against it (and repeated at 48 hours if the location is unknown). Methotrexate is never given before the diagnosis is established. Laparoscopy is for unstable patients or when imaging is diagnostic of rupture.
8. At 32 weeks, a 29-year-old woman has repeated blood pressures of 162/112 mmHg, proteinuria and a severe headache. Which medication is given to prevent eclamptic seizures?
- A. IV phenytoin
- B. IV labetalol
- C. IV diazepam
- D. Oral levetiracetam
- E. IV magnesium sulfate
Show answer and explanation
Answer: E. IV magnesium sulfate
Magnesium sulfate is the drug of choice for preventing (and treating) eclamptic seizures and is superior to phenytoin and diazepam. Severe hypertension is treated separately, with labetalol, nifedipine or hydralazine, to reduce the risk of stroke; labetalol does not prevent seizures. Delivery is planned once the mother is stabilized.
Psychiatry
9. A 34-year-old woman has had 6 weeks of low mood, loss of interest, early waking, poor concentration and excessive guilt, and she is struggling at work. She has no suicidal ideation, psychotic features or history of mania. What is the most appropriate first-line pharmacological treatment?
- A. Quetiapine given alone as the first agent
- B. A selective serotonin reuptake inhibitor
- C. Lorazepam taken nightly for sleep and anxiety
- D. Referral for electroconvulsive therapy
- E. Lithium carbonate titrated to a therapeutic level
Show answer and explanation
Answer: B. A selective serotonin reuptake inhibitor
For a moderate major depressive episode, first-line options are psychotherapy (such as CBT) and/or a first-line antidepressant; SSRIs such as escitalopram or sertraline are well tolerated and effective. Lithium and atypical antipsychotics are augmentation strategies, and benzodiazepines do not treat depression. ECT is reserved for severe, psychotic or treatment-resistant depression.
10. A 45-year-old man with depression, recently separated and living alone, says he plans to hang himself this weekend and has bought a rope. He declines admission. What is the most appropriate next step?
- A. Give a 2-week supply of an antidepressant and follow up
- B. Keep him safe and arrange an urgent psychiatric assessment
- C. Book an outpatient counselling appointment next month
- D. Send a letter to his family doctor with your concerns
- E. Ask him to sign a no-suicide contract before leaving
Show answer and explanation
Answer: B. Keep him safe and arrange an urgent psychiatric assessment
A specific plan, intent, access to means, recent loss and living alone indicate high, imminent risk. He must not be left alone; the physician arranges urgent psychiatric assessment and, if he refuses, uses the provincial mental health act criteria for involuntary assessment. No-suicide contracts offer no protection, and outpatient plans are inadequate at this level of risk.
Population health & ethics
11. A new screening test is evaluated in 1000 people, 200 of whom have the disease. It is positive in 180 of those with the disease and negative in 720 of those without it. What is its positive predictive value?
- A. 18%
- B. 50%
- C. 69%
- D. 82%
- E. 90%
Show answer and explanation
Answer: C. 69%
True positives are 180 and false positives are 800 − 720 = 80, so PPV = 180 / (180 + 80) ≈ 69%. Sensitivity is 180/200 = 90% and specificity 720/800 = 90%. Unlike sensitivity and specificity, PPV depends on prevalence and falls when the test is used in a lower-prevalence population.
12. A 78-year-old man has wet gangrene of the foot, and the surgeon recommends below-knee amputation. He understands the diagnosis, the risk of death without surgery and the alternatives, and consistently refuses. What is the most appropriate course of action?
- A. Sedate him and operate, since it is life-saving
- B. Respect his refusal and keep offering other care
- C. Apply to a court for an order to treat him
- D. Ask his daughter to sign the consent instead
- E. Proceed under the emergency exception to consent
Show answer and explanation
Answer: B. Respect his refusal and keep offering other care
A capable adult may refuse any treatment, even life-saving treatment, and understanding and appreciating the consequences shows capacity. Substitute decision-makers act only when the patient is incapable, and the emergency exception does not override a known, capable refusal. The physician documents the discussion, respects the decision, offers palliative and other care, and revisits the decision if he changes his mind.
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Last reviewed 2026-09-30
Frequently asked questions
Are these real MCCQE questions?
No. Every PassMCCQE question is original, written to the MCCQE format and the MCC blueprint. Real MCC questions and "recalls" are confidential, and using them risks your result.
How many questions are on the MCCQE?
230 multiple-choice questions with one best answer and 3–5 options, in two sections of 160 minutes.
What score do I need to pass?
The MCC reports a scaled score from 300 to 600; 439 or more is a pass. It is not a percentage correct, so treat practice percentages as a guide only.