Free MCCQE Practice Questions: Test Your Medical Knowledge (2026)

Correct Answer: B

This is an inferior STEMI (ST-elevation in II, III, aVF). The standard of care is dual antiplatelet therapy (aspirin + P2Y12 inhibitor) and emergent PCI when available within 90 minutes of first medical contact. This is consistent with Canadian Cardiovascular Society (CCS) guidelines.

• A is incorrect: Waiting for troponins delays treatment. STEMI is diagnosed by ECG, not troponin
• C is incorrect: While aortic dissection should be considered, the presentation (ST-elevation, typical ACS history) makes STEMI far more likely. CT angio would dangerously delay reperfusion
• D is partially correct: Thrombolytics are appropriate if PCI is unavailable within 120 minutes, but PCI is preferred when available
• E is incorrect: Serial troponin monitoring is appropriate for NSTEMI, not STEMI. Beta-blockers should not be given acutely in potential cardiogenic shock

Correct Answer: B

Under Canada's MAID legislation (Bill C-14, amended by Bill C-7 in 2021), two independent physicians or nurse practitioners must assess the patient's eligibility. This is a safeguard to ensure the request is voluntary, informed, and meets all legal criteria.

• A is incorrect: There is no minimum age of 75. The patient must be 18 years or older
• C is incorrect: Family consent is not required. MAID is the patient's autonomous decision. Family members have no legal authority to consent or refuse on the patient's behalf
• D is incorrect: Since Bill C-7 (2021), natural death does not need to be "reasonably foreseeable." Patients with serious and incurable conditions can be eligible even if death is not imminent
• E is incorrect: Psychiatric assessment is not mandatory for all requests. It may be recommended if there are concerns about capacity or if the condition is primarily mental illness (which has its own criteria)

Why this matters for the MCCQE: Canadian medical ethics questions are high-yield and frequently tested. IMGs often struggle here because MAID doesn't exist in most other countries. See our IMG guide for more Canadian-specific study priorities.

Correct Answer: C

At 4 months, infants should be able to reach for and grasp objects placed in front of them. This is a fine motor milestone expected at 3–4 months.

• A is incorrect: Pull to stand typically occurs at 9–10 months
• B is incorrect: Hand-to-hand transfer is a 6–7 month milestone
• D is incorrect: Walking with support (cruising) typically occurs at 9–12 months
• E is incorrect: Specific "mama/dada" use typically occurs at 10–12 months

High-yield tip: The MCCQE tests developmental milestones frequently. Know the major milestones at 2, 4, 6, 9, 12, 18, and 24 months.

Correct Answer: B

Using Bayes' theorem or a 2×2 table:

• In a population of 1,000: 50 have cancer, 950 do not
• True positives: 50 × 0.90 = 45
• False positives: 950 × 0.20 = 190
• PPV = 45 / (45 + 190) = 45/235 ≈ 19%

This demonstrates a critical concept: even with good sensitivity and specificity, PPV is low when prevalence is low. This is why screening programs target high-risk populations.

• D (80%) is the specificity, not the PPV — a common trap
• E (90%) is the sensitivity, not the PPV

Why this matters: Biostatistics and epidemiology questions appear on every MCCQE Part 1. Know sensitivity, specificity, PPV, NPV, NNT, and relative/absolute risk reduction.

Correct Answer: C

Before initiating treatment for depression, you must rule out medical causes (hypothyroidism, anemia, substance use, medication side effects) and perform a comprehensive psychiatric assessment. The Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines recommend discussing treatment options with the patient, which include psychotherapy, pharmacotherapy, or both.

• A is incorrect: Starting medication before completing assessment and ruling out medical causes is premature
• B is incorrect: Mild to moderate depression should be managed in primary care. Psychiatry referral is appropriate for severe, treatment-resistant, or complex cases
• D is incorrect: Benzodiazepines are not first-line for depression and carry dependence risk
• E is incorrect: While lifestyle modifications are beneficial adjuncts, relying on them alone for a patient meeting criteria for major depressive episode (≥2 weeks, ≥5 symptoms) is inadequate

MCCQE approach: The exam rewards thorough, stepwise clinical reasoning. "Complete the assessment first" is often the correct answer when a question presents a new, undiagnosed patient.

Correct Answer: B

For Rh-negative pregnant patients, Canadian guidelines (SOGC — Society of Obstetricians and Gynaecologists of Canada) recommend:

1. Antibody screening (indirect Coombs test) at the first prenatal visit
2. Routine RhIG prophylaxis at 28 weeks if the antibody screen is negative
3. Postpartum RhIG within 72 hours if the newborn is Rh-positive

• A is incorrect: RhIG is not given at 12 weeks routinely — it's given at 28 weeks for prophylaxis
• C is incorrect: Waiting until delivery misses the opportunity for antepartum prophylaxis
• D is incorrect: While knowing the father's Rh status is helpful, RhIG is recommended regardless because paternity cannot always be confirmed
• E is incorrect: Amniocentesis is invasive and not indicated for routine blood type determination

Correct Answer: C

The patient demonstrates all four elements of capacity: understanding, appreciation, reasoning, and expressing a choice. A diagnosis of dementia does not automatically negate capacity. Capacity is decision-specific and time-specific — a patient may lack capacity for complex financial decisions but retain capacity for a specific medical decision.

• A is incorrect: Next of kin cannot override a capable patient's autonomy. Substitute decision-making only applies when the patient lacks capacity
• B is incorrect: There is no indication for a psychiatric consultation when the patient clearly demonstrates capacity
• D is incorrect: Ethics committees are for complex contested cases, not straightforward capacity assessments
• E is incorrect: Judicial assessment is unnecessary and delaying surgery for a hip fracture increases morbidity and mortality

Key principle for MCCQE: Capacity is always presumed unless demonstrated otherwise. The burden of proof is on those claiming incapacity, not on the patient to prove it.

Correct Answer: B

This presentation — progressive dyspnea in a long-term smoker with obstructive spirometry (FEV1/FVC < 0.70) and minimal reversibility — is classic COPD (GOLD stage 2, moderate). Canadian Thoracic Society guidelines recommend initial pharmacotherapy with a LAMA or LABA monotherapy for moderate COPD.

• A is incorrect: Asthma typically shows significant bronchodilator reversibility. ICS monotherapy is not first-line for COPD
• C is incorrect: Pulmonary fibrosis shows restrictive (not obstructive) spirometry pattern
• D is incorrect: Systemic corticosteroids are for acute exacerbations, not maintenance therapy
• E is incorrect: While COPD and bronchiectasis can coexist, the presentation and spirometry are more consistent with COPD. Long-term azithromycin is reserved for frequent exacerbators

Correct Answer: C

The social determinants of health — including income, employment, education, and social support — are the primary drivers of health outcomes at the population level. The factory closure creating economic instability affects multiple families simultaneously, creating a community-wide pattern rather than individual cases.

• A is incorrect: While genetics play a role in individual vulnerability, an increase across multiple unrelated adolescents points to environmental/social factors
• B is incorrect: Blaming individual families ignores the structural cause (economic instability) affecting the entire community
• D is incorrect: School programs may help but don't address the root cause
• E is incorrect: Medication access is a downstream issue. The question asks about the underlying factor

MCCQE relevance: Population health and social determinants are heavily tested. Think upstream — the MCCQE expects you to identify structural causes, not just individual treatment plans.

Correct Answer: C

This is a tension pneumothorax, a clinical diagnosis requiring immediate intervention. The triad of decreased breath sounds, tracheal deviation away from the affected side, and hemodynamic instability (tachycardia, hypotension, JVD) is classic.

Needle decompression at the 2nd intercostal space, midclavicular line (or 4th/5th intercostal space, anterior axillary line) is the life-saving intervention. This is followed by chest tube insertion.

• A and B are incorrect: Tension pneumothorax is a clinical diagnosis. Imaging delays treatment in a patient who may arrest imminently
• D is incorrect: Positive pressure ventilation before decompression will worsen the tension pneumothorax
• E is incorrect: While resuscitation is important, the primary problem is obstructive shock from the pneumothorax, not hypovolemia. Fluids alone won't fix the underlying cause