MCCQE Part 1 Practice Test 2026

About the MCCQE Part 1 exam

The Medical Council of Canada Qualifying Exam Part 1 (MCCQE Part 1) is a medical examination administered in Canada. It is designed to assess candidates' knowledge and proficiency across 6 key subject areas including Medicine, Surgery, Pediatrics, Obstetrics & Gynecology. This exam is widely recognized as an essential benchmark for medical students and practitioners.

Use short MCCQE Part 1 practice sets to identify topics to revisit. Choose a subject and difficulty, answer questions, then review the explanations. New accounts get 30 question credits; further new questions use paid credits. Retaking previously seen questions is free.

Whether you're a first-time candidate or retaking the MCCQE Part 1 to improve your score, InfinityMock helps you identify your strengths and weaknesses through detailed performance analytics. Our platform covers Medicine, Surgery, Pediatrics, Obstetrics & Gynecology, Psychiatry, Population Health, with questions available at Easy, Medium, and Hard difficulty levels. Track your progress, review detailed explanations, and build the confidence you need to pass on exam day.

MCCQE Part 1 — quick answers

MCCQE Part 1 at a glance

8 free MCCQE Part 1 practice questions (2026)

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1. A 64-year-old man presents to the emergency department with sudden-onset, tearing chest pain that radiates to his back. His blood pressure is 185/95 mmHg and his heart rate is 98 bpm. A CT angiogram of the chest and abdomen confirms an acute Stanford Type B aortic dissection. What is the most appropriate initial pharmacotherapy to manage his hemodynamics?

   • Intravenous sodium nitroprusside monotherapy
   • Intravenous labetalol
   • Intravenous hydralazine
   • Intravenous diltiazem
   Show answer & explanation

   Answer: B. Intravenous labetalol

   In acute aortic dissection, the goal of pharmacotherapy is to reduce both heart rate (target < 60 bpm) and systolic blood pressure (target 100-120 mmHg) to minimize aortic wall shear stress (dP/dt). Intravenous beta-blockers, such as labetalol or esmolol, are first-line because they provide both negative inotropy and chronotropy. Vasodilators like sodium nitroprusside or hydralazine should never be used as monotherapy because they cause reflex tachycardia and increased shear stress, which can worsen the dissection.

   Topic: Medicine · hard

2. A 62-year-old woman presents with progressive dyspnea on exertion and a persistent dry cough over the past 8 months. On physical examination, there is prominent digital clubbing and fine, late-inspiratory Velcro-like crackles at both lung bases. A high-resolution CT (HRCT) scan of the chest demonstrates subpleural, basal-predominant reticular opacities, traction bronchiectasis, and honeycombing without ground-glass opacities. Pulmonary function tests show a restrictive pattern with a reduced DLCO. Which of the following is the most appropriate next step to slow disease progression?

   • High-dose oral prednisone
   • Nintedanib
   • Azathioprine combined with N-acetylcysteine
   • Methotrexate
   Show answer & explanation

   Answer: B. Nintedanib

   The patient's clinical presentation and HRCT findings are highly diagnostic of Idiopathic Pulmonary Fibrosis (IPF) demonstrating a definite Usual Interstitial Pneumonia (UIP) pattern. Antifibrotic agents, such as nintedanib or pirfenidone, are the only approved therapies shown to slow the decline in forced vital capacity (FVC) and reduce disease progression. Immunosuppressants like prednisone and azathioprine (previously evaluated in the PANTHER-IPF trial) are associated with increased mortality and hospitalization in IPF patients and should be avoided.

   Topic: Medicine · hard

3. A 34-year-old woman presents with worsening fatigue and generalized pruritus. Laboratory investigations reveal an alkaline phosphatase (ALP) level of 420 U/L (normal < 120 U/L), alanine aminotransferase (ALT) of 65 U/L (normal < 35 U/L), and normal bilirubin. Serum antimitochondrial antibody (AMA) titer is positive at 1:160. An abdominal ultrasound shows a normal biliary tree without dilation. What is the most appropriate initial long-term pharmacotherapy for this patient?

   • Ursodeoxycholic acid (UDCA)
   • Prednisone
   • Obeticholic acid
   • Cholestyramine
   Show answer & explanation

   Answer: A. Ursodeoxycholic acid (UDCA)

   This patient presents with classic features of Primary Biliary Cholangitis (PBC), characterized by elevated ALP, positive AMA, and normal biliary ducts on ultrasound. Ursodeoxycholic acid (UDCA) is the first-line therapy of choice. It slows histological progression, improves biochemical markers, and prolongs transplant-free survival. Cholestyramine is used to treat pruritus but does not alter the progression of the disease. Obeticholic acid is reserved as a second-line agent for patients who do not tolerate or have an inadequate response to UDCA.

   Topic: Medicine · hard

4. A 45-year-old man presents with visible red urine. He notes that he developed a mild sore throat and runny nose 2 days ago. He has had similar episodes of red urine associated with upper respiratory tract infections in the past. His blood pressure is 142/92 mmHg. Urinalysis shows 3+ blood and 1+ protein, with dysmorphic red blood cells on microscopy. His serum creatinine is normal at 95 µmol/L. What is the most likely diagnosis?

   • Post-streptococcal glomerulonephritis
   • IgA nephropathy
   • Granulomatosis with polyangiitis
   • Anti-glomerular basement membrane (GBM) disease
   Show answer & explanation

   Answer: B. IgA nephropathy

   IgA nephropathy typically presents with recurrent episodes of gross hematuria concurrent with, or within 1-2 days of, an upper respiratory tract infection (known as synpharyngitic hematuria). Post-streptococcal glomerulonephritis (PSGN), by contrast, has a longer latent period of 1 to 3 weeks after pharyngitis or skin infection, is associated with low C3 levels, and is not typically recurrent.

   Topic: Medicine · hard

5. A 28-year-old woman presents 6 weeks postpartum with profound fatigue, severe lethargy, and an inability to lactate. She experienced significant postpartum hemorrhage during delivery requiring multiple blood transfusions. On examination, she is hypotensive (BP 88/54 mmHg) and has lost her pubic and axillary hair. Laboratory workup reveals: Sodium 130 mmol/L, Potassium 4.0 mmol/L. What is the most appropriate initial diagnostic investigation to evaluate her endocrine status?

   • Cosyntropin stimulation test
   • Insulin tolerance test
   • Measurement of early morning serum cortisol and ACTH levels
   • 24-hour urinary free cortisol
   Show answer & explanation

   Answer: C. Measurement of early morning serum cortisol and ACTH levels

   The clinical scenario describes Sheehan syndrome (postpartum pituitary gland necrosis following severe obstetric hemorrhage). The initial step to evaluate central (secondary) adrenal insufficiency is measuring early morning serum cortisol and ACTH. Cortisol will be low, and ACTH will be inappropriately low or normal. A cosyntropin (ACTH) stimulation test can be misleadingly normal in the acute or subacute phase (weeks to a few months) of central adrenal insufficiency because the adrenal glands have not yet had time to fully atrophy from lack of ACTH stimulation.

   Topic: Medicine · hard

6. A 32-year-old woman is brought to the emergency department due to progressive confusion and petechial rashes on her lower limbs. She is febrile (38.2°C). Laboratory investigations show: Hemoglobin 80 g/L, Platelets 12 x 10^9/L, Creatinine 190 µmol/L. Coagulation studies (PT and aPTT) are normal. A peripheral blood smear reveals numerous schistocytes (4-5 per high-power field). What is the most urgent next step in the management of this patient?

   • Transfusion of pooled platelets
   • Initiation of plasma exchange (plasmapheresis)
   • Intravenous immunoglobulin (IVIG) administration
   • High-dose intravenous methylprednisolone alone
   Show answer & explanation

   Answer: B. Initiation of plasma exchange (plasmapheresis)

   This patient presents with the classic pentad of Thrombotic Thrombocytopenic Purpura (TTP): microangiopathic hemolytic anemia (schistocytes on smear), thrombocytopenia, renal insufficiency, fever, and neurological symptoms. TTP is a hematological emergency with a high mortality rate if untreated. Immediate plasma exchange (plasmapheresis) is the mainstay of treatment as it removes the autoantibodies against ADAMTS13 and replaces the deficient enzyme. Platelet transfusions are generally contraindicated in TTP as they can worsen the microvascular thrombosis.

   Topic: Medicine · hard

7. A 74-year-old woman presents with a new-onset, severe left-sided headache, scalp tenderness when brushing her hair, and jaw pain while chewing food. Today, she experienced two episodes of transient, painless vision loss in her left eye, lasting about 5 minutes each. Her erythrocyte sedimentation rate (ESR) is 98 mm/h. What is the most appropriate immediate management strategy?

   • Schedule a temporal artery biopsy within 48 hours and wait for results before starting steroids
   • Initiate high-dose intravenous methylprednisolone
   • Start oral prednisone 60 mg daily
   • Start low-dose aspirin and refer to ophthalmology for outpatient review
   Show answer & explanation

   Answer: B. Initiate high-dose intravenous methylprednisolone

   The patient has clinical features of Giant Cell Arteritis (GCA) with threatened vision loss (amaurosis fugax, jaw claudication). When GCA presents with visual symptoms, immediate administration of high-dose intravenous methylprednisolone (typically 500 to 1000 mg daily for 3 days) is required to prevent permanent, irreversible bilateral vision loss. Treatment should never be delayed for a temporal artery biopsy, which can be performed up to 1-2 weeks after starting steroid therapy without losing diagnostic yield.

   Topic: Medicine · hard

8. A 21-year-old college student presents with a 24-hour history of severe headache, photophobia, fever, and neck stiffness. On physical exam, he is lethargic, has a temperature of 39.1°C, and exhibits a positive Kernig sign. Lumbar puncture is performed, and cerebrospinal fluid (CSF) analysis reveals: WBC count 3,200/µL (92% neutrophils), Glucose 1.2 mmol/L (simultaneous blood glucose 6.2 mmol/L), and Protein 2.1 g/L. Gram stain shows Gram-positive diplococci. In addition to ceftriaxone and vancomycin, which of the following should be administered concurrently?

   • Dexamethasone
   • Ampicillin
   • Acyclovir
   • Rifampin
   Show answer & explanation

   Answer: A. Dexamethasone

   The clinical picture and CSF findings (high neutrophils, low glucose, high protein) with Gram-positive diplococci indicate Streptococcus pneumoniae meningitis. In adults with suspected or proven pneumococcal meningitis, adjunctive dexamethasone (10 mg IV) should be administered prior to or concurrently with the first dose of antibiotics. This has been shown to reduce rates of hearing loss, neurological sequelae, and mortality by mitigating the intense inflammatory response triggered by bacterial lysis. Ampicillin is added for Listeria coverage in patients >50 years old or those with immunocompromise, which does not apply to this young, healthy patient.

   Topic: Medicine · hard

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MCCQE Part 1 Exam Subjects

Available practice subjects: Medicine, Surgery, Pediatrics, Obstetrics & Gynecology, Psychiatry, Population Health. Select a subject for focused preparation. Coverage is not a guarantee of the complete official syllabus.

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