MCCQE Part 1 · Clinical Medicine and Surgery

Adult Medicine, Surgery and Emergencies

42 practice questions, each with the answer and an explanation.

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Random questions from this topic, one at a time. You see the answer and the explanation straight after each one.

All 42 questions

  1. A 58-year-old man has 40 minutes of crushing central chest pain with sweating. The ECG shows ST elevation in leads II, III and aVF. Which action is the most urgent?
  2. A woman develops hives, wheeze and a falling blood pressure two minutes after a wasp sting. What is the first drug to give?
  3. A 22-year-old with type 1 diabetes has vomiting, deep rapid breathing, glucose 28 mmol/L, pH 7.1 and potassium 4.2 mmol/L. What is the best initial management?
  4. A man with cirrhosis vomits a large volume of fresh blood and is tachycardic. After starting resuscitation, which combination is most appropriate?
  5. A 45-year-old has pleuritic chest pain and tachycardia after a long flight. He is stable, with a high pretest probability of pulmonary embolism. What is the next best step?
  6. A 70-year-old smoker with COPD has worse dyspnea and purulent sputum but a normal mental state. Which treatment bundle is standard?
  7. A trauma patient has severe respiratory distress, absent breath sounds on the right, a deviated trachea and low blood pressure. What should be done first?
  8. A 19-year-old has periumbilical pain that moves to the right lower quadrant, with anorexia and a low fever. What is the most likely diagnosis?
  9. A dialysis patient has weakness and peaked T waves with a widened QRS; potassium is 7.4 mmol/L. What is the first treatment?
  10. A patient with atrial fibrillation has a heart rate of 170, blood pressure 70/40 and confusion. What is the best management?
  11. A tired 50-year-old woman with weight gain and cold intolerance has a high TSH and a low free T4. What is the treatment?
  12. A febrile adult has neck stiffness and photophobia, and a lumbar puncture will be delayed by two hours. What is the best step?
  13. A 72-year-old has sudden left-sided weakness and slurred speech that began 90 minutes ago. What must be done before thrombolysis?
  14. A patient with sodium 122 mmol/L is euvolemic with concentrated urine and low plasma osmolality. What is the best initial therapy for chronic SIADH?
  15. A man with back pain has urinary retention, saddle numbness and reduced anal tone. What is the next step?
  16. A 74-year-old has new temporal headache, jaw claudication and an ESR of 95 mm/h. What is the best immediate action?
  17. A man with heavy alcohol use has severe epigastric pain radiating to the back and a lipase five times normal. What is the cornerstone of early management?
  18. A healthy 28-year-old woman has dysuria and frequency without fever or flank pain. Which is a reasonable first-line therapy?
  19. A patient has pneumonia, confusion, urea 8 mmol/L, respiratory rate 32, blood pressure 85/50 and age 68. What does the CURB-65 score suggest?
  20. A patient with vomiting, distension and prior abdominal surgery has dilated small bowel loops on a film. What is the initial management of suspected obstruction?
  21. An elderly man on warfarin has a head injury with a new intracranial bleed and an INR of 4.8. What is the best reversal strategy?
  22. A 55-year-old has a swollen red first metatarsophalangeal joint with no joint trauma. In acute gout, which drug is appropriate?
  23. A 52-year-old non-diabetic patient has a repeated blood pressure of 160/100 mmHg and no compelling indication. Which is a first-line drug class?
  24. A patient is diagnosed with type 2 diabetes and has normal kidney function. Which agent is typically started first alongside lifestyle measures?
  25. A patient has heart failure with an ejection fraction of 30 percent and is on an ACE inhibitor and furosemide. Which addition improves survival?
  26. A 14-year-old has sudden severe left scrotal pain with a high-riding testis and absent cremasteric reflex. What is the next step?
  27. A patient with tearing chest pain radiating to the back has a blood pressure of 190/110 and a widened mediastinum. Which initial drug choice is best?
  28. A patient with fever, heart rate 125, blood pressure 82/50 and lactate 4.5 mmol/L is likely to have sepsis. What is recommended within the first hour?
  29. A patient presents 5 hours after intentionally taking 40 tablets of acetaminophen. What is the antidote?
  30. A man is found unresponsive with pinpoint pupils and a respiratory rate of 5. What is the immediate antidote?
  31. A 62-year-old man has a hemoglobin of 90 g/L, a low MCV and low ferritin. What is the most important next step?
  32. A child with asthma has a severe attack with wheeze and a saturation of 88 percent. What is the first-line treatment?
  33. A man with alcohol dependence is admitted with tremor, sweating and agitation 36 hours after his last drink. Which approach is correct?
  34. A patient has a red, warm, spreading area on the lower leg without pus or abscess and no systemic illness. What is a suitable oral antibiotic?
  35. A patient has severe pain, tense swelling and pain on passive stretch of the forearm after a fracture. What is the definitive treatment?
  36. After a blow to the head, a young man is briefly unconscious, wakes, then deteriorates with a blown pupil. What is the likely diagnosis and management?
  37. A patient has a sudden severe headache described as the worst of her life. A CT performed 3 hours after onset is normal. What is the next step?
  38. A twisted ankle has tenderness at the posterior edge of the lateral malleolus and inability to bear weight. Using the Ottawa ankle rules, what is indicated?
  39. A 70 kg adult has 20 percent total body surface area partial-thickness burns. By the Parkland formula (4 mL/kg per percent), how much fluid is given in the first 8 hours?
  40. A patient's arterial gas shows pH 7.25, PaCO2 30 mmHg, bicarbonate 12 mmol/L, sodium 140 and chloride 100. What is the anion gap and interpretation?
  41. A patient with severe hyponatremia of 108 mmol/L for several days is alcohol dependent and malnourished. How fast should sodium rise per 24 hours?
  42. A 65-year-old with peripheral edema, a creatinine rise and potassium 6.0 is on an ACE inhibitor, spironolactone and ibuprofen. Which step addresses the cause?

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