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Medical Council of Canada · Last updated November 2026

MCCQE (Medical Council of Canada Qualifying Examination, formerly Part I): free practice test

The national qualifying exam for medical graduates in Canada, required of international medical graduates applying to Canadian residency and for the LMCC. One day, 230 multiple-choice questions on critical medical knowledge and clinical decision-making at the level of a graduating Canadian medical student, built on the MCC Examination Objectives and blueprint. Four exam sessions a year; maximum 4 attempts.

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About the MCCQE exam

The national qualifying exam for medical graduates in Canada, required of international medical graduates applying to Canadian residency and for the LMCC. One day, 230 multiple-choice questions on critical medical knowledge and clinical decision-making at the level of a graduating Canadian medical student, built on the MCC Examination Objectives and blueprint. Four exam sessions a year; maximum 4 attempts.

What's on the exam

MCCQE
Internal Medicine
6 key facts
Surgery and Emergency Medicine
6 key facts
Pediatrics
6 key facts
Obstetrics and Gynecology
6 key facts
Psychiatry
6 key facts
Population Health and Prevention
6 key facts
Ethics, Law and Communication
6 key facts

Each branch is a topic in the official outline. Members see every key fact on the full mind map. Read the free study guide →

How to pass the MCCQE exam

  • 115 questions in 2 hours 40 minutes is about 83 seconds each. Flag hard questions and come back, but finish the section: once you leave it you can't return, and blanks score zero.
  • The blueprint leans on management (about 35%) and assessment and diagnosis (about 45%), but health promotion and illness prevention is still about 20%. Canadian screening and immunization guidance is easy marks.
  • Answer as a Canadian graduate would: Canadian guidelines (CTFPHC, NACI, CPS, SOGC, CANMAT, Diabetes Canada), SI units and Canadian law on consent, capacity and reporting.
  • There's no negative marking: answer every question. The real exam uses three to five options; ours use four.

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Create a free account after the test: your score by topic, a mistakes bank, the complete study notes for the first topic, flashcards and the High-Yield Numbers Sheet.

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What's in the premium MCCQE prep

Premium MCCQE prep is studied one topic at a time. Each step starts with that topic's key notes and flashcard deck, then its own question sets of 25, so you master one topic before you move to the next. When every topic is strong, the 6 full mock exams show you're ready.

3,000practice questions, every answer explained
6full-length mock exams, 230 questions each, timed
800flashcards with spaced repetition, sorted by topic
60comprehensive key notes across 7 topics

Your step-by-step study path

  1. 1
    Internal Medicine9 key notes, 115 flashcards, then 450 practice questions in 18 sets of 25
    Notes free with an account
  2. 2
    Surgery and Emergency Medicine9 key notes, 115 flashcards, then 425 practice questions in 17 sets of 25
    Premium
  3. 3
    Pediatrics9 key notes, 115 flashcards, then 425 practice questions in 17 sets of 25
    Premium
  4. 4
    Obstetrics and Gynecology9 key notes, 115 flashcards, then 425 practice questions in 17 sets of 25
    Premium
  5. 5
    Psychiatry8 key notes, 115 flashcards, then 425 practice questions in 17 sets of 25
    Premium
  6. 6
    Population Health and Prevention8 key notes, 115 flashcards, then 425 practice questions in 17 sets of 25
    Premium
  7. 7
    Ethics, Law and Communication8 key notes, 110 flashcards, then 425 practice questions in 17 sets of 25
    Premium
  8. Final step: 6 full mock exams230 questions each, timed like test day. Pass them, then book your exam.
    Premium
Free with an account

Read the complete MCCQE study notes for “Internal Medicine”

Our first full set of comprehensive notes, about 18 minutes of reading: How MCCQE medicine questions work · Emergencies: order matters · Cardiovascular · Respiratory · Endocrine and renal · Answer the Canadian way, a worked exam example, the traps examiners use and a one-minute recap. Create a free account to read it and see how premium notes work before you decide.

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Study tools included

3,000 practice questions

3,000 exam-style questions per exam, organized topic by topic in sets of 25. Every answer explained, with the rule it comes from.

6 full mock exams

6 full-length timed mock exams per exam, with real question counts and time limits, so test day feels like practice day.

Exam Readiness Score

One 0 to 100 number that tells you when you're ready to book. Reach 80 and you're covered by our Pass Guarantee.

800 flashcards + spaced repetition

800 flashcards per exam, in a deck for each topic, that come back right before you'd forget them. Five minutes a day keeps every number fresh.

60 comprehensive key notes

60 key notes per exam, split across its topics and each explained in full: the concepts, worked exam examples, the traps examiners use and a quick recap. Your first set is free with an account.

Mind maps

See the whole exam on one screen: every topic and the facts under it.

Sample questions with answers

These are the questions in the free test above, with answers. Try the test first. You'll learn more by getting some wrong.

1. A 22-year-old woman with type 1 diabetes has diabetic ketoacidosis: glucose 28 mmol/L, pH 7.10, bicarbonate 8 mmol/L and potassium 3.0 mmol/L. She has had 1 L of 0.9% saline. What is the most appropriate next step?
Answer: Give IV potassium and hold insulin until potassium is at least 3.3 mmol/L. Insulin drives potassium into cells. Starting it with a potassium below 3.3 mmol/L risks dangerous hypokalemia and arrhythmia, so Diabetes Canada advises replacing potassium first and starting insulin once it reaches 3.3 mmol/L. Bicarbonate is not routine at this pH, and long-acting subcutaneous insulin doesn't treat DKA.
2. A 30-year-old woman has pleuritic chest pain. She is not tachycardic, has no leg swelling, no history of thromboembolism, no hemoptysis and no recent surgery, and pulmonary embolism is not the most likely diagnosis. Her Wells score places her at low pretest probability, and a high-sensitivity D-dimer is negative. What is the most appropriate next step for possible PE?
Answer: No further testing for pulmonary embolism. In a patient with low pretest probability, a negative high-sensitivity D-dimer safely rules out PE, so no imaging is needed. Imaging would expose her to radiation and the risk of false positives. A D-dimer is not useful when pretest probability is high: go straight to imaging.
3. A 67-year-old man is found to have non-valvular atrial fibrillation. He has no hypertension, diabetes, heart failure, vascular disease or previous stroke. His renal function is normal. Under the Canadian Cardiovascular Society algorithm, what is the most appropriate stroke prevention?
Answer: A direct oral anticoagulant such as apixaban. The CCS "CHADS-65" approach recommends oral anticoagulation for anyone aged 65 or older, or with any CHADS2 risk factor, and prefers a DOAC over warfarin in non-valvular AF. Antiplatelet therapy alone is not recommended for stroke prevention in AF.
4. A 40-year-old man fell from standing height and hit his head. He had a brief witnessed loss of consciousness and now has a GCS of 15. Under the Canadian CT Head Rule, which feature, on its own, puts him at high risk and indicates CT?
Answer: Signs of a basal skull fracture, such as hemotympanum. High-risk features are GCS below 15 two hours after injury, a suspected open or depressed skull fracture, any sign of basal skull fracture, two or more episodes of vomiting, and age 65 or older. Retrograde amnesia counts (as medium risk) only if it is 30 minutes or more, one vomit is not enough, and headache is not a criterion.
5. A 70 kg man has partial- and full-thickness burns over 30% of his total body surface area. Using the Parkland formula, how much crystalloid should he receive in the first 24 hours after the burn, in total?
Answer: 8,400 mL. Parkland: 4 mL × weight (kg) × %TBSA = 4 × 70 × 30 = 8,400 mL of Ringer's lactate over 24 hours. Half (4,200 mL) goes in the first 8 hours from the time of the burn, not from arrival, and the rest over the next 16 hours. Then titrate to urine output (about 0.5 mL/kg/h in adults); superficial burns are not counted in the TBSA.
6. A 15-day-old infant has a rectal temperature of 38.4 °C. She is feeding a little less but looks well, and there is no obvious source. What is the most appropriate management?
Answer: Full sepsis evaluation including lumbar puncture, admission and empirical IV antibiotics. Febrile infants 21 days old or younger have a high rate of serious bacterial infection, including bacteremia and meningitis, and look-well appearance is unreliable. The Canadian Paediatric Society recommends blood and urine cultures, lumbar puncture, admission and empirical IV antibiotics for this age group.
7. An 18-month-old is pale and irritable. He drinks about 1.5 L of cow's milk a day and eats little solid food. Hemoglobin is 82 g/L with a low MCV. What is the most likely cause of his anemia?
Answer: Iron deficiency from excessive cow's milk intake. Large volumes of cow's milk are low in iron, displace iron-rich foods and can cause occult intestinal blood loss. The Canadian Paediatric Society advises limiting cow's milk to about 500 to 750 mL a day in toddlers. Treat with oral iron and diet change, and check the response.
8. Shortly after a vaginal birth, a woman has heavy bleeding. The placenta is complete and the uterine fundus feels soft and boggy above the umbilicus. What is the most appropriate first step?
Answer: Bimanual uterine massage and oxytocin. Uterine atony is the commonest cause of postpartum hemorrhage (tone, trauma, tissue, thrombin). The first steps are uterine massage and oxytocin, with resuscitation and tranexamic acid. Carboprost is second line (avoid in asthma), ergonovine is contraindicated with hypertension, and surgery is a last resort.
9. A woman whose previous pregnancy was complicated by early-onset pre-eclampsia is now 11 weeks pregnant. Which intervention reduces her risk of pre-eclampsia in this pregnancy?
Answer: Low-dose acetylsalicylic acid at bedtime, started before 16 weeks. SOGC guidance recommends low-dose ASA (81 to 162 mg) at bedtime for women at increased risk, started before 16 weeks and continued until about 36 weeks. It reduces pre-eclampsia, especially preterm disease. Antihypertensives treat high blood pressure but don't prevent pre-eclampsia, and salt restriction and bed rest have no proven benefit.
10. A 34-year-old man has a first episode of moderate major depressive disorder without psychotic features. He would like medication. Under the CANMAT guidelines, which is a first-line choice?
Answer: Sertraline. CANMAT lists SSRIs such as sertraline among first-line antidepressants, alongside psychotherapy. Quetiapine is second line, MAOIs such as phenelzine are third line because of interactions and dietary restrictions, and lithium is used for augmentation, not as monotherapy for unipolar depression.
11. An 82-year-old woman, two days after hip fracture surgery, becomes acutely confused at night, with fluctuating attention and periods of drowsiness. What is the most appropriate initial approach?
Answer: Look for and treat underlying causes, and use non-drug measures. Acute onset, fluctuation and inattention indicate delirium. Look for the causes (pain, infection, urinary retention, constipation, hypoxia, electrolytes, drugs such as opioids and anticholinergics) and use reorientation, sleep, glasses, hearing aids and family. Benzodiazepines and restraints worsen delirium; antipsychotics are only for severe distress or danger.
12. A 55-year-old man at average risk for colorectal cancer asks about screening. According to the Canadian Task Force on Preventive Health Care, what is recommended?
Answer: A fecal immunochemical test (FIT) every 2 years. The CTFPHC recommends screening adults aged 50 to 74 at average risk with a fecal test (FIT or gFOBT) every 2 years or flexible sigmoidoscopy every 10 years, and recommends against colonoscopy as the primary screening test. Provincial programs follow the same approach with FIT.
13. In a randomized trial, 10% of patients in the control group and 6% in the treatment group had a stroke over 5 years. How many patients need to be treated for 5 years to prevent one stroke?
Answer: 25. Absolute risk reduction = 10% − 6% = 4% (0.04). Number needed to treat = 1 ÷ 0.04 = 25. The relative risk reduction (4 ÷ 10 = 40%) sounds larger, which is why NNT and ARR matter for decisions.
14. A 45-year-old Jehovah's Witness is bleeding after a car crash. He is alert and has capacity. After you explain that he may die without a blood transfusion, he clearly refuses it and shows a signed card refusing blood. What is the most appropriate action?
Answer: Respect his refusal and use all acceptable alternatives. A capable adult can refuse any treatment, even life-saving treatment, and the refusal must be respected. Malette v. Shulman (Ontario Court of Appeal, 1990) found a physician liable for transfusing a patient who carried a card refusing blood. Use alternatives such as crystalloids, tranexamic acid and surgical control of bleeding.
15. A 3-year-old has bruises of different ages on the back and buttocks, and the parents' explanation does not fit the injuries. What is the physician's legal obligation?
Answer: Report directly to child protection services when there are reasonable grounds to suspect abuse. Every province and territory requires anyone, including physicians, who has reasonable grounds to suspect a child is being abused or neglected to report it promptly to child protection services. Proof is not required, the duty can't be delegated, and it overrides confidentiality. A medical work-up can continue alongside the report.

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Certification guide

How to become a doctor in Canada as an international medical graduate: Medical licences in Canada are issued by each province's or territory's medical regulatory authority, but most international medical graduates start in the same place: an account with the [Medical Council of Canada](https://mcc.ca/examinations-assessments/mccqe/), verification of their medical degree, and the MCCQE. From there the usual routes are a Canadian residency through CaRMS or, for experienced family physicians, a practice-ready assessment. Here is the path and what it costs.

MCCQE exam FAQ

How many questions are on the MCCQE exam?

230 multiple-choice questions in two sections of 115 (includes unscored pilot questions), with a time limit of 5 hours 20 minutes (2 hours 40 minutes per section), with an optional 45-minute break. Format: closed book, computer-based; you can flag and return to questions only within the current section.

What is the passing score for MCCQE?

439 on the MCC's 300 to 600 score scale (introduced in 2025).

How much does the MCCQE exam cost?

C$1,500 application fee (2026); first-time IMGs also pay C$150 for a physiciansapply.ca account and C$232 per credential for source verification. MCC fees are reviewed every year, so confirm on the MCC website before you apply.

Which languages is the MCCQE exam offered in?

English or French.

Where do I take the MCCQE exam?

Prometric test centres in Canada and over 70 countries (remote proctoring is no longer offered).

Is this MCCQE practice test free?

Yes. The 15-question practice test on this page is free, with an explanation for every answer and no signup. A free account also unlocks the complete study notes for the first topic. The full MCCQE prep is Premium at C$207 a month for this exam.

What's in the premium MCCQE prep?

3,000 practice questions organized topic by topic (Internal Medicine: 450; Surgery and Emergency Medicine: 425; Pediatrics: 425; Obstetrics and Gynecology: 425; Psychiatry: 425; Population Health and Prevention: 425; Ethics, Law and Communication: 425), 6 full-length timed mock exams of 230 questions, 800 flashcards and 60 comprehensive key notes split across all 7 topics, plus a mistakes bank and the Readiness Score.

Related practice tests

Exam details are summarized from the official candidate information available in November 2026. the Medical Council of Canada changes formats and fees, so confirm with Medical Council of Canada (MCC) before you book. MCCQEQuizBank is not affiliated with the Medical Council of Canada or Prometric.

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