MCCQE - Medical Council of Canada Qualifying Examination Cardiovascular Disease Management Questions and Answers 1 — Questions and Answers
Question 1: A 68-year-old male with a history of hypertension and type 2 diabetes presents for a routine follow-up. His blood pressure is 145/92 mmHg despite adherence to lifestyle modifications. According to the 2025 Hypertension Canada guidelines, which of the following is the most appropriate initial pharmacological treatment?
- Amlodipine monotherapy
- A single-pill combination of an ACE inhibitor and a dihydropyridine calcium channel blocker (Correct answer)
- Lisinopril monotherapy
- Hydrochlorothiazide monotherapy
Correct answer: A single-pill combination of an ACE inhibitor and a dihydropyridine calcium channel blocker
The 2025 Hypertension Canada guidelines recommend initiating pharmacotherapy for adults with a blood pressure ≥ 140/90 mmHg. For most patients requiring medication, upfront combination therapy, ideally as a single-pill combination, is recommended. The preferred combinations are an ACE inhibitor or ARB plus either a dihydropyridine calcium channel blocker or a thiazide/thiazide-like diuretic.
Question 2: A 55-year-old woman with no prior history of cardiovascular disease is found to have a non-fasting LDL-cholesterol level of 5.2 mmol/L. Her 10-year cardiovascular disease risk is calculated to be 18% using the Framingham Risk Score. According to the 2021 Canadian Cardiovascular Society (CCS) Dyslipidemia Guidelines, what is the most appropriate next step in management?
- Initiate high-intensity statin therapy.
- Recommend lifestyle modifications only and recheck lipids in 5 years.
- Initiate moderate-intensity statin therapy. (Correct answer)
- Initiate ezetimibe therapy.
Correct answer: Initiate moderate-intensity statin therapy.
According to the 2021 CCS Dyslipidemia Guidelines, for individuals in the intermediate-risk category (Framingham Risk Score 10-19.9%), a discussion about initiating moderate-intensity statin therapy is recommended if LDL-C is ≥3.5 mmol/L. High-intensity statin is typically reserved for those with a risk score ≥20% or established atherosclerotic cardiovascular disease.
Question 3: A 72-year-old male with a new diagnosis of non-valvular atrial fibrillation has a CHADS2 score of 3. He is being started on anticoagulation for stroke prevention. Which of the following is a key component of his management plan according to the Canadian Cardiovascular Society (CCS) guidelines?
- Prescribing a reduced dose of a direct oral anticoagulant (DOAC) to minimize bleeding risk, regardless of specific criteria.
- Initiating dual antiplatelet therapy in addition to oral anticoagulation.
- Screening for and managing modifiable cardiovascular risk factors such as hypertension and obesity. (Correct answer)
- Scheduling an elective cardioversion within the first month of diagnosis.
Correct answer: Screening for and managing modifiable cardiovascular risk factors such as hypertension and obesity.
The 2020 CCS/CHRS Atrial Fibrillation Guidelines emphasize a comprehensive approach to management. A crucial part of this is the management of modifiable cardiovascular risk factors (e.g., hypertension, obesity, sleep apnea) to reduce cardiovascular events and decrease the burden of atrial fibrillation.
Question 4: A 62-year-old man underwent a percutaneous coronary intervention (PCI) with a drug-eluting stent for stable ischemic heart disease. He has no history of bleeding or stroke. Based on the Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology (CCS/CAIC) antiplatelet therapy guidelines, what is the recommended duration of dual antiplatelet therapy (DAPT)?
- 1 month
- 3 months
- 12 months
- 6 months (Correct answer)
Correct answer: 6 months
For patients undergoing PCI for a non-acute coronary syndrome indication, such as stable ischemic heart disease, the CCS/CAIC guidelines recommend 6 months of DAPT with ASA and clopidogrel. An extension up to 1 year can be considered.
Question 5: Which of the following is the primary goal of initiating a rhythm-control strategy in a symptomatic patient with atrial fibrillation, according to current Canadian cardiovascular guidelines?
- To eliminate the need for long-term oral anticoagulation.
- To reduce the risk of stroke and systemic embolism.
- To improve quality of life and reduce AF-related symptoms. (Correct answer)
- To decrease the risk of heart failure development.
Correct answer: To improve quality of life and reduce AF-related symptoms.
The primary indication for a rhythm-control strategy (using antiarrhythmic drugs or ablation) in patients with atrial fibrillation is to reduce AF-related symptoms and improve quality of life. While rhythm control can have other benefits, symptom improvement is the main goal. Stroke prevention with anticoagulation is still required based on the patient's risk profile, irrespective of the rhythm-control strategy.
Question 6: A 66-year-old female with a history of myocardial infarction 3 years ago presents for follow-up. She is on aspirin, a beta-blocker, and a high-intensity statin. Her blood pressure is well-controlled. She asks if she should stop her statin now that she feels well. According to secondary prevention guidelines for cardiovascular disease, what is the most appropriate advice?
- Stop the statin as it is no longer needed for secondary prevention after 3 years.
- Continue the high-intensity statin indefinitely. (Correct answer)
- Reduce the statin to a low-intensity dose for maintenance.
- Switch from the statin to a fibrate for long-term management.
Correct answer: Continue the high-intensity statin indefinitely.
For patients with established atherosclerotic cardiovascular disease (secondary prevention), high-intensity statin therapy should be continued indefinitely, unless not tolerated. Statins are a cornerstone of secondary prevention to reduce the risk of recurrent cardiovascular events, and their benefit is long-term.
MCCQE - Medical Council of Canada Qualifying Examination Cardiovascular Disease Management Questions and Answers 1
A 68-year-old male with a history of hypertension and type 2 diabetes presents for a routine follow-up.
His blood pressure is 145/92 mmHg despite adherence to lifestyle modifications.
According to the 2025 Hypertension Canada guidelines, which of the following is the most appropriate initial pharmacological treatment?