How Many Questions Are on the MCCQE1? Full Breakdown

Short answer: the MCCQE1 is a one-day computer-based exam of about 210 multiple-choice questions plus 38 Clinical Decision Making (CDM) cases. The two sections are timed separately and scored separately, but roll up into a single scaled score. Here is what that actually looks like on exam day.

The two sections

Multiple-choice section

• ~210 MCQs, single-best-answer, four to five options each.
• 3.5 hours total, no formal breaks — you can pause but the clock keeps running.
• Split roughly evenly across the MCC dimensions: adult health, women's health, child health, mental health, and population health / ethics.
• Roughly 60 seconds per question if you use your time cleanly.

Clinical Decision Making (CDM) section

• ~38 cases, each with 1–4 sub-questions.
• Mix of short-answer (write a diagnosis, order a test, choose a management step) and short-menu (pick from a longer list).
• 4 hours total, with a lunch break separating the sections.
• Cases are timed as one pool, so you can spend more time on complex ones.

Total on the day

• ~210 MCQs + ~38 CDMs = roughly 248 scored items.
• Total seat time (including lunch and check-in): about 9 hours.
• Total scored time: 7.5 hours.

Some administrations include a small number of unscored pilot items — you won't know which ones. Answer everything as if it counts.

What this means for how you prepare

The volume implies three things:

1. Endurance matters. By CDM hour 3 your accuracy drops. Simulate at least two full-length timed exams before the real thing.
2. Time-per-question is tight on MCQs. If you can't average 60 seconds in practice, you'll leave 20+ questions unanswered on exam day. This is trainable.
3. CDM ≠ MCQ. MCQ practice alone won't prepare you for the short-answer format. You need at least 80 CDM-style cases with written rationales.

How much practice you actually need

For a competitive score (260+), aim for:

• 2,000–3,000 mixed-system MCQs across your prep window.
• 80–150 CDM cases with rubric-graded short answers.
• 2 full-length timed simulations in the final two weeks.

MDReview's daily mix targets this volume automatically, with AI-graded SAQ for the CDM portion and spaced repetition on any question you get wrong.

Common questions

How long is the MCCQE1? 7.5 scored hours split into a 3.5-hour MCQ section and a 4-hour CDM section, separated by a lunch break.

How many questions can I skip? None if you want a competitive score. Every unanswered item counts as wrong. Guess before time expires.

Are there breaks? One lunch break between sections, plus optional unpaid breaks within each section (the clock keeps running).

Start free

If you want to know how your current MCQ pace compares to the exam requirement, try MDReview free — the first timed block gives you a per-question pace read-out you can benchmark against 60 seconds.

Related: MCCQE1 Pass Rate 2026 · How to Study for MCCQE1 · Best MCCQE1 Question Bank.