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Medical Council of Canada MCCQE Part 1 Sample Questions:

1. A 77-year-old woman is brought to the Emergency Department by ambulance because she has severe heel ulcers and dehydration. Her husband reports that she has been sick for the past 6 to 8 weeks with a cough and congestion. He shares that he has tried to bring her to medical attention on several occasions, but she refused.
The paramedics reported that her bed at home was soiled and that they could hardly reach her room due to clutter. On questioning, her answers seem reasonable. Which one of the following is the most critical next step?

A) Find out whether the husband has a criminal record
B) Determine whether the patient has alcohol or substance use disorder
C) Assess the patient's decision-making ability
D) Assess the risk of financial abuse by her husband
E) Obtain pictures to confirm the state of their house

2. A 34-year-old man sustained a blunt testicular trauma 2 hours ago. On physical examination, the patient has a
1.5-cm tall scrotal hematoma. You cannot palpate the testicle. Which one of the following is the best initial management?

A) Order a technetium 99m pertechnetate scan
B) Plan surgical exploration
C) Order ultrasonography of the scrotum
D) Discharge with analgesics
E) Observe for 24 hours and discharge if stable

3. A 24-year-old woman with chronic anorexia nervosa presents to the Emergency Department with diarrhea, chest pain and palpitations. She is noted to have a BMI of 13, a heart rate of 48/min, significant orthostatic hypotension and a temperature of 35.9 °C. Her electrocardiogram shows frequent premature ventricular contractions. Her blood work indicates elevated liver transaminases and evidence of acute kidney injury from dehydration. She agrees to admission for medical stabilization only if she does not receive fluids either orally or intravenously, as they will cause her to gain weight and to feel bloated. Which one of the following is the best next step?

A) Ask her if she has a substitute decision-maker
B) Obtain a psychiatric consultation
C) Start intravenous fluids and physically restrain if necessary
D) Assess her capacity to consent for medical treatment
E) Refuse to admit her unless she agrees to full treatment

4. A 38-year-old woman has progressive renal failure despite optimal medical treatment for her glomerulonephritis. Her ex-husband asks if he might be considered as a kidney donor. They have joint custody of their 10-year-old son. Which one of the following is the best response to the ex-husband's request?

A) Advise against a donation because of their divorce.
B) He may proceed with assessment for possible organ donation.
C) His request must be refused because of the risk of leaving their child with 2 unhealthy parents.

5. A 40-year-old woman presents with a 3-month history of discharge from her right nipple. The discharge was initially milky white, but over the last 2 weeks, the patient has noted blood stains on her bra. There is mild discomfort in the same breast around the time of menses periods. On physical examination, the upper outer quadrant of the breast is tender, but there are no palpable lumps. You are able to express fluid from the nipple which is in fact blood-tinged. Which one of the following is the most likely diagnosis?

A) Mammary duct ectasia.
B) Paget disease.
C) Staphylococcal infection.
D) Intraductal papilloma.
E) Ductal carcinoma in situ.

Solutions: