Free Practice Questions for Medical Council of Canada MCCQE Exam

One of the strongest modifiable risk factors for postoperative delirium in older adults is exposure to anticholinergic medications (e.g., diphenhydramine, certain antidepressants). Avoiding these can reduce delirium risk.

Toronto Notes 2023 – Geriatrics, “Delirium Prevention”:

“Avoid high-risk medications including anticholinergics, benzodiazepines, and narcotics if possible. Maintain orientation cues and adequate pain control.”

MCCQE1 Objectives (Medicine > Geriatrics > 41-1: Cognitive Impairment):

“Candidates must recognize predisposing factors for delirium and apply prevention strategies, including medication review.”

Opiates (B) should be used judiciously; untreated pain can also cause delirium. Cognitive screening (C) is helpful for baseline but does not prevent delirium. Benzodiazepines (D) increase delirium risk. Family involvement is actually helpful (E).

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This patient has classic signs of cardiac tamponade (Beck's triad: hypotension, muffled heartsounds, elevated JVP, plus pulsus paradoxus). However, she also has advanced metastatic cancer, functional decline, and has stopped active treatment. In this context, a goals-of-care discussion is the most appropriate next step to determine her wishes regarding interventions like pericardiocentesis.

Toronto Notes 2023 – Palliative Care:

“End-of-life care should prioritize quality of life and patient preferences. In patients with terminal illness and life-threatening conditions (e.g., tamponade), initiate a conversation about goals before aggressive intervention.”

MCCQE1 Objectives – Internal Medicine > Palliative and End-of-Life Care:

“Candidates must assess prognosis, patient values, and initiate appropriate end-of-life discussions before invasive treatment.”

Although pericardiocentesis (A) may relieve symptoms, it should follow consent based on the patient’s goals. ICU (E), fluids (B), or transfusion (D) are not appropriate without this discussion.

Comprehensive and Detailed Explanation:

This patient has secondary amenorrhea, galactorrhea, and worsening headaches—suggestive of hyperprolactinemia, possibly due to a pituitary adenoma (prolactinoma). Visual field defects (typically bitemporal hemianopia) can result from optic chiasm compression.

Toronto Notes 2023 – Endocrinology / Reproductive Health:

“Prolactinomas may cause amenorrhea, galactorrhea, headaches, and visual field defects. Evaluate with serum prolactin and visual field testing.”

MCCQE1 Objectives (Endocrinology > 37-2: Pituitary Disorders):

“Candidates must recognize clinical signs of prolactinomas and know when to assess visual fields.”

Hirsutism (D) suggests androgen excess. Low BMI (B) can cause hypothalamic amenorrhea but wouldn’t explain galactorrhea. Nodular breast findings (A) are not related.

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Chronic mesenteric ischemia (also known as “intestinal angina”) presents as postprandial abdominal pain, leading to food avoidance and significant weight loss. GI exams may be normal. Imaging (e.g., angiography or CT angio) confirms the diagnosis.

Toronto Notes 2023 – Gastroenterology, “Chronic Mesenteric Ischemia”:

“Classic triad: postprandial abdominal pain, weight loss, and food aversion. Physical exam and GI series may be normal.”

MCCQE1 Objectives (Gastroenterology > 47-1: Abdominal Pain):

“Candidates must suspect mesenteric ischemia in older adults with risk factors and postprandial pain leading to weight loss.”

PUD (A) usually causes epigastric pain relieved by food. Cholelithiasis (B) causes RUQ pain. Colon cancer (D) presents with altered bowel habits or bleeding. Mesenteric adenitis (C) occurs in younger patients, often with infection.

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Comprehensive and Detailed Explanation:

Infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse in women under 35 years. Since she has been trying for only 5 months, reassurance is appropriate.

Toronto Notes 2023 – Gynecology:

“Investigations for infertility in women under 35 should begin after 12 months of attempting to conceive, unless other risk factors are present.”

MCCQE1 Objectives (Gynecology > 82-1: Infertility):

“Candidates must apply appropriate timing and indications for infertility investigations based on patient age and history.”

Earlier testing is not warranted here. Options A–D are part of the infertility work-up but not before 12 months.

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The first step in evaluating a new, hot, swollen joint is arthrocentesis to rule out septic arthritis and crystal arthropathy. Joint aspiration provides fluid for microscopy, culture, and crystal analysis, which guides definitive diagnosis and treatment.

Toronto Notes 2023 – Rheumatology, Monoarthritis:

“Joint aspiration is the most important first step in evaluating monoarthritis. Septic arthritis must be ruled out before initiating any therapy.”

MCCQE1 Objectives – Internal Medicine > Rheumatology:

“Candidates should perform joint aspiration in the presence of acute monoarthritis to differentiate between septic arthritis, gout, and other causes.”

Radiography (A) and serum uric acid (B) do not establish cause acutely. Empiric antibiotics (D) and NSAIDs (E) should only be started after ruling out septic arthritis.

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This presentation suggests hereditary hemochromatosis. Common features include hyperpigmentation ("bronze diabetes"), hepatomegaly, diabetes, fatigue, and elevated liver enzymes. Serum ferritin is a screening test for iron overload, and elevated levels support the diagnosis.

Toronto Notes 2023 – Endocrinology / Gastroenterology:

“Hemochromatosis presents with skin hyperpigmentation, hepatomegaly, diabetes, fatigue. Diagnosis begins with serum ferritin and transferrin saturation.”

MCCQE1 Objectives (Internal Medicine > Metabolic and Endocrine > 37-1):

“Candidates must investigate iron overload syndromes using ferritin and transferrin saturation.”

Cortisol (B) is for adrenal insufficiency. A1AT (C) is a liver disease cause but not typical here. Amylase (E) is for pancreatitis. A1c (A) would confirm diabetes but not the underlying cause.

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Comprehensive and Detailed Explanation:

This patient has tardive dyskinesia, a late-onset, often irreversible movement disorder caused by chronic dopamine receptor blockade (e.g., haloperidol). It is especially common in older adults and may not resolve after stopping the drug.

Toronto Notes 2023 – Psychiatry, “Extrapyramidal Symptoms”:

“Tardive dyskinesia is often irreversible and typically occurs after prolonged antipsychotic use. Elderly patients are at greater risk.”

MCCQE1 Objectives (Psychiatry > 71-5: Side Effects of Psychotropics):

“Candidates must recognize tardive dyskinesia and understand that it can persist or worsen even after discontinuation of antipsychotics.”

Anticholinergics may worsen it (D). The condition does not reliably improve with age (C). It does not affect a majority of patients (A).

Fibrocystic change is the most common benign breast condition in women of reproductive age. It typically presents with diffuse nodularity or "lumpy" areas, especially in the upper outer quadrant, and varies with the menstrual cycle. No dominant mass or systemic signs are expected.

Toronto Notes 2023 – Gynecology, “Benign Breast Conditions”:

“Fibrocystic changes often present with bilateral or unilateral nodularity, most commonly in the upper outer quadrants, without discrete masses.”

MCCQE1 Objectives (Gynecology > 81-1: Breast Conditions):

“Candidates must differentiate benign breast conditions from malignant ones based on presentation and physical exam findings.”

Paget disease (B) presents with nipple changes. Intraductal carcinoma (C) typically shows a discrete mass or suspicious features. Phyllodes tumours are usually well-circumscribed. Mastitis (E) is inflammatory and associated with erythema, fever, and tenderness.

Comprehensive and Detailed Explanation:

Travel to rural Cambodia poses a high risk of malaria, which can be life-threatening in pregnancy. Antimalarial prophylaxis is strongly recommended for pregnant women traveling to endemic regions. Chloroquine or mefloquine (depending on resistance patterns) may be used in pregnancy under specialist guidance.

Toronto Notes 2023 – Infectious Disease / Travel Medicine:

“Malaria prophylaxis is indicated in pregnant women traveling to endemic regions. The risk of severe malaria and poor fetal outcomes is high.”

MCCQE1 Objectives (Public Health > 65-3: Travel Medicine and Pregnancy):

“Candidates must provide preventive care to pregnant travelers including vaccination and malaria prophylaxis.”

Tetanus boosters (D) are given every 10 years. Hep B Ig (B) is for acute post-exposure prophylaxis. Ciprofloxacin (C) is contraindicated in pregnancy.