Free Practice Questions for Medical Council of Canada MCCQE Exam

This patient’s symptoms are consistent with panic disorder with agoraphobia , characterized by recurrent panic attacks and avoidance of places where escape may be difficult. She has avoided leaving her home for 6 months due to fear of panic symptoms (palpitations, tremors, sweating, dyspnea, choking sensation), which is classic for agoraphobia.

MCCQE objectives emphasize that first-line management includes cognitive behavioral therapy (CBT) with graded exposure therapy , which involves gradual, systematic exposure to feared situations (e.g., short walks progressing to longer distances). Encouraging incremental exposure directly addresses avoidance behavior and reduces anxiety over time.

Lithium is used for bipolar disorder, not panic disorder. Chlorpromazine (an antipsychotic) is not first-line and carries unnecessary side effects. Reassurance alone is insufficient because panic disorder significantly impairs functioning. Hospitalization is not indicated unless there is suicidality or inability to care for oneself.

Therefore, gradual exposure through increasing walks is the most appropriate next step, consistent with evidence-based management of panic disorder with agoraphobia.

A febrile neonate (≤28 days old) requires a full sepsis evaluation (e.g., blood cultures, urine testing, lumbar puncture) because of the high risk of serious bacterial infection despite a well appearance. MCCQE objectives emphasize both appropriate medical management and effective communication with parents. When caregivers are distressed about painful procedures, the best approach is empathetic communication and reassurance that adequate analgesia and comfort measures (e.g., topical anesthetic, oral sucrose, swaddling) will be provided.

Threatening child protection involvement is inappropriate unless there is clear refusal of life-saving care after thorough discussion. Saying the infant “will not remember” dismisses parental concerns and undermines trust. Proceeding without addressing concerns violates principles of shared decision-making. Excluding parents from procedures may increase anxiety and is not routinely recommended.

The physician should acknowledge concerns, explain the rationale for testing (risk of occult sepsis), outline pain-control strategies, and invite questions. This maintains trust while ensuring timely, evidence-based care.

This infant has evidence of urinary outflow obstruction on ultrasound. The most common cause in male infants is posterior urethral valves. Poor urinary stream is a hallmark symptom of bladder outlet obstruction in neonates.

Toronto Notes 2023 – Pediatrics, “Pediatric Urology” Section:

“Posterior urethral valves should be suspected in male infants with recurrent UTIs, hydronephrosis, and a weak urinary stream. Diagnosis is confirmed by voiding cystourethrogram.”

MCCQE1 Objectives (Pediatrics > 78-4: Urinary Tract Abnormalities):

“Candidates must identify congenital causes of urinary obstruction. Poor stream and hydronephrosis are classic features of posterior urethral valves.”

Crying with urination (E) is nonspecific. Hematuria (B) and malodorous urine (D) are common with infections. Circumcision (A) is unrelated.

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This patient presents with hypotension, diffuse abdominal pain, and a history of contact sports injury with preceding symptoms of infectious mononucleosis (sore throat, fatigue). The spleen is commonly enlarged in mononucleosis, making it vulnerable to rupture after even minor trauma.

Toronto Notes 2023 – General Surgery and Infectious Diseases Sections:

“Splenic rupture is a known complication of mononucleosis, particularly after trauma. Symptoms may include diffuse abdominal pain, hypotension, and signs of hemorrhagic shock.”

MCCQE1 Objectives (Surgery > 84-1: Abdominal Trauma):

“Candidates should identify splenic rupture as a cause of hypotension and abdominal pain following blunt abdominal trauma, especially in patients with splenomegaly.”

Appendicitis (B) would present with localized right lower quadrant pain. Pneumonia (C) and pyelonephritis (D) would present with respiratory or urinary symptoms. Ruptured duodenum (E) is much less likely without specific trauma to that region or signs of peritonitis.

In a patient with known diverticular bleeding and no red flags (e.g., weight loss, anemia, family history), repeating colonoscopy is not required. Diverticular bleeding is typically self-limited. Colonoscopy within the past few years with clear findings suffices.

Toronto Notes 2023 – Gastroenterology, Lower GI Bleed:

“Patients with known diverticulosis and self-limited bleeding who have had prior complete colonoscopy do not require repeat endoscopy unless symptoms recur or persist.”

MCCQE1 Objectives – Internal Medicine > Gastroenterology:

“Candidates must recognize when no further invasive investigation is necessary in elderly patients with known benign findings and resolved symptoms.”

Option E is considerate but not clinically necessary for independent patients. Options A, B, and D are not indicated in resolved, low-risk cases.

For an otherwise healthy 60-year-old woman, screening mammography every 2 years provides the greatest proven population-health benefit among the listed options. MCCQE prevention objectives emphasize selecting screening that meaningfully reduces morbidity and mortality in the target age group. Breast cancer screening with mammography in women aged approximately 50–74 has evidence for earlier detection and reduction in breast-cancer mortality, and biennial screening balances benefit with harms (false positives, overdiagnosis) better than annual screening.

Annual cervical cytology is not recommended for average-risk women; screening intervals are longer (and discontinuation is generally considered after adequate prior screening at older ages). Bone densitometry is typically initiated later (commonly at 65) for average-risk women, with earlier testing reserved for additional risk factors. Routine annual fasting lipids and annual fasting glucose are not the most useful universal interventions in a healthy person; testing frequency is risk-based rather than yearly for all. Therefore, biennial mammography is the best choice for highest preventive value in this patient.

Orchiopexy is the treatment of choice for cryptorchidism and should be performed between 6–18 months of age. Early surgery improves fertility outcomes and reduces malignancy risk.

Toronto Notes 2023 – Pediatrics, Urology:

“Undescended testes should be referred for orchiopexy ideally before 18 months of age. Observation beyond 6 months is not recommended.”

MCCQE1 Objectives – Pediatrics > Genitourinary Disorders:

“Candidates must recognize and refer for cryptorchidism early to optimize testicular function and reduce cancer risk.”

Hormonal therapies (C, D) are not recommended due to limited efficacy. Observation (A) is too late beyond

Primary herpetic gingivostomatitis caused by HSV-1 is common in toddlers. It presents with high fever, irritability, drooling, refusal to eat, and painful oral ulcers on the lips, gums, and tongue. Cervical lymphadenopathy is common.

Toronto Notes 2023 – Pediatrics, “Infectious Conditions in Children”:

“Primary HSV-1 infection in children presents with high fever, cervical lymphadenopathy, and painful oral ulcers (gingivostomatitis).”

MCCQE1 Objectives (Pediatrics > 75-2: Infectious Diseases):

“Candidates must recognize viral exanthems and enanthems, including herpetic gingivostomatitis, based on clinical findings.”

Kawasaki (A) includes conjunctivitis, strawberry tongue, and extremity changes. Epiglottitis (B) presents with drooling but without oral ulcers. Mono (C) lacks the ulcerative pattern. Hand-foot-mouth (D) affects palms and soles, not inner lips and gums predominantly.

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Methadone maintenance therapy during pregnancy is the recommended treatment for opioid use disorder and should be continued at a stable dose. However, regardless of maternal dose stability, neonates are at significant risk of neonatal abstinence syndrome (NAS) due to in utero opioid exposure. MCCQE objectives emphasize anticipatory guidance and appropriate newborn monitoring in substance-exposed pregnancies.

Symptoms of NAS (irritability, tremors, poor feeding, vomiting, diarrhea, seizures) typically begin within 24–72 hours after birth but may be delayed with long-acting opioids such as methadone. Therefore, routine observation in hospital for at least 72 hours is recommended to monitor for withdrawal and initiate supportive or pharmacologic treatment if needed.

Naloxone is contraindicated in opioid-dependent neonates except in life-threatening respiratory depression because it may precipitate severe withdrawal. Stable maternal dosing does not eliminate NAS risk, so early discharge is inappropriate. Breastfeeding is generally encouraged in stable methadone-maintained mothers, as methadone transfer in breast milk is minimal and may reduce withdrawal severity. Continuing methadone during pregnancy is safer than untreated opioid use.

This presentation has “red flags” for raised intracranial pressure: headaches that are progressive, worse in the morning, and worsened by coughing/valsalva. In MCCQE objectives, these features require urgent evaluation for secondary causes (e.g., intracranial mass, hemorrhage, obstructive hydrocephalus) rather than empiric treatment for primary headache. His chronic cough and heavy smoking increase concern for an underlying malignancy with possible brain metastasis or paraneoplastic processes, further strengthening the indication for neuroimaging. Therefore, the best next step is CT head (often the fastest initial test to identify mass effect, hemorrhage, or hydrocephalus; MRI may follow depending on findings).

Treating presumed migraine with a triptan is inappropriate when secondary headache is possible and could also pose vascular risk. His blood pressure is elevated but not in a hypertensive emergency and does not explain these classic intracranial pressure features; serial BP monitoring or starting antihypertensives should not delay imaging. Temporal arteritis is less likely without temporal tenderness, jaw claudication, visual symptoms, or systemic inflammatory clues.