Free Practice Questions for Medical Council of Canada MCCQE Exam

Comprehensive and Detailed Explanation:

In a workplace medical note, physicians are responsible for commenting on the patient’s functional capacity and any required accommodations—not providing detailed medical diagnoses or test results unless consented to. The goal is to support a safe return to work with appropriate modifications.

Toronto Notes 2023 – ELOM, “Documentation and Work Notes”:

“Physicians should focus on functional abilities and restrictions, rather than detailed diagnoses or treatments, in employer communications.”

MCCQE1 Objectives (ELOM > 90-2: Confidentiality and Occupational Fitness):

“Candidates must maintain patient confidentiality and document work-related limitations and accommodations in employer letters.”

Diagnosis (B), imaging (E), and treatment plans (A) are confidential medical details. C (physiotherapist’s evaluation) is not the physician’s documentation.

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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.

Comprehensive and Detailed Explanation:

Given his age and a first-degree relative with colon cancer diagnosed before age 60, this patient meets criteria for early colon cancer screening. Colonoscopy is the gold standard for both screening and diagnosis in this context.

Toronto Notes 2023 – Gastroenterology, “Colorectal Cancer Screening”:

“Patients with a first-degree relative diagnosed with colorectal cancer before age 60 should begin screening at age 40, or 10 years before the relative’s diagnosis. Colonoscopy is the preferred method.”

MCCQE1 Objectives (Population Health > Preventive Screening > 63-1):

“Candidates must apply colorectal cancer screening guidelines and select appropriate tests based on risk level.”

FIT (A) is for average-risk screening. MRI (B) and CT colonography (E) are secondary. Barium enema (D) is outdated.

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Comprehensive and Detailed Explanation:

Basement apartments are often damp environments, increasing the risk of mold exposure. Mold is a well-known asthma trigger. Given the timing (autumn/winter) and environment change, mold allergy is the most likely cause.

Toronto Notes 2023 – Respirology / Allergy:

“Mold is a common indoor allergen, especially in damp environments. It frequently exacerbates asthma, particularly in fall/winter.”

MCCQE1 Objectives (Pediatrics > 75-2: Asthma Triggers):

“Candidates must identify common environmental triggers for asthma, including mold exposure in humid or poorly ventilated housing.”

Cat allergy (B) would have triggered earlier. Pollen (D) is less relevant in winter. Cold intolerance (E) is not a major asthma trigger without exercise. Fungal infection (A) is unlikely without systemic symptoms.

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Comprehensive and Detailed Explanation:

The ECG reveals:

Regular P waves that are not consistently followed by QRS complexes

A dissociation between the atrial (P wave) and ventricular (QRS complex) activity

A slow ventricular rate (~40 bpm) independent of atrial rate

These findings are characteristic of a third-degree (complete) atrioventricular (AV) block, where there is no conduction of atrial impulses to the ventricles. The atria and ventricles beatindependently, and the ventricular rate is maintained by an escape rhythm, often junctional or ventricular in origin.

This correlates with the patient’s symptoms (dizziness, hypotension) and bradycardia, suggesting inadequate cardiac output due to AV dissociation.

Toronto Notes 2023 – Cardiology:

“Third-degree AV block shows complete AV dissociation with independent atrial and ventricular activity. It typically presents with bradycardia and hypotension. Urgent pacing may be required.”

MCCQE1 Objectives (Cardiology > 34-2: Bradyarrhythmias and Conduction Disorders):

“Candidates must identify complete heart block and recognize its clinical urgency.”

Ruling out other options:

A. Sinus bradycardia would show regular P waves with 1:1 P-QRS conduction.

B. First-degree AV block has prolonged PR intervals (>200 ms) but all P waves are conducted.

D. Junctional escape rhythm may present with bradycardia, but P waves would be absent, inverted, or occur after QRS complexes.

E. Mobitz type I (Wenckebach) has progressively lengthening PR intervals before a dropped QRS.

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Comprehensive and Detailed Explanation:

This neonate likely has gonococcal conjunctivitis, which typically presents 2–5 days after birth with bilateral purulent discharge and swelling. This is an emergency due to the risk of corneal perforation. Empiric IV antibiotics and hospital admission are indicated.

Toronto Notes 2023 – Pediatrics, Neonatal Infections:

“Neonatal conjunctivitis within the first 1–2 weeks should raise suspicion for gonococcal or chlamydial infection. Gonorrhea requires urgent IV antibiotics and hospitalization.”

MCCQE1 Objectives – Pediatrics > Neonatal Infection:

“Candidates must recognize neonatal conjunctivitis and initiate empiric treatment while awaiting culture results.”

Lacrimal massage (E) and warm compresses (D) are used for nasolacrimal duct obstruction. Oral or topical antibiotics (B, C) are insufficient for suspected gonococcal infection.

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Comprehensive and Detailed Explanation:

The authority to license and regulate physicians to practise medicine is held by the medical regulatory colleges in each province or territory (e.g., CPSO in Ontario, CPSBC in BC).

MCC Objectives (ELOM > 90-1: Medical Regulation in Canada):

“Licensure to practise medicine is granted by the provincial or territorial medical regulatory authority.”

Toronto Notes 2023 – Ethics and Canadian Health Care System:

“Medical regulatory colleges determine physician licensure and discipline in each jurisdiction.”

The CFPC/RCPSC (C) certify physicians, not license them. Ministries of Health (A) oversee health policy, not licensing. Associations (E) advocate for physicians but do not regulate. Hospital boards (B) grant privileges, not licenses.

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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The levonorgestrel-releasing intrauterine system (LNG-IUS) is the first-line treatment for heavy menstrual bleeding, particularly in women with risk factors for endometrial hyperplasia and contraindications to systemic hormones (e.g., morbid obesity, diabetes, OSA).

Toronto Notes 2023 – Gynecology, “Abnormal Uterine Bleeding” Section:

“The LNG-IUS is highly effective in reducing menstrual bleeding and improving hemoglobin levels. It is particularly recommended in women with obesity, chronic anovulation, or contraindications to estrogen.”

MCCQE1 Objectives (Obstetrics and Gynecology > 82-1: Abnormal Uterine Bleeding):

“Candidates must consider the LNG-IUS as a preferred non-surgical treatment for chronic heavy menstrual bleeding when endometrial pathology has been excluded.”

Oral contraceptives (C) are not first-line in morbid obesity due to increased thromboembolic risk. Cyclic medroxyprogesterone (D) is less effective than LNG-IUS. Hysterectomy (A) is definitive but should follow failure of conservative therapy.

Fibroadenomas can grow slightly or fluctuate in size. A minimal increase (from 1.5 cm to 1.7 cm) over six months is clinically insignificant. No malignant features are reported, and the previous biopsy confirmed benign nature. Annual follow-up is appropriate.

Toronto Notes 2023 – Obstetrics and Gynecology, “Breast Disorders” Section:

“Fibroadenomas are benign breast masses that may slightly enlarge. Routine imaging follow-up at 6 to 12 months is appropriate for lesions with benign imaging and histology.”

MCCQE1 Objectives (Obstetrics and Gynecology > 82-3: Breast Mass):

“Candidates must distinguish between benign and suspicious masses and determine appropriate intervals for follow-up imaging.”

Repeat biopsy (A) or surgery (B) is unwarranted without suspicious change. MRI (C) is not needed in stable, benign lesions. Tamoxifen (D) is not used for fibroadenomas.

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