Free Practice Questions for Medical Council of Canada MCCQE Exam

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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This patient has a grade III splenic laceration successfully managed non-operatively. MCCQE surgical objectives emphasize that in hemodynamically stable patients, non-operative management (NOM) is standard for many blunt splenic injuries to preserve splenic function. Because the spleen remains intact, vaccination against encapsulated organisms is not required (this is indicated after splenectomy or functional asplenia).

Prior to discharge, the most important counseling point is activity restriction to reduce the risk of delayed splenic rupture. Patients are advised to avoid vigorous physical activity, contact sports, and heavy lifting for approximately 3 months , depending on injury severity and follow-up imaging protocols. This allows adequate healing of splenic parenchyma.

Routine interval splenectomy is not indicated after successful NOM. Angiography with embolization is reserved for ongoing bleeding or vascular blush on imaging. Weekly hemoglobin checks are not routinely required if the patient is clinically stable.

Thus, counseling regarding avoidance of vigorous activity is the key discharge recommendation.

Comprehensive and Detailed Explanation:

Decreased libido in elderly patients can be multifactorial, but depression is a common and important cause that must be ruled out before hormone therapy or other steps. A proper mental health screen should precede further interventions.

Toronto Notes 2023 – Psychiatry / Geriatrics:

“In elderly men, reduced libido may be linked to depression, medical illness, or medications. Depression screening is essential.”

MCCQE1 Objectives (Psychiatry > 71-1: Mood Disorders / Sexual Health):

“Candidates must consider depression as a common cause of decreased libido and assess accordingly before initiating hormone therapy.”

Testosterone testing (D) may follow. Prescribing (C) is premature. Couples counselling (B) may help if interpersonal issues are identified. Interviewing together (A) may inhibit disclosure.

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Comprehensive and Detailed Explanation:

The combination of upper extremity hypertension and weak femoral pulses is classic for aortic coarctation. A soft systolic murmur may be present. This condition often becomes apparent during routine screening in school-aged children.

Toronto Notes 2023 – Pediatrics / Cardiology:

“Coarctation of the aorta presents with upper limb hypertension, diminished femoral pulses, and sometimes a systolic murmur. BP discrepancy is key.”

MCCQE1 Objectives (Pediatrics > 78-1: Congenital Heart Disease):

“Candidates must recognize signs of aortic coarctation, including weak lower limb pulses and systemic hypertension in children.”

VSD (A) typically presents with a louder murmur. Reflux nephropathy (B) may cause hypertension but without femoral pulse discrepancy. Renal artery thrombosis (C) is rare. Essential hypertension (D) is less likely in this age group with these findings.

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This child presents with “red flag” features for malignancy: a firm, fixed, nontender supraclavicular lymph node > 2 cm in size, with associated hepatosplenomegaly and night sweats. These features are most concerning for lymphoma.

Toronto Notes 2023 – Pediatrics, “Lymphadenopathy in Children”:

“Malignant lymphadenopathy tends to be firm, fixed, painless, and located in supraclavicular areas. Systemic signs (fever, weight loss, hepatosplenomegaly, night sweats) are concerning for lymphoma.”

MCCQE1 Objectives (Pediatrics > 78-3: Hematology/Oncology):

“Candidates should differentiate between benign and malignant lymphadenopathy and recognize features suggestive of lymphoma.”

Cat-scratch disease (B) is usually tender and associated with cat exposure. Kawasaki disease (C) presents with fever and mucocutaneous findings. Acute bacterial lymphadenitis (D) is painful, warm, and rapid in onset. Viral lymphadenopathy (E) is often bilateral, small, and tender.

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Comprehensive and Detailed Explanation:

Providing clinical advice (particularly treatment advice) without formally seeing or evaluating the patient creates a physician-patient relationship, potentially establishing a duty of care. If the advice leads to harm, you could be found liable, even if you never saw the patient directly.

Toronto Notes 2023 – Legal Medicine:

“Giving specific medical advice about diagnosis or treatment may imply a physician-patient relationship and establish duty of care.”

MCCQE1 Objectives (ELOM > 90-2: Legal Risk Management):

“Candidates must understand that liability can arise from informal consultations where medical advice is given.”

Providing advice (D) is riskier than simply hearing about a case or patient (A, C). Recommending consultation (B) does not establish duty of care. Not seeing the patient (E) does not automatically shield from liability if treatment advice was given.

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This child has pancytopenia (severe thrombocytopenia, leukopenia, and anemia) plus systemic symptoms (fatigue, intermittent fever) and hepatosplenomegaly, strongly suggesting bone marrow failure/infiltration, most commonly acute lymphoblastic leukemia (ALL) in this age group. MCCQE objectives emphasize recognizing red flags for childhood malignancy: unexplained bruising/petechiae from thrombocytopenia, recurrent or persistent fever, pallor, and organomegaly due to leukemic infiltration or extramedullary hematopoiesis.

Immune thrombocytopenia typically causes isolated thrombocytopenia with otherwise normal hemoglobin and WBC count and usually no hepatosplenomegaly. Iron deficiency anemia causes microcytic anemia but does not explain profound thrombocytopenia and leukopenia. Viral illness may transiently suppress counts but is less likely to cause marked pancytopenia with significant organomegaly. Bacterial sepsis can cause thrombocytopenia but usually presents with acute toxicity and does not typically produce this pattern of sustained pancytopenia and hepatosplenomegaly.

Next steps (clinically) would include urgent peripheral smear, oncology referral, and bone marrow evaluation.

In a patient presenting with physical symptoms (e.g., hip pain) and prominent psychosocial red flags — loss of interest, decreased libido, and withdrawal — the next step is to screen for depression. Somatization is common in mood disorders.

Toronto Notes 2023 – Psychiatry, Depression:

“Patients with depression may present with somatic complaints. A thorough psychosocial assessment is essential in such cases, particularly when symptoms interfere with functioning.”

MCCQE1 Objectives – Psychiatry > Mood Disorders:

“Candidates must consider depression in patients with non-specific physical symptoms and reduced interest or motivation, particularly with social withdrawal.”

Imaging or physiotherapy may be needed later, but the most urgent and informative step is psychiatric screening.

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A mood journal is a structured tool that allows the patient to record mood fluctuations, triggers, and timing. It is particularly helpful in identifying mood disorders such as premenstrual dysphoric disorder, bipolar disorder, or cyclothymia.

Toronto Notes 2023 – Psychiatry, Mood Disorders:

“Mood diaries are useful in identifying temporal patterns, such as menstrual cycle–linked mood changes, and in distinguishing between affective disorders.”

MCCQE1 Objectives – Psychiatry > Diagnostic Evaluation:

“Candidates should use clinical tools such as symptom diaries to assist in establishing the pattern and nature of psychiatric symptoms.”

Personality testing (A) is not first-line. Urine drug screen (B) is only indicated with suspicion of substance use. Lorazepam (D) treats symptoms, not diagnosis. Interviewing the boyfriend (E) may help, but only as a supplement to direct observation and self-report.

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