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Medical Council of Canada MCCQE practice test software contains many Medical Council of Canada MCCQE practice exam designs just like the real MCCQE Part 1 Exam (MCCQE) exam. These MCCQE practice exams contain all the MCCQE questions that clearly and completely elaborate on the difficulties and hurdles you will face in the final MCCQE Exam. We update our Medical Council of Canada MCCQE exam questions bank regularly to match the changes and improve the quality of MCCQE questions so you can get a better experience.
| Section | Weight | Objectives |
|---|---|---|
| Physician Activities | 50% | - Management - Communication - Professional Behaviours - Psychosocial Aspects |
| Dimensions of Care | 50% | - Acute Care - Chronic Care - Assessment and Diagnosis - Health Promotion and Illness Prevention |
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NEW QUESTION # 316
A 69-year-old woman with long-standing hypertension presents to the emergency department with a 2-hour history of persistent chest and back pain. A posteroanterior chest radiograph shows suspicious widening of the mediastinal shadow. Which one of the following is most likely to yield a clinical diagnosis?
Answer: D
Explanation:
The presentation is highly suspicious for acute aortic dissection - sudden chest/back pain and mediastinal widening on chest x-ray. The most definitive and widely available test is contrast-enhanced computed tomography (CT) of the chest.
Toronto Notes 2023 - Cardiology, Aortic Dissection:
"CT angiography of the chest is the gold standard for stable patients with suspected aortic dissection. Look for mediastinal widening on chest x-ray as a clue." MCCQE1 Objectives - Internal Medicine > Cardiovascular Disease:
"Candidates should recognize acute aortic dissection and select appropriate imaging, such as CT chest, for diagnosis in stable patients." Transthoracic echo (A) may miss dissections. ECG (C) helps rule out MI but not dissection. V/Q scan (D) and pulmonary angiography (E) are for suspected pulmonary embolism.
NEW QUESTION # 317
A 70-year-old woman presents to the Emergency Department with a 2-day history of dysuria and right flank pain. Upon arrival, she is quite unwell. Her vital signs are as follows: blood pressure 70/38 mm Hg, heart rate
130/min, respiratory rate 24/min, temperature 39.4 °C.
Due to difficulty obtaining peripheral access, a central line is inserted. There is a lot of ongoing bleeding around the line insertion site. Her blood work shows:
White blood cell count: 19.8 × 10#/L (4-10)
Hemoglobin: 101 g/L (123-157)
Platelets: 85 × 10#/L (130-400)
Blood film: schistocytes
INR: 1.9 (0.9-1.2)
Fibrinogen: < 1 g/L (2-4)
Which one of the following is the most likely cause of her ongoing bleeding?
Answer: C
Explanation:
This patient is in septic shock, likely from pyelonephritis, with hypotension, tachycardia, and fever. Her laboratory findings demonstrate thrombocytopenia (platelets 85 × 10#/L), elevated INR, very low fibrinogen (
< 1 g/L), and schistocytes on blood film, along with active bleeding from the central line site. These findings are classic for disseminated intravascular coagulation (DIC).
MCCQE objectives emphasize recognizing DIC as a complication of severe sepsis. In DIC, systemic activation of coagulation leads to widespread microthrombi formation and consumption of platelets and clotting factors (consumptive coagulopathy), resulting in both thrombosis and bleeding. Low fibrinogen and prolonged INR are key distinguishing features.
ITP causes isolated thrombocytopenia without coagulation abnormalities. TTP presents with thrombocytopenia and schistocytes but typically has normal coagulation studies. Heparin-induced thrombocytopenia requires prior heparin exposure and does not cause elevated INR or low fibrinogen.
Vitamin K deficiency causes prolonged INR but does not produce thrombocytopenia or schistocytes.
Thus, DIC secondary to sepsis is the most likely cause of her bleeding.
NEW QUESTION # 318
A 28-year-old woman presents to your office with a 6-month history of intermittent dizziness associated with nausea and a rotational sensation. Physical examination shows pallor of 1 optic disk, generalized hyperreflexia and nystagmus to the left. Which one of the following is the most likely diagnosis?
Answer: C
Explanation:
Multiple sclerosis (MS) is most likely because the patient has vertigo-like symptoms plus objective central neurologic signs : optic disc pallor (suggesting prior optic neuritis with optic atrophy), generalized hyperreflexia (upper motor neuron involvement), and nystagmus (can be central when accompanied by other CNS findings). MCCQE objectives emphasize differentiating peripheral from central causes of vertigo.
Peripheral disorders (labyrinthitis, Meniere disease) typically present with vertigo and nausea but do not cause optic nerve abnormalities or diffuse hyperreflexia . Acoustic neuroma can cause vestibular symptoms but usually features progressive unilateral hearing loss/tinnitus and does not explain optic disc pallor and generalized UMN signs. Prolactinoma causes endocrine symptoms (galactorrhea, amenorrhea, infertility) and may cause bitemporal hemianopia from chiasmal compression, not intermittent vertigo with UMN findings.
MS commonly affects young women and can produce brainstem/cerebellar involvement (vertigo, nystagmus) and optic nerve involvement, with symptoms separated in time, matching a 6-month intermittent course.
NEW QUESTION # 319
A 7-year-old boy is brought to your clinic with a 2-day history of being mildly unwell with malaise and decreased appetite but no fever. This morning, it was discovered that he had oral lesions as shown in the attached image. His mother wonders how she can prevent this from spreading to his younger siblings.
Which one of the following is the best advice?
Answer: B
Explanation:
The clinical presentation of mild prodromal symptoms followed by oral lesions in a school-aged child is most consistent with a viral stomatitis such as primary herpes simplex virus (HSV-1) infection. HSV-1 is highly contagious and is transmitted primarily through direct contact with infected oral secretions. According to MCCQE objectives on pediatric infectious diseases, prevention of transmission relies on appropriate infection control measures, particularly avoidance of sharing utensils, cups, toothbrushes, and minimizing direct contact such as kissing during the active lesion phase. Antibiotics are not indicated because this is a viral infection.
Routine antiviral prophylaxis for healthy siblings is not recommended. Varicella vaccination is unrelated to HSV infection and would not prevent spread. The condition is contagious, especially when lesions are present and viral shedding occurs. Therefore, counseling families regarding strict hand hygiene and avoidance of direct contact with oral secretions is the most appropriate preventive strategy.
NEW QUESTION # 320
A 26-year-old woman, gravida 3, para 2, presents for her 1st antenatal visit. She states she is at 26 weeks' gestation and is healthy. On abdominal examination, her fundus is palpated at the umbilicus. Which one of the following is the most likely explanation for this finding?
Answer: A
Explanation:
Comprehensive and Detailed Explanation:
At 20 weeks' gestation, the uterine fundus typically reaches the umbilicus. If the fundal height is lower than expected at a stated gestational age of 26 weeks, the most likely explanation-especially with no prior care- is a dating error.
Toronto Notes 2023 - Obstetrics:
"Fundal height at the umbilicus corresponds to ~20 weeks. In women lacking early prenatal care, dating errors are common causes of fundal height discrepancy." MCCQE1 Objectives (Obstetrics > 80-3: Routine Antenatal Care):
"Candidates must interpret fundal height and reconcile discrepancies with gestational age." IUGR and oligohydramnios are possible but require imaging confirmation. Bicornuate uterus may cause fundal shape anomalies but not significant dating discrepancy. A mole (D) would increase, not decrease, size.
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NEW QUESTION # 321
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