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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q164-Q169):

NEW QUESTION # 164
A 78-year-old woman is brought to the Emergency Department by her son because she has a sodium level of
124 mmol/L (136-146). The sodium was checked as part of a blood work panel ordered by her primary health care provider to investigate symptoms of urinary frequency, fatigue, and thirst. Today, she has a blood glucose level of 44.0 mmol/L (4.0-11.0). The original blood work done by her primary health care provider did not include glucose. The patient is treated for hyperglycemia and dehydration and begins insulin. The patient and her son repeatedly express their frustration that their primary health care provider missed the diagnosis. Which one of the following is the best next step?

A. Call the primary health care provider to alert them to their oversight
B. Offer to find an alternate health care provider to assume the patient's primary care
C. Report the primary health care provider to the provincial or territorial medical regulatory authority
D. Explain that routine glucose screening was not indicated
E. Empathize with the patient and her son and agree that the health care provider did not meet the standard of care

Answer: A

Explanation:
In situations involving potential oversight, the appropriate next step is to contact the other physician directly.
This supports collegial communication, continuity of care, and provides an opportunity to clarify the clinical situation. It avoids premature judgment while allowing the primary provider to respond and address concerns.
Toronto Notes 2023 - ELOM, "Professionalism and Interprofessional Communication":
"When concerns arise about another provider's care, direct communication is preferred before considering formal reporting. This maintains collaboration and fairness." MCCQE1 Objectives (ELOM > 90-2: Communication and Accountability):
"Candidates must demonstrate collegiality and appropriate methods for addressing concerns regarding another physician's care." Empathizing (D) and validating blame is unprofessional. Reporting (B) is premature. Offering another provider (C) could undermine continuity. (E) is incorrect since the glucose should have been checked based on the presenting symptoms.

NEW QUESTION # 165
You are a physician working at a university campus health centre. Staff at the centre are thinking about initiating a campus-wide education campaign on stimulant medication use and misuse. From a physician's perspective, which one of the following is the key message to include in this campaign?

A. Ethical perspectives regarding nonprescription stimulant medication use.
B. Legal perspectives regarding nonprescription stimulant medication use.
C. Improvement of study habits through educational initiatives.
D. Adverse effects and health risks associated with stimulant medication use.
E. Prevalence of stimulant medication use by students on university campuses.

Answer: D

Explanation:
The key public health message from a physician's perspective is the evidence-based health risks and adverse effects associated with nonprescribed stimulant use (e.g., insomnia, anxiety, cardiovascular events, and dependency). This is central to a harm-reduction approach.
Toronto Notes 2023 - Public Health & Psychiatry, Substance Use:
"Misuse of prescription stimulants is common among university students. Education campaigns should emphasize medical risks including cardiovascular complications, addiction potential, and psychiatric disturbances." MCCQE1 Objectives - Preventive Medicine > Health Promotion:
"Candidates should identify core messages in public education campaigns, prioritizing evidence-based risks and harm reduction." Legal and ethical issues (B, C) are important but secondary to the health implications. Prevalence data (D) informs the campaign design, but is not the message itself. Study habits (A) are relevant for academic counseling, not medical messaging.

NEW QUESTION # 166
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?

A. Dating error
B. Bicornuate uterus
C. Partial hydatidiform mole
D. Oligohydramnios
E. Intrauterine growth restriction

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.
-

NEW QUESTION # 167
You are examining a newborn in the delivery room. He was born at full term by spontaneous vaginal delivery.
On examination, he is active, and his vital signs are within normal range. His head circumference is at the third percentile, with height and weight at the 10th percentile. Auscultation of his chest is clear with normal cardiovascular examination findings. The abdomen is protuberant with a liver edge palpable at 4 cm below the costal margin and mild splenomegaly. Which one of the following is the most likely diagnosis?

A. Congenital viral infection
B. Lipid storage disease
C. Cystic fibrosis
D. Cephalic molding
E. Trisomy 21

Answer: A

Explanation:
Microcephaly, intrauterine growth restriction, hepatosplenomegaly, and normal vital signs in a term newborn strongly suggest congenital viral infection (e.g., CMV, toxoplasmosis, rubella).
Toronto Notes 2023 - Pediatrics, Congenital Infections:
"Signs of congenital TORCH infections include microcephaly, hepatosplenomegaly, and growth restriction.
Early identification is key."
MCCQE1 Objectives - Pediatrics > Infectious Disease:
"Candidates must recognize signs suggestive of congenital infections and distinguish from genetic or structural abnormalities." Cephalic molding (A) is benign and resolves spontaneously. Lipid storage diseases (B) are not present at birth. Cystic fibrosis (C) does not cause microcephaly or hepatosplenomegaly at birth. Trisomy 21 (D) has distinct dysmorphic features not described here.

NEW QUESTION # 168
A 37-year-old man presents with chronic back, neck, and shoulder pain following a workplace injury 4 years ago. He has a history of alcohol misuse and PTSD related to the incident. Current medications (acetaminophen, naproxen, amitriptyline, gabapentin) provide inadequate pain relief. He requests oxycodone after self-trialing it with temporary benefit. After history and physical assessment, which one of the following is the best next step?

A. Ordering repeat imaging of the spine and shoulder to confirm the diagnosis.
B. Prescribing a low-dose, long-acting opioid and reassessing in 1 week for effectiveness.
C. Prescribing a short course of a short-acting opioid to be used only as needed.
D. Referring the patient to substance use and mental health support services.
E. Prescribing cannabis.

Answer: D

Explanation:
The patient has chronic non-cancer pain with comorbid PTSD and alcohol misuse - high-risk factors for opioid use disorder. Before any opioid prescribing, a comprehensive interdisciplinary approach including mental health and substance use support is essential.
Toronto Notes 2023 - Pain Management and Addiction Medicine:
"In chronic pain patients with substance use or mental health comorbidities, refer to addiction/mental health services before considering opioid therapy." MCCQE1 Objectives (ELOM > 99-4: Safe Prescribing):
"Candidates must assess for substance use risk factors and manage chronic pain using a multidisciplinary approach." Imaging (A) is unlikely to alter management. Opioids (B, C) should not be first-line in this context. Cannabis (E) is not first-line and lacks robust evidence in complex chronic pain.

NEW QUESTION # 169
......

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