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Medical Council of Canada MCCQE Sure Pass & MCCQE Brain Exam

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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q193-Q198):

NEW QUESTION # 193
A 59-year-old woman is referred to you because of a 2-month history of left nipple discharge. She is otherwise healthy and is not on any medication. There are no palpable lesions on breast examination. She is able to express a small amount of blood-tinged liquid from her breast. Which one of the following would be the best next step?

A. Serum prolactin.
B. Mammography.
C. Magnetic resonance imaging of breast.
D. Galactography.
E. Biopsy of nipple complex.

Answer: B

Explanation:
Spontaneous, unilateral, blood-tinged nipple discharge in a postmenopausal woman is considered pathologic and warrants imaging to rule out intraductal pathology including malignancy. The best initial test is diagnostic mammography, often with ultrasound if indicated.
Toronto Notes 2023 - Breast Disorders:
"Unilateral, spontaneous, bloody nipple discharge should be evaluated with mammography and targeted ultrasound. Further tests such as MRI or duct excision are based on findings." MCCQE1 Objectives (Gynecology > 81-1: Breast Conditions):
"Candidates must recognize red flags for breast malignancy and apply appropriate initial diagnostic imaging." Serum prolactin (C) is indicated in galactorrhea. Galactography (D) and MRI (E) are second-line. Biopsy (A) is premature without imaging.

NEW QUESTION # 194
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. Prescribing cannabis.
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. Ordering repeat imaging of the spine and shoulder to confirm the diagnosis.
E. Referring the patient to substance use and mental health support services.

Answer: E

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 # 195
A 72-year-old man presents to your clinic with worsening lower leg edema. He has hypertension, type 2 diabetes, and a history of heavy drinking. On examination, he is pale and has a BMI of 35. Vital signs are as follows:
Blood pressure: 110/60 mm Hg
Heart rate: 102/min
Temperature: Afebrile
His jugular venous pressure is 4 cm above the sternal angle. Cardiac auscultation is normal, and his lungs are clear. His liver is not palpable; he has abdominal distension, bulging flanks, and pitting edema below the knees. While awaiting test results, which one of the following is the best next step?

A. Compression stockings
B. Sodium restriction
C. Ramipril
D. Nadolol
E. Lactulose

Answer: B

Explanation:
This patient has signs suggestive of decompensated liver cirrhosis (ascites, peripheral edema, low-normal BP, alcohol use, abdominal distension). Sodium restriction is the cornerstone of first-line management to prevent fluid retention in cirrhotic ascites.
Toronto Notes 2023 - Gastroenterology, "Cirrhosis and Ascites" Section:
"Sodium restriction (<2 g/day) is the most important non-pharmacologic management for ascites. Fluid restriction is added only in cases of severe hyponatremia." MCCQE1 Objectives (Internal Medicine > 76-5: Liver Disease):
"Candidates must manage ascites conservatively using sodium restriction, with diuretics added as needed." Lactulose (E) is used for hepatic encephalopathy, not ascites. Ramipril (B) may worsen renal function in cirrhosis. Nadolol (C) is used for variceal bleeding prophylaxis. Compression stockings (D) are not helpful in ascites-related edema.

NEW QUESTION # 196
A 38-year-old marathon runner presents to your office with a 6-month history of increasing right hip pain.
The pain is worse with acclivity and has prevented him from running for the last 4 months. He denies fever or chills. His wife adds that she is concerned because he is increasingly disengaged with the family and not interested in other activities he usually enjoys, including sex. Which one of the following is the best next step in management?

A. Short course of anti-inflammatory medications.
B. Further inquiry into depressive symptoms.
C. Magnetic resonance imaging of the pelvis and right hip.
D. Blood work including inflammatory markers.
E. Physiotherapy for hip strengthening.

Answer: B

Explanation:
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.

NEW QUESTION # 197
An intoxicated 28-year-old man is brought to the Emergency Department after being found in the snow. His vital signs are as follows:
Temperature: 33°C
Respiratory rate: 22/min
Heart rate: 123/min
The patient is shivering and displays some dysarthria and ataxia. After his wet clothing is removed, he is provided with a warm blanket. The results of the subsequent physical examination are unremarkable, except for frostbite of the ears and fingers. Which one of the following is the best next step?

A. Perform a peritoneal lavage.
B. Apply heating pads to extremities.
C. Start continuous arteriovenous rewarming.
D. Set the room temperature to 28°C.
E. Continuous warm bladder irrigation.

Answer: D

Explanation:
This patient is experiencing mild hypothermia (32-35°C), evidenced by shivering, ataxia, and tachycardia.
First-line management includes passive external rewarming - removing wet clothing, providing warm blankets, and ensuring a warm environment (ambient temperature ~28°C).
Toronto Notes 2023 - Emergency Medicine, Environmental Injuries:
"Mild hypothermia (32-35°C): Treatment includes passive rewarming (warm blankets, warm environment).
Avoid active rewarming methods to extremities due to risk of afterdrop." MCCQE1 Objectives - Internal Medicine > Environmental Exposure:
"Candidates must recognize appropriate levels of hypothermia and select evidence-based rewarming strategies based on severity." Options A, C, and D are used in moderate to severe hypothermia (<32°C or unconscious patients). Heating pads (B) may cause tissue damage, especially with frostbite.

NEW QUESTION # 198
......

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