Medical Council of Canada MCCQE Part 1 Sample Questions:

1. 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?

A) Idiopathic thrombocytopenic purpura.
B) Vitamin K deficiency.
C) Disseminated intravascular coagulation.
D) Heparin-induced thrombocytopenia.
E) Thrombotic thrombocytopenic purpura.

2. A 62-year-old man (wealthy philanthropist) with emphysema from smoking and a 21-year-old woman (elementary teacher) with cystic fibrosis are both compatible matches for a lung transplant. Which criterion determines organ allocation?

A) The date the patient was placed on the waiting list.
B) The clinical severity of the patient's pulmonary disease.
C) Whether the underlying condition is due to self-induced illness.
D) The patient's value and contributions to society.
E) The patient has family members who rely on them for income.

3. A 68-year-old man with a history of diabetes, hypertension, delirium tremens, and tobacco addiction comes to the Emergency Department with his daughter. She tells you that his behavior has become unmanageable and she feels he may require an increased level of care. His vital signs are:
Blood pressure: 162/105 mm Hg
Heart rate: 112/min, regular
Temperature: 37.8°C
On history, his daughter explains she had to confiscate a half-empty bottle of alcohol from his room yesterday. He is now convinced that there are bugs crawling all over him and he will not relax. He appears pale, sweaty, and shaky. His most recent blood glucose is 7.8 mmol/L (3.8-11.1). Which one of the following is the best next step?

A) Consult a Geriatric Psychiatrist to assess the patient.
B) Provide the family member with a prescription of antipsychotics for the patient.
C) Interview the patient in private to ensure this is not a case of elder abuse.
D) Administer benzodiazepines and intravenous hydration.

4. A 55-year-old man with alcohol use disorder presents with a 2-day history of confusion. On examination, you note a sixth nerve palsy and a horizontal nystagmus. Which one of the following is the most likely diagnosis?

A) Cerebellar hemorrhage
B) Cerebellar degeneration
C) Hepatic encephalopathy
D) Wernicke encephalopathy
E) Subdural hematoma

5. A couple is diagnosed with primary infertility secondary to azoospermia. They are not interested in in vitro fertilization techniques, so you recommend insemination with a sperm donor. The male partner is hesitant. He thinks he might have difficulty accepting raising a child who is not biologically his. Which one of the following is the best next step?

A) Tell the couple adoption is a better option
B) Suggest transfer of care to another physician
C) Recommend that the donor be a person who is known and significant to the couple
D) Propose a trial of ovulation induction with gonadotropins
E) Arranging a consultation with a psychologist

Solutions: