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Free PDF Quiz Unparalleled Medical Council of Canada - Authorized MCCQE Pdf

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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q209-Q214):

NEW QUESTION # 209
A 30-year-old woman presents to your office with a 6-week history of left lower quadrant pain and dyspareunia. A pelvic ultrasound is normal. Which one of the following is the most important immediate investigation?

A. Cervical swabs
B. Laparoscopy
C. Hysterosalpingography
D. Endometrial biopsy
E. Magnetic resonance imaging

Answer: A

Explanation:
This clinical presentation is highly suggestive of chronic pelvic inflammatory disease (PID), especially given the left lower quadrant pain and dyspareunia with a normal pelvic ultrasound. PID is often caused by sexually transmitted infections (STIs), such as Chlamydia trachomatis or Neisseria gonorrhoeae, which may not be evident on imaging.
Toronto Notes 2023 - Gynecology:
"Cervical swabs for N. gonorrhoeae and C. trachomatis are essential in the workup of suspected PID or cervicitis, even when imaging is normal. Dyspareunia and chronic pelvic pain with normal imaging should prompt testing for STIs." MCCQE1 Objectives (Obstetrics & Gynecology > 82-6: Pelvic Pain):
"Candidates must consider and investigate for infectious causes of pelvic pain, including PID, which requires cervical swab testing as an essential first-line investigation." Laparoscopy (A) is invasive and reserved for uncertain or refractory cases. Hysterosalpingography (C) is used in infertility workups, not acute pain. Endometrial biopsy (D) and MRI (E) are not first-line.

NEW QUESTION # 210
You are counselling the wife of a 75-year-old man admitted under your care after a fall. The patient is confused, disoriented, barely sleeps at night and has complex visual hallucinations of animals running through his room. Given his state, which one of the following is the best advice for the wife?

A. She should visit him as little as possible since this can lead to heightened agitation
B. She should confront him with the fact that what he sees and feels is not real
C. She should not take it personally if he says hurtful things
D. She should tell him that she will not come back to visit him if he remains aggressive
E. She should avoid giving him information since he is unable to understand

Answer: C

Explanation:
This scenario describes acute delirium, common in hospitalized elderly patients. Patients may say things they don't mean. Reassuring family members not to take hurtful comments personally is an important part of family counseling.
Toronto Notes 2023 - Geriatrics, "Delirium":
"Patients may become agitated, hallucinate, or be aggressive. Families should be counseled not to take the behavior personally and continue to support orientation." MCCQE1 Objectives (Geriatrics > 41-1: Cognitive Disorders):
"Candidates must support caregivers of delirious patients, providing guidance on managing emotional and behavioral symptoms." Avoiding visits (A), confronting the patient (C), or emotional withdrawal (E) are counterproductive.
Providing gentle information is appropriate (contradicts B).

NEW QUESTION # 211
An 87-year-old man presents with a 2-week history of stiffness in both shoulders and both hips. On further questioning, he tells you that he has experienced a 2 kg unintentional weight loss over the last month. His past medical history is otherwise unremarkable and he is on no medications. On examination, he has limited range of motion due to pain in his shoulders and hips. The remainder of his examination, including muscle strength and joint exam, is normal. Which one of the following will you specifically ask about regarding his history?

A. Tremor
B. Anhedonia
C. Night sweats
D. Recent diarrheal illness
E. Unilateral headache

Answer: E

Explanation:
Comprehensive and Detailed Explanation:
This is a classic presentation of polymyalgia rheumatica (PMR), characterized by pain and stiffness in the shoulders and hips in older adults. PMR is closely associated with giant cell arteritis (GCA), which presents with unilateral headache, jaw claudication, visual symptoms, and scalp tenderness. Given the risk of vision loss with GCA, it's critical to screen for these symptoms in all patients with suspected PMR.
Toronto Notes 2023 - Rheumatology, PMR and GCA:
"Patients with PMR should be assessed for symptoms of GCA such as headache, visual changes, and jaw claudication. GCA can result in permanent vision loss if not promptly treated." MCCQE1 Objectives - Internal Medicine > Rheumatology:
"Candidates must identify signs of GCA in patients with PMR and understand the need for prompt diagnosis and treatment."

NEW QUESTION # 212
You are counselling a couple that is concerned about the risk that their second child could be affected by the same X-linked recessive disorder (hemophilia A) as their last child, a boy. Neither parent has this disorder.
What is the probability that their second child will be affected?

A. 25% if the child is a girl
B. 25% if the child is a boy
C. 50% if the child is a girl
D. 50% if the child is a boy
E. 100% whether the child is a boy or a girl

Answer: D

Explanation:
Comprehensive and Detailed Explanation:
In X-linked recessive disorders such as hemophilia A, carrier mothers (usually asymptomatic) have a 50% chance of passing the affected X chromosome to each son, who would then express the disease. Each daughter has a 50% chance of being a carrier but is generally not affected.
Toronto Notes 2023 - Genetics:
"X-linked recessive inheritance: Carrier mother has a 50% chance of having an affected son and a 50% chance of having a carrier daughter." MCCQE1 Objectives (Genetics > 61-1: Inheritance Patterns):
"Candidates must apply principles of X-linked inheritance to assess risk in offspring." If the mother is a known carrier (as inferred from having an affected son), the chance of a second affected boy is 50%.

NEW QUESTION # 213
A 48-year-old woman presents with a 2-year history of regular, heavy menstrual flow. She has a BMI of 54, poorly controlled type 2 diabetes, and obstructive sleep apnea. Laboratory results are as follows:
Hemoglobin: 82 g/L (123-157)
Ferritin: 6 µg/L (11-307)
Endometrial biopsy: Absence of hyperplasia or malignancy
Transvaginal ultrasound:
* Uterus: 12 cm × 8.2 cm × 6 cm
* Intramural fibroids
* Endometrial thickness: 14 mm
* Ovaries: Normal
Which one of the following is the best next step?

A. Cyclic medroxyprogesterone
B. Continuous combined oral contraception
C. Hysterectomy
D. Levonorgestrel-releasing intrauterine system

Answer: D

Explanation:
The levonorgestrel-releasing intrauterine system (LNG-IUS) is the first-line treatment for heavy menstrual bleeding, particularly in women with risk factors for endometrial hyperplasia and contraindications to systemic hormones (e.g., morbid obesity, diabetes, OSA).
Toronto Notes 2023 - Gynecology, "Abnormal Uterine Bleeding" Section:
"The LNG-IUS is highly effective in reducing menstrual bleeding and improving hemoglobin levels. It is particularly recommended in women with obesity, chronic anovulation, or contraindications to estrogen." MCCQE1 Objectives (Obstetrics and Gynecology > 82-1: Abnormal Uterine Bleeding):
"Candidates must consider the LNG-IUS as a preferred non-surgical treatment for chronic heavy menstrual bleeding when endometrial pathology has been excluded." Oral contraceptives (C) are not first-line in morbid obesity due to increased thromboembolic risk. Cyclic medroxyprogesterone (D) is less effective than LNG-IUS. Hysterectomy (A) is definitive but should follow failure of conservative therapy.

NEW QUESTION # 214
......

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Evan Ward Evan Ward

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