Medical Council of Canada MCCQE Part 1 Sample Questions:

1. A 27-year-old woman presents with an enlarged thyroid. She had not noticed it herself until her mother brought it to her attention. She is asymptomatic from an endocrine perspective, and her serum thyroid- stimulating hormone (TSH) is normal.
Which one of the following is the most appropriate next step?

A) Serum calcium
B) Serum T3 and T4
C) Computed tomography of the neck
D) Fine-needle aspiration of the thyroid
E) Ultrasound of the thyroid

2. A 66-year-old woman has a 3-month history of dry cough and weight loss. A new chest radiograph reveals a large 2-cm mass in her right upper lobe, which is consistent with carcinoma. You look at her previous films and realize that you had read her chest radiograph as normal 1 year ago, but now clearly see a faint opacity in precisely the same location as her current lesion. Which one of the following is the best next step?

A) Prepare a report only after communicating with your department head
B) Create a report only after communicating with your medical regulatory authority
C) Write a report only after communicating with your professional insurer
D) Remark only on the new chest radiograph in your report
E) Comment on the previous chest radiograph and the new one in your report

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

4. A 36-year-old woman presents to the office with a 2-month history of multiple asymptomatic bumps on her vulva. She is not currently sexually active but has had 2 male sexual partners in the past, with the most recent relationship ending 1 year ago. On examination, she appears to have genital warts. She has not received the human papillomavirus (HPV) vaccine and is not interested in any treatment that is not absolutely necessary.
Which of the following is the best next step?

A) Papanicolaou test.
B) Cryotherapy.
C) HPV vaccine.
D) Excisional biopsy.
E) Contact tracing.

5. A 24-year-old woman with chronic anorexia nervosa presents to the Emergency Department with diarrhea, chest pain and palpitations. She is noted to have a BMI of 13, a heart rate of 48/min, significant orthostatic hypotension and a temperature of 35.9 °C. Her electrocardiogram shows frequent premature ventricular contractions. Her blood work indicates elevated liver transaminases and evidence of acute kidney injury from dehydration. She agrees to admission for medical stabilization only if she does not receive fluids either orally or intravenously, as they will cause her to gain weight and to feel bloated. Which one of the following is the best next step?

A) Refuse to admit her unless she agrees to full treatment
B) Ask her if she has a substitute decision-maker
C) Assess her capacity to consent for medical treatment
D) Start intravenous fluids and physically restrain if necessary
E) Obtain a psychiatric consultation

Solutions: