Medical Council of Canada Qualifying Exam — Questions and Answers

Question 1: Under Canadian law, who is the most appropriate substitute decision-maker for an incapable adult patient with no advance directive?

The attending physician
The provincial public guardian
The hospital ethics committee
The patient's spouse or partner (Correct answer)

Correct answer: The patient's spouse or partner

A spouse or partner is typically the highest-priority substitute decision-maker under most provincial consent legislation in Canada.

Question 2: A 48-year-old man with no cardiac history presents with palpitations, diaphoresis, tremor, and intense fear of dying during discrete 15-minute episodes. ECG and cardiac workup are normal. What is the most likely diagnosis?

Generalized anxiety disorder
Hyperthyroidism
Panic disorder (Correct answer)
Somatic symptom disorder

Correct answer: Panic disorder

Panic disorder is characterized by recurrent unexpected panic attacks with somatic symptoms and fear of dying, with normal medical workup.

Question 3: Which developmental screening tool is validated for use in Canadian primary care settings for children 0–5 years?

Bayley Scales of Infant Development
Griffiths Mental Development Scales
Denver Developmental Screening Test II (Denver II)
Ages and Stages Questionnaires (ASQ) (Correct answer)

Correct answer: Ages and Stages Questionnaires (ASQ)

The Ages and Stages Questionnaires (ASQ) is a widely validated, parent-completed screening tool recommended for use in Canadian primary care for children aged 0–66 months.

Question 4: Which of the following clinical features is most characteristic of a small bowel obstruction (SBO) rather than a large bowel obstruction (LBO)?

Profuse, early-onset bilious vomiting (Correct answer)
A plain abdominal radiograph showing significant colonic gas with haustra
Marked abdominal distension appearing early in the course
Obstipation as a primary presenting feature

Correct answer: Profuse, early-onset bilious vomiting

Early and frequent vomiting, often bilious, is a hallmark of a proximal SBO due to the rapid accumulation of fluid and gas proximal to the obstruction. In LBO, vomiting is typically a late feature, and prominent distension is more characteristic. Obstipation is common to both. Haustra are specific to the large bowel.

Question 5: A 25-year-old woman presents with ascending weakness that began in her feet 2 weeks after a gastrointestinal illness. Deep tendon reflexes are absent bilaterally. CSF shows elevated protein with normal cell count. What is the most likely diagnosis?

Botulism
Multiple sclerosis
Transverse myelitis
Guillain-Barré syndrome (Correct answer)

Correct answer: Guillain-Barré syndrome

Guillain-Barré syndrome presents with ascending flaccid paralysis, areflexia, and albuminocytologic dissociation (high CSF protein, normal cells) often following infection.

Question 6: A 75-year-old man presents with fluctuating cognition, visual hallucinations of animals and people, and parkinsonian features. He is very sensitive to haloperidol. What is the most likely diagnosis?

Parkinson's disease dementia
Vascular dementia
Alzheimer's disease
Lewy body dementia (Correct answer)

Correct answer: Lewy body dementia

Lewy body dementia is characterized by fluctuating cognition, recurrent visual hallucinations, parkinsonism, and severe neuroleptic sensitivity, distinguishing it from other dementias.

Question 7: Researchers wish to investigate a potential link between a rare form of cancer and exposure to a specific industrial solvent. They identify 100 individuals with this cancer and a comparison group of 200 individuals without the cancer, matched for age and sex. They then proceed to collect detailed occupational histories from all participants to determine past exposure to the solvent. Which study design does this best describe?

Cross-Sectional Study
Randomized Controlled Trial
Case-Control Study (Correct answer)
Prospective Cohort Study

Correct answer: Case-Control Study

This is a case-control study. The design starts by identifying individuals with the disease (cases) and a group without the disease (controls), and then looks back retrospectively to compare the frequency of past exposure to a risk factor. This approach is particularly efficient for studying rare diseases.

Question 8: A 23-year-old primigravida at 22 weeks presents with painless cervical dilation of 3 cm and bulging membranes. There are no contractions and no signs of infection. What is the most appropriate intervention?

Emergency caesarean delivery
Bed rest in Trendelenburg position only
Induction of labour given lethal fetal prognosis
Emergency cervical cerclage (Correct answer)

Correct answer: Emergency cervical cerclage

Physical (emergency) cerclage placed for cervical incompetence with dilated cervix and bulging membranes at pre-viable gestational age can prolong pregnancy significantly.

Question 9: A candidate fails MCCQE Part 1 on the first attempt. Before registering for a re-attempt, the most important preparatory step is:

Purchasing every available new Qbank to maximize question exposure
Switching all study materials to USMLE-focused resources for a different perspective
Obtaining the MCC performance feedback report to identify specific weak clinical presentation areas (Correct answer)
Extending the study period by at least 12 months regardless of the score gap

Correct answer: Obtaining the MCC performance feedback report to identify specific weak clinical presentation areas

The MCC provides performance feedback by content category after a failed attempt, enabling targeted remediation rather than undirected re-studying of all content.

Question 10: A 75-year-old patient has been deemed incapable of making medical decisions due to advanced dementia. He does not have a power of attorney for personal care or an advance directive. According to the typical hierarchy of substitute decision-makers (SDMs) in most Canadian provinces, who should the medical team approach first for consent?

The patient's eldest adult child.
A close friend who has known the patient for 40 years.
A court-appointed guardian.
The patient's spouse. (Correct answer)

Correct answer: The patient's spouse.

Most provinces and territories in Canada have legislation that specifies a ranked hierarchy of automatic substitute decision-makers (SDMs) for patients who are incapable of consenting to treatment and have not legally appointed someone. [2, 20] While the exact order can vary slightly, the spouse or partner is consistently ranked at or near the top of the list, above adult children, parents, or siblings. [8, 20] A court-appointed guardian would only be sought if no one higher on the list is available or willing to act. A close friend is typically much lower on the hierarchy, if included at all. [8]

Question 11: A 30-year-old man with alcohol use disorder has his last drink 48 hours ago. He now presents with agitation, tremor, diaphoresis, tachycardia, and a witnessed tonic-clonic seizure. What is the most appropriate immediate treatment?

Haloperidol IM
IV lorazepam (Correct answer)
Oral naltrexone
IV phenytoin

Correct answer: IV lorazepam

IV benzodiazepines (e.g., lorazepam, diazepam) are first-line treatment for alcohol withdrawal seizures and delirium tremens by enhancing GABA-A activity.

Question 12: According to DSM-5 criteria, for a diagnosis of Generalized Anxiety Disorder (GAD), excessive anxiety and worry must be present more days than not for a minimum duration of:

6 months (Correct answer)
2 weeks
3 months
1 month

Correct answer: 6 months

The core time criterion for a diagnosis of Generalized Anxiety Disorder in the DSM-5 is the presence of excessive anxiety and worry occurring more days than not for at least 6 months. This chronicity distinguishes GAD from more transient or situational anxiety.

Question 13: At what age do most children achieve daytime bladder control (daytime continence)?

3–4 years
18–24 months
4–5 years
2–3 years (Correct answer)

Correct answer: 2–3 years

Most children achieve reliable daytime bladder control between ages 2 and 3 years, though nighttime dryness may take longer.

Question 14: A 45-year-old man is brought to the ER after a high-speed MVC. He is hemodynamically stable. CT scan shows a grade III splenic laceration with a small perisplenic hematoma but no active extravasation. What is the appropriate management?

Non-operative management with admission, serial abdominal exams, and bed rest (Correct answer)
Emergent splenectomy
Diagnostic laparoscopy
Non-operative management with angioembolization

Correct answer: Non-operative management with admission, serial abdominal exams, and bed rest

Hemodynamically stable patients with grade I–III splenic lacerations and no active extravasation are candidates for non-operative management with ICU admission, serial exams, and serial hemoglobin monitoring.

Question 15: What is the primary purpose of the MCCQE Part I exam?

To assess medical knowledge and clinical decision-making. (Correct answer)
To evaluate advanced surgical skills.
To determine proficiency in hospital administration.
To test the ability to manage healthcare systems.

Correct answer: To assess medical knowledge and clinical decision-making.

The MCCQE Part I is a national standardized examination designed to evaluate a candidate's fundamental medical knowledge and their ability to apply this knowledge to make sound clinical decisions. It serves as a crucial step for licensure in Canada, ensuring that physicians possess the necessary cognitive skills to practice safely and effectively.

Question 16: What is a recommended resource for studying for the MCCQE Part I?

Textbooks on healthcare management.
Practice Tests and Self-Assessment Tools (SAE). (Correct answer)
Clinical placement reports.
Hospital work experience.

Correct answer: Practice Tests and Self-Assessment Tools (SAE).

Practice Tests and Self-Assessment Tools (SAE) are highly recommended resources for studying for the MCCQE Part I. These tools simulate the exam format and content, allowing candidates to familiarize themselves with question types and assess their knowledge gaps effectively.

Question 17: A patient presents with sudden onset tearing chest pain radiating to the back. BP is 190/100 mmHg in the right arm and 150/80 mmHg in the left arm. CXR shows widened mediastinum. What is the immediate management?

IV nitroprusside alone
IV alteplase
Emergency coronary angiography
IV labetalol first, then nitroprusside for BP target <120/80 (Correct answer)

Correct answer: IV labetalol first, then nitroprusside for BP target <120/80

In type A aortic dissection, heart rate control with IV beta-blocker (labetalol) precedes vasodilator therapy to prevent reflex tachycardia while targeting SBP <120 mmHg.

Question 18: When MCCQE Part II results are released, candidates receive a score report that includes which of the following?

A ranking of the candidate against all prior MCCQE Part II takers
A comparison of their score to every individual candidate in their cohort
An overall pass/fail outcome along with domain-level performance feedback (Correct answer)
Individual question-level feedback detailing which items were answered correctly

Correct answer: An overall pass/fail outcome along with domain-level performance feedback

The MCCQE Part II score report provides an overall pass/fail result and performance feedback organized by competency domains.

Question 19: Which Tanner stage describes the onset of breast development (thelarche) in females?

Tanner stage 1
Tanner stage 2 (Correct answer)
Tanner stage 4
Tanner stage 3

Correct answer: Tanner stage 2

Tanner stage 2 marks the beginning of breast development with a small breast bud, signaling the start of puberty in girls.

Question 20: What document must candidates provide to confirm their eligibility for the MCCQE Part II?

Proof of practice in a clinical setting.
A residency completion certificate.
A valid MCC student or graduate number. (Correct answer)
A reference letter from a supervisor.

Correct answer: A valid MCC student or graduate number.

To confirm eligibility for the MCCQE Part II, candidates must provide a valid MCC student or graduate number. This number is assigned after successful credential verification and passing the MCCQE Part I, signifying their progress through the Canadian medical licensure pathway.

Question 21: A community-based intervention reduces hypertension prevalence by 5 percentage points (from 30% to 25%). What is the absolute risk reduction?

5% (Correct answer)
20%
25%
17%

Correct answer: 5%

Absolute risk reduction = 30% − 25% = 5 percentage points.

Question 22: A 28-year-old G2P1 woman at 26 weeks gestation is undergoing screening for gestational diabetes mellitus (GDM). According to the preferred screening strategy recommended by Diabetes Canada and the SOGC, what is the initial step?

A 50g glucose challenge test (GCT) (Correct answer)
A fasting plasma glucose measurement
A 100g, 3-hour oral glucose tolerance test (OGTT)
A random blood glucose measurement

Correct answer: A 50g glucose challenge test (GCT)

The preferred approach for GDM screening in Canada, recommended by Diabetes Canada and the SOGC, is a two-step process. The initial step is a 50g, 1-hour glucose challenge test (GCT), which can be done at any time of day without fasting. If the result of the GCT is abnormal, the patient then proceeds to the second step, which is a diagnostic 75g or 100g oral glucose tolerance test (OGTT).

Question 23: What is the consequence for a candidate who provides false or misleading information during the MCCQE registration process?

A monetary fine only
Cancellation of registration and possible permanent ineligibility (Correct answer)
A warning letter with no further action
Requirement to retake a professionalism module

Correct answer: Cancellation of registration and possible permanent ineligibility

Providing false information can result in immediate cancellation of the registration and may lead to permanent ineligibility to sit any MCC examination.

Question 24: Which doctrine requires physicians to disclose information that a reasonable patient in the same circumstances would want to know before consenting to treatment?

Modified objective standard (Correct answer)
Therapeutic privilege
Subjective patient standard
Professional practice standard

Correct answer: Modified objective standard

The modified objective standard requires disclosure of what a reasonable patient would want to know, as established in Reibl v. Hughes.

Question 25: A 26-year-old G1P0 at 34 weeks presents with painless, bright red vaginal bleeding. She denies contractions. Ultrasound shows placenta previa. What is the most appropriate next step?

Admit for observation, IV access, crossmatch, and corticosteroids (Correct answer)
Immediate caesarean delivery
Digital cervical exam to assess dilation
Amniotomy to hasten delivery

Correct answer: Admit for observation, IV access, crossmatch, and corticosteroids

Stable placenta previa at 34 weeks warrants expectant management with hospitalization, corticosteroids for fetal lung maturity, and avoidance of digital exam to prevent further hemorrhage.

Question 26: A 17-year-old boy presents with a 9-month history of inattention, hyperactivity, and impulsivity in multiple settings since early childhood, causing academic failure. After diagnosis of ADHD, what is first-line pharmacotherapy in Canada?

Clonidine
Bupropion
Atomoxetine
Stimulant medication (methylphenidate or amphetamine) (Correct answer)

Correct answer: Stimulant medication (methylphenidate or amphetamine)

Stimulant medications (methylphenidate or mixed amphetamine salts) are first-line pharmacotherapy for ADHD across all age groups in Canadian guidelines.

Question 27: A 42-year-old woman undergoes laparoscopic cholecystectomy. On POD 1 she has right upper quadrant pain, rising bilirubin, and bile drain output. HIDA scan shows biliary leak. What is the most common bile duct injury in laparoscopic cholecystectomy?

Clip occlusion of the common hepatic duct
Transection of the common bile duct
Cautery injury to the right hepatic duct
Injury to the cystic duct—CBD junction (Correct answer)

Correct answer: Injury to the cystic duct—CBD junction

The most common bile duct injury in laparoscopic cholecystectomy is a cystic duct stump leak or clip misplacement at the cystic duct–CBD junction due to misidentification of structures.

Question 28: A 72-year-old woman with AF on warfarin (INR 2.5) undergoes elective knee replacement. What is the recommended perioperative anticoagulation strategy for low-to-moderate thromboembolic risk?

Stop warfarin 5 days pre-op with heparin bridging
Stop warfarin 5 days pre-op without bridging (Correct answer)
Switch to aspirin perioperatively
Continue warfarin throughout surgery

Correct answer: Stop warfarin 5 days pre-op without bridging

For AF patients with low-to-moderate thromboembolic risk (CHA₂DS₂-VASc <4), warfarin is held 5 days pre-op without bridging anticoagulation to reduce bleeding.

Question 29: A factory worker cohort has higher lung disease rates than the general population. Comparing to the general population introduces which bias?

Hawthorne effect
Recall bias
Healthy worker effect (Correct answer)
Berkson bias

Correct answer: Healthy worker effect

The healthy worker effect occurs because employed populations are generally healthier than the general population, underestimating occupational risks.

Question 30: A 72-year-old man with a known 5.5 cm abdominal aortic aneurysm presents with sudden onset severe back and flank pain, hypotension, and a pulsatile abdominal mass. BP is 80/50. What is the immediate management priority?

Permissive hypotension targeting SBP 50-70 mmHg and emergent surgical repair (Correct answer)
IV fluid resuscitation to normalize blood pressure before surgery
Endovascular aortic repair (EVAR) as first-line
CT angiography to confirm rupture

Correct answer: Permissive hypotension targeting SBP 50-70 mmHg and emergent surgical repair

Ruptured AAA is a surgical emergency; permissive hypotension (SBP 50–70 mmHg) is maintained to reduce further hemorrhage while rushing the patient to the OR for open or endovascular repair.

Question 31: A physician is called to testify as an expert witness in a malpractice case. What is their primary duty?

Advocate strongly for the side that retained them
Avoid disclosing information that might harm a colleague
Protect the reputation of the medical profession
Provide impartial, objective evidence to assist the court (Correct answer)

Correct answer: Provide impartial, objective evidence to assist the court

Expert witnesses have a duty to the court to provide honest, objective, and impartial testimony regardless of who retained them.

Question 32: A 50-year-old man presents with grandiose delusions that he has been chosen to lead the country, decreased need for sleep, pressured speech, and reckless spending for 10 days. He has no insight. What is the acute treatment of choice?

Cognitive behavioural therapy alone
Antipsychotic with or without a mood stabilizer (Correct answer)
Start an SSRI alone
Lithium monotherapy for acute mania

Correct answer: Antipsychotic with or without a mood stabilizer

Acute mania with psychotic features requires an antipsychotic, often combined with a mood stabilizer such as lithium or valproate, for rapid symptom control.

Question 33: A 29-year-old woman at 20 weeks is found to have cervical length of 18 mm on transvaginal ultrasound during routine anatomy scan. She had a second-trimester loss last pregnancy. What is the most appropriate management?

Immediate induction of labour
Cervical cerclage placement (Correct answer)
Progesterone suppositories alone
Bed rest and pelvic rest only

Correct answer: Cervical cerclage placement

Women with prior second-trimester loss and short cervix benefit from cervical cerclage to reduce the risk of recurrent preterm birth.

Question 34: A healthy term infant's birth weight is 3.2 kg. By what age should this infant regain birth weight after the expected physiological weight loss?

3–5 days
21 days
7–10 days
14 days (Correct answer)

Correct answer: 14 days

Neonates typically lose up to 7–10% of birth weight in the first few days and should regain birth weight by 10–14 days of life.

Question 35: Following a large company picnic, 45 of the 100 employees who ate potato salad developed gastroenteritis, while 10 of the 200 employees who did not eat the potato salad developed the same symptoms. What is the primary purpose of calculating the attack rates for these two groups?

To establish the incubation period of the pathogen.
To calculate the odds ratio of the exposure.
To identify the likely source of the foodborne outbreak. (Correct answer)
To determine the case-fatality rate of the illness.

Correct answer: To identify the likely source of the foodborne outbreak.

Calculating and comparing attack rates between exposed and unexposed groups is a fundamental step in an outbreak investigation to identify the source. In this case, the attack rate for those who ate the salad is 45/100 (45%), and for those who did not, it's 10/200 (5%). The significantly higher attack rate in the exposed group strongly implicates the potato salad as the source of the outbreak.

Question 36: A 60-year-old man presents with a 3-week history of depressed mood, anhedonia, psychomotor retardation, and 10 lb weight loss following his wife's death 2 months ago. Which finding most supports a diagnosis of MDD rather than normal bereavement?

Feeling sad on anniversaries
Dreaming about the deceased
Persistent tearfulness
Marked functional impairment and suicidal ideation (Correct answer)

Correct answer: Marked functional impairment and suicidal ideation

Marked functional impairment and suicidal ideation distinguish major depressive disorder from normal grief, which typically does not involve suicidality.

Question 37: A 55-year-old man undergoes elective right hemicolectomy. On post-operative day 3 he develops fever, tachycardia, and worsening abdominal pain with peritoneal signs. CT shows free air and fluid. What is the most likely diagnosis and appropriate next step?

C. difficile colitis — oral vancomycin
Wound infection — open wound and antibiotics
Anastomotic leak — return to OR for washout and stoma creation (Correct answer)
Ileus — nasogastric decompression

Correct answer: Anastomotic leak — return to OR for washout and stoma creation

Post-operative peritonitis with free air on POD 3 after bowel resection is anastomotic leak until proven otherwise, requiring urgent surgical re-exploration, washout, and fecal diversion.

Question 38: A 7-year-old boy is brought in for short stature. He is growing at 4 cm/year. Bone age is 7 years. Thyroid function and IGF-1 are normal. What is the most likely diagnosis?

Growth hormone deficiency
Hypothyroidism
Familial short stature (Correct answer)
Constitutional growth delay

Correct answer: Familial short stature

Familial short stature features a bone age matching chronological age, normal growth velocity, and a family history of short stature, distinguishing it from constitutional delay where bone age is delayed.

Question 39: The Canadian Task Force on Preventive Health Care recommends against routine PSA screening for prostate cancer in average-risk men primarily because:

Benefits of screening are outweighed by harms including overdiagnosis and overtreatment (Correct answer)
PSA tests are technically unreliable
Prostate cancer is not detectable by PSA
All men with elevated PSA develop cancer

Correct answer: Benefits of screening are outweighed by harms including overdiagnosis and overtreatment

High rates of overdiagnosis and overtreatment (incontinence, impotence) from PSA screening outweigh modest mortality benefits in average-risk men.

Question 40: A 68-year-old woman with atrial fibrillation presents with sudden severe periumbilical pain out of proportion to physical exam findings, followed by bloody diarrhea 6 hours later. CT angiography shows filling defect in the superior mesenteric artery. What is the priority management?

IV heparin anticoagulation and urgent surgical or endovascular revascularization (Correct answer)
Vasopressin infusion via angiography catheter
Immediate exploratory laparotomy
Broad-spectrum antibiotics and bowel rest

Correct answer: IV heparin anticoagulation and urgent surgical or endovascular revascularization

Acute mesenteric ischemia from embolic occlusion requires immediate anticoagulation with heparin and urgent revascularization (surgical embolectomy or endovascular therapy) to prevent bowel infarction.

Question 41: A 55-year-old man with a history of alcoholism presents with hematemesis. Endoscopy reveals bleeding esophageal varices. After band ligation, he remains hemodynamically unstable. What is the appropriate next intervention?

Sengstaken-Blakemore tube placement as a bridge to TIPS (Correct answer)
Vasopressin infusion alone
Repeat endoscopic band ligation
Emergent esophageal transection

Correct answer: Sengstaken-Blakemore tube placement as a bridge to TIPS

Persistent variceal hemorrhage uncontrolled by endoscopy requires balloon tamponade (Sengstaken-Blakemore tube) as a temporary bridge while arranging TIPS (transjugular intrahepatic portosystemic shunt).

Question 42: A patient with Clostridium difficile infection fails metronidazole therapy. What is the most appropriate next step?

Initiate intravenous vancomycin
Add rifaximin to current metronidazole
Start oral vancomycin (Correct answer)
Switch to intravenous metronidazole at higher doses

Correct answer: Start oral vancomycin

Oral vancomycin is recommended for patients who fail or are intolerant to metronidazole for C. difficile infection, as it achieves high luminal concentrations.

Question 43: A 33-year-old woman presents with 2 years of hypomanic episodes (lasting 4+ days) alternating with depressive episodes, never meeting full criteria for mania or major depression. What is the diagnosis?

Cyclothymic disorder (Correct answer)
Bipolar I disorder
Bipolar II disorder
Persistent depressive disorder (dysthymia)

Correct answer: Cyclothymic disorder

Cyclothymic disorder requires at least 2 years of hypomanic and depressive symptoms that never meet full criteria for a hypomanic or major depressive episode.

Question 44: A 70-year-old man with no prior psychiatric history develops visual hallucinations, fluctuating cognition, and REM sleep behaviour disorder. Parkinsonism follows 6 months later. What is the most likely diagnosis?

Delirium tremens
Alzheimer's dementia
Dementia with Lewy bodies (Correct answer)
Vascular dementia

Correct answer: Dementia with Lewy bodies

Dementia with Lewy bodies classically presents with visual hallucinations, fluctuating cognition, REM sleep behaviour disorder, and parkinsonism.

Question 45: Which ECG finding is most specific for right ventricular strain in acute pulmonary embolism?

Sinus tachycardia
ST elevation in V1
New right bundle branch block
S1Q3T3 pattern (Correct answer)

Correct answer: S1Q3T3 pattern

The S1Q3T3 pattern (S wave in lead I, Q wave and T-wave inversion in lead III) is the classic though not highly sensitive ECG finding for acute RV strain in PE.

Question 46: A patient with renal failure is prescribed imipenem-cilastatin. Why is cilastatin included in this formulation?

It inhibits renal dehydropeptidase-I, preventing imipenem hydrolysis in the kidney (Correct answer)
It reduces imipenem nephrotoxicity by competitive renal tubular secretion
It enhances imipenem's penetration across the blood-brain barrier
It inhibits bacterial beta-lactamases that would otherwise inactivate imipenem

Correct answer: It inhibits renal dehydropeptidase-I, preventing imipenem hydrolysis in the kidney

Cilastatin inhibits dehydropeptidase-I on the renal brush border, preventing hydrolysis of imipenem to a nephrotoxic metabolite and increasing urinary drug levels.

Question 47: Which official document published by the Medical Council of Canada serves as the primary blueprint for MCCQE Part 1 content?

Canadian Residency Matching Service (CaRMS) Guide
MCC Objectives for the Qualifying Examination (Correct answer)
CanMEDS Physician Competency Framework
AFMC Undergraduate Medical Education Report

Correct answer: MCC Objectives for the Qualifying Examination

The MCC Objectives for the Qualifying Examination outlines the clinical presentations, disciplines, and competencies that form the basis of all MCCQE Part 1 content.

Question 48: A study follows 1,000 smokers and 1,000 non-smokers for 10 years to compare lung cancer incidence. What type of study is this?

Case-control study
Cross-sectional study
Prospective cohort study (Correct answer)
Randomized controlled trial

Correct answer: Prospective cohort study

A prospective cohort study follows groups with different exposures forward in time to measure disease incidence.

Question 49: A 45-year-old man with no other medical history is diagnosed with a first episode of moderate Major Depressive Disorder. According to the Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines, which of the following is the most appropriate initial pharmacological treatment?

Lithium
Quetiapine
Lorazepam
Sertraline (Correct answer)

Correct answer: Sertraline

According to CANMAT guidelines, second-generation antidepressants, including Selective Serotonin Reuptake Inhibitors (SSRIs) like sertraline, are recommended as first-line pharmacotherapy for moderate to severe Major Depressive Disorder. Quetiapine, an atypical antipsychotic, is considered a second-line agent or for adjunctive use. Lithium is a mood stabilizer primarily used for bipolar disorder. Lorazepam is a benzodiazepine used for short-term management of anxiety and is not a primary treatment for depression.

Question 50: A patient with schizophrenia on long-term haloperidol develops repetitive lip-smacking movements and tongue protrusion that persist after medication dose reduction. What is this condition?

Akathisia
Acute dystonia
Parkinsonism
Tardive dyskinesia (Correct answer)

Correct answer: Tardive dyskinesia

Tardive dyskinesia is a late-onset, potentially irreversible movement disorder caused by dopamine receptor supersensitivity from chronic antipsychotic use.

Question 51: At what age does the anterior fontanelle normally close?

9–12 months
12–18 months (Correct answer)
3–6 months
6–9 months

Correct answer: 12–18 months

The anterior fontanelle normally closes between 12 and 18 months of age; early closure may suggest craniosynostosis.

Question 52: What is the approximate timeframe within which candidates typically receive their MCCQE Part I results after the exam sitting?

Approximately 8–12 weeks (Correct answer)
Within 48 hours
Same day via automated scoring
Up to 6 months

Correct answer: Approximately 8–12 weeks

MCCQE Part I results are typically released approximately 8–12 weeks after the exam sitting.

Question 53: Standardized mortality ratio (SMR) is used to:

Measure absolute mortality in a study population
Compare observed deaths in a study population to expected deaths based on a reference population (Correct answer)
Calculate the case fatality rate of a disease
Estimate the life expectancy of a cohort

Correct answer: Compare observed deaths in a study population to expected deaths based on a reference population

SMR = observed deaths / expected deaths × 100; an SMR > 100 indicates excess mortality compared to the reference population.

Question 54: A 32-year-old woman with bipolar I disorder is stable on lithium and becomes pregnant. What is the primary concern regarding lithium use in the first trimester?

Placental abruption
Ebstein's anomaly risk (Correct answer)
Neonatal hypothyroidism
Neonatal seizures

Correct answer: Ebstein's anomaly risk

Lithium use in the first trimester carries a small but increased risk of Ebstein's anomaly, a cardiac malformation of the tricuspid valve.

Question 55: When comparing two interventions, which statistical measure directly quantifies the clinical importance of a treatment effect rather than just statistical significance?

Chi-square statistic
p-value
95% confidence interval width
Effect size (e.g., Cohen's d) (Correct answer)

Correct answer: Effect size (e.g., Cohen's d)

Effect size measures the magnitude of the treatment difference, independent of sample size and statistical significance.

Question 56: How does the MCC ensure content validity of the MCCQE?

By testing candidates on pharmacology exclusively
Through item development committees with physician subject-matter experts (Correct answer)
By mirroring USMLE content specifications exactly
By using only faculty from one Canadian university

Correct answer: Through item development committees with physician subject-matter experts

The MCC uses multidisciplinary committees of practicing physicians and specialists to develop and review exam items, ensuring content reflects current medical practice.

Question 57: A 30-year-old man presents 3 days after a cat bite to the right hand with fever, ascending lymphangitis, and purulent wound discharge. He is penicillin-allergic (anaphylaxis). Blood cultures are pending. Which antibiotic covers Pasteurella multocida in a penicillin-anaphylaxis patient?

Clindamycin
Metronidazole
First-generation cephalosporin (cephalexin)
Doxycycline or a fluoroquinolone (e.g., ciprofloxacin) (Correct answer)

Correct answer: Doxycycline or a fluoroquinolone (e.g., ciprofloxacin)

Pasteurella multocida, the key pathogen in cat bites, is resistant to clindamycin; doxycycline or a fluoroquinolone (ciprofloxacin) provides coverage in true penicillin-allergic patients.

Question 58: A 20-year-old male presents after a motor vehicle collision with hypotension, tachycardia, and abdominal distension. FAST ultrasound shows free fluid in Morrison's pouch and the splenorenal space. He remains hypotensive despite 2 L IV crystalloid. What is the next step?

CT abdomen with contrast for injury characterization
Emergent exploratory laparotomy (Correct answer)
Angioembolization of splenic artery
Diagnostic peritoneal lavage

Correct answer: Emergent exploratory laparotomy

A hemodynamically unstable trauma patient with FAST-positive free fluid requires emergent exploratory laparotomy; CT is contraindicated in the unstable patient.

Question 59: A 22-year-old college student fears being watched or judged in social situations, avoids classes, and has impaired daily functioning for over 6 months. What is the first-line pharmacological treatment?

Bupropion
Selective serotonin reuptake inhibitor (SSRI) (Correct answer)
Haloperidol
Diazepam

Correct answer: Selective serotonin reuptake inhibitor (SSRI)

SSRIs (e.g., paroxetine, sertraline) are first-line pharmacotherapy for social anxiety disorder, with evidence for both acute and long-term treatment.

Question 60: Which study material focuses on clinical decision-making for the MCCQE?

Business management guides.
Toronto Notes. (Correct answer)
Patient satisfaction surveys.
Hospital administrative reports.

Correct answer: Toronto Notes.

Toronto Notes is a widely recognized and comprehensive study guide specifically designed to aid medical students and graduates in preparing for Canadian medical licensing exams, including the MCCQE. It provides concise summaries of medical knowledge and clinical decision-making principles relevant to the exam.

Question 61: Which of the following Qbank features is most important when selecting a MCCQE-specific preparation resource?

A mobile app with offline mode for studying without internet access
The largest total number of questions regardless of content alignment
Questions sourced exclusively from USMLE Step 2 CK question pools
Questions organized by MCC Objective clinical presentations with Canadian guideline-based explanations (Correct answer)

Correct answer: Questions organized by MCC Objective clinical presentations with Canadian guideline-based explanations

MCCQE questions are organized around MCC Objective clinical presentations and Canadian clinical standards, so content alignment is the critical differentiator among Qbanks.

Question 62: What does 'equating' refer to in the context of MCCQE Part I score reporting?

Standardizing pass rates to 70% each year
Ranking candidates relative to each other
Converting letter grades to numerical scores
Adjusting raw scores so results are comparable across different exam administrations (Correct answer)

Correct answer: Adjusting raw scores so results are comparable across different exam administrations

Equating ensures that a scaled score of, say, 250 means the same level of ability regardless of which version of the exam was administered.

Question 63: Which of the following is NOT listed as an eligibility requirement for MCCQE Part I?

Enrollment in or graduation from a recognized medical school
Paying the applicable examination fee
Obtaining an MCC identification number
Holding a valid license to practice medicine in any jurisdiction (Correct answer)

Correct answer: Holding a valid license to practice medicine in any jurisdiction

A license to practice medicine is not required for MCCQE Part I; candidates are typically students or recent graduates who have not yet been licensed.

Question 64: A 35-year-old man with schizophrenia develops high fever, muscle rigidity, diaphoresis, and altered consciousness after starting haloperidol. What is the most appropriate immediate management?

Discontinue antipsychotic and provide supportive care (Correct answer)
Add benztropine only
Increase haloperidol dose
Switch to clozapine immediately

Correct answer: Discontinue antipsychotic and provide supportive care

Neuroleptic malignant syndrome (NMS) requires immediate discontinuation of the offending antipsychotic and aggressive supportive care including IV fluids and cooling.

Question 65: A 40-year-old woman presents with colicky right flank pain radiating to the groin, hematuria, and nausea. CT KUB shows a 7 mm stone at the ureterovesical junction with mild hydronephrosis. She is afebrile and pain-controlled. What is the management?

Percutaneous nephrostomy
Medical expulsive therapy with tamsulosin and close follow-up (Correct answer)
Extracorporeal shock wave lithotripsy (ESWL) immediately
Emergency ureteroscopy

Correct answer: Medical expulsive therapy with tamsulosin and close follow-up

A 7 mm ureteral stone without infection or renal failure can be managed conservatively with medical expulsive therapy (alpha-blocker) and analgesia, as spontaneous passage is likely with close monitoring.

Question 66: What distinguishes therapeutic privilege from withholding information inappropriately?

Therapeutic privilege is rarely justified and applies only when disclosure itself would directly cause serious harm (Correct answer)
Therapeutic privilege allows withholding information whenever the physician feels it is best
Therapeutic privilege is standard practice for all bad-news disclosures
Therapeutic privilege requires family consent before withholding information

Correct answer: Therapeutic privilege is rarely justified and applies only when disclosure itself would directly cause serious harm

Therapeutic privilege is a narrow exception permitting non-disclosure only when the disclosure itself (not the diagnosis) would directly harm the patient.

Question 67: Which measure is most appropriate for estimating causation in a case-control study?

Risk difference
Odds ratio (Correct answer)
Incidence rate ratio
Relative risk

Correct answer: Odds ratio

Case-control studies sample on disease status, making incidence impossible to calculate directly; the odds ratio approximates relative risk when disease is rare.

Question 68: A 40-year-old man presents with a painful, irreducible bulge in the right groin below and lateral to the pubic tubercle that appeared during heavy lifting. He has nausea but no vomiting. What type of hernia is most likely and what is the next step?

Spigelian hernia — CT confirmation then repair
Indirect inguinal hernia — elective repair
Femoral hernia — urgent surgical repair due to high strangulation risk (Correct answer)
Direct inguinal hernia — conservative management with truss

Correct answer: Femoral hernia — urgent surgical repair due to high strangulation risk

A femoral hernia presents below and lateral to the pubic tubercle and carries a high risk of incarceration and strangulation, warranting urgent operative repair.

Question 69: A 55-year-old diabetic man presents with foot drop and inability to evert his foot. There is sensory loss over the dorsum of the foot. Which nerve is most likely injured?

Common peroneal nerve (Correct answer)
Femoral nerve
Sciatic nerve
Tibial nerve

Correct answer: Common peroneal nerve

Common peroneal nerve injury causes foot drop (weakness of dorsiflexion and eversion) and sensory loss over the dorsum of the foot and lateral leg.

Question 70: A physician is asked to complete a disability form for a patient they have not examined. What is the ethical concern?

Fraudulent certification without adequate assessment (Correct answer)
Conflict with substitute decision-maker rights
Breach of therapeutic privilege
Violation of patient confidentiality

Correct answer: Fraudulent certification without adequate assessment

Signing medical-legal documents without an adequate examination constitutes fraud and violates professional integrity.

Question 71: A 31-year-old woman with Type 1 diabetes at 36 weeks has her glucose poorly controlled (HbA1c 9.2%). Which neonatal complication is most directly related to maternal hyperglycemia during the third trimester?

Neonatal polycythemia from erythropoietin deficiency
Neonatal hypoglycemia from fetal hyperinsulinism (Correct answer)
Neonatal seizures from cerebral hypoxia
Neonatal hypothyroidism from iodine deficiency

Correct answer: Neonatal hypoglycemia from fetal hyperinsulinism

Maternal hyperglycemia causes fetal hyperglycemia, which stimulates fetal pancreatic beta cells to produce excess insulin; after birth, this hyperinsulinism causes neonatal hypoglycemia.

Question 72: A 3-year-old boy is at the 5th percentile for height. His growth velocity over the past year was 5 cm. Which finding would most suggest constitutional growth delay over growth hormone deficiency?

Bone age delayed by 2 years with normal growth velocity (Correct answer)
Height below the third percentile for mid-parental height
Bone age equal to chronological age
Low IGF-1 level

Correct answer: Bone age delayed by 2 years with normal growth velocity

Constitutional growth delay is characterized by delayed bone age with a normal growth velocity and a family history of late puberty.

Question 73: A 78-year-old woman presents with acute onset confusion, abdominal distension, and obstipation. AXR shows a grossly dilated sigmoid colon in an inverted U-shape pointing to the right upper quadrant. What is the diagnosis and first-line treatment?

Cecal volvulus — right hemicolectomy
Sigmoid volvulus — endoscopic detorsion via flexible sigmoidoscopy (Correct answer)
Ogilvie's syndrome — neostigmine administration
Large bowel obstruction from carcinoma — CT then surgery

Correct answer: Sigmoid volvulus — endoscopic detorsion via flexible sigmoidoscopy

The 'coffee bean sign' on AXR is pathognomonic of sigmoid volvulus, and endoscopic decompression is the initial treatment of choice unless there are signs of ischemia or perforation.

Question 74: A 35-year-old pregnant woman (32 weeks) presents with right upper quadrant pain and elevated liver enzymes. WBC is 14. Ultrasound shows gallbladder wall thickening and pericholecystic fluid. What is the management?

Laparoscopic cholecystectomy during the second trimester only
Conservative management until delivery, then cholecystectomy
Laparoscopic cholecystectomy regardless of trimester for acute cholecystitis (Correct answer)
Percutaneous cholecystostomy tube only

Correct answer: Laparoscopic cholecystectomy regardless of trimester for acute cholecystitis

Acute cholecystitis in pregnancy is treated with laparoscopic cholecystectomy regardless of trimester, as conservative management has high recurrence and risk of preterm labor.

Question 75: What does the number needed to harm (NNH) represent?

The absolute risk difference between two groups
The number of patients who must be treated for one additional patient to experience harm (Correct answer)
The probability that a given patient will experience harm
The relative risk increase due to an intervention

Correct answer: The number of patients who must be treated for one additional patient to experience harm

NNH = 1 / absolute risk increase; it quantifies how many patients need treatment before one additional harmful event occurs.

Question 76: Which of the following is an example of tertiary prevention?

Cervical cancer screening (Pap smear)
Hepatitis B vaccination
Water fluoridation to prevent dental caries
Stroke rehabilitation to minimize disability (Correct answer)

Correct answer: Stroke rehabilitation to minimize disability

Tertiary prevention reduces the impact of established disease by restoring function and minimizing complications.

Question 77: A 3-year-old girl has a bone age of 5 years, elevated LH/FSH, and advanced pubertal staging. MRI of the brain is most likely to show:

Craniopharyngioma
Hypothalamic hamartoma (Correct answer)
Pineal gland cyst
Normal MRI

Correct answer: Hypothalamic hamartoma

Hypothalamic hamartoma is the most common identifiable CNS cause of central precocious puberty in young children, causing premature GnRH pulsatility.

Question 78: Which resource helps candidates understand the MCC objectives?

Pharmacology review apps.
Online hospital case studies.
MCC Objectives website. (Correct answer)
Medical school lecture notes.

Correct answer: MCC Objectives website.

The MCC Objectives website is the authoritative resource for understanding the specific learning objectives and content areas covered by the MCCQE exams. Reviewing these objectives is crucial for candidates to focus their study efforts and ensure comprehensive preparation.

Question 79: An international medical graduate (IMG) applies for MCCQE Part I and requests test accommodations for a disability. When must this request be submitted?

During the registration process, by the accommodation request deadline (Correct answer)
At any time before the exam date
Only after receiving the examination scheduling permit
On the day of the examination at the test center

Correct answer: During the registration process, by the accommodation request deadline

Accommodation requests must be submitted during registration by the MCC's published deadline; late requests may not be granted.

Question 80: A 72-year-old male with a new diagnosis of non-valvular atrial fibrillation has a CHADS2 score of 3. He is being started on anticoagulation for stroke prevention. Which of the following is a key component of his management plan according to the Canadian Cardiovascular Society (CCS) guidelines?

Prescribing a reduced dose of a direct oral anticoagulant (DOAC) to minimize bleeding risk, regardless of specific criteria.
Screening for and managing modifiable cardiovascular risk factors such as hypertension and obesity. (Correct answer)
Scheduling an elective cardioversion within the first month of diagnosis.
Initiating dual antiplatelet therapy in addition to oral anticoagulation.

Correct answer: Screening for and managing modifiable cardiovascular risk factors such as hypertension and obesity.

The 2020 CCS/CHRS Atrial Fibrillation Guidelines emphasize a comprehensive approach to management. A crucial part of this is the management of modifiable cardiovascular risk factors (e.g., hypertension, obesity, sleep apnea) to reduce cardiovascular events and decrease the burden of atrial fibrillation.

Question 81: What is the minimum passing score for the MCCQE Part I?

210.
300.
250.
226. (Correct answer)

Correct answer: 226.

The minimum passing score for the MCCQE Part I is 226 on a scaled score. This specific threshold is determined through a rigorous standard-setting process to ensure that all candidates who pass possess the necessary level of competence for entry into supervised medical practice in Canada.

Question 82: A woman delivers a healthy infant but her placenta fails to deliver after 40 minutes of active management. On manual exploration, the placenta cannot be separated from the uterine wall. What is the most likely diagnosis?

Placenta previa
Uterine inversion
Retained placental cotyledon
Placenta accreta (Correct answer)

Correct answer: Placenta accreta

Placenta accreta is characterized by abnormal adherence of placental villi to the myometrium, preventing normal separation and delivery.

Question 83: Which of the following statements best reflects the guidance from the Canadian Medical Association (CMA) and provincial regulatory bodies regarding physicians providing ongoing medical care to their close family members?

It should be strictly limited to minor conditions or emergencies when no other physician is available. (Correct answer)
It is encouraged, as it improves access to care and convenience for the family.
It is only prohibited for prescribing controlled substances, but is acceptable for all other care.
It is permissible without restriction, provided the family member gives explicit consent.

Correct answer: It should be strictly limited to minor conditions or emergencies when no other physician is available.

The CMA Code of Ethics and Professionalism, along with standards from provincial colleges, strongly advises against physicians treating themselves or close family members. [4, 9, 11] The rationale is that personal relationships can compromise professional objectivity, affect clinical judgment, and create difficulties in areas like taking a sensitive history or performing intimate examinations. [4, 15] The explicit exception is for minor problems or in an emergency situation where another physician is not readily available. [4, 16] Even in these cases, care should be transferred to another physician as soon as practical. This guidance extends beyond just prescribing controlled substances and applies to routine and ongoing care in general. [15]

Question 84: A male infant's testicular volume is 4 mL bilaterally. At what Tanner stage is he, and what is the typical age for this stage?

Tanner 4; age 13–15 years
Tanner 2; age 9–11 years (Correct answer)
Tanner 3; age 11–13 years
Tanner 1; age 8–10 years

Correct answer: Tanner 2; age 9–11 years

Tanner stage 2 in males is defined by testicular volume ≥4 mL (or length >2.5 cm), typically occurring between ages 9 and 11 years.

Question 85: A 26-year-old G1P0 at 30 weeks is admitted with threatened preterm labour and intact membranes. Cervical length is 22 mm and fetal fibronectin is positive. What is the most evidence-based intervention to reduce neonatal morbidity if delivery occurs?

Antenatal corticosteroids (betamethasone) to accelerate fetal lung maturity (Correct answer)
Prophylactic antibiotics to prevent ascending infection
Cervical cerclage with singleton pregnancy and no prior preterm birth
Oral progesterone supplementation to stop contractions

Correct answer: Antenatal corticosteroids (betamethasone) to accelerate fetal lung maturity

Antenatal corticosteroids (betamethasone 12 mg IM x2 doses) are the most impactful intervention for reducing neonatal RDS, IVH, and mortality when preterm birth is anticipated between 24-34 weeks.

Question 86: Which growth parameter is most useful for assessing nutritional status in a 2-year-old?

Mid-upper arm circumference
Height for age
Head circumference
Weight for height (BMI) (Correct answer)

Correct answer: Weight for height (BMI)

Weight for height (or BMI-for-age) reflects current nutritional status and identifies both wasting and overweight in young children.

Question 87: A 45-year-old man with dilated cardiomyopathy (EF 25%) on optimal medical therapy has LBBB with QRS 155 ms. What device therapy should be considered?

Permanent pacemaker
Implantable loop recorder
Implantable cardioverter-defibrillator alone
Cardiac resynchronization therapy (CRT) (Correct answer)

Correct answer: Cardiac resynchronization therapy (CRT)

CRT is indicated in HFrEF with LVEF ≤35%, LBBB, and QRS ≥150 ms on optimal medical therapy to improve symptoms and reduce mortality.

Question 88: A screening test for colorectal cancer is applied to 10,000 people; 200 test positive, 50 have true disease (all test positive), and 150 are false positives. What is the specificity?

98.4% (Correct answer)
25%
75%
100%

Correct answer: 98.4%

Specificity = TN / (TN + FP) = 9,800 / (9,800 + 150) = 9,800/9,950 ≈ 98.5%.

Question 89: Which antifungal drug works by inhibiting 1,3-beta-D-glucan synthase, disrupting the fungal cell wall?

Caspofungin (Correct answer)
Amphotericin B
Voriconazole
Flucytosine

Correct answer: Caspofungin

Caspofungin is an echinocandin that inhibits 1,3-beta-D-glucan synthase, reducing glucan polymer synthesis in the fungal cell wall.

Question 90: On the MCCQE Part I score report, the 'national mean' information is useful for the candidate primarily because it allows them to:

Calculate their exact percentile rank independently
Request an automatic regrade if they score below the mean
Determine whether they passed the exam
Understand how their performance compares to the overall candidate pool (Correct answer)

Correct answer: Understand how their performance compares to the overall candidate pool

The national mean provides context by showing how a candidate's score relates to the broader group of exam writers.

Question 91: A 9-month-old infant cannot sit without support and does not transfer objects between hands. Which developmental domain is most delayed?

Fine motor
Gross motor (Correct answer)
Social-emotional
Language

Correct answer: Gross motor

Sitting without support is a gross motor milestone expected by 6–7 months; failure to achieve this by 9 months indicates gross motor delay.

Question 92: A 28-year-old woman presents with recurrent episodes of binge eating followed by self-induced vomiting, dental erosions, and parotid gland enlargement. Which electrolyte abnormality is most likely?

Hypokalemia (Correct answer)
Hypernatremia
Hypercalcemia
Hyperkalemia

Correct answer: Hypokalemia

Repeated purging in bulimia nervosa causes loss of gastric acid, leading to hypokalemic, hypochloremic metabolic alkalosis.

Question 93: A 65-year-old diabetic man presents with a perianal abscess. After incision and drainage, a fistula-in-ano is suspected. Which classification system is used to guide surgical management?

Milligan-Morgan classification
Hinchey classification
Lockhart-Mummery classification
Parks classification (Correct answer)

Correct answer: Parks classification

The Parks classification categorizes fistulas-in-ano as intersphincteric, transsphincteric, suprasphincteric, or extrasphincteric, guiding surgical strategy to preserve continence.

Question 94: A 40-year-old man presents with persistent worry about multiple life domains, muscle tension, irritability, and sleep disturbance for more than 6 months. What is the first-line psychotherapy?

Psychodynamic therapy
Hypnotherapy
Cognitive behavioural therapy (CBT) (Correct answer)
Interpersonal therapy

Correct answer: Cognitive behavioural therapy (CBT)

CBT is the most evidence-based psychotherapy for generalized anxiety disorder, targeting maladaptive worry and avoidance behaviours.

Question 95: In Bradford Hill's criteria, which criterion addresses the plausibility of the cause-effect relationship based on current biological knowledge?

Biological plausibility (Correct answer)
Specificity
Coherence
Temporality

Correct answer: Biological plausibility

Biological plausibility requires that the association makes sense given existing biological and medical knowledge.

Question 96: A 58-year-old man presents with hematemesis and melena. He is hemodynamically stable after resuscitation. Upper endoscopy reveals a duodenal ulcer with a visible vessel (Forrest Ia). What is the endoscopic treatment of choice?

Epinephrine injection alone
Combination therapy: epinephrine injection plus thermal coagulation or hemoclip (Correct answer)
Argon plasma coagulation alone
Endoscopic band ligation

Correct answer: Combination therapy: epinephrine injection plus thermal coagulation or hemoclip

High-risk peptic ulcer stigmata (Forrest Ia/Ib/IIa) require combination endoscopic therapy—epinephrine injection plus a second modality (thermal coagulation or mechanical clips)—to reduce rebleeding risk.

Question 97: A candidate is planning a 4-month MCCQE Part 1 study schedule. Which approach best allocates time across the preparation period?

Integrate content review with daily Qbank practice from week 1, saving full-length simulations for the final 2–3 weeks (Correct answer)
Alternate weeks between reading only and question-only practice throughout all 4 months
Complete all Qbank questions first, then do content review of weak areas in the final month
Spend the first 3 months reading Toronto Notes cover to cover, then do questions in the final month

Correct answer: Integrate content review with daily Qbank practice from week 1, saving full-length simulations for the final 2–3 weeks

Integrating active recall (Qbank) with content review from the start ensures spaced repetition and prevents the 'reading trap' of passive study without application.

Question 98: How does the MCC Learning Management System (LMS) assist candidates?

Focuses on medical licensing requirements.
Provides access to tailored study materials. (Correct answer)
Offers free clinical placements.
Facilitates peer group discussions.

Correct answer: Provides access to tailored study materials.

The MCC Learning Management System (LMS) assists candidates by providing access to tailored study materials, resources, and sometimes practice questions directly from the Medical Council of Canada. This ensures candidates have official and relevant preparation tools at their disposal.

Question 99: A 38-year-old woman presents with persistent medically unexplained neurological symptoms including paralysis and blindness following a stressful event. Neurological examination is inconsistent. What is the most likely diagnosis?

Factitious disorder
Functional neurological symptom disorder (conversion disorder) (Correct answer)
Somatic symptom disorder
Malingering

Correct answer: Functional neurological symptom disorder (conversion disorder)

Functional neurological symptom disorder (conversion disorder) presents with neurological symptoms that are incompatible with recognized neurological disease and occur after psychological stress.

Question 100: A 68-year-old man presents with sudden onset of right-sided weakness and aphasia that began 45 minutes ago. CT head shows no hemorrhage. He has no contraindications to thrombolysis. What is the most appropriate next step?

Arrange urgent carotid endarterectomy
Start aspirin 325 mg orally
Administer IV alteplase (tPA) (Correct answer)
Begin heparin infusion

Correct answer: Administer IV alteplase (tPA)

IV alteplase is indicated within 4.5 hours of ischemic stroke onset in eligible patients with no contraindications, making it the most appropriate immediate intervention.

Question 101: A 55-year-old woman develops sudden severe headache ('thunderclap'), neck stiffness, and photophobia. Non-contrast CT head is negative for hemorrhage. What is the next critical step?

CT angiography for aneurysm
Lumbar puncture to look for xanthochromia (Correct answer)
Start empiric acyclovir for herpes encephalitis
MRI brain with gadolinium

Correct answer: Lumbar puncture to look for xanthochromia

A negative CT does not exclude subarachnoid hemorrhage; lumbar puncture must be performed to detect xanthochromia or elevated RBCs, as CT sensitivity drops significantly after 6–12 hours.

Question 102: A 22-year-old is brought to the clinic by his family due to a 7-month history of progressive social withdrawal, disorganized speech, and a firm belief that his thoughts are being broadcasted by a local radio station. He also reports hearing a voice that provides a running commentary on his actions. His functioning at university has declined significantly. What is the most likely diagnosis?

Schizophreniform disorder
Delusional disorder
Schizophrenia (Correct answer)
Brief psychotic disorder

Correct answer: Schizophrenia

The diagnosis of schizophrenia requires the presence of characteristic symptoms for at least one month, with continuous signs of the disturbance persisting for at least six months. This patient's 7-month history of psychotic symptoms (delusions, hallucinations) and functional decline fits the criteria for schizophrenia. Schizophreniform disorder has a duration of 1 to 6 months. Brief psychotic disorder lasts less than one month. Delusional disorder is characterized by delusions without the other prominent symptoms of schizophrenia like disorganized speech and significant negative symptoms.

Question 103: Which of the following study designs is most prone to the ecological fallacy?

Ecological study (Correct answer)
Case-control study
Cross-sectional study
Cohort study

Correct answer: Ecological study

Ecological studies use group-level data; applying group associations to individuals risks the ecological fallacy.

Question 104: A 33-year-old G2P1 with a previous low transverse caesarean section is labouring at 39 weeks. At 8 cm dilation, she reports severe sudden abdominal pain and the CTG shows prolonged bradycardia. Her previous scar is tender on palpation. What is the most feared complication?

Uterine dehiscence without rupture
Placental abruption over the scar
Complete uterine rupture (Correct answer)
Scar ectopic pregnancy rupture

Correct answer: Complete uterine rupture

Uterine rupture during trial of labour after caesarean (TOLAC) presents with sudden pain, scar tenderness, and acute fetal distress, requiring immediate emergency caesarean.

Question 105: Which epidemiological study design provides the strongest evidence for causality?

Ecological study
Randomized controlled trial (Correct answer)
Case-control study
Case series

Correct answer: Randomized controlled trial

Randomized controlled trials minimize confounding through randomization, providing the strongest causal evidence.

Question 106: A neonate born at 29 weeks develops respiratory distress, intercostal retractions, and nasal flaring within 2 hours of birth. CXR shows ground-glass opacification with air bronchograms. What is the pathophysiology?

Transient tachypnea of the newborn
Meconium aspiration causing airway obstruction
Group B Streptococcal pneumonia
Surfactant deficiency causing alveolar collapse (Correct answer)

Correct answer: Surfactant deficiency causing alveolar collapse

Respiratory distress syndrome (RDS) in premature neonates is caused by surfactant deficiency, leading to diffuse alveolar collapse and the characteristic ground-glass appearance.

Question 107: A physician receives a gift worth $500 from a grateful patient. What is the most ethically appropriate response?

Accept it and donate to charity
Report the gift to the licensing body immediately
Decline politely or accept only nominal gifts and document accordingly (Correct answer)
Accept it as a token of appreciation without concern

Correct answer: Decline politely or accept only nominal gifts and document accordingly

Accepting substantial gifts can create real or perceived conflicts of interest; physicians should decline or limit gifts to nominal value.

Question 108: What is the required status for medical students applying for the MCCQE Part I?

Graduated from a medical program within the last year.
Currently practicing medicine.
In the final year of medical school. (Correct answer)
Completed at least two years of medical school.

Correct answer: In the final year of medical school.

Medical students are eligible to apply for the MCCQE Part I when they are in their final year of a recognized medical school program. This allows them to take the exam before or shortly after graduation, facilitating their transition into postgraduate training and licensure.

Question 109: A 25-year-old man sustains a stab wound to the left chest at the 5th intercostal space, midclavicular line. He is hypotensive with distended neck veins and muffled heart sounds. Trachea is midline. What is the immediate intervention?

Bilateral chest tubes
Pericardiocentesis or emergency thoracotomy for cardiac tamponade (Correct answer)
Needle decompression at 2nd ICS midclavicular line
Emergency chest X-ray

Correct answer: Pericardiocentesis or emergency thoracotomy for cardiac tamponade

Beck's triad (hypotension, JVD, muffled heart sounds) with a penetrating chest wound indicates cardiac tamponade, treated emergently with pericardiocentesis or left anterolateral thoracotomy.

Question 110: A 25-year-old primigravida at 10 weeks with hyperemesis gravidarum is found to have thyroid-stimulating hormone (TSH) of 0.02 mIU/L and free T4 elevated. She has no goiter and no personal history of thyroid disease. What is the most appropriate management?

Start methimazole immediately for Graves disease
Perform radioactive iodine scan to exclude autonomous nodule
Reassure that this is gestational transient hyperthyroidism; treat hyperemesis (Correct answer)
Start propylthiouracil to prevent fetal thyrotoxicosis

Correct answer: Reassure that this is gestational transient hyperthyroidism; treat hyperemesis

Gestational transient thyrotoxicosis (GTT) is caused by TSH receptor stimulation by hCG in early pregnancy; it resolves spontaneously and antithyroid drugs are not indicated.

Question 111: A 55-year-old man presents post-thyroidectomy with stridor, voice hoarseness, and respiratory distress 2 hours after surgery. Neck is swelling. What is the immediate bedside intervention?

IV dexamethasone
Racemic epinephrine nebulization
Bedside wound opening to evacuate hematoma (Correct answer)
Emergent reintubation with video laryngoscopy

Correct answer: Bedside wound opening to evacuate hematoma

Post-thyroidectomy neck hematoma causing airway compromise requires immediate bedside wound opening to decompress the hematoma before definitive airway management or return to OR.

Question 112: During a well-child visit for a 13-year-old male, you note the presence of coarse, dark, curly pubic hair spread over the pubis, increased penile length and width, and testicular volume of approximately 12 mL. According to the Tanner stages, which stage of pubertal development does this describe?

Tanner Stage 4
Tanner Stage 3 (Correct answer)
Tanner Stage 5
Tanner Stage 2

Correct answer: Tanner Stage 3

Tanner Stage 3 in males is characterized by the continued growth of the penis and testes, with testicular volume typically between 9-12 mL. The pubic hair becomes coarser, darker, and curlier, spreading over the pubic symphysis. Stage 2 involves the initial enlargement of the testes and sparse, straight pubic hair. Stage 4 involves further growth, darkening of the scrotal skin, and adult-quality hair that has not yet spread to the thighs. Stage 5 represents full adult genitalia and pubic hair distribution.

Question 113: A physician who obtained the Licentiate of the Medical Council of Canada (LMCC) more than 20 years ago wishes to retake MCCQE Part I to update their credentials. What is the MCC's position?

They are eligible to retake it freely since they never used all 5 attempts
They must apply through a special senior physician pathway
They are eligible only if they have been out of practice for 5+ years
They are ineligible because the LMCC has already been awarded (Correct answer)

Correct answer: They are ineligible because the LMCC has already been awarded

Once the LMCC has been awarded, the candidate is no longer eligible to retake the MCCQE examinations.

Question 114: A 14-year-old girl is at Tanner stage 1 with no signs of puberty. Her karyotype returns 45,X. Which additional finding is most likely?

Normal bone age
Elevated FSH and LH (Correct answer)
Low FSH and LH
Elevated estrogen

Correct answer: Elevated FSH and LH

Turner syndrome (45,X) causes primary ovarian insufficiency; without negative feedback from estrogen, FSH and LH are markedly elevated (hypergonadotropic hypogonadism).

Question 115: A 40-year-old man presents with a 3-month history of progressively worsening headaches, worse in the morning and with Valsalva maneuver. He has papilledema and no focal deficits. MRI shows a ring-enhancing lesion with surrounding edema. What is the most likely diagnosis?

Brain abscess
Glioblastoma multiforme (Correct answer)
Primary CNS lymphoma
Metastatic carcinoma

Correct answer: Glioblastoma multiforme

Glioblastoma multiforme (GBM) classically presents as a ring-enhancing lesion with central necrosis and surrounding edema in an adult, often with progressive headaches and raised ICP signs.

Question 116: What component is included in the MCCQE Part II?

Multiple-choice questions.
Administrative role-play scenarios.
Clinical simulation stations. (Correct answer)
Written case studies.

Correct answer: Clinical simulation stations.

The MCCQE Part II is an Objective Structured Clinical Examination (OSCE) that includes clinical simulation stations. These stations assess practical clinical skills, communication, and professionalism in a simulated patient encounter setting, rather than relying on multiple-choice questions or administrative tasks.

Question 117: A 19-year-old man presents with a 6-month history of social withdrawal, flat affect, disorganized speech, and auditory hallucinations. He has no prior psychiatric history and no substance use. What is the most likely diagnosis?

Schizophreniform disorder
Schizophrenia (Correct answer)
Delusional disorder
Brief psychotic disorder

Correct answer: Schizophrenia

Schizophrenia requires at least 6 months of symptoms including at least 1 month of active-phase symptoms; this patient meets full criteria.

Question 118: A patient on warfarin develops a urinary tract infection. Which antibiotic choice requires the most careful INR monitoring due to interaction with warfarin metabolism?

Pivmecillinam
Nitrofurantoin
Fosfomycin
Trimethoprim-sulfamethoxazole (Correct answer)

Correct answer: Trimethoprim-sulfamethoxazole

Trimethoprim-sulfamethoxazole inhibits CYP2C9, reducing warfarin metabolism and significantly elevating INR, increasing hemorrhage risk.

Question 119: In preparing for the CDM (Clinical Decision-Making) section of MCCQE Part 1, the most effective practice strategy is:

Completing rapid-fire single-best-answer questions without case context
Memorizing drug dosages and laboratory reference ranges
Reading internal medicine subspecialty textbooks for comprehensive disease knowledge
Practicing with CDM-style case simulations that require sequenced decision-making across the clinical encounter (Correct answer)

Correct answer: Practicing with CDM-style case simulations that require sequenced decision-making across the clinical encounter

CDM cases unfold sequentially across history, physical exam, investigations, and management phases, so practicing with simulation tools that replicate this structure builds the required reasoning skills.

Question 120: A patient on isoniazid (INH) for latent TB prophylaxis develops peripheral neuropathy. Which supplement should be co-administered with INH to prevent this complication?

Folic acid
Vitamin B12 (cyanocobalamin)
Vitamin B6 (pyridoxine) (Correct answer)
Vitamin D

Correct answer: Vitamin B6 (pyridoxine)

INH competitively inhibits pyridoxal phosphate (active vitamin B6) metabolism, causing deficiency that leads to peripheral neuropathy; pyridoxine supplementation prevents this.

Question 121: A physician has a personal moral objection to prescribing medical assistance in dying (MAID). What is their legal obligation in Canada?

They must provide MAID regardless of personal beliefs
They must provide an effective referral to a willing provider (Correct answer)
They must transfer the patient's care entirely
They may refuse without any further duty

Correct answer: They must provide an effective referral to a willing provider

Under Bill C-14 and professional guidelines, conscientious objectors must provide timely and effective referrals so patients can access MAID.

Question 122: A 15-year-old presents alone requesting contraception and demonstrates clear understanding of the treatment. Under the mature minor doctrine, what should the physician do?

Refuse treatment without parental consent
Refer to a specialist only
Notify parents before any treatment
Provide treatment after assessing capacity (Correct answer)

Correct answer: Provide treatment after assessing capacity

Adolescents who demonstrate capacity to understand and appreciate treatment decisions may consent independently under the mature minor doctrine.

Question 123: A candidate fails MCCQE Part II twice. What is the most likely required next step according to MCC policies?

Rewriting MCCQE Part I before being allowed another Part II attempt
Immediate referral to a provincial licensing board for suspension
Automatic permanent disqualification from the MCCQE program
A mandatory review of the candidate's training and possible remediation before a third attempt (Correct answer)

Correct answer: A mandatory review of the candidate's training and possible remediation before a third attempt

After repeated Part II failures, the MCC typically requires the candidate to undergo review and may mandate remediation before authorizing another attempt.

Question 124: A 34-year-old woman at 39 weeks undergoes caesarean section. During closure, brisk bleeding is noted from the uterine incision edges that does not stop with suture. She receives oxytocin, ergometrine, and carboprost without effect. Estimated blood loss is 3 L. What is the next surgical step?

Uterine curettage to remove retained products
Internal iliac artery ligation
B-Lynch compression suture (Correct answer)
Peripartum hysterectomy immediately

Correct answer: B-Lynch compression suture

B-Lynch compression suture is a uterine-preserving surgical option for refractory uterine atony after medical management fails, compressing the uterus to reduce bleeding.

Question 125: Herd immunity thresholds are primarily determined by which parameter?

Case fatality rate
Secondary attack rate
Incubation period
Basic reproduction number (R₀) (Correct answer)

Correct answer: Basic reproduction number (R₀)

The herd immunity threshold is calculated as 1 − 1/R₀; a higher R₀ requires greater population immunity.

Question 126: A 45-year-old female presents with a 12-hour history of constant right upper quadrant (RUQ) pain, fever, and nausea after a fatty meal. Examination reveals a temperature of 38.5°C, localized RUQ tenderness, and a positive Murphy's sign. Ultrasound confirms gallstones, a thickened gallbladder wall, and pericholecystic fluid. In addition to intravenous fluids and analgesia, what is the most appropriate next step in management?

Discharge with oral antibiotics and follow-up
Schedule an urgent ERCP
Administer broad-spectrum intravenous antibiotics (Correct answer)
Arrange for an outpatient cholecystectomy in 6-8 weeks

Correct answer: Administer broad-spectrum intravenous antibiotics

The patient has a clear diagnosis of acute cholecystitis. Initial management involves supportive care (NPO, IV fluids, analgesia) and the administration of broad-spectrum intravenous antibiotics to cover common biliary pathogens. This stabilizes the patient and treats the infectious component in preparation for an early cholecystectomy, which is the definitive treatment.

Question 127: At what age does a child typically develop the pincer grasp (thumb-forefinger apposition)?

12 months
4 months
6 months
9 months (Correct answer)

Correct answer: 9 months

The mature pincer grasp develops around 9–10 months, allowing precise grasping of small objects between thumb and index finger.

Question 128: Which of the following best describes the role of CanMEDS competencies in MCCQE preparation?

CanMEDS is assessed only in the MCCQE Part 2 OSCE format
CanMEDS applies only to residency evaluation and has no relevance to MCCQE
CanMEDS is tested exclusively through essay questions in a separate written component
CanMEDS roles inform the construct of clinical vignettes and may be explicitly tested in CDM and MCQ sections (Correct answer)

Correct answer: CanMEDS roles inform the construct of clinical vignettes and may be explicitly tested in CDM and MCQ sections

The MCC integrates CanMEDS roles (Medical Expert, Communicator, Collaborator, etc.) into its exam framework, and some clinical decision-making questions explicitly test non-Medical Expert competencies.

Question 129: Which of the following best describes the 'dual-component' nature of MCCQE Part I?

It combines MCQ questions with Clinical Decision Making (CDM) cases in a single exam day (Correct answer)
It separates basic science from clinical knowledge across two days
It alternates between oral and written components
It has a morning MCQ session and an afternoon OSCE

Correct answer: It combines MCQ questions with Clinical Decision Making (CDM) cases in a single exam day

MCCQE Part I is administered in a single day with both MCQ and CDM components, testing knowledge recall and clinical decision-making together.

Question 130: A 29-year-old woman with recurrent major depression is started on fluoxetine. After 2 weeks, she reports increased energy but has not yet experienced mood improvement. What is the most appropriate counselling at this point?

Reassure that full response is expected within 2 weeks
Add a second antidepressant immediately
Advise that increased energy before mood improvement may transiently increase suicide risk (Correct answer)
Stop fluoxetine due to lack of response

Correct answer: Advise that increased energy before mood improvement may transiently increase suicide risk

During early antidepressant treatment, returning energy before mood improvement can increase the risk of acting on suicidal ideation, requiring close monitoring.

Question 131: A research participant enrolled in a clinical trial develops an unexpected serious adverse event. What is the researcher's immediate obligation?

Complete the trial before reporting to minimize bias
Inform only the sponsor and continue
Immediately report the event to the Research Ethics Board and consider stopping the trial (Correct answer)
Withdraw the participant silently to protect trial data

Correct answer: Immediately report the event to the Research Ethics Board and consider stopping the trial

Serious adverse events must be promptly reported to the REB; participant safety takes precedence over data integrity.

Question 132: A 26-year-old man presents with recurrent, intrusive thoughts about contamination and compulsive hand washing that takes 3 hours daily. He finds the thoughts distressing and ego-dystonic. What is the first-line treatment?

CBT with exposure and response prevention (ERP) and/or SSRI (Correct answer)
Psychodynamic therapy alone
Benzodiazepine monotherapy
Antipsychotic monotherapy

Correct answer: CBT with exposure and response prevention (ERP) and/or SSRI

CBT with exposure and response prevention (ERP) combined with an SSRI is first-line treatment for OCD, targeting both behavioral and neurochemical mechanisms.

Question 133: A 36-year-old G2P1 at 32 weeks presents with sudden onset dyspnea, hypoxia (SpO2 82%), hypotension, and cardiovascular collapse immediately after an amniotomy. She develops DIC. What is the most likely diagnosis?

Massive pulmonary embolism
Tension pneumothorax
Severe septic shock
Amniotic fluid embolism (Correct answer)

Correct answer: Amniotic fluid embolism

Amniotic fluid embolism (AFE) is characterized by sudden cardiovascular collapse, hypoxia, and DIC following amniotic fluid entry into maternal circulation, classically triggered by amniotomy or delivery.

Question 134: A 30-year-old woman presents with recurrent, unexpected panic attacks and has developed a significant fear of having another attack, leading her to avoid crowded public spaces. Which of the following represents a first-line, evidence-based treatment for her condition?

Psychoanalytic psychotherapy
Buspirone monotherapy
Cognitive-Behavioural Therapy (CBT) (Correct answer)
Propranolol as needed

Correct answer: Cognitive-Behavioural Therapy (CBT)

Both Cognitive-Behavioural Therapy (CBT) and SSRI antidepressants are considered first-line, evidence-based treatments for panic disorder with agoraphobia. CBT is highly effective for helping patients understand and manage the cognitive and behavioural aspects of the disorder. Propranolol may manage some physical symptoms but is not a first-line treatment for the core disorder. Buspirone is generally not effective for panic disorder. Psychoanalytic psychotherapy is not considered a first-line, evidence-based treatment.

Question 135: Which mechanism best explains why aminoglycosides exhibit concentration-dependent bactericidal activity?

They inhibit DNA gyrase more potently at elevated concentrations
They irreversibly bind the 50S ribosomal subunit at higher concentrations
Higher peak concentrations drive greater uptake into bacteria via the electron transport chain (Correct answer)
They competitively inhibit transpeptidase in a concentration-dependent manner

Correct answer: Higher peak concentrations drive greater uptake into bacteria via the electron transport chain

Aminoglycoside uptake into bacterial cells is energy-dependent and increases with higher drug concentrations, producing a concentration-dependent kill curve.

Question 136: A mother brings her 2-year-old son for a routine check-up. She is concerned about his language development. Which of the following findings would be most reassuring and considered a normal developmental milestone for his age?

He can combine two words to make simple phrases, such as 'more juice'. (Correct answer)
He speaks in full, grammatically correct sentences.
He can name four primary colours correctly.
He has a vocabulary of about 10 words and gestures for his needs.

Correct answer: He can combine two words to make simple phrases, such as 'more juice'.

At two years of age, a key language milestone is the ability to combine two words into simple phrases. A vocabulary of around 50 words is typical, and using two-word sentences (e.g., 'want cookie,' 'mama go') is expected. Speaking in full sentences is a milestone for older children (around 3-4 years), while a 10-word vocabulary is more typical for a child around 15-18 months. Naming colours is a more advanced skill, usually developing between 3 and 4 years.

Question 137: A 6-month-old infant is brought in for a developmental assessment. Which of the following primitive reflexes would be considered an abnormal finding if it is still strongly present?

Plantar grasp
Babinski reflex
Moro reflex (Correct answer)
Landau reflex

Correct answer: Moro reflex

The Moro reflex, or startle reflex, typically disappears or integrates by 2 to 4 months of age. Its persistence beyond 6 months can be a red flag for neurological issues. The plantar grasp reflex disappears later, around 9-12 months. The Babinski reflex can be normal up to 2 years of age. The Landau reflex appears around 4-5 months and integrates around 12-24 months.

Question 138: An 18-month-old boy has no words and does not point to objects. He previously said 'mama' and 'dada' at 12 months but has stopped. What is the most important next step?

Reassure and recheck at 24 months
Start iron supplementation
Evaluate for autism spectrum disorder (Correct answer)
Order chromosomal microarray

Correct answer: Evaluate for autism spectrum disorder

Language regression combined with loss of pointing and no words at 18 months are red flags for autism spectrum disorder requiring immediate evaluation.

Question 139: A public health intervention reduces the relative risk of stroke from 0.40 to 0.20. What is the relative risk reduction?

50% (Correct answer)
60%
20%
80%

Correct answer: 50%

Relative risk reduction = (RR_old − RR_new) / RR_old = (0.40 − 0.20) / 0.40 = 50%.

Question 140: Which finding on echocardiography is most consistent with cardiac tamponade?

Right ventricular diastolic collapse (Correct answer)
Left ventricular hypertrophy
Aortic root dilation
Mitral valve prolapse

Correct answer: Right ventricular diastolic collapse

Diastolic collapse of the right ventricle on echocardiography is the hallmark finding of cardiac tamponade due to external pericardial compression.

Question 141: A hospital-based study aims to determine if smoking is a risk factor for pancreatitis. Cases are recruited from the hospital's gastroenterology ward. Controls are recruited from the hospital's pulmonary ward, which treats many patients with smoking-related diseases. This study design is most susceptible to which type of bias?

Selection bias (Correct answer)
Observer bias
Recall bias
Confounding

Correct answer: Selection bias

This is a form of selection bias, specifically Berkson's bias. The control group is not representative of the general population from which the cases arose. Because the control group (pulmonary patients) has a much higher prevalence of smoking than the general population, the association between smoking and pancreatitis may be artificially weakened or missed entirely.

Question 142: At which age would you expect a child to begin stranger anxiety?

2–3 months
12–15 months
4–5 months
6–9 months (Correct answer)

Correct answer: 6–9 months

Stranger anxiety typically emerges between 6 and 9 months as the infant develops object permanence and preferential attachment to caregivers.

Question 143: Which of the following is a valid reason the MCC may grant a candidate an extension to the 10-year window to complete MCCQE Part II after passing Part I?

The candidate experienced a prolonged medical illness or parental leave (Correct answer)
The candidate changed their country of intended practice
The candidate failed Part II multiple times and requests extra time
The candidate chose to pursue a non-medical career temporarily

Correct answer: The candidate experienced a prolonged medical illness or parental leave

The MCC may grant extensions to the 10-year window for documented extenuating circumstances such as serious illness or parental leave.

Question 144: A 27-year-old G3P2 delivers a 4.2 kg infant vaginally. The anterior shoulder is delivered but the body does not follow despite gentle downward traction. The turtle sign is noted. What manoeuvre should be performed first?

Internal rotation (Woods screw)
Fundal pressure (Kristeller manoeuvre)
McRoberts manoeuvre with suprapubic pressure (Correct answer)
Zavanelli manoeuvre

Correct answer: McRoberts manoeuvre with suprapubic pressure

McRoberts manoeuvre (hyperflexion of maternal thighs) combined with suprapubic pressure is the first-line management for shoulder dystocia.

Question 145: A 15-year-old female patient, who appears insightful and articulate, requests a prescription for oral contraceptives. She understands the risks, benefits, and alternatives, but explicitly asks you not to inform her parents. What is the most appropriate course of action for a physician in Canada?

Refuse to prescribe until parental consent is obtained, as she is a minor.
Assess her capacity to consent; if she is deemed a 'mature minor', provide the prescription without notifying her parents. (Correct answer)
Provide the prescription but insist on booking a follow-up appointment with the patient and her parents together.
Inform the parents of her request, respecting their role as legal guardians.

Correct answer: Assess her capacity to consent; if she is deemed a 'mature minor', provide the prescription without notifying her parents.

In Canada, the legal principle of the 'mature minor' doctrine applies. This common law doctrine, upheld by the Supreme Court of Canada, states that if a minor is capable of understanding the nature of a proposed treatment and its consequences, they can provide valid consent. [6, 18] Age is not the determining factor; capacity is. Therefore, the physician's primary duty is to assess the 15-year-old's capacity. [3] If she demonstrates sufficient understanding (i.e., is a mature minor), her consent is valid, and her request for confidentiality should be respected. [6] Insisting on parental consent or breaching her confidentiality against her wishes would be inappropriate.

Question 146: A 65-year-old man develops confusion, agitation, and disorientation 2 days after hip replacement surgery. He has fluctuating consciousness and is worse at night. What is the most likely diagnosis?

Bipolar disorder with psychosis
Dementia with Lewy bodies
Postoperative delirium (Correct answer)
New-onset schizophrenia

Correct answer: Postoperative delirium

Postoperative delirium is common in elderly patients, characterized by acute onset, fluctuating consciousness, and disorientation, often precipitated by surgery, anesthesia, and pain medications.

Question 147: The MCCQE Part II uses which primary format to assess clinical competence for scoring purposes?

Computer-based multiple-choice questions
Objective Structured Clinical Examination (OSCE) stations (Correct answer)
Written long-answer clinical vignettes
Standardized oral examination with physician examiners

Correct answer: Objective Structured Clinical Examination (OSCE) stations

The MCCQE Part II is delivered as an OSCE with multiple clinical stations where candidates interact with standardized patients.

Question 148: A 50-year-old woman presents with right iliac fossa pain, fever, and a palpable mass. CT shows a perforated appendicitis with a 4 cm periappendiceal abscess and no free perforation. What is the preferred management in a stable patient?

IV antibiotics alone without drainage
Open drainage with primary appendectomy
IV antibiotics and CT-guided percutaneous drainage, followed by interval appendectomy (Correct answer)
Immediate laparoscopic appendectomy

Correct answer: IV antibiotics and CT-guided percutaneous drainage, followed by interval appendectomy

A well-contained periappendiceal abscess in a stable patient is best managed with percutaneous drainage and antibiotics, followed by interval appendectomy at 6–8 weeks to rule out underlying malignancy.

Question 149: A 30-year-old primigravida undergoes IOL at 41 weeks. After 18 hours of oxytocin augmentation, she is 9 cm dilated. Suddenly, she reports sharp constant abdominal pain, fetal heart rate drops to 60 bpm, and her uterine contraction pattern disappears. What is the most likely diagnosis?

Amniotic fluid embolism
Cord prolapse
Uterine rupture (Correct answer)
Placental abruption

Correct answer: Uterine rupture

Uterine rupture classically presents with sudden cessation of contractions, fetal distress, constant abdominal pain, and can occur with prolonged oxytocin use.

Question 150: A 52-year-old woman presents with a fixed, unshakeable belief that her intestines have rotted away, despite normal investigations. She is otherwise alert and oriented. What is this symptom called, and in what condition is it classically seen?

Thought insertion in schizophrenia
Cotard's delusion (nihilistic delusion) in severe depression with psychotic features (Correct answer)
Somatic delusion in delusional disorder
Capgras syndrome in dementia

Correct answer: Cotard's delusion (nihilistic delusion) in severe depression with psychotic features

Cotard's delusion (nihilistic delusion of body decay or non-existence) is classically associated with severe psychotic depression.

Question 151: Which of the following findings most strongly suggests that an incarcerated inguinal hernia has progressed to strangulation?

The patient reports a recent increase in the size of the bulge.
The patient develops fever, tachycardia, and erythema over the hernia. (Correct answer)
The patient experiences nausea and constipation.
The hernia can no longer be manually reduced.

Correct answer: The patient develops fever, tachycardia, and erythema over the hernia.

Incarceration means the hernia is non-reducible. Strangulation implies compromised blood flow to the herniated contents, leading to ischemia. Systemic signs of infection/inflammation (fever, tachycardia) and localized skin changes (erythema, extreme tenderness) are red flags for strangulation, which is a surgical emergency. Nausea and constipation can occur with simple incarceration due to obstruction, but the systemic signs point specifically to strangulation.

Question 152: What is the primary criterion for taking the MCCQE Part II?

Passing MCCQE Part I and 12 months of postgraduate training. (Correct answer)
Holding a permanent medical license.
Certification in a medical specialty.
Completion of a PhD in medical sciences.

Correct answer: Passing MCCQE Part I and 12 months of postgraduate training.

The primary criterion for taking the MCCQE Part II is successfully passing the MCCQE Part I and completing at least 12 months of acceptable postgraduate clinical training. This ensures candidates have both the foundational knowledge and initial practical experience before being assessed on advanced clinical skills.

Question 153: Which of the following is the most significant risk factor for uterine atony, the leading cause of primary postpartum hemorrhage (PPH)?

Primiparity
Overdistention of the uterus (Correct answer)
Prolonged second stage of labor
History of manual removal of placenta

Correct answer: Overdistention of the uterus

Uterine atony, the failure of the uterus to contract adequately after delivery, is the most common cause of PPH. Overdistention of the uterus is a major risk factor for atony. Conditions leading to overdistention include multiple gestation, polyhydramnios, and fetal macrosomia. The stretched uterine muscle fibers have more difficulty contracting effectively. While other options can be risk factors, uterine overdistention is considered one of the most significant.

Question 154: A surgeon discovers an unexpected finding during an operation that was not discussed preoperatively. The finding poses no immediate threat. What is the correct action?

Wake the patient to obtain consent
Complete the consented procedure and discuss the finding postoperatively (Correct answer)
Treat the finding immediately while the patient is already under anaesthesia
Contact the next-of-kin for consent

Correct answer: Complete the consented procedure and discuss the finding postoperatively

Non-urgent unexpected findings should not be treated without prior consent; the surgeon should complete the consented procedure and obtain informed consent later.

Question 155: A 28-year-old G1P0 at 26 weeks is found to have a 1-hour 50g GCT of 8.9 mmol/L. A 2-hour 75g OGTT shows fasting 5.4, 1-hour 11.2, and 2-hour 9.0 mmol/L. What is the most appropriate initial management?

Start metformin and dietary counselling
Start insulin immediately given OGTT results
Medical nutrition therapy (MNT) and lifestyle modification for 2 weeks before pharmacotherapy (Correct answer)
Repeat OGTT in 4 weeks to confirm diagnosis

Correct answer: Medical nutrition therapy (MNT) and lifestyle modification for 2 weeks before pharmacotherapy

Newly diagnosed gestational diabetes mellitus (GDM) is initially managed with medical nutrition therapy and lifestyle modification; pharmacotherapy is added if targets are not met within 1-2 weeks.

Question 156: Which of the following best describes the role of the Physician Credentials Registry of Canada (PCRC) in MCCQE eligibility?

PCRC issues the MCC identification number directly
PCRC verifies postgraduate training hours for Part II eligibility
PCRC collects and verifies medical school credentials on behalf of the MCC (Correct answer)
PCRC administers the computer-based testing for Part I

Correct answer: PCRC collects and verifies medical school credentials on behalf of the MCC

The PCRC collects and verifies primary source medical education credentials that the MCC uses to determine examination eligibility.

Question 157: A 27-year-old woman presents after an argument with her partner. She describes intense fear of abandonment, unstable relationships, impulsive self-harm, and chronic feelings of emptiness. What is the most likely diagnosis?

Bipolar II disorder
Histrionic personality disorder
Borderline personality disorder (Correct answer)
Cyclothymic disorder

Correct answer: Borderline personality disorder

Borderline personality disorder is characterized by fear of abandonment, unstable relationships, impulsivity, self-harm, and chronic emptiness.

Question 158: A candidate preparing for MCCQE Part 1 is unsure whether to prioritize pediatrics or geriatrics in the final month, given limited study time. The most rational basis for this decision is:

The number of Toronto Notes pages dedicated to each discipline
Personal clinical interest and rotation experience
The relative weighting of each discipline in the MCC Objectives and their frequency in the candidate's Qbank performance data (Correct answer)
The advice of peers who wrote the exam in a previous year

Correct answer: The relative weighting of each discipline in the MCC Objectives and their frequency in the candidate's Qbank performance data

The MCC Objectives explicitly indicate the relative emphasis of different disciplines, and personal performance data from Qbank practice identifies which gap has greater score-improvement potential.

Question 159: A meta-analysis pools results from 15 RCTs. Significant heterogeneity is detected (I² = 75%). The most appropriate next step is to:

Explore sources of heterogeneity through subgroup analysis or meta-regression (Correct answer)
Exclude all studies and declare evidence insufficient
Report the pooled estimate as the final answer
Increase the sample size of the smallest study

Correct answer: Explore sources of heterogeneity through subgroup analysis or meta-regression

High heterogeneity (I² > 50%) warrants investigation of clinical or methodological reasons through subgroup analysis or meta-regression.

Question 160: Which finding on developmental assessment at 12 months is the most concerning red flag?

No pincer grasp
Does not point to show objects (Correct answer)
No single words
No walking independently

Correct answer: Does not point to show objects

Absence of declarative pointing (pointing to share interest) by 12 months is a red flag for autism spectrum disorder and requires urgent developmental assessment.

Question 161: A researcher finds an odds ratio of 2.5 (95% CI: 0.9–6.8) for the association between a dietary factor and colon cancer. What is the correct interpretation?

There is a statistically significant association
The result is not statistically significant at the 0.05 level (Correct answer)
The dietary factor is definitively protective
The study has insufficient external validity

Correct answer: The result is not statistically significant at the 0.05 level

Because the 95% CI crosses 1.0, the result is not statistically significant at α = 0.05.

Question 162: A psychiatrist is treating a patient who reveals a credible and detailed plan to cause serious physical harm to his former supervisor. The patient has a history of violent outbursts. According to Canadian legal and ethical principles, the psychiatrist's primary duty is to:

Document the threat thoroughly in the patient's chart and increase the frequency of therapy sessions.
Immediately discharge the patient from care to sever professional responsibility.
Maintain absolute patient confidentiality to preserve the therapeutic relationship.
Take reasonable steps to protect the potential victim, which may include warning them and/or notifying the police. (Correct answer)

Correct answer: Take reasonable steps to protect the potential victim, which may include warning them and/or notifying the police.

While patient confidentiality is a cornerstone of medical ethics, it is not absolute. The Supreme Court of Canada decision in Smith v. Jones established a 'public safety' exception. [19] When there is a clear, serious, and imminent risk of harm to an identifiable person or group, the physician's duty to protect the public outweighs the duty of confidentiality. [5, 12, 19] The physician has a duty to take reasonable steps to prevent the harm, which can include warning the potential victim and/or contacting the police. [19] Simply documenting the threat is insufficient, and discharging the patient is an abdication of responsibility. Maintaining absolute confidentiality in this scenario would be a breach of the duty to protect.

Question 163: Which of the following is the most common cause of postpartum hemorrhage?

Uterine atony (Correct answer)
Coagulopathy
Genital tract lacerations
Retained placental tissue

Correct answer: Uterine atony

Uterine atony accounts for approximately 70-80% of postpartum hemorrhage cases.

Question 164: A 42-year-old man with bipolar disorder on lithium reports polyuria, polydipsia, and fine tremor. His lithium level is 0.7 mEq/L (therapeutic). What is the most appropriate management for polyuria?

Start desmopressin only
Increase lithium dose
Add amiloride or reduce lithium dose if clinically appropriate (Correct answer)
Switch to valproate immediately

Correct answer: Add amiloride or reduce lithium dose if clinically appropriate

Lithium-induced nephrogenic diabetes insipidus is managed by reducing the lithium dose (if safe) and/or adding amiloride, which reduces lithium reabsorption in collecting ducts.

Question 165: A 4-year-old child cannot hop on one foot, cannot copy a circle, and uses only 3-word sentences. Which domain is NOT delayed based on expected milestones?

Gross motor
Language
Fine motor
None — all three are delayed (Correct answer)

Correct answer: None — all three are delayed

By age 4, children should hop on one foot (gross motor), copy a circle (fine motor), and use 4–5 word sentences (language), so all three domains are delayed.

Question 166: A 78-year-old female with a history of atrial fibrillation presents with the sudden onset of severe, diffuse abdominal pain. On examination, her abdomen is soft and non-tender with normal bowel sounds. Laboratory tests reveal a significant metabolic acidosis and a markedly elevated lactate level. Which of the following is the most likely diagnosis?

Ruptured abdominal aortic aneurysm
Acute mesenteric ischemia (Correct answer)
Perforated diverticulitis
Acute pancreatitis

Correct answer: Acute mesenteric ischemia

The classic presentation of acute mesenteric ischemia is 'pain out of proportion to physical exam findings'. The severe pain with a benign abdominal exam, combined with risk factors (atrial fibrillation, a source of emboli) and evidence of tissue hypoperfusion (metabolic acidosis, high lactate), is highly suggestive of this diagnosis. The other options would typically present with more pronounced physical findings like tenderness, guarding, or a pulsatile mass.

Question 167: A patient with HFrEF (EF 30%) remains symptomatic on maximally tolerated ACE inhibitor and beta-blocker. What is the next best step?

Add sacubitril/valsartan replacing ACE inhibitor (Correct answer)
Add aldosterone antagonist
Add digoxin
Refer for cardiac transplant evaluation

Correct answer: Add sacubitril/valsartan replacing ACE inhibitor

Sacubitril/valsartan (ARNI) replaces ACE inhibitor in symptomatic HFrEF patients and reduces mortality and hospitalizations (PARADIGM-HF trial).

Question 168: A 72-year-old female with atrial fibrillation, managed with warfarin, is diagnosed with a urinary tract infection. Which of the following antibiotics, if prescribed, would most significantly increase her risk of bleeding by potentiating the effect of warfarin?

Cephalexin
Nitrofurantoin
Ciprofloxacin (Correct answer)
Amoxicillin

Correct answer: Ciprofloxacin

Ciprofloxacin is a known inhibitor of the cytochrome P450 enzyme system (specifically CYP1A2 and CYP3A4), which is involved in the metabolism of warfarin. [1, 16] By inhibiting its metabolism, ciprofloxacin can lead to elevated serum levels of warfarin, increasing the INR and the risk of significant bleeding. [6, 18]

Question 169: A 55-year-old woman on phenelzine for depression eats aged cheese and develops severe hypertensive crisis. What is the mechanism?

Serotonin syndrome from cheese-induced 5-HT release
Tyramine-induced norepinephrine surge due to MAO inhibition (Correct answer)
Histamine toxicity from fermentation
Direct vasopressin release from casein

Correct answer: Tyramine-induced norepinephrine surge due to MAO inhibition

MAO inhibitors block tyramine breakdown; dietary tyramine triggers massive norepinephrine release from sympathetic terminals, causing hypertensive crisis.

Question 170: A 30-year-old woman presents with right lower quadrant pain, low-grade fever, and elevated WBC. Ultrasound is non-diagnostic. CT with contrast shows a 9 mm appendix with periappendiceal fat stranding. She has no perforation or abscess. What is standard of care?

Open appendectomy via McBurney incision
Laparoscopic appendectomy (Correct answer)
IV antibiotics alone with outpatient follow-up
Interval appendectomy in 6 weeks

Correct answer: Laparoscopic appendectomy

Uncomplicated acute appendicitis confirmed on CT is treated with laparoscopic appendectomy, which is the current standard of care offering lower morbidity and faster recovery than open surgery.

Question 171: A 40-year-old woman with mitral stenosis (MVA 1.0 cm²) develops AF with rapid ventricular response at 140 bpm. She is hemodynamically stable. What is the priority intervention?

Immediate DC cardioversion
Emergency balloon mitral valvuloplasty
Anticoagulation initiation only
Rate control with beta-blocker or diltiazem (Correct answer)

Correct answer: Rate control with beta-blocker or diltiazem

In mitral stenosis with AF and rapid rate, rate control is prioritized to allow adequate diastolic filling time across the stenotic valve before definitive intervention.

Question 172: A 48-year-old man presents with a painful erythematous and edematous right lower leg with rapidly spreading erythema, crepitus on palpation, and systemic sepsis. Blood glucose is 22 mmol/L. What is the diagnosis and immediate treatment?

Deep vein thrombosis — anticoagulation
Gas gangrene (myonecrosis) — hyperbaric oxygen first
Necrotizing fasciitis — emergent surgical debridement and broad-spectrum antibiotics (Correct answer)
Cellulitis — IV penicillin

Correct answer: Necrotizing fasciitis — emergent surgical debridement and broad-spectrum antibiotics

Crepitus, rapidly advancing erythema, and sepsis in a diabetic patient indicate necrotizing fasciitis requiring immediate aggressive surgical debridement, which is life-saving and cannot be delayed.

Question 173: A 24-year-old woman presents with periods of depressed mood for 2 weeks every month beginning a week before menstruation and resolving within a few days of its onset, with significant functional impairment. What is the diagnosis?

Premenstrual syndrome (PMS)
Premenstrual dysphoric disorder (PMDD) (Correct answer)
Dysthymia
Major depressive disorder with seasonal pattern

Correct answer: Premenstrual dysphoric disorder (PMDD)

PMDD is distinguished from PMS by marked functional impairment and mood symptoms (not just physical) confirmed prospectively across at least two cycles.

Question 174: A 60-year-old man presents with left lower quadrant pain, fever, and leukocytosis. CT shows pericolic fat stranding and a small extraluminal air bubble adjacent to the sigmoid colon (Hinchey Stage II). He is stable. What is the standard management?

IV antibiotics and CT-guided drainage of any abscess, with elective sigmoid resection later (Correct answer)
Oral antibiotics as outpatient
Primary sigmoid resection with anastomosis immediately
Emergent Hartmann's procedure

Correct answer: IV antibiotics and CT-guided drainage of any abscess, with elective sigmoid resection later

Hinchey II diverticulitis (pericolic or pelvic abscess without free perforation) is managed with IV antibiotics and percutaneous drainage if the abscess is ≥3 cm, followed by elective resection.

Question 175: A patient presents with wide-complex tachycardia at 180 bpm. He is hemodynamically stable. Which drug is appropriate for acute management if VT is suspected?

Digoxin IV
Amiodarone IV (Correct answer)
Adenosine IV
Verapamil IV

Correct answer: Amiodarone IV

IV amiodarone is first-line for hemodynamically stable monomorphic VT when the diagnosis is confirmed or strongly suspected.

Question 176: Which of the following best describes a systematic review?

A narrative literature review without defined search criteria
An expert opinion on a clinical question
A comprehensive synthesis of all relevant studies on a topic using explicit methods (Correct answer)
A single large observational study

Correct answer: A comprehensive synthesis of all relevant studies on a topic using explicit methods

Systematic reviews use pre-specified, reproducible search and selection criteria to synthesize evidence from multiple studies.

Question 177: Which study resource type is most effective for rapidly reviewing high-yield clinical presentations listed in the MCC Objectives?

Full subspecialty textbooks (e.g., Harrison's Principles of Internal Medicine)
Research journal articles from CMAJ and NEJM
Annotated clinical vignette Qbanks with detailed explanations (Correct answer)
Medical school lecture slides from first and second year

Correct answer: Annotated clinical vignette Qbanks with detailed explanations

Annotated Qbanks directly train pattern recognition for clinical vignettes while providing high-yield summaries that map to exam-tested presentations.

Question 178: A 70-year-old man presents with sudden onset painless bright red rectal bleeding causing hemodynamic instability. He has no abdominal pain. Nasogastric aspirate is bile-stained without blood. What is the most appropriate next diagnostic and therapeutic step?

Colonoscopy after rapid bowel prep
Emergent sigmoidoscopy
Upper GI endoscopy
CT angiography followed by interventional radiology embolization (Correct answer)

Correct answer: CT angiography followed by interventional radiology embolization

Hemodynamically significant lower GI bleeding in an elderly patient warrants CT angiography (if actively bleeding at ≥0.3 mL/min) to localize the source, followed by angioembolization.

Question 179: A 50-year-old man with hypertension and no diabetes has a 10-year ASCVD risk of 12%. His LDL is 3.5 mmol/L. What is the best management?

Lifestyle modification alone
Low-intensity statin
High-intensity statin plus ezetimibe
Moderate-intensity statin (Correct answer)

Correct answer: Moderate-intensity statin

For intermediate ASCVD risk (7.5–20%) with LDL ≥2.6 mmol/L, moderate-intensity statin therapy is recommended after risk discussion.

Question 180: A candidate has 6 weeks remaining before MCCQE Part 1 and has completed only 40% of his Qbank. What is the most strategic approach?

Focus exclusively on reviewing his incorrect questions from the completed 40%
Prioritize high-yield, high-frequency MCC Objective presentations and complete targeted Qbank blocks for untested areas (Correct answer)
Stop Qbank practice and focus solely on reading Toronto Notes for the remaining weeks
Rush through the remaining 60% of questions without reviewing explanations to maximize question exposure

Correct answer: Prioritize high-yield, high-frequency MCC Objective presentations and complete targeted Qbank blocks for untested areas

With limited time, prioritizing high-yield clinical presentations from the MCC Objectives while selectively tackling untested Qbank content maximizes score impact per study hour.

Question 181: What is the typical duration of each MCCQE Part II OSCE station?

11 minutes (Correct answer)
20 minutes
30 minutes
5 minutes

Correct answer: 11 minutes

Each MCCQE Part II station is 11 minutes long, giving candidates adequate time to complete the clinical encounter with a standardized patient.

Question 182: A 50-year-old man with Crohn's disease presents with severe right lower quadrant pain, fever, and a palpable mass. CT reveals a 5 cm phlegmon/abscess in the right iliac fossa with no free perforation. What is the preferred initial management?

CT-guided percutaneous drainage and IV antibiotics, with interval resection (Correct answer)
High-dose systemic corticosteroids
Colonoscopy and mucosal biopsy
Immediate surgical resection of terminal ileum

Correct answer: CT-guided percutaneous drainage and IV antibiotics, with interval resection

A Crohn's-related abscess without free perforation is best managed initially with CT-guided percutaneous drainage and antibiotics, followed by elective bowel resection after inflammation resolves.

Question 183: On the MCCQE Part II OSCE, what is the impact of a 'critical error' at a clinical station?

Critical errors have no special weighting; all items are scored equally
Critical errors only affect the final score if committed on more than three stations
A critical error can result in automatic failure of that station regardless of overall station score (Correct answer)
A critical error adds bonus points to other stations to compensate

Correct answer: A critical error can result in automatic failure of that station regardless of overall station score

Committing a critical error (e.g., a dangerous patient safety omission) at an OSCE station can result in automatic failure of that station.

Question 184: A 15-year-old girl has not yet had her first menstrual period but has Tanner stage 4 breast development and pubic hair. What is the most appropriate next step?

Reassure; primary amenorrhea is defined as no menses by age 16 with secondary sexual characteristics (Correct answer)
Refer to genetics for Turner syndrome workup
Order pelvic ultrasound and hormone panel now
Start oral contraceptive pills

Correct answer: Reassure; primary amenorrhea is defined as no menses by age 16 with secondary sexual characteristics

Primary amenorrhea is defined as no menses by age 15 in the presence of secondary sexual characteristics, so this 15-year-old does not yet meet diagnostic criteria.

Question 185: During a vacuum-assisted vaginal delivery, a pop is heard and the cup detaches. After reapplication, another pop occurs. What is the recommended course of action?

Abandon vacuum and proceed to caesarean delivery (Correct answer)
Allow up to 5 cup detachments if fetal descent is occurring
Increase vacuum pressure and continue
Apply forceps immediately to complete delivery

Correct answer: Abandon vacuum and proceed to caesarean delivery

Two cup detachments (pop-offs) are an indication to abandon vacuum delivery and proceed to caesarean to prevent fetal injury.

Question 186: A 10-year-old girl begins breast development. This is considered precocious puberty. What is the most common underlying cause?

Congenital adrenal hyperplasia
Adrenal tumor
Central (gonadotropin-dependent) precocious puberty — idiopathic (Correct answer)
McCune-Albright syndrome

Correct answer: Central (gonadotropin-dependent) precocious puberty — idiopathic

Wait — precocious puberty in girls is defined as onset before age 8, so a 10-year-old with breast development is normal; however if the question intends age 7, the most common cause of true precocious puberty is idiopathic central precocious puberty.

Question 187: A 34-year-old woman reports re-experiencing a car accident through flashbacks and nightmares, hypervigilance, emotional numbing, and avoidance of driving for 3 months. What is the first-line pharmacotherapy?

Bupropion
Alprazolam
Propranolol
Sertraline (SSRI) (Correct answer)

Correct answer: Sertraline (SSRI)

SSRIs (sertraline, paroxetine) are first-line pharmacotherapy for PTSD, targeting mood, anxiety, and intrusion symptoms.

Question 188: A 65-year-old man presents with painless obstructive jaundice, a palpable non-tender gallbladder, and 15 kg weight loss over 3 months. CT shows a mass in the head of the pancreas with dilated biliary and pancreatic ducts. What eponymous sign describes the palpable gallbladder?

Trousseau's sign
Murphy's sign
Courvoisier's sign (Correct answer)
Grey Turner's sign

Correct answer: Courvoisier's sign

Courvoisier's sign is a palpable non-tender gallbladder in the setting of painless jaundice, classically indicating malignant biliary obstruction (pancreatic head carcinoma) rather than gallstone disease.

Question 189: Which of the following best describes the MCCQE Part II station structure?

Standardized patient encounters assessed by physician examiners (Correct answer)
Multiple choice questions administered at clinical sites
Written essay stations only
Oral examination with a single examiner panel

Correct answer: Standardized patient encounters assessed by physician examiners

MCCQE Part II OSCE stations involve standardized patients while physician examiners observe and rate performance using structured checklists.

Question 190: A 55-year-old man with schizophrenia requires clozapine due to treatment resistance. What mandatory monitoring is required due to clozapine's most dangerous adverse effect?

Absolute neutrophil count (ANC) monitoring per registry protocol (Correct answer)
Thyroid function tests biweekly
Liver function tests weekly
Serum creatinine monthly

Correct answer: Absolute neutrophil count (ANC) monitoring per registry protocol

Clozapine carries a risk of potentially fatal agranulocytosis, requiring mandatory ANC monitoring through a national registry (e.g., weekly for 26 weeks, then biweekly).

Question 191: A 33-year-old man presents with testicular pain and swelling that began 4 hours ago. The testis is high-riding with a horizontal lie. Doppler ultrasound shows absent blood flow. What is the time window for salvage with surgical detorsion?

Within 6 hours — approximately 90–100% salvage (Correct answer)
Within 12 hours — approximately 50% salvage
Within 1 hour — near 100% salvage
Within 24 hours — approximately 10% salvage

Correct answer: Within 6 hours — approximately 90–100% salvage

Testicular salvage rates approach 90–100% if surgical detorsion is performed within 6 hours of onset; rates drop to ~50% at 12 hours and <10% at 24 hours.

Question 192: A pharmaceutical company offers a physician an all-expenses-paid trip to a resort in exchange for prescribing their medication. This arrangement is best described as:

Acceptable if the physician discloses it to patients
Acceptable continuing medical education
An inappropriate conflict of interest and potential bribery (Correct answer)
A standard industry practice permitted by the CMA

Correct answer: An inappropriate conflict of interest and potential bribery

Accepting inducements from industry in exchange for prescribing constitutes a serious conflict of interest and violates professional and legal standards.

Question 193: A candidate is deciding between using AMBOSS or a dedicated MCCQE Qbank for exam preparation. The primary advantage of a dedicated MCCQE Qbank is:

AMBOSS questions are written at a lower difficulty level than MCCQE questions
Dedicated MCCQE Qbanks include free access to Toronto Notes
Its questions are mapped directly to MCC Objectives and reflect Canadian clinical practice patterns (Correct answer)
It has higher total question count than AMBOSS

Correct answer: Its questions are mapped directly to MCC Objectives and reflect Canadian clinical practice patterns

Dedicated MCCQE resources align question stems and answers with Canadian guidelines (e.g., Health Canada drug approvals, Canadian screening recommendations) rather than US-based standards.

Question 194: Which body issues the Medical Council of Canada (MCC) identification number required to register for the MCCQE Part I?

Royal College of Physicians and Surgeons
Provincial medical licensing authority
Association of Faculties of Medicine of Canada
Medical Council of Canada (Correct answer)

Correct answer: Medical Council of Canada

The MCC itself issues the unique MCC identification number needed for all MCC examination registrations.

Question 195: A 2-year-old uses 2-word phrases and has a vocabulary of 50 words. Which assessment is most appropriate?

Refer for speech therapy immediately
Test for hearing loss
Order brain MRI
Reassure parents; development is normal (Correct answer)

Correct answer: Reassure parents; development is normal

By age 2, children are expected to have at least 50 words and use 2-word combinations, so this child's language development is within normal limits.

Question 196: A 45-year-old woman with moderate depression and comorbid chronic pain is seeking pharmacotherapy that addresses both conditions. Which antidepressant class is most appropriate?

SNRI (e.g., duloxetine) (Correct answer)
SSRI (e.g., fluoxetine)
Bupropion
Tricyclic antidepressant at full antidepressant dose

Correct answer: SNRI (e.g., duloxetine)

SNRIs such as duloxetine have evidence for both depression and neuropathic/chronic pain through noradrenergic and serotonergic mechanisms.

Question 197: A physician learns that a colleague is practicing while impaired by alcohol. What is the primary professional obligation?

Inform the hospital administrator only
Document observations and wait for a formal complaint
Report to the regulatory college or appropriate authority (Correct answer)
Confront the colleague privately and take no further action if they deny it

Correct answer: Report to the regulatory college or appropriate authority

Physicians have a professional and ethical duty to report a colleague whose impairment poses a risk to patient safety to the appropriate regulatory body.

Question 198: A 24-year-old male presents with 12 hours of right flank pain and dysuria. He has a low-grade fever and mild tenderness in the right lower quadrant, but also significant right costovertebral angle (CVA) tenderness. A urinalysis shows 5-10 WBCs and 5-10 RBCs. What is the most likely diagnosis?

Retrocecal Appendicitis (Correct answer)
Acute Pyelonephritis
Ureteral Colic
Testicular Torsion

Correct answer: Retrocecal Appendicitis

A retrocecal appendix can irritate the adjacent psoas muscle, ureter, and bladder, leading to atypical symptoms that mimic a urinary tract or renal pathology, such as flank pain, CVA tenderness, and sterile pyuria. The presence of right lower quadrant tenderness should maintain a high index of suspicion for appendicitis despite the urinary symptoms.

Question 199: A medical student performing a supervised procedure causes harm due to a technical error. Who bears the primary legal responsibility?

No one, as student errors are exempt from liability
The medical student alone
The supervising physician and the institution (Correct answer)
The hospital administration only

Correct answer: The supervising physician and the institution

The supervising physician holds primary responsibility for the actions of supervised trainees, and the institution may also bear vicarious liability.

Question 200: A 55-year-old male with a history of NSAID use for arthritis presents to the emergency department with a sudden onset of severe, diffuse abdominal pain. On examination, he is tachycardic, hypotensive, and has a rigid, board-like abdomen with guarding and rebound tenderness. Which of the following is the most appropriate initial imaging modality to confirm the suspected diagnosis?

Upright chest X-ray (Correct answer)
CT scan with oral contrast
Abdominal ultrasound
HIDA scan

Correct answer: Upright chest X-ray

The clinical presentation is highly suggestive of peritonitis from a perforated viscus (e.g., peptic ulcer). An upright chest X-ray is the fastest and most appropriate initial imaging test to look for free air under the diaphragm (pneumoperitoneum), which would confirm the diagnosis. While a CT scan is more sensitive, the chest X-ray is a crucial and rapid first step, especially in a potentially unstable patient.

Question 201: Which of the following is the primary goal of primary prevention?

Reducing the prevalence of an established disease
Preventing the occurrence of disease in healthy individuals (Correct answer)
Minimizing disability after disease onset
Early detection of disease before symptoms appear

Correct answer: Preventing the occurrence of disease in healthy individuals

Primary prevention targets risk factor reduction to prevent disease from ever occurring in at-risk populations.

Question 202: A traveler returns from Southeast Asia with severe malaria caused by Plasmodium falciparum. Chloroquine resistance is suspected. Which combination treatment is standard first-line therapy?

Artemisinin-based combination therapy (ACT) (Correct answer)
Mefloquine monotherapy
Atovaquone-proguanil plus primaquine
Quinine plus doxycycline

Correct answer: Artemisinin-based combination therapy (ACT)

Artemisinin-based combination therapy (ACT) is the WHO-recommended first-line treatment for uncomplicated chloroquine-resistant P. falciparum malaria.

Question 203: How are MCCQE Part II examiners trained to ensure inter-rater reliability?

Only standardized patients rate candidate performance
Examiners undergo structured training with calibration sessions and benchmark videos (Correct answer)
Examiners are replaced each exam cycle to prevent bias
Examiners are self-trained using published rubrics

Correct answer: Examiners undergo structured training with calibration sessions and benchmark videos

MCC trains examiners with calibration exercises and reference videos so ratings are consistent across different examiners and sites.

Question 204: A new mother is concerned about her 4-month-old infant's fine motor skills. Which of the following observations would be an expected and appropriate milestone for this age?

Transfers an object from one hand to the other.
Brings hands to midline and to the mouth. (Correct answer)
Demonstrates a mature pincer grasp to pick up a small object.
Builds a tower of two blocks.

Correct answer: Brings hands to midline and to the mouth.

By 4 months, an infant should be able to bring their hands together at the midline and bring them to their mouth. Transferring objects hand-to-hand typically develops around 6 months. The pincer grasp (using thumb and index finger) matures later, around 9-12 months. Building a tower of blocks is a skill that emerges around 12-15 months.

Question 205: A 24-year-old female has a history of multiple tumultuous relationships that end abruptly, recurrent acts of self-harm during periods of stress, and chronic feelings of emptiness. She often makes frantic efforts to avoid perceived abandonment by her partners. This clinical picture is most characteristic of which core feature of Borderline Personality Disorder?

Grandiose sense of self-importance
Instability in relationships, self-image, and affects (Correct answer)
Pervasive distrust and suspiciousness
Social inhibition and feelings of inadequacy

Correct answer: Instability in relationships, self-image, and affects

A pervasive pattern of instability is the hallmark of Borderline Personality Disorder, as defined by the DSM-5. This includes instability in interpersonal relationships (e.g., alternating between idealization and devaluation), unstable self-image, and affective instability (intense mood swings). The patient's presentation directly reflects these core features. Distrust is characteristic of Paranoid PD, grandiosity of Narcissistic PD, and social inhibition of Avoidant PD.

Question 206: A 32-year-old G1P0 woman at 33 weeks gestation presents with a sudden gush of clear fluid from her vagina. She denies contractions or vaginal bleeding. On sterile speculum examination, pooling of fluid is noted in the posterior fornix, which tests positive for ferning. The fetal heart rate is 140 bpm with moderate variability. Which of the following is the most appropriate next step in management?

Induction of labor with oxytocin
Administration of a single course of antenatal corticosteroids (Correct answer)
Discharge home with instructions for expectant management
Immediate delivery via Cesarean section

Correct answer: Administration of a single course of antenatal corticosteroids

The patient has preterm prelabour rupture of membranes (PPROM). According to SOGC guidelines, for PPROM between 24 and 34 weeks gestation, a single course of antenatal corticosteroids is recommended to enhance fetal lung maturity and reduce the risk of other complications of prematurity. Induction of labor is generally not indicated unless there are signs of maternal or fetal infection or compromise, and expectant management is preferred to allow the fetus to mature further. Immediate delivery is not warranted in a stable mother and fetus. Outpatient management may be considered in select cases but initial inpatient observation and administration of corticosteroids is standard.

Question 207: A student is using USMLE Step 2 CK resources (e.g., UWorld) as a primary MCCQE study tool. Which limitation should she be most aware of?

US-based resources may reference guidelines, drugs, and screening thresholds that differ from Canadian standards (Correct answer)
UWorld questions are written at a lower cognitive level than MCCQE questions
USMLE Step 2 CK and MCCQE Part 1 cover completely different clinical disciplines
UWorld does not cover internal medicine, which is heavily tested on the MCCQE

Correct answer: US-based resources may reference guidelines, drugs, and screening thresholds that differ from Canadian standards

Differences include Canadian vs. US drug approval status, screening recommendations (e.g., Canadian Task Force guidelines), and publicly funded healthcare system context that affects management decisions.

Question 208: A 45-year-old man presents with sudden onset severe epigastric pain radiating to the back, nausea, and vomiting after a heavy meal. Serum lipase is 1200 U/L. CT shows peripancreatic fat stranding but no necrosis. What is the Ranson criterion at admission that most strongly predicts severity?

WBC > 16 x10⁹/L
Serum glucose > 11 mmol/L (Correct answer)
LDH > 350 IU/L
Age > 55 years

Correct answer: Serum glucose > 11 mmol/L

Serum glucose > 11 mmol/L (200 mg/dL) at admission is one of the five Ranson criteria assessed on presentation and is a key predictor of severe pancreatitis.

Question 209: A 16-year-old girl is brought in by her parents due to refusal to maintain a minimally normal body weight, intense fear of gaining weight, and distorted body image. Her BMI is 15.5. What medical complication is most life-threatening?

Amenorrhea
Constipation
Cardiac arrhythmias from electrolyte imbalance (Correct answer)
Lanugo hair

Correct answer: Cardiac arrhythmias from electrolyte imbalance

Cardiac arrhythmias due to electrolyte disturbances (especially hypokalemia and hypophosphatemia) are the leading cause of death in anorexia nervosa.

Question 210: Which Canadian clinical reference is most useful for quickly verifying drug doses, screening intervals, and preventive care thresholds aligned with Canadian guidelines during MCCQE preparation?

Epocrates (primarily US-approved medications)
Merck Manual (US publication)
Compendium of Pharmaceuticals and Specialties (CPS) / e-CPS (Correct answer)
UpToDate (US-based clinical decision support)

Correct answer: Compendium of Pharmaceuticals and Specialties (CPS) / e-CPS

The CPS/e-CPS is the Canadian standard pharmaceutical reference and contains Health Canada–approved indications, doses, and warnings that align with MCCQE-tested content.

Question 211: A 25-year-old woman presents with acute right lower quadrant pain and a positive pregnancy test (beta-hCG 2500 IU/L). Transvaginal ultrasound shows no intrauterine pregnancy and free fluid in the pelvis. She is hemodynamically stable. What is the next step?

Repeat beta-hCG in 48 hours only
Diagnostic laparoscopy to confirm and treat ectopic pregnancy (Correct answer)
Serial ultrasound every 2 weeks
Single-dose methotrexate

Correct answer: Diagnostic laparoscopy to confirm and treat ectopic pregnancy

Free fluid with no IUP and a positive beta-hCG is ectopic pregnancy until proven otherwise; diagnostic and therapeutic laparoscopy is indicated even in stable patients when the tube cannot be visualized as intact.

Question 212: Who is eligible to take the MCCQE Part I?

Graduates with a minimum of 5 years of practice.
Only Canadian medical school graduates.
Graduates from recognized medical schools. (Correct answer)
Only licensed practicing physicians.

Correct answer: Graduates from recognized medical schools.

Eligibility for the MCCQE Part I extends to graduates from medical schools recognized by the Medical Council of Canada. This includes both Canadian medical school graduates and international medical graduates whose credentials have been verified as meeting Canadian standards.

Question 213: Which pharmacokinetic property makes once-daily dosing of aminoglycosides advantageous compared to traditional thrice-daily dosing?

Renal tubular saturation during the trough period reduces nephrotoxicity
Improved time-dependent killing reduces total dose needed
The post-antibiotic effect allows bacterial suppression between doses (Correct answer)
Extended half-life with once-daily dosing avoids peak toxicity

Correct answer: The post-antibiotic effect allows bacterial suppression between doses

Aminoglycosides exhibit a prolonged post-antibiotic effect (PAE), meaning bacterial growth remains suppressed even after drug levels fall below the MIC.

Question 214: Which lipid-lowering drug class is most appropriate as first-line therapy for a patient with LDL 4.5 mmol/L and established atherosclerotic cardiovascular disease?

Niacin
Fibrates
High-intensity statins (Correct answer)
Bile acid sequestrants

Correct answer: High-intensity statins

High-intensity statins (e.g., atorvastatin 40–80 mg, rosuvastatin 20–40 mg) are first-line for secondary prevention, reducing LDL by ≥50% and lowering CV events.

Question 215: Which statement accurately describes the mechanism of action of linezolid?

It inhibits the 30S ribosomal subunit, preventing tRNA binding
It inhibits bacterial DNA gyrase and topoisomerase IV
It binds the 50S subunit at the peptidyl transferase center, preventing initiation complex formation (Correct answer)
It disrupts the cytoplasmic membrane via calcium-dependent depolarization

Correct answer: It binds the 50S subunit at the peptidyl transferase center, preventing initiation complex formation

Linezolid binds the 23S rRNA of the 50S subunit, blocking formation of the 70S initiation complex and halting protein synthesis.

Question 216: A 2-year-old with Down syndrome has a height at the 50th percentile on standard WHO growth charts. What is the correct interpretation?

Cannot be interpreted without bone age
Tall stature for Down syndrome (Correct answer)
Normal growth for Down syndrome
Short stature for Down syndrome

Correct answer: Tall stature for Down syndrome

Children with Down syndrome have shorter expected stature; their growth should be plotted on Down syndrome–specific growth charts, where the 50th percentile on standard charts would represent tall stature.

Question 217: A physician prescribes an antibiotic that acts by inhibiting bacterial DNA gyrase and topoisomerase IV, thereby preventing DNA replication and repair. Which of the following antibiotic classes utilizes this mechanism of action?

Fluoroquinolones (Correct answer)
Beta-lactams
Aminoglycosides
Macrolides

Correct answer: Fluoroquinolones

Fluoroquinolones (e.g., ciprofloxacin, levofloxacin) exert their bactericidal effect by inhibiting bacterial DNA gyrase (topoisomerase II) and topoisomerase IV. [4, 11] These enzymes are essential for bacterial DNA replication, transcription, and repair, and their inhibition leads to bacterial cell death. [23]

Question 218: A 60-year-old woman with known gallstones presents with fever, right upper quadrant pain, and jaundice (Charcot's triad). She then develops hypotension and altered consciousness (Reynolds' pentad). What is the diagnosis and priority management?

Choledocholithiasis — elective ERCP as outpatient
Mirizzi syndrome — hepaticojejunostomy
Ascending cholangitis — IV antibiotics, urgent biliary decompression via ERCP (Correct answer)
Acute cholecystitis — laparoscopic cholecystectomy within 24 hours

Correct answer: Ascending cholangitis — IV antibiotics, urgent biliary decompression via ERCP

Reynolds' pentad (Charcot's triad plus shock and confusion) indicates acute suppurative cholangitis requiring urgent biliary decompression via ERCP and IV broad-spectrum antibiotics.

Question 219: Under Canadian privacy law (PIPEDA and provincial equivalents), a patient's health information can be disclosed without consent in which situation?

When a family member requests it for estate planning
When required by law, such as mandatory public health reporting (Correct answer)
When the employer requests it for occupational records
When a lawyer requests it for an unrelated legal matter

Correct answer: When required by law, such as mandatory public health reporting

Mandatory reporting obligations under public health legislation create lawful exceptions to the general rule of patient consent for disclosure.

Question 220: In an intention-to-treat analysis, participants are analyzed according to:

The outcome they experienced
Their actual treatment received
Whether they completed the study protocol
Their randomized group assignment regardless of adherence (Correct answer)

Correct answer: Their randomized group assignment regardless of adherence

Intention-to-treat preserves the benefits of randomization by analyzing participants in their originally assigned groups.

Question 221: A candidate passes MCCQE Part I but does not proceed to Part II. What happens to their Part I result validity?

Part I results expire after 5 years if Part II is not completed (Correct answer)
Part I results are automatically cancelled if Part II is not attempted within 1 year
Part I results expire after 2 years
Part I results remain valid indefinitely regardless of Part II completion

Correct answer: Part I results expire after 5 years if Part II is not completed

MCCQE Part I results are valid for a set period (generally 5 years) within which candidates must complete Part II for full qualification purposes.

Question 222: The attributable fraction in exposed individuals measures which of the following?

The absolute risk difference between exposed and unexposed
The proportion of disease among exposed individuals attributable to the exposure (Correct answer)
The ratio of disease risk in exposed vs. unexposed
The proportion of disease in the population due to the exposure

Correct answer: The proportion of disease among exposed individuals attributable to the exposure

Attributable fraction in exposed = (RR − 1) / RR, representing the proportion of exposed cases due to the exposure.

Question 223: A physician prescribes a beta-blocker to a patient with a known and clearly documented allergy to this class of medication. The pharmacy's computer system flags the error before the medication is dispensed, and the patient suffers no physical harm. What is the physician's primary ethical obligation in this situation?

Do not inform the patient, as no harm occurred and disclosure would only cause unnecessary anxiety.
Disclose the near miss to the patient, apologize, and explain the corrective measures being implemented. (Correct answer)
Thank the pharmacist for their diligence but take no further action regarding the patient.
Only document the event in the hospital's internal incident reporting system.

Correct answer: Disclose the near miss to the patient, apologize, and explain the corrective measures being implemented.

Ethical guidelines from the Canadian Medical Association and provincial colleges emphasize a duty of candour and transparency with patients. This includes the disclosure of medical errors, even when they do not result in harm (i.e., 'near misses'). The physician has an ethical obligation to inform the patient about what happened, apologize for the error, and explain what steps will be taken to prevent it from happening again. This approach respects patient autonomy and helps to maintain trust in the patient-physician relationship. Relying solely on internal reporting is insufficient as it omits the crucial step of communicating with the patient.

Question 224: A 60-year-old woman with Wolff-Parkinson-White syndrome develops AF. Which drug is contraindicated?

Digoxin (Correct answer)
DC cardioversion
Amiodarone IV
Procainamide

Correct answer: Digoxin

Digoxin (and verapamil, diltiazem) are contraindicated in WPW with AF because blocking the AV node increases conduction through the accessory pathway, risking VF.

Question 225: A 31-year-old G1P0 at 28 weeks presents with preterm prelabour rupture of membranes (PPROM). Speculum exam confirms rupture. She has no signs of chorioamnionitis. What antibiotic regimen is most appropriate?

Amoxicillin-clavulanate for 10 days
No antibiotics unless fever develops
Metronidazole alone for 7 days
Erythromycin and ampicillin for 48 hours then oral erythromycin for 5 days (Correct answer)

Correct answer: Erythromycin and ampicillin for 48 hours then oral erythromycin for 5 days

The standard regimen for PPROM without chorioamnionitis is IV ampicillin plus erythromycin for 48 hours followed by oral erythromycin for 5 days (avoiding amoxicillin-clavulanate due to NEC risk).

Question 226: What does the MCCQE Part II assess in its scoring?

Written case analysis.
Knowledge of theoretical medical sciences.
Hospital management abilities.
Clinical skills and communication. (Correct answer)

Correct answer: Clinical skills and communication.

The MCCQE Part II, being an OSCE, specifically assesses a candidate's practical clinical skills, including history-taking, physical examination, diagnosis, management, and crucial communication abilities. It evaluates how effectively candidates interact with patients and apply their knowledge in a clinical setting.

Question 227: Which of the following correctly identifies a key difference between MCCQE Part I and Part II?

Part I can be taken before medical school graduation; Part II cannot
Part I is OSCE-based; Part II is written
Part I tests clinical skills; Part II tests medical knowledge
Part I is computer-based written exam; Part II is a clinical skills OSCE (Correct answer)

Correct answer: Part I is computer-based written exam; Part II is a clinical skills OSCE

MCCQE Part I is a computer-administered written examination, while Part II is an OSCE assessing direct clinical and communication skills.

Question 228: A patient with New York Heart Association Class III HFrEF (EF 28%) continues to have symptoms despite ACE inhibitor, beta-blocker, MRA, and SGLT2 inhibitor. What additional therapy should be considered?

Add digoxin for symptom relief
Add hydralazine-nitrate combination
Refer for left ventricular assist device (LVAD) evaluation (Correct answer)
Switch ACE inhibitor to ARNI

Correct answer: Refer for left ventricular assist device (LVAD) evaluation

Refractory advanced HF on quadruple therapy with persistent Class III–IV symptoms warrants evaluation for advanced therapies including LVAD or cardiac transplantation.

Question 229: A 68-year-old man 6 weeks after MI develops fever, pleuritic chest pain, and pericardial friction rub. ECG shows diffuse ST elevation. What is the most likely diagnosis?

Pulmonary embolism
Dressler syndrome (Correct answer)
Aortic dissection
Reinfarction

Correct answer: Dressler syndrome

Dressler syndrome (post-cardiac injury syndrome) presents 2–10 weeks after MI with fever, pericarditis, and pleuritis due to autoimmune reaction to myocardial antigens.

Question 230: A 29-year-old at 34 weeks develops fever (38.8°C), uterine tenderness, maternal tachycardia, and fetal tachycardia (baseline 175 bpm) after PPROM 36 hours ago. What is the correct management?

Tocolysis to delay delivery while completing antibiotic course
Broad-spectrum antibiotics and expectant management until 37 weeks
Repeat amniocentesis to confirm infection before delivery
Immediate delivery regardless of gestational age plus broad-spectrum antibiotics (Correct answer)

Correct answer: Immediate delivery regardless of gestational age plus broad-spectrum antibiotics

Clinical chorioamnionitis is an indication for immediate delivery at any gestational age, combined with broad-spectrum intrapartum antibiotics, as expectant management risks maternal sepsis and fetal death.

Question 231: A 40-year-old G1P0 at 41+3 weeks undergoes IOL with cervical ripening. After 12 hours, the CTG shows a baseline of 165 bpm with reduced variability and repetitive late decelerations. The cervix is 4 cm dilated and 80% effaced. What is the most appropriate management?

Intrauterine resuscitation with tocolysis and amnioinfusion
Proceed to emergency caesarean section for non-reassuring fetal status (Correct answer)
Reduce oxytocin and apply fetal scalp electrode for monitoring
Continue labour with amniotomy to accelerate progress

Correct answer: Proceed to emergency caesarean section for non-reassuring fetal status

Persistent late decelerations with reduced variability constitute a Category III (non-reassuring) CTG pattern requiring expedient delivery, typically by caesarean at this stage of labour.

Medical Council of Canada Qualifying Exam

The MCCQE Part I is a computer-based examination that assesses the competence of candidates who have obtained a medical degree. It evaluates the critical medical knowledge and clinical decision-making ability required for entry into supervised clinical practice in Canada.

230

Questions

320 min

Time Limit

73%

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