Pass the Medical Council of Canada MCCQE Part 1 MCCQE Questions and answers with ExamsMirror

Chronic mesenteric ischemia (also known as “intestinal angina”) presents as postprandial abdominal pain, leading to food avoidance and significant weight loss. GI exams may be normal. Imaging (e.g., angiography or CT angio) confirms the diagnosis.

Toronto Notes 2023 – Gastroenterology, “Chronic Mesenteric Ischemia”:

“Classic triad: postprandial abdominal pain, weight loss, and food aversion. Physical exam and GI series may be normal.”

MCCQE1 Objectives (Gastroenterology > 47-1: Abdominal Pain):

“Candidates must suspect mesenteric ischemia in older adults with risk factors and postprandial pain leading to weight loss.”

PUD (A) usually causes epigastric pain relieved by food. Cholelithiasis (B) causes RUQ pain. Colon cancer (D) presents with altered bowel habits or bleeding. Mesenteric adenitis (C) occurs in younger patients, often with infection.

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This patient presents with signs of acute compartment syndrome (pain out of proportion, paresthesia, pallor, swelling, decreased pulses, and dark urine indicating rhabdomyolysis). Measuring compartment pressures is the diagnostic test of choice to confirm the diagnosis and guide urgent surgical fasciotomy.

Toronto Notes 2023 – Orthopedics:

“Acute compartment syndrome should be suspected in any patient with severe extremity pain, swelling, sensory deficits, and tense compartments. Confirm with compartment pressure measurements. Fasciotomy is indicated if pressure is >30 mmHg or within 30 mmHg of diastolic pressure.”

MCCQE1 Objectives (Surgery > 51-2: Limb Trauma):

“Candidates must diagnose acute compartment syndrome and initiate appropriate surgical referral after confirming with pressure measurements.”

Angiography and Doppler studies assess vascular compromise but are not the first step in suspected compartment syndrome. Fixing the hip (C) and testing myoglobin (E) are not diagnostic steps.

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Comprehensive and Detailed Explanation:

The child’s presentation (weight gain, short stature, truncal obesity, facial swelling, hypertrichosis) is classic for Cushing syndrome. One of the hallmark findings on physical examination in pediatric Cushing syndrome is hypertension, due to increased cortisol-mediated mineralocorticoid receptor activation.

Toronto Notes 2023 – Pediatrics / Endocrinology:

“Cushing syndrome in children presents with growth failure, weight gain, moon facies, truncal obesity, and hypertension.”

MCCQE1 Objectives (Pediatrics > 77-2: Endocrine Disorders in Children):

“Candidates must identify clinical signs of hypercortisolism and evaluate for associated findings such as elevated blood pressure.”

Café-au-lait spots (A) suggest neurofibromatosis. Goiter (C) is more related to thyroid dysfunction. Hepatomegaly (D) and acanthosis (E) are more commonly seen in metabolic syndrome or insulin resistance.

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Disseminated gonococcal infection (DGI) typically presents with the classic triad of polyarthralgia, tenosynovitis, and skin lesions (especially pustules on extremities). A prior urogenital infection and systemic symptoms further support this diagnosis.

Toronto Notes 2023 – Infectious Disease, STIs:

“DGI presents with arthritis-dermatitis syndrome: fever, asymmetric polyarthralgia, tenosynovitis, and vesiculopustular skin lesions. It may follow asymptomatic or unrecognized urogenital infection.”

MCCQE1 Objectives – Infectious Disease > STIs:

“Candidates must recognize systemic manifestations of gonorrhea including DGI and distinguish it from other forms of arthritis or systemic illness.”

Reactive arthritis (C) may follow STI but includes conjunctivitis and urethritis. HIV (A) does not typically cause this triad. RA (D) has different distribution and chronicity. Varicella (E) presents with diffuse vesicular rash, not joint pain.

In a case-control study, participants are selected based on outcome (e.g., presence or absence of neonatal jaundice), and then past exposures are evaluated. This is consistent with the described methodology.

Toronto Notes 2023 – Epidemiology, “Study Designs”:

“Case-control studies start with the outcome and look backward to assess exposures. They are efficient for studying rare conditions or those with long latency.”

MCCQE1 Objectives (Population Health > 65-2: Epidemiology and Study Design):

“Candidates must distinguish between common study designs and recognize the correct classification based on study structure.”

Cross-sectional studies (A) assess exposure and outcome at the same time. Cohort studies (C) begin with exposure and follow forward. Clinical trials (D) are interventional. Ecological studies (E) analyze population-level data.

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Physicians in Canada who have conscientious objections to procedures such as abortion are legally and ethically required to make an effective referral to another provider or service that can offer the treatment. The provider must not delay access to care.

Toronto Notes 2023 – ELOM, “Conscientious Objection”:

“A physician who objects to providing a service for reasons of conscience must make an effective referral to another provider or agency.”

MCCQE1 Objectives (ELOM > Professionalism > 90-1):

“Candidates must recognize the obligation to refer patients for services they themselves will not provide due to personal or religious beliefs.”

Delaying care (C), imposing personal beliefs (A), or suggesting alternatives like adoption (D) is inappropriate and may violate patient autonomy.

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During an outbreak in a long-term care facility, prompt control measures include keeping symptomatic staff at home to prevent spread. Staff are often vectors of infection, and exclusion is a key public health intervention.

Toronto Notes 2023 – Infectious Diseases, “Infection Control and Prevention”:

“During influenza outbreaks in institutional settings, exclusion of symptomatic staff is critical to controlling spread.”

MCCQE1 Objectives (Population Health > 63-2: Outbreak Management):

“Candidates must understand outbreak control, including staff exclusion, cohorting, and surveillance in congregate settings.”

Vaccination (B) is preventive but not immediately effective during an outbreak. Masking and visitor vaccination are supportive but secondary measures.

Comprehensive and Detailed Explanation:

Travel to rural Cambodia poses a high risk of malaria, which can be life-threatening in pregnancy. Antimalarial prophylaxis is strongly recommended for pregnant women traveling to endemic regions. Chloroquine or mefloquine (depending on resistance patterns) may be used in pregnancy under specialist guidance.

Toronto Notes 2023 – Infectious Disease / Travel Medicine:

“Malaria prophylaxis is indicated in pregnant women traveling to endemic regions. The risk of severe malaria and poor fetal outcomes is high.”

MCCQE1 Objectives (Public Health > 65-3: Travel Medicine and Pregnancy):

“Candidates must provide preventive care to pregnant travelers including vaccination and malaria prophylaxis.”

Tetanus boosters (D) are given every 10 years. Hep B Ig (B) is for acute post-exposure prophylaxis. Ciprofloxacin (C) is contraindicated in pregnancy.

The levonorgestrel-releasing intrauterine system (LNG-IUS) is the first-line treatment for heavy menstrual bleeding, particularly in women with risk factors for endometrial hyperplasia and contraindications to systemic hormones (e.g., morbid obesity, diabetes, OSA).

Toronto Notes 2023 – Gynecology, “Abnormal Uterine Bleeding” Section:

“The LNG-IUS is highly effective in reducing menstrual bleeding and improving hemoglobin levels. It is particularly recommended in women with obesity, chronic anovulation, or contraindications to estrogen.”

MCCQE1 Objectives (Obstetrics and Gynecology > 82-1: Abnormal Uterine Bleeding):

“Candidates must consider the LNG-IUS as a preferred non-surgical treatment for chronic heavy menstrual bleeding when endometrial pathology has been excluded.”

Oral contraceptives (C) are not first-line in morbid obesity due to increased thromboembolic risk. Cyclic medroxyprogesterone (D) is less effective than LNG-IUS. Hysterectomy (A) is definitive but should follow failure of conservative therapy.

Comprehensive and Detailed Explanation:

An advance directive is a legally binding document that outlines a competent person's preferences regarding future medical care. If the patient clearly stated a refusal of treatment in the event of a life-threatening condition, this directive must be followed, even if the patient is currently incapacitated and family disagrees.

Toronto Notes 2023 – Ethics and Law:

“Advance directives must be respected when valid, clear, and applicable. Substitute decision-makers cannot override them.”

MCCQE1 Objectives (ELOM > 90-4: Informed Consent and Advance Directives):

“Candidates must apply valid advance directives to guide care for incapacitated patients.”

B (parents as SDMs) is incorrect if an advance directive exists. A and D are irrelevant—capacity has already been documented. C is unnecessary when an advance directive is clear.

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