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

Fibroadenomas can grow slightly or fluctuate in size. A minimal increase (from 1.5 cm to 1.7 cm) over six months is clinically insignificant. No malignant features are reported, and the previous biopsy confirmed benign nature. Annual follow-up is appropriate.

Toronto Notes 2023 – Obstetrics and Gynecology, “Breast Disorders” Section:

“Fibroadenomas are benign breast masses that may slightly enlarge. Routine imaging follow-up at 6 to 12 months is appropriate for lesions with benign imaging and histology.”

MCCQE1 Objectives (Obstetrics and Gynecology > 82-3: Breast Mass):

“Candidates must distinguish between benign and suspicious masses and determine appropriate intervals for follow-up imaging.”

Repeat biopsy (A) or surgery (B) is unwarranted without suspicious change. MRI (C) is not needed in stable, benign lesions. Tamoxifen (D) is not used for fibroadenomas.

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Laryngomalacia is the most common cause of chronic stridor in infants. It presents with inspiratory stridor that worsens with feeding, supine positioning, or agitation. The child remains otherwise well and meets developmental milestones.

Toronto Notes 2023 – Pediatrics, Airway Disorders:

“Laryngomalacia presents with intermittent inspiratory stridor, typically beginning in the first few months of life. Diagnosis is clinical and prognosis is usually good.”

MCCQE1 Objectives – Pediatrics > Respiratory Disorders:

“Candidates must recognize the typical presentation of laryngomalacia and differentiate it from other causes of pediatric stridor.”

Vascular ring (A) or subglottic hemangioma (C) often present with more severe or progressive symptoms. Foreign body aspiration (D) presents acutely. TE fistula (E) usually causes feeding difficulties from birth.

Comprehensive and Detailed Explanation:

This patient has stress urinary incontinence and an incidental cystocele. First-line management of mild pelvic organ prolapse and stress incontinence includes pelvic floor physiotherapy (e.g., Kegel exercises). Surgical options are reserved for severe or refractory cases.

Toronto Notes 2023 – Gynecology, Pelvic Floor Disorders:

“For asymptomatic prolapse or mild stress incontinence, recommend pelvic floor strengthening. Conservative management is preferred before surgical referral.”

MCCQE1 Objectives – Gynecology > Urogynecology:

“Candidates should initiate pelvic floor therapy in women with mild prolapse or urinary leakage prior to specialist referral.”

Topical estrogen (B) helps with atrophic vaginitis, not stress incontinence. Hysterectomy (A) and specialist referral (C) are premature. Avoiding impact sports (E) is not a treatment.

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In elderly women with long-term pessary use and signs of vaginal atrophy (thin epithelium, bleeding, odor), local estrogen is the most appropriate initial treatment to restore the vaginal epithelium and reduce inflammation and discharge. Vaginal estrogen improves mucosal integrity and reduces complications like ulceration, infection, and bleeding.

Toronto Notes 2023 – Gynecology, “Pelvic Organ Prolapse and Pessary Care” Section:

“Local vaginal estrogen therapy is recommended for postmenopausal women with vaginal atrophy who are using pessaries. It reduces the risk of erosions, bleeding, and infection, especially when pessary follow-up has been suboptimal.”

MCCQE1 Objectives (Obstetrics and Gynecology > 82-9: Vaginal Bleeding in Postmenopausal Women):

“Candidates should recognize vaginal atrophy as a common and treatable cause of bleeding in elderly women using pessaries.”

A biopsy (E) may be needed if symptoms persist after atrophy is treated. Hysteroscopy (A) is invasive and not first-line in this setting. Metronidazole (B) is not indicated without evidence of bacterial vaginosis. Daily saline douching (D) is not recommended and may irritate atrophic mucosa.

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Patient education is foundational in managing fibromyalgia. Understanding the chronic but non-progressive nature of the disease, reassurance, and emphasis on self-management are crucial. It helps set realistic expectations and enhances engagement in therapy.

Toronto Notes 2023 – Rheumatology, Fibromyalgia:

“Patient education is essential. Explain the nature of fibromyalgia, emphasizing that although it is chronic, it is non-deforming and can be managed through exercise, sleep hygiene, and cognitive strategies.”

MCCQE1 Objectives – Psychiatry & Rheumatology > Chronic Pain Syndromes:

“Candidates must recognize the value of education and behavioral interventions in managing functional syndromes.”

SSRIs (D) may be used if depression is present. Iron/B12 (B) are not indicated without evidence of deficiency. Cannabinoids (A) lack strong evidence in fibromyalgia.

The patient is obese (BMI 35), has type 2 diabetes, and shows a hepatocellular pattern of transaminitis (elevated ALT > AST). These are typical features of nonalcoholic steatohepatitis (NASH), the inflammatory subtype of nonalcoholic fatty liver disease (NAFLD).

Toronto Notes 2023 – Gastroenterology, NAFLD and NASH:

“NASH should be suspected in patients with metabolic syndrome, obesity, and type 2 diabetes, especially with elevated transaminases and normal bilirubin or INR.”

MCCQE1 Objectives – Internal Medicine > Hepatology:

“Candidates should recognize the clinical profile of NAFLD/NASH, particularly in asymptomatic patients with metabolic risk factors and isolated liver enzyme elevations.”

Acute hepatitis B (A) typically has higher ALT and symptoms. Pancreatic carcinoma (B) affects biliary enzymes or bilirubin. Metformin (D) does not elevate liver enzymes. HCC (E) would often present with systemic or localized symptoms and abnormal imaging.

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Visible rectal bleeding, even in the absence of systemic symptoms, warrants diagnostic colonoscopy to rule out colorectal cancer, polyps, or IBD—especially in adults over 40. FIT is for asymptomatic screening only.

Toronto Notes 2023 – Gastroenterology, “Approach to Lower GI Bleeding”:

“In patients with overt rectal bleeding, colonoscopy is the investigation of choice regardless of age or FIT status.”

MCCQE1 Objectives (Internal Medicine > Gastroenterology > 47-1):

“Candidates must evaluate rectal bleeding with colonoscopy, even in the presence of minor findings on physical exam (e.g., skin tag).”

FIT (A) is not appropriate for symptomatic patients. CEA (D) is a tumor marker for surveillance, not diagnosis. CT colonography (C) is less sensitive for lesions than colonoscopy.

Primary herpetic gingivostomatitis caused by HSV-1 is common in toddlers. It presents with high fever, irritability, drooling, refusal to eat, and painful oral ulcers on the lips, gums, and tongue. Cervical lymphadenopathy is common.

Toronto Notes 2023 – Pediatrics, “Infectious Conditions in Children”:

“Primary HSV-1 infection in children presents with high fever, cervical lymphadenopathy, and painful oral ulcers (gingivostomatitis).”

MCCQE1 Objectives (Pediatrics > 75-2: Infectious Diseases):

“Candidates must recognize viral exanthems and enanthems, including herpetic gingivostomatitis, based on clinical findings.”

Kawasaki (A) includes conjunctivitis, strawberry tongue, and extremity changes. Epiglottitis (B) presents with drooling but without oral ulcers. Mono (C) lacks the ulcerative pattern. Hand-foot-mouth (D) affects palms and soles, not inner lips and gums predominantly.

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This is a classic presentation of diabetic peripheral neuropathy: bilateral distal sensory symptoms with preserved motor function and no other systemic findings. The most useful test to confirm this in a previously undiagnosed patient is HbA1c.

Toronto Notes 2023 – Endocrinology, Diabetes Complications:

“Peripheral neuropathy is a common complication of undiagnosed or poorly controlled diabetes. Confirm with HbA1c if diagnosis is not yet established.”

MCCQE1 Objectives – Internal Medicine > Endocrinology:

“Candidates should evaluate for diabetes in patients with peripheral neuropathy and screen appropriately with HbA1c.”

Folate (B) and B12 deficiency may also cause neuropathy but are less likely in the absence of nutritional risk factors. Other choices (A, D, E) are unrelated to this pattern.

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This scenario describes acute delirium, common in hospitalized elderly patients. Patients may say things they don’t mean. Reassuring family members not to take hurtful comments personally is an important part of family counseling.

Toronto Notes 2023 – Geriatrics, “Delirium”:

“Patients may become agitated, hallucinate, or be aggressive. Families should be counseled not to take the behavior personally and continue to support orientation.”

MCCQE1 Objectives (Geriatrics > 41-1: Cognitive Disorders):

“Candidates must support caregivers of delirious patients, providing guidance on managing emotional and behavioral symptoms.”

Avoiding visits (A), confronting the patient (C), or emotional withdrawal (E) are counterproductive. Providing gentle information is appropriate (contradicts B).

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