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

This patient has classic acute pericarditis : pleuritic chest pain relieved by sitting forward, a pericardial friction rub, diffuse ST-segment elevation with PR depression on ECG, and a small pericardial effusion on echocardiogram. MCCQE objectives emphasize recognizing the characteristic clinical and ECG features that distinguish pericarditis from myocardial infarction (diffuse ST elevation rather than territorial changes).

First-line treatment for uncomplicated acute pericarditis is high-dose nonsteroidal anti-inflammatory therapy , such as acetylsalicylic acid (ASA) or ibuprofen, often combined with colchicine to reduce recurrence risk. ASA is particularly appropriate when ischemia is in the differential diagnosis.

Apixaban (anticoagulation) is not indicated and may worsen effusion. Pericardiocentesis is reserved for large effusions or cardiac tamponade. Levofloxacin is unnecessary without evidence of bacterial infection. Beta-blockers such as metoprolol do not treat pericardial inflammation.

Thus, high-dose acetylsalicylic acid is the most appropriate initial management for uncomplicated acute pericarditis.

An empty uterus with β-hCG > 1500–2000 IU/L raises concern for a pregnancy of unknown location (PUL), including the possibility of ectopic pregnancy. However, the patient is hemodynamically stable and asymptomatic. In such cases, the best initial step is to repeat serum β-hCG in 48 hours to assess the rise or fall of hCG levels.

Toronto Notes 2023 – Obstetrics, " First Trimester Bleeding " :

“If β-hCG > 1500 IU/L and no intrauterine pregnancy is visualized on ultrasound, repeat β-hCG in 48 hours to determine rise or decline. A suboptimal rise (less than 66%) suggests ectopic pregnancy.”

MCCQE1 Objectives (Obstetrics > 79-1: Early Pregnancy Complications):

“In a patient with early pregnancy bleeding, the candidate must interpret quantitative β-hCG trends to distinguish ectopic pregnancy, miscarriage, or viable intrauterine pregnancy.”

Immediate administration of methotrexate or invasive procedures such as D & C or laparoscopy are not appropriate until further diagnostic clarification is obtained.

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This child likely has infectious mononucleosis caused by Epstein-Barr virus (EBV), characterized by fever, sore throat, cervical lymphadenopathy, fatigue, and splenomegaly. A palpable spleen is a hallmark of EBV in children.

Toronto Notes 2023 – Pediatrics, “Infectious Mononucleosis”:

“Key features include fever, pharyngitis, lymphadenopathy, and splenomegaly. Children may have milder symptoms but often exhibit palpable spleen.”

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

“Candidates should recognize common viral syndromes such as EBV and identify complications including splenomegaly.”

Other options (renal mass, ascites, etc.) are inconsistent with this viral presentation.

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Comprehensive and Detailed Explanation:

Infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse in women under 35 years. Since she has been trying for only 5 months, reassurance is appropriate.

Toronto Notes 2023 – Gynecology:

“Investigations for infertility in women under 35 should begin after 12 months of attempting to conceive, unless other risk factors are present.”

MCCQE1 Objectives (Gynecology > 82-1: Infertility):

“Candidates must apply appropriate timing and indications for infertility investigations based on patient age and history.”

Earlier testing is not warranted here. Options A–D are part of the infertility work-up but not before 12 months.

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In Canada and in most jurisdictions internationally, physicians have a professional and in some cases legal obligation to provide emergency assistance. Documentation should be done in your own records afterward. Aviation laws and Good Samaritan protections offer liability coverage for health professionals acting in good faith.

Toronto Notes 2023 – ELOM, “Physician Obligations and Medical-Legal Responsibility”:

“Physicians should respond to in-flight or public emergencies when capable. Documentation should be completed after the event, and liability is protected under Good Samaritan laws.”

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

“Candidates must demonstrate appropriate professional behavior, including willingness to assist in emergencies and understanding of legal protections.”

Avoiding assistance (A), or placing conditional barriers (D), is unethical and inappropriate.

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Comprehensive and Detailed Explanation:

Rapid progression of pain out of proportion to exam, systemic symptoms (anxiety), and skin changes without major swelling are classic for necrotizing fasciitis—a surgical emergency. Discoloration and extreme tenderness should raise immediate concern.

Toronto Notes 2023 – Emergency Medicine / Surgery:

“Necrotizing fasciitis presents with severe pain, systemic toxicity, rapid progression, and early skin changes (discoloration). Pain out of proportion is a key clue.”

MCCQE1 Objectives (Emergency Medicine > 51-1: Soft Tissue Infections):

“Candidates must recognize necrotizing fasciitis and initiate urgent surgical consultation.”

Plantaris rupture (A) is benign and localized. DVT (B) is more gradual and often with swelling. Cellulitis (C) progresses more slowly and is less painful. Baker’s cyst (D) causes posterior knee pain, not severe systemic illness.

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The clinical picture is most consistent with acute pancreatitis (alcohol-related, epigastric pain radiating to back, vomiting, and ileus). CT abdomen with contrast is the best diagnostic tool if the diagnosis is uncertain or complications are suspected.

Toronto Notes 2023 – Gastroenterology, “Pancreatitis”:

“CT abdomen is indicated when diagnosis is unclear, symptoms are severe, or complications (e.g., necrosis, ileus) are suspected.”

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

“Candidates must investigate acute epigastric pain appropriately, especially in the context of alcohol use and systemic features.”

Ultrasound (B) is first-line for gallstones but not best here. Laparotomy (A) is not warranted without peritonitis or perforation. Endoscopy (D) is not indicated. Sengstaken-Blakemore (E) is for variceal bleeding, which is not suspected here.

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This patient’s presentation—knee effusion with a soft tissue mass in the popliteal fossa following exertion—is classic for a Baker (popliteal) cyst , which represents distention of the gastrocnemius–semimembranosus bursa, often associated with intra-articular pathology (e.g., meniscal injury or osteoarthritis). MCCQE objectives emphasize selecting the least invasive, most appropriate imaging modality to confirm suspected cystic lesions.

Ultrasound is the best initial diagnostic test because it is noninvasive, readily available, and highly sensitive for distinguishing a cystic structure from a solid mass or vascular pathology (e.g., popliteal artery aneurysm or deep vein thrombosis). It can also assess for complications such as cyst rupture.

Arthroscopy is invasive and not required for diagnosis. Arthrocentesis evaluates joint effusion but does not confirm a popliteal cyst. Aspiration of the mass without imaging is inappropriate due to risk of vascular injury. CT is unnecessary and exposes the patient to radiation.

Therefore, ultrasound is the preferred method to confirm a Baker cyst.

This patient presents with symptoms and signs of ulnar neuropathy—most likely at the elbow (cubital tunnel). Weakness in the intrinsic hand muscles and positive Tinel sign at the ulnar nerve are suggestive. Nerve conduction studies are the gold standard to confirm and localize the lesion.

Toronto Notes 2023 – Neurology, “Peripheral Nerve Disorders”:

“In cases of suspected mononeuropathy such as ulnar nerve compression, nerve conduction studies confirm the diagnosis and localize the lesion.”

MCCQE1 Objectives (Medicine > Neurology > 35-2):

“Candidates should identify and investigate focal mononeuropathies using nerve conduction studies to confirm the diagnosis and location.”

Splinting (A, C) may help after diagnosis. Physiotherapy (B) is adjunctive. MRI (D) is not the first-line investigation.

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This patient has clinical signs of an eating disorder — fatigue, low BMI, hypotension, and hypokalemia — likely secondary to nutritional deficiencies or purging. The first step is to sensitively explore the patient ' s perception of weight and body image. Effective management requires rapport and careful conversation.

Toronto Notes 2023 – Psychiatry, Eating Disorders:

“Approach patients with suspected eating disorders non-judgmentally. Begin with permission to discuss weight or body image. Screening tools like SCOFF can help guide further assessment.”

MCCQE1 Objectives – Psychiatry > Eating Disorders:

“Candidates must recognize signs of eating disorders and initiate a respectful and effective patient-centered discussion.”

Referring to the ED (B) is not urgent without hemodynamic instability. Advising caloric intake (C) bypasses assessment. GI referral (D) is not appropriate at this stage.

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