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MCCQE Certification Dumps & MCCQE Study Guide Files & MCCQE Practice Test Questions

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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q215-Q220):

NEW QUESTION # 215
A 58-year-old woman presents to your office with refractory bipolar I disorder. She is on the following medications: lithium carbonate, valproic acid, and olanzapine. She also takes acetaminophen for osteoarthritis and pantoprazole for gastroesophageal reflux. Lately, she has noticed she bruises very easily. Laboratory work displays a platelet count of 70 × 10#/L (normal 130-400). Which one of the following is most likely to induce this side effect?

A. Valproic acid
B. Olanzapine
C. Lithium carbonate
D. Acetaminophen
E. Pantoprazole

Answer: A

Explanation:
Valproic acid is well known to cause thrombocytopenia, especially at higher serum concentrations or in patients over 60. Bruising with platelet count <100 × 10#/L is a classic manifestation.
Toronto Notes 2023 - Psychiatry, Mood Disorders & Pharmacology Section:
"Valproic acid is associated with hematologic side effects including thrombocytopenia. Platelet counts should be monitored regularly." MCCQE1 Objectives - Psychiatry > Pharmacotherapy:
"The candidate must recognize adverse effects of mood stabilizers including hematologic complications of valproic acid." Other listed medications (A-D) have no common or direct link with thrombocytopenia in this context.

NEW QUESTION # 216
A 38-year-old man is brought by his wife to the Emergency Department with fatigue, dizziness, and nausea after completing a hiking tour on a hot, humid day. His wife became worried after he had collapsed. He has been sweating heavily and vomited twice on the drive in. His medical history is unremarkable, and he takes no medications. His vital signs on arrival are as follows:
Blood pressure
85/57 mm Hg
Heart rate
120/min
Respiratory rate
18/min
Temperature
40.1 °C
Oxygen saturation
95%, room air
-
On physical examination, the patient's skin is dry, flushed, and warm to the touch. He has a diffuse erythematous papular rash. Findings of a thorough physical examination are otherwise unremarkable. An electrocardiogram shows sinus tachycardia. Which one of the following is the best next step?

A. Blood cultures
B. Serum thyrotropin (thyroid-stimulating hormone)
C. Computed tomography of the head
D. Serum creatine kinase test
E. Serum C-reactive protein test

Answer: D

Explanation:
This patient has classic features of exertional heat stroke-hyperthermia, hypotension, CNS symptoms (collapse), and hot, dry skin. A key complication of heat stroke is rhabdomyolysis, which can cause renal failure. Serum creatine kinase (CK) is the best next diagnostic step to confirm muscle breakdown.
Toronto Notes 2023 - Emergency Medicine, "Environmental Exposures":
"In heat stroke, check for rhabdomyolysis (#CK), renal impairment, and coagulopathy. Prompt cooling and hydration are critical." MCCQE1 Objectives (Internal Medicine > 59-3: Environmental and Toxic Exposures):
"Candidates must recognize heat-related illnesses and investigate for complications such as rhabdomyolysis and acute kidney injury." CT head (C) is not indicated unless persistent neurological symptoms. TSH (B), CRP (D), and blood cultures (E) are irrelevant to acute exertional hyperthermia.

NEW QUESTION # 217
An 80-year-old woman presents to your office with weight loss and generalized weakness. Her husband calls you after the appointment and asks that his wife not be told if she is diagnosed with cancer as hearing this will likely "kill her." Investigations subsequently show that she has metastatic lung cancer. Which one of the following is the best next step?

A. Tell her husband she has metastatic lung cancer.
B. Arrange an urgent consultation with her children to confirm her wishes.
C. Book an immediate appointment with your patient.
D. Tell the patient she requires a computed tomography scan of the chest.
E. Telephone her to inform her she has a bad pneumonia and prescribe antibiotics.

Answer: C

Explanation:
According to Canadian medical ethics and legal standards, physicians mustcommunicate diagnosis and treatment options directly to the patient, unless the patient hasexplicitly waived their right to knowor delegated decision-making authority. The patient's autonomy is paramount.
Toronto Notes 2023 - Ethical, Legal, and Organizational Medicine, "Truth-Telling" Section:
"Physicians are obligated to disclose relevant health information to patients unless the patient has clearly indicated a desire not to be informed. Family members do not have the authority to request that information be withheld from a competent adult." MCCQE1 Objectives (ELOM > Ethical Issues > Medical Ethics):
"The candidate must be able to apply the principles of patient autonomy... This includes full disclosure of diagnosis, prognosis, and treatment options unless waived by the patient." Booking an immediate appointment (C) allows you to assess her decision-making capacity and proceed with informed discussion. The other options either bypass the patient (A, B, E) or provide misleading/incomplete information (A, D), which violates ethical and legal obligations.

NEW QUESTION # 218
An 88-year-old married man is admitted following a cardiac arrest at home. He was not expected to recover, and after 2 weeks, he remains in a coma. His wife states, "I cannot let him go. That would be murder." As the attending physician looking after her husband, which one of the following is the best next course of action?

A. Encourage her to imagine what her husband would have wanted
B. Remove him from life support as this would not be murder
C. Say nothing further and wait until she comes around to accepting his state
D. Seek advice from the provincial or territorial public guardian
E. Emphasize that the duration of his stay in the Intensive Care Unit will be limited

Answer: A

Explanation:
In discussions about end-of-life care, it is critical to shift the focus from the substitute decision-maker's own feelings to what the patient would have wanted. This approach promotes ethically sound and patient-centered decisions. It is respectful, supportive, and maintains trust.
Toronto Notes 2023 - ELOM, "Advance Care Planning and End-of-Life Decisions":
"When a patient cannot express wishes, decisions must be based on known prior wishes or substituted judgment-what the patient would have wanted." MCCQE1 Objectives (ELOM > 90-2: Capacity, Consent, and End-of-Life Care):
"Candidates must guide surrogate decision-makers toward reflecting on the patient's values and previously expressed wishes." Options A and B are inappropriate-waiting without engagement or unilateral withdrawal is unethical. C does not address the wife's emotional or ethical concerns. E is premature unless the wife is clearly unable or unfit to act as decision-maker.

NEW QUESTION # 219
A 40-year-old man presents to the emergency department with a 24-hour history of severe abdominal pain and recurrent vomiting. He has a long-term history of alcohol use disorder. His blood pressure is 90/60 mm Hg, and his heart rate is 120/min. The pain is located mostly in the epigastrium but radiates to the right upper quadrant and to his back. Radiographs of the abdomen and chest reveal some distended small bowel loops in his upper abdomen. Laboratory work results are pending. After fluid resuscitation, which one of the following is the best next step?

A. Computed tomography
B. Immediate laparotomy
C. Sengstaken-Blakemore tube
D. Ultrasonography
E. Upper gastrointestinal endoscopy

Answer: A

Explanation:
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.

NEW QUESTION # 220
......

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