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Medical Council of Canada MCCQE Reliable Study Materials, Detailed MCCQE Study Plan
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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q54-Q59):
NEW QUESTION # 54
A 43-year-old man is referred to you for an incidental finding of elevated hemoglobin. Laboratory results are as follows:
Hemoglobin
185 g/L (130-170)
Mean corpuscular volume
92 fL (60-100)
White blood cells
7.8×1037.8×103 / L (4-10)
Platelets
250×103250×103 / L (130-400)
His BMI is 23. He has type 2 diabetes for which he takes gliclazide MR 60 mg daily. Which one of the following features on history could explain his laboratory abnormality?
- A. Alcohol abuse
- B. Hypothyroidism
- C. Hypertension
- D. Cirrhosis
- E. Central sleep apnea
Answer: E
Explanation:
Elevated hemoglobin in the absence of polycythemia vera can be due to secondary causes such as chronic hypoxia. Central sleep apnea, often associated with diabetes or neurologic conditions, leads to intermittent hypoxia and compensatory erythropoiesis.
Toronto Notes 2023 - Hematology and Respiratory Medicine, "Polycythemia" Section:
"Secondary erythrocytosis may result from hypoxic conditions including sleep apnea, COPD, or high altitude.
Assess for sleep-disordered breathing in patients with elevated hemoglobin and no myeloproliferative features." MCCQE1 Objectives (Internal Medicine > 76-7: Hematologic Abnormalities):
"Candidates must investigate secondary causes of elevated hemoglobin, including hypoxia-related conditions." Hypertension (A), hypothyroidism (C), and cirrhosis (D) do not cause polycythemia. Alcohol (B) typically causes macrocytosis and anemia.
NEW QUESTION # 55
A 25-year-old woman, gravida 1, para 1, aborta 0, gave birth to a newborn who is hypotonic with a large protruding tongue and brachycephaly. The newborn has a single palmar crease bilaterally and short, broad hands with a curved fifth digit. These features best support a clinical diagnosis of which one of the following?
- A. Prader-Willi syndrome.
- B. Turner syndrome.
- C. Trisomy 21.
- D. Fetal alcohol syndrome.
- E. Congenital hypothyroidism.
Answer: C
Explanation:
This constellation of features-hypotonia, macroglossia, brachycephaly, single palmar crease, short broad hands with clinodactyly-is classic for Down syndrome (Trisomy 21).
Toronto Notes 2023 - Pediatrics, "Genetic Syndromes":
"Trisomy 21 features include hypotonia, upslanting palpebral fissures, epicanthic folds, flat nasal bridge, brachycephaly, macroglossia, single palmar crease, and clinodactyly." MCCQE1 Objectives (Pediatrics > 78-3: Congenital and Genetic Disorders):
"Candidates must recognize key dysmorphic features associated with common genetic syndromes including Trisomy 21." Prader-Willi and congenital hypothyroidism may have hypotonia but lack the full phenotypic pattern. Turner syndrome is seen in females with short stature and webbed neck. Fetal alcohol syndrome presents with smooth philtrum and microcephaly.
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NEW QUESTION # 56
A 66-year-old woman suffering from a progressive neurological disease is admitted to a long-term care centre. Her husband does not wish to participate in discussions about the seriousness of his wife's disease and is convinced that she will soon come back home. During his 2nd visit to the centre, he gives you a cheque for a substantial sum made out to you, the treating physician, for your own research. Which one of the following is the best response to your patient's husband?
- A. Accept the money as a contribution to the long-term care centre's fundraising campaign
- B. Refer the husband to the centre's social worker
- C. Inform him you would only be able to accept a smaller amount of money
- D. Suggest he donate to your medical group
- E. Decline to accept the cheque
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
Physicians must avoid conflicts of interest and maintain professional boundaries with patients and their families. Accepting a personal financial gift, regardless of intent, is inappropriate and unethical.
Toronto Notes 2023 - Ethics and Professionalism:
"Personal gifts of significant value from patients or families should be declined to avoid real or perceived conflicts of interest." MCCQE1 Objectives (ELOM > 90-3: Professionalism and Boundaries):
"Candidates must maintain ethical boundaries and refuse financial incentives that could compromise or appear to compromise clinical judgment." Other options (A, B, E) still involve a conflict. D is helpful, but the ethical obligation is to decline the cheque directly.
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NEW QUESTION # 57
A 69-year-old woman with long-standing hypertension presents to the emergency department with a 2-hour history of persistent chest and back pain. A posteroanterior chest radiograph shows suspicious widening of the mediastinal shadow. Which one of the following is most likely to yield a clinical diagnosis?
- A. Electrocardiography
- B. Pulmonary angiography
- C. Transthoracic echocardiography
- D. Computed tomography of the chest
- E. Ventilation-perfusion lung scan
Answer: D
Explanation:
The presentation is highly suspicious for acute aortic dissection - sudden chest/back pain and mediastinal widening on chest x-ray. The most definitive and widely available test is contrast-enhanced computed tomography (CT) of the chest.
Toronto Notes 2023 - Cardiology, Aortic Dissection:
"CT angiography of the chest is the gold standard for stable patients with suspected aortic dissection. Look for mediastinal widening on chest x-ray as a clue." MCCQE1 Objectives - Internal Medicine > Cardiovascular Disease:
"Candidates should recognize acute aortic dissection and select appropriate imaging, such as CT chest, for diagnosis in stable patients." Transthoracic echo (A) may miss dissections. ECG (C) helps rule out MI but not dissection. V/Q scan (D) and pulmonary angiography (E) are for suspected pulmonary embolism.
NEW QUESTION # 58
A 62-year-old man (wealthy philanthropist) with emphysema from smoking and a 21-year-old woman (elementary teacher) with cystic fibrosis are both compatible matches for a lung transplant. Which criterion determines organ allocation?
- A. The clinical severity of the patient's pulmonary disease.
- B. The patient's value and contributions to society.
- C. The patient has family members who rely on them for income.
- D. The date the patient was placed on the waiting list.
- E. Whether the underlying condition is due to self-induced illness.
Answer: A
NEW QUESTION # 59
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