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Medical Council of Canada MCCQE Part 1 Sample Questions:

1. You are providing medical care to a 78-year-old man and notice a skin lesion which you suspect is malignant melanoma. He has been living in a long-term care facility for 2 years because of incontinence, mobility and vision problems. He is well-liked by facility staff and residents, manages his own affairs and communicates clearly. He has designated his daughter to be his substitute decision-maker and has signed a Do Not Resuscitate (DNR) order. Which one of the following is the best next step in providing care to this patient for his skin lesion?

A) Contact the daughter to inform her of your findings and discuss possible investigations.
B) Discuss your tentative diagnosis with him and ask about his preferences regarding investigations.
C) Ask him whether you can discuss your diagnosis and care with his daughter.
D) Respect his DNR wishes, and do nothing about the skin lesion.
E) Perform a biopsy to ensure an accurate diagnosis before discussing diagnosis and treatment.

2. A previously well 2-year-old girl is brought to the Emergency Department with difficulty breathing that has been gradually worsening over the last 24 hours. Her parents say she has a sore throat. On examination, you note that she appears ill. She has stridor and is in moderate respiratory distress, drooling and emitting a muffled voice. Vital signs are as follows: respiratory rate 34/min, heart rate 160/min, temperature 40.2°C.

Which one of the following is the most likely diagnosis?

A) Retropharyngeal abscess.
B) Acute viral bronchiolitis.
C) Laryngomalacia.
D) Airway foreign body.
E) Croup.

3. An 18-year-old woman presents to the Emergency Department with a 3-day history of vomiting and right upper quadrant pain. She is alert but appears unwell and jaundiced. She was previously healthy and has not travelled recently. She has no risk factors for blood-borne pathogens. She denies hematemesis or hematochezia. On further history, she reports that she took a full bottle of pills that she found in her parents' medicine cabinet several hours before she started vomiting. Without intervention, which one of the following is the most likely outcome?

A) Ventricular fibrillation
B) Rapid-onset cerebral edema
C) Status epilepticus
D) Acute renal failure
E) Fulminant hepatic failure

4. You have just completed a well-baby check on a 6-month-old in the office where you have recently begun to practice. You ask the registered nurse to give the immunizations. She refuses, saying this is not within her scope of practice. Which one of the following is the best next step?

A) Insist that she give the immunizations as she should be competent to do so.
B) Contact the provincial/territorial nursing regulatory body to make a complaint about her.
C) Give the immunizations yourself and then discuss the matter with the nurse later.
D) Recognize your error in making the request and refrain from asking again.
E) Offer to be present while she gives the immunizations so that she will be supervised.

5. A 62-year-old woman is referred to your clinic for evaluation of hypercalcemia. She has a history of hypertension and vitamin D deficiency. Her medications include hydrochlorothiazide and vitamin D supplements. Laboratory investigations are as follows:
Calcium: 2.72 mmol/L (#)
Phosphate: 0.9 mmol/L (#)
Parathyroid hormone (PTH): 0.9 pmol/L (#)
25-hydroxy vitamin D: 80 nmol/L (normal)
Which one of the following is the best next step?

A) Start calcitriol
B) Order serum protein electrophoresis and urine for light chains
C) Order 24-hour urine calcium
D) Refer for consideration of parathyroidectomy
E) Switch to a different antihypertensive medication

Solutions: