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Medical Council of Canada MCCQE Part 1 Sample Questions:

1. A 79-year-old woman presents to the Emergency Department with sudden-onset severe chest and back pain that started 1 hour ago. She has a history of hypertension and looks unwell. Her vital signs are as follows:
blood pressure 168/108 mm Hg, heart rate 110/min, respiratory rate 22/min, temperature 36.7°C. Findings of a physical examination of the chest and abdomen are normal. An urgent computed tomography (CT) scan of the chest and abdomen shows an aortic dissection extending from the descending thoracic aorta to the upper abdominal aorta. The branches of the abdominal aorta are patent. Following initial resuscitation, which one of the following is the best next step?

A) Begin anticoagulation with heparin.
B) Begin intravenous beta-blocker therapy.
C) Start thrombolytic therapy.
D) Insert an intra-aortic balloon pump.
E) Immediate surgical repair.

2. A 37-year-old woman presents to your clinic with frequent palpitations. She has no other symptoms and is quite active. Physical examination and resting electrocardiogram findings are normal. Which one of the following is the best next step?

A) #-Blocker
B) Echocardiogram
C) Treadmill exercise test
D) Holter monitoring

3. An otherwise healthy 43-year-old woman presents to your clinic for a left breast mass. Six months ago, she underwent a bilateral breast magnetic resonance imaging (MRI) after watching a television program on breast cancer prevention. An ultrasound-guided biopsy of a 1.5 cm mass confirmed, at the time, that she had fibroadenoma. The follow-up ultrasound now reveals a mass measuring 1.7 cm. Which one of the following is the best next step in the management of this patient?

A) Proceed with needle-localized left lumpectomy.
B) Order a MRI of both breasts to rule out anything else.
C) Repeat the biopsy to confirm the diagnosis.
D) Reassure the patient and reassess in 12 months.
E) Administer prophylactic tamoxifen to decrease the risk of cancer.

4. An otherwise healthy 21-year-old college student is brought to the Emergency Department after falling from the rooftop terrace of a night club. A grade III splenic laceration measuring 3 cm is identified on computed tomography scan. You elect to manage the patient non-operatively with close monitoring, repeat examinations and hemoglobin levels. A repeat computed tomography at 48 hours shows no deterioration. Diet is resumed and over the next few days, the patient resumes ambulation. Which one of the following do you discuss with your patient prior to discharge?

A) Arrange weekly outpatient follow-up with repeat hemoglobin measurement.
B) Organize an angiography with possible embolization.
C) Recommend avoidance of vigorous activity for 3 months.
D) Plan an interval laparoscopic splenectomy within the next 6 weeks.
E) Vaccinate against encapsulated organisms.

5. A 42-year-old man presents for a follow-up visit for mild hypertension. His blood pressure has been consistently elevated over the last 2 visits. In discussion with the patient, you decide to initiate antihypertensives. He had previously been on ramipril and stopped when he developed tongue swelling. His past medical history consists of asthma and hyperlipidemia. Which one of the following is the most appropriate treatment at this time?

A) Hydralazine.
B) Enalapril.
C) Hydrochlorothiazide.
D) Metoprolol.
E) Clonidine.

Solutions: