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

The presentation is consistent with cervical spondylosis — a degenerative condition. In the absence of neurologic findings, further imaging beyond plain radiography is not warranted. Management includes conservative measures such as physiotherapy and analgesia.

Toronto Notes 2023 – Rheumatology, Cervical Spondylosis:

“Patients with typical cervical spondylosis and no red flags (e.g., neurologic deficits) do not require MRI. Treatment is conservative. Radiographs showing disc space narrowing and osteophytes confirm diagnosis.”

MCCQE1 Objectives – Internal Medicine > Musculoskeletal Disorders:

“Candidates must recognize typical degenerative spine disorders and avoid unnecessary investigations when clinical findings are straightforward.”

MRI (B) is useful if myelopathy or radiculopathy is suspected. CT (A), EMG (C), and LP (D) are not indicated here.

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Comprehensive and Detailed Explanation:

This patient is pregnant and febrile with a new headache, photophobia, and clonus — all features concerning for preeclampsia with neurologic involvement. Clonus is a key finding suggestive of central nervous system irritability. Urine protein/creatinine ratio helps confirm the diagnosis of preeclampsia.

Toronto Notes 2023 – Obstetrics, Hypertensive Disorders in Pregnancy:

“Headache, clonus, and visual disturbances are concerning for severe preeclampsia. A urine protein/creatinine ratio or 24-hour urine collection confirms diagnosis.”

MCCQE1 Objectives – Obstetrics > Hypertension in Pregnancy:

“Candidates must recognize signs of preeclampsia and assess with appropriate biochemical testing.”

CT (A) or LP (B) are not indicated unless focal neurologic signs or seizures are present. Fetal imaging and amniocentesis (C, D) do not address maternal symptoms.

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The most important pre-vaccination history to elicit is any previous anaphylaxis to vaccine components. mRNA COVID-19 vaccines (e.g., Pfizer-BioNTech and Moderna) may contain polyethylene glycol (PEG), a potential allergen. This is a contraindication to administration.

Toronto Notes 2023 – Infectious Disease & Immunization Chapter:

“Absolute contraindications to mRNA COVID-19 vaccination include a documented anaphylactic reaction to a component of the vaccine such as polyethylene glycol (PEG).”

MCCQE1 Objectives – Population Health > Preventive Medicine > Immunizations:

“The candidate must be able to assess for contraindications prior to immunization, including anaphylaxis to previous vaccines or components.”

Breastfeeding and occupational exposure (Options B and D) do not preclude vaccination. Current immunosuppression (Option C) may affect vaccine efficacy but is not a contraindication unless specifically advised.

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This patient’s headache is consistent with tension-type or stress-related headache. The symptoms are mild, responsive to over-the-counter medications, and without red flags (neurologic signs, worsening pattern, nocturnal pain). Reassurance is appropriate.

Toronto Notes 2023 – Neurology, “Headache” Section:

“In the absence of red flags (e.g., sudden onset, focal deficits, age >50, worsening pattern), reassurance is the best course. Tension headaches are often related to stress and improve with lifestyle modification and simple analgesia.”

MCCQE1 Objectives (Internal Medicine > 76-6: Neurologic Symptoms):

“Candidates should recognize benign headache patterns and avoid unnecessary investigations.”

CT head (B) is not indicated. Stronger analgesics (D) may cause rebound headache. Specialist or psychiatric referrals (A, E) are premature.

Comprehensive and Detailed Explanation:

The combination of upper extremity hypertension and weak femoral pulses is classic for aortic coarctation. A soft systolic murmur may be present. This condition often becomes apparent during routine screening in school-aged children.

Toronto Notes 2023 – Pediatrics / Cardiology:

“Coarctation of the aorta presents with upper limb hypertension, diminished femoral pulses, and sometimes a systolic murmur. BP discrepancy is key.”

MCCQE1 Objectives (Pediatrics > 78-1: Congenital Heart Disease):

“Candidates must recognize signs of aortic coarctation, including weak lower limb pulses and systemic hypertension in children.”

VSD (A) typically presents with a louder murmur. Reflux nephropathy (B) may cause hypertension but without femoral pulse discrepancy. Renal artery thrombosis (C) is rare. Essential hypertension (D) is less likely in this age group with these findings.

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The first step in any MAID request is to explore the patient's motivations, psychosocial concerns, and mental health status. The request should be taken seriously and approached with compassion. Exploring the reasons is essential to determine eligibility and to distinguish suffering from other potentially treatable issues (e.g., depression, loss of hope).

Toronto Notes 2023 – ELOM, "Medical Assistance in Dying":

“Upon receiving a request for MAID, the physician must first explore the patient’s motivations, ensure understanding of their condition, and assess for coercion, depression, or other treatable factors.”

MCCQE1 Objectives (ELOM > Ethical Dilemmas > End-of-Life Care):

“Candidates must demonstrate understanding of the ethical and legal framework surrounding MAID and respond appropriately to requests by exploring reasons and providing necessary support and referrals.”

MAID is available to mature minors in some jurisdictions but not uniformly. Assuming the patient is ineligible or redirecting to other treatments without discussion is inappropriate.

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This patient presents with panic-like somatic symptoms triggered by bereavement. Normal investigations rule out cardiac pathology. Grief therapy is appropriate as the underlying stressor is unresolved grief and anxiety.

Toronto Notes 2023 – Psychiatry, Grief and Anxiety Disorders:

“Bereavement-related anxiety and somatization are common. Grief counseling can help reduce somatic and psychological symptoms when medical causes are ruled out.”

MCCQE1 Objectives – Psychiatry > Anxiety and Bereavement:

“Candidates should recognize psychological sequelae of grief, including panic and health anxiety, and provide appropriate psychological support.”

Metoprolol (C) is not indicated without confirmed cardiac cause. Lorazepam (B) may offer short-term relief but does not address the underlying grief. Stress testing (A) is unnecessary with repeated normal investigations.

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Comprehensive and Detailed Explanation:

Publication bias refers to the tendency for positive results to be published more often than negative or inconclusive ones. In your review, 3 of 4 studies show positive findings. However, studies showing no effect may not have been published, skewing your impression.

Toronto Notes 2023 – Public Health, Critical Appraisal:

“Publication bias can lead to overestimation of treatment efficacy. Systematic reviews must account for unpublished or negative findings.”

MCCQE1 Objectives – Preventive Medicine > Critical Appraisal:

“Candidates must recognize and account for biases such as publication bias in interpreting literature.”

Random error (A) and power (D) affect individual studies. Systematic and information biases (B, E) affect data quality, not publication trends.

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A history of previous alcohol withdrawal seizures is the single greatest predictor of future withdrawal seizures. This establishes a sensitization response within the central nervous system.

Toronto Notes 2023 – Addiction Medicine:

“A prior history of alcohol withdrawal seizures is the most important risk factor for recurrent seizures during future withdrawal episodes.”

MCCQE1 Objectives (Internal Medicine > Substance Use > 58-3):

“Candidates must identify individuals at high risk for severe alcohol withdrawal based on past withdrawal history, including seizures and delirium tremens.”

Although quantity, duration, and comorbidities contribute to risk, a prior withdrawal seizure most strongly predicts recurrence.

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The patient is obese (BMI 35), has type 2 diabetes, and shows a hepatocellular pattern of transaminitis (elevated ALT > AST). These are typical features of nonalcoholic steatohepatitis (NASH), the inflammatory subtype of nonalcoholic fatty liver disease (NAFLD).

Toronto Notes 2023 – Gastroenterology, NAFLD and NASH:

“NASH should be suspected in patients with metabolic syndrome, obesity, and type 2 diabetes, especially with elevated transaminases and normal bilirubin or INR.”

MCCQE1 Objectives – Internal Medicine > Hepatology:

“Candidates should recognize the clinical profile of NAFLD/NASH, particularly in asymptomatic patients with metabolic risk factors and isolated liver enzyme elevations.”

Acute hepatitis B (A) typically has higher ALT and symptoms. Pancreatic carcinoma (B) affects biliary enzymes or bilirubin. Metformin (D) does not elevate liver enzymes. HCC (E) would often present with systemic or localized symptoms and abnormal imaging.

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