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

According to Canadian guidelines, women aged 50 to 74 at average risk for breast cancer should undergo routine screening mammography every 2 to 3 years. A great-aunt with breast cancerdoes not raise this patient's risk to high. Mammography is appropriate as she is now due for the next screen.

Toronto Notes 2023 – Population Health, “Screening Guidelines” Section:

“Routine mammography is recommended every 2 years for average-risk women aged 50 to 74. Family history in second-degree or more distant relatives (e.g., great-aunt) does not qualify for high-risk screening or MRI.”

MCCQE1 Objectives (Population Health > 97-5: Screening and Prevention):

“Candidates should apply Canadian screening recommendations including mammography for average-risk women ≥50 years old.”

Self-breast exams (C) are not recommended for screening. PET scan (D) and MRI (E) are reserved for high-risk populations or diagnostic clarification.

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Comprehensive and Detailed Explanation:

The patient presents with classic symptoms of schizophrenia: delusions, hallucinations, social withdrawal, and disorganized appearance. The first-line treatment is antipsychotic medication—risperidone is a well-tolerated option among second-generation antipsychotics.

Toronto Notes 2023 – Psychiatry, “Schizophrenia”:

“Schizophrenia is treated with second-generation antipsychotics such as risperidone. These reduce positive symptoms like delusions and hallucinations.”

MCCQE1 Objectives (Psychiatry > 71-3: Psychotic Disorders):

“Candidates must recognize and manage schizophrenia with antipsychotics and distinguish from other mood or personality disorders.”

CBT (E) is supportive but not first-line. ECT (A) is used for severe depression or catatonia. Valproic acid (C) and carbamazepine (D) are mood stabilizers, not first-line for schizophrenia.

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Comprehensive and Detailed Explanation:

This patient has hypercalcemia with suppressed PTH, ruling out primary hyperparathyroidism. The differential includes malignancy-associated hypercalcemia, vitamin D intoxication, and medications. Given the low PTH and normal vitamin D level, malignancy (e.g., multiple myeloma) is a leading concern. Serum protein electrophoresis and urine for Bence-Jones proteins (light chains) are appropriate next steps.

Toronto Notes 2023 – Endocrinology, “Hypercalcemia”:

“PTH-independent hypercalcemia should prompt investigation for malignancy. Multiple myeloma is a common cause in older adults—order SPEP and UPEP.”

MCCQE1 Objectives (Endocrinology > 37-1: Calcium Disorders):

“Candidates must investigate non-PTH mediated hypercalcemia, including consideration of multiple myeloma.”

A (urine calcium) helps in familial hypocalciuric hypercalcemia, but this is unlikely given low PTH. B (calcitriol) would worsen hypercalcemia. C is inappropriate because PTH is suppressed. D (changing HCTZ) may help, but malignancy must be ruled out first.

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Persistent postmenopausal bleeding requires thorough evaluation. An inadequate endometrial biopsy result does not rule out pathology. Hysteroscopy allows for direct visualization and targeted biopsy and is the gold standard when biopsy is non-diagnostic.

Toronto Notes 2023 – Gynecology, “Abnormal Uterine Bleeding and Endometrial Cancer” Section:

“Persistent bleeding with insufficient biopsy requires further evaluation, preferably via hysteroscopy and directed biopsy. This is especially important in patients on HRT or with risk factors for endometrial pathology.”

MCCQE1 Objectives (Obstetrics & Gynecology > 82-9: Postmenopausal Bleeding):

“Candidates must investigate abnormal bleeding in postmenopausal women with hysteroscopy when endometrial sampling is non-diagnostic.”

Changing hormones (A), reducing progestin (E), or performing colposcopy (C) are not appropriate without confirming the cause of bleeding.

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This infant likely has infantile colic, defined by the “rule of 3s”: crying >3 hours per day, >3 days per week, for >3 weeks, usually starting in the first few months of life. It is benign and self-limited, typically resolving by 3–4 months of age.

Toronto Notes 2023 – Pediatrics, “Common Concerns in Infancy”:

“Colic is self-limited. No routine testing is required in healthy, thriving infants. Reassurance and support for parents are key.”

MCCQE1 Objectives (Pediatrics > 78-1: Behavioral Pediatrics):

“Candidates must recognize normal variations such as colic and avoid unnecessary interventions. Counseling and reassurance are essential.”

Sedatives (D) are contraindicated. Investigations (C) are unnecessary without red flags. Resolution (B) usually occurs by 3–4 months, not as late as 12 months.

This patient presents with hypotension, diffuse abdominal pain, and a history of contact sports injury with preceding symptoms of infectious mononucleosis (sore throat, fatigue). The spleen is commonly enlarged in mononucleosis, making it vulnerable to rupture after even minor trauma.

Toronto Notes 2023 – General Surgery and Infectious Diseases Sections:

“Splenic rupture is a known complication of mononucleosis, particularly after trauma. Symptoms may include diffuse abdominal pain, hypotension, and signs of hemorrhagic shock.”

MCCQE1 Objectives (Surgery > 84-1: Abdominal Trauma):

“Candidates should identify splenic rupture as a cause of hypotension and abdominal pain following blunt abdominal trauma, especially in patients with splenomegaly.”

Appendicitis (B) would present with localized right lower quadrant pain. Pneumonia (C) and pyelonephritis (D) would present with respiratory or urinary symptoms. Ruptured duodenum (E) is much less likely without specific trauma to that region or signs of peritonitis.

This patient presents with fever, confusion, anemia with schistocytes, thrombocytopenia, and renal impairment — fulfilling the classic pentad of thrombotic thrombocytopenic purpura (TTP). TTP is a hematologic emergency requiring plasma exchange.

Toronto Notes 2023 – Hematology, “Microangiopathic Hemolytic Anemia” Section:

“TTP is a medical emergency. Features include MAHA, thrombocytopenia, renal failure, neurologic symptoms, and fever. Schistocytes on blood film are diagnostic.”

MCCQE1 Objectives (Internal Medicine > 76-7: Hematologic Disorders):

“Candidates must urgently recognize TTP and initiate emergent plasma exchange therapy.”

AML (B) does not present with schistocytes. HIV (C) can cause thrombocytopenia but not MAHA. ITP (D) causes isolated thrombocytopenia without anemia or schistocytes.

The clinical presentation ofmultiple fractures at different stages of healingin a young child raisesstrong suspicion of physical abuse(non-accidental trauma). In such situations,mandatory reporting to child protection services is legally and ethically required, even in the absence of parental admission or clear history.

Toronto Notes 2023 – Pediatrics, Child Maltreatment Section:

“Red flags include inconsistent history, delay in seeking care, multiple injuries in various stages of healing, and injuries not consistent with developmental level. Health care professionals arelegally obligatedto report suspected child abuse or neglect to child protection authorities without delay.”

MCCQE1 Objectives (Medical Expert > Pediatrics > 77-2):

"The candidate must be able to recognize when the findings are consistent with child abuse... When child abuse is suspected,the physician has a legal obligation to report to the appropriate child protection agencyimmediately."

Options B, C, D, and E do not address the immediate child safety risk and legal duty. Social work involvement (E) is supportive but must follow or accompany notification to child protection, not replace it.

Comprehensive and Detailed Explanation:

Given his age and a first-degree relative with colon cancer diagnosed before age 60, this patient meets criteria for early colon cancer screening. Colonoscopy is the gold standard for both screening and diagnosis in this context.

Toronto Notes 2023 – Gastroenterology, “Colorectal Cancer Screening”:

“Patients with a first-degree relative diagnosed with colorectal cancer before age 60 should begin screening at age 40, or 10 years before the relative’s diagnosis. Colonoscopy is the preferred method.”

MCCQE1 Objectives (Population Health > Preventive Screening > 63-1):

“Candidates must apply colorectal cancer screening guidelines and select appropriate tests based on risk level.”

FIT (A) is for average-risk screening. MRI (B) and CT colonography (E) are secondary. Barium enema (D) is outdated.

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Comprehensive and Detailed Explanation:

This patient has end-stage heart failure with frequent hospitalizations, progressive symptoms, and functional decline. The most appropriate next step is to initiate a goals-of-care conversation, including acknowledgment of the prognosis.

Toronto Notes 2023 – Cardiology / Palliative Care:

“In advanced heart failure with recurrent admissions and functional decline, a goals-of-care discussion should be initiated to align treatment with patient values.”

MCCQE1 Objectives (Cardiology > 34-4 / ELOM > 90-2):

“Candidates must recognize end-stage illness and provide appropriate communication and palliative care planning.”

Deactivating the defibrillator (B) may be appropriate later but should follow a goals-of-care conversation. Reassuring (C) ignores the true clinical trajectory.