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

Button batteries lodged in the esophagus require urgent endoscopic removal due to risk of tissue necrosis, perforation, and tracheoesophageal fistula within hours. Batteries beyond the esophagus may pass spontaneously if the child is asymptomatic.

Toronto Notes 2023 – Pediatrics, “Foreign Body Ingestion”:

“Button batteries in the esophagus are medical emergencies and must be removed immediately. Batteries in the stomach or intestines may be observed if the child is asymptomatic.”

MCCQE1 Objectives (Pediatrics > 78-2: Gastrointestinal Emergencies):

“Candidates must identify when foreign body ingestion poses immediate risk and requires emergency intervention.”

Batteries in the stomach or intestines (A–C, E) usually pass without complication, especially if the child is asymptomatic and the battery is <2 cm.

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Comprehensive and Detailed Explanation:

Rapid progression of pain out of proportion to exam, systemic symptoms (anxiety), and skinchanges without major swelling are classic for necrotizing fasciitis—a surgical emergency. Discoloration and extreme tenderness should raise immediate concern.

Toronto Notes 2023 – Emergency Medicine / Surgery:

“Necrotizing fasciitis presents with severe pain, systemic toxicity, rapid progression, and early skin changes (discoloration). Pain out of proportion is a key clue.”

MCCQE1 Objectives (Emergency Medicine > 51-1: Soft Tissue Infections):

“Candidates must recognize necrotizing fasciitis and initiate urgent surgical consultation.”

Plantaris rupture (A) is benign and localized. DVT (B) is more gradual and often with swelling. Cellulitis (C) progresses more slowly and is less painful. Baker’s cyst (D) causes posterior knee pain, not severe systemic illness.

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Comprehensive and Detailed Explanation:

This patient has stress urinary incontinence and an incidental cystocele. First-line management of mild pelvic organ prolapse and stress incontinence includes pelvic floor physiotherapy (e.g., Kegel exercises). Surgical options are reserved for severe or refractory cases.

Toronto Notes 2023 – Gynecology, Pelvic Floor Disorders:

“For asymptomatic prolapse or mild stress incontinence, recommend pelvic floor strengthening. Conservative management is preferred before surgical referral.”

MCCQE1 Objectives – Gynecology > Urogynecology:

“Candidates should initiate pelvic floor therapy in women with mild prolapse or urinary leakage prior to specialist referral.”

Topical estrogen (B) helps with atrophic vaginitis, not stress incontinence. Hysterectomy (A) and specialist referral (C) are premature. Avoiding impact sports (E) is not a treatment.

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Medical record retention is governed by laws and policies established by the provincial or territorial medical regulatory authorities (e.g., College of Physicians and Surgeons of Ontario).These bodies set requirements for how long patient records must be maintained and how to handle former patients’ data.

Toronto Notes 2023 – Ethics and Health Systems:

“Retention of medical records is regulated by provincial/territorial colleges, which outline minimum retention periods and storage responsibilities.”

MCCQE1 Objectives (ELOM > Legal Requirements > Professional Responsibilities):

“The candidate must be able to identify the legal responsibilities of physicians regarding record-keeping, as guided by regulatory authorities.”

National organizations such as Health Canada, CFPC, CMA, and MCC do not set these rules for individual practice management.

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Comprehensive and Detailed Explanation:

During mass casualty incidents, effective triage is essential to optimize care delivery. A trained physician is best used in triage or direct care. Triage is the foundation of disaster management.

Toronto Notes 2023 – Public Health / Disaster Medicine:

“In disaster response, trained healthcare providers should be deployed to triage and stabilize patients in emergency departments.”

MCCQE1 Objectives (Public Health > 65-1: Disaster Response):

“Candidates must understand principles of mass casualty management and assign appropriate roles during triage and care delivery.”

Media (D) and logistics (A, C) are secondary roles. Triage and direct care take priority.

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This infant has evidence of urinary outflow obstruction on ultrasound. The most common cause in male infants is posterior urethral valves. Poor urinary stream is a hallmark symptom of bladder outlet obstruction in neonates.

Toronto Notes 2023 – Pediatrics, “Pediatric Urology” Section:

“Posterior urethral valves should be suspected in male infants with recurrent UTIs, hydronephrosis, and a weak urinary stream. Diagnosis is confirmed by voiding cystourethrogram.”

MCCQE1 Objectives (Pediatrics > 78-4: Urinary Tract Abnormalities):

“Candidates must identify congenital causes of urinary obstruction. Poor stream and hydronephrosis are classic features of posterior urethral valves.”

Crying with urination (E) is nonspecific. Hematuria (B) and malodorous urine (D) are common with infections. Circumcision (A) is unrelated.

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Comprehensive and Detailed Explanation:

Transient synovitis is the most common cause of hip pain and limp in children aged 3–10 years. It is often preceded by a viral infection. Patients appear well, can often bear weight, and have only mild to moderate elevation in inflammatory markers. Radiographs are normal.

Toronto Notes 2023 – Pediatrics, “Limping Child”:

“Transient synovitis is benign and self-limiting. Presentation includes mild limp, low-grade fever, normal or slightly elevated CRP/ESR, and ability to bear weight.”

MCCQE1 Objectives (Pediatrics > 78-2: Musculoskeletal Disorders):

“Candidates must distinguish between transient synovitis and more serious causes of limping, such as septic arthritis.”

Septic arthritis (A) usually causes inability to bear weight and more significant fever and CRP elevation. Osteomyelitis (B) typically presents with localized tenderness and systemic signs. Bursitis (D) is rare in young children. JIA (E) is chronic.

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The image shows an asymmetrical light reflex (corneal light reflex not centered in both eyes), which is diagnostic of strabismus. This misalignment of the eyes must be treated early to prevent amblyopia (lazy eye).

Toronto Notes 2023 – Pediatrics, Ophthalmology:

“Strabismus presents with misaligned visual axes. The Hirschberg light reflex is off-center in the affected eye. Prompt referral is necessary to prevent amblyopia.”

MCCQE1 Objectives – Pediatrics > Vision and Developmental Disorders:

“Candidates must recognize strabismus on visual screening and refer early for correction to prevent permanent vision impairment.”

Pseudostrabismus (B) can be ruled out here because the light reflex is not symmetric. Ptosis (A) involves drooping of the eyelid, which is not evident. Cataracts (D) would typically present with a leukocoria (white reflex), not misalignment.

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This patient presents with signs of acute compartment syndrome (pain out of proportion, paresthesia, pallor, swelling, decreased pulses, and dark urine indicating rhabdomyolysis). Measuring compartment pressures is the diagnostic test of choice to confirm the diagnosis and guide urgent surgical fasciotomy.

Toronto Notes 2023 – Orthopedics:

“Acute compartment syndrome should be suspected in any patient with severe extremity pain, swelling, sensory deficits, and tense compartments. Confirm with compartment pressure measurements. Fasciotomy is indicated if pressure is >30 mmHg or within 30 mmHg of diastolic pressure.”

MCCQE1 Objectives (Surgery > 51-2: Limb Trauma):

“Candidates must diagnose acute compartment syndrome and initiate appropriate surgical referral after confirming with pressure measurements.”

Angiography and Doppler studies assess vascular compromise but are not the first step in suspected compartment syndrome. Fixing the hip (C) and testing myoglobin (E) are not diagnostic steps.

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Comprehensive and Detailed Explanation:

For small renal masses (<4 cm), partial nephrectomy (nephron-sparing surgery) is the standard of care in patients who are surgical candidates. It preserves renal function and provides oncologic control.

Toronto Notes 2023 – Urology / Oncology:

“Small renal tumors <4 cm should be treated with partial nephrectomy. Active surveillance or ablation may be alternatives in poor surgical candidates.”

MCCQE1 Objectives (Urology > 59-2: Renal Masses):

“Candidates must manage small renal tumors with nephron-sparing surgery when feasible.”

MRI (A) is unnecessary after CT confirmation. Radiation (B) is not first-line. Surveillance (D) may be appropriate for elderly or frail patients, not this one. Ablation (E) is for high-risk surgical patients.

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