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

The patient with the angulated thigh, hypotension relative to baseline, and tachycardia likely has a femoral shaft fracture with concealed hemorrhage. This poses an immediate risk of hypovolemic shock and requires urgent assessment and stabilization.

Toronto Notes 2023 – Emergency Medicine, “Trauma Triage and Prioritization”:

“Patients with long bone fractures, especially femoral fractures, are at high risk for hemorrhage and should be prioritized for stabilization and hemorrhage control.”

MCCQE1 Objectives (Surgery > 51-1: Trauma):

“Candidates must prioritize trauma patients based on signs of instability or risk of deterioration, such as tachycardia and occult bleeding.”

This is a classic presentation of acute acetaminophen (paracetamol) overdose. The most serious consequence, especially with delayed treatment, is fulminant hepatic failure.

Toronto Notes 2023 – Toxicology, Acetaminophen Toxicity:

“Acetaminophen overdose is the most common cause of acute liver failure. Delayed presentation leads to jaundice, coagulopathy, encephalopathy, and possible death.”

MCCQE1 Objectives – Internal Medicine > Toxicology:

“Candidates must identify acetaminophen overdose by clinical history and recognize fulminant hepatic failure as a primary complication.”

Cerebral edema (C) may occur secondarily, but fulminant hepatic failure is the most direct and expected outcome. Renal failure (B), arrhythmias (E), and seizures (A) are not typical with acetaminophen.

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This case suggests diversion of prescription opioids, a serious safety and regulatory concern. The physician must balance maintaining patient care with minimizing risk. Daily dispensing via a monitored pharmacy is the safest and most practical solution to prevent misuse or theft, while avoiding immediate discontinuation of the patient’s needed medication.

Toronto Notes 2023 – Chronic Pain & Substance Use:

“In cases of concern for opioid diversion, consider witnessed daily dispensing, prescription monitoring, and involving caregivers when appropriate.”

MCCQE1 Objectives (Internal Medicine > Pain Management > 56-2):

“The candidate must demonstrate understanding of strategies for safe prescribing and monitoring of controlled substances, including mitigation of diversion.”

Calling the police (A) is not the physician’s immediate duty. Providing an early refill (B) worsens risk. Tapering (C) may be appropriate later, but first the medication must be safeguarded. Increasing quantity (D) is inappropriate.

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Physicians in Canada may charge patients for uninsured services (e.g., completion of forms, cosmetic procedures, some travel-related vaccines), but they may not charge extra for insured services or preferential access. Doing so violates the Canada Health Act, which mandates accessibility and universality of insured services.

Toronto Notes 2023 – ELOM, Health Care System:

“Physicians may charge for uninsured services but may not charge block fees for insured services, nor can they charge for expedited access to insured services.”

MCCQE1 Objectives – ELOM > Health Policy and System:

“Candidates must recognize practices that violate the principles of publicly funded health care, including charging for insured services or access premiums.”

Option A is not permitted under law. Options B, D, and E involve insured services (e.g., home visits, after-hours care) and cannot be billed directly to patients.

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Valproic acid is well known to cause thrombocytopenia, especially at higher serum concentrations or in patients over 60. Bruising with platelet count <100 × 10⁹/L is a classic manifestation.

Toronto Notes 2023 – Psychiatry, Mood Disorders & Pharmacology Section:

“Valproic acid is associated with hematologic side effects including thrombocytopenia. Platelet counts should be monitored regularly.”

MCCQE1 Objectives – Psychiatry > Pharmacotherapy:

“The candidate must recognize adverse effects of mood stabilizers including hematologic complications of valproic acid.”

Other listed medications (A–D) have no common or direct link with thrombocytopenia in this context.

The image shows classic features of “early childhood caries” (ECC), often called "baby bottle tooth decay.” This typically affects upper incisors first due to prolonged exposure to milk/formula or sugary drinks during sleep.

Toronto Notes 2023 – Pediatrics, “Dental Health” Section:

“ECC is most commonly caused by prolonged nighttime bottle feeding with milk or juice. It affects upper anterior teeth due to pooling and lack of protective salivary flow.”

MCCQE1 Objectives (Pediatrics > 78-2: Preventive Care):

“Candidates must recognize risk factors for dental caries in young children, including nighttime bottle use and sugary liquid exposure.”

Antibiotics (C) or iron (D) can stain but do not cause this pattern of decay. Vitamin D (A) causes enamel hypoplasia or delayed eruption. Fluoride deficiency (B) causes diffuse decay, not selective anterior tooth loss.

In postmenopausal women with severe vasomotor symptoms, hormone therapy (estrogen with progesterone in women with an intact uterus) is the most effective treatment. It improves hot flashes, sleep, and mood symptoms.

Toronto Notes 2023 – Gynecology, Menopause Management:

“Combination hormone therapy is first-line for moderate to severe menopausal symptoms. Non-hormonal agents may be considered if contraindications exist.”

MCCQE1 Objectives – Gynecology > Menopause:

“Candidates must recognize the indication and benefits of hormone therapy for vasomotor symptoms in appropriate patients.”

Lifestyle changes (A) are supportive but insufficient. Primrose oil (C) lacks robust evidence. SSRIs (D) and clonidine (E) are second-line.

In a patient presenting with physical symptoms (e.g., hip pain) and prominent psychosocial red flags — loss of interest, decreased libido, and withdrawal — the next step is to screen for depression. Somatization is common in mood disorders.

Toronto Notes 2023 – Psychiatry, Depression:

“Patients with depression may present with somatic complaints. A thorough psychosocial assessment is essential in such cases, particularly when symptoms interfere with functioning.”

MCCQE1 Objectives – Psychiatry > Mood Disorders:

“Candidates must consider depression in patients with non-specific physical symptoms and reduced interest or motivation, particularly with social withdrawal.”

Imaging or physiotherapy may be needed later, but the most urgent and informative step is psychiatric screening.

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Comprehensive and Detailed Explanation:

The patient is in a persistent vegetative state and medically stable, meaning he does not need continued hospitalization. The goal is to provide appropriate long-term care in the least restrictive setting, typically at home with robust home care support services. This approach aligns with ethical care, family-centered goals, and medical appropriateness.

Toronto Notes 2023 – Pediatrics / Neurodevelopment & Chronic Care:

“Home care with appropriate medical and caregiver support is often the best setting for children with severe neurological impairments who are medically stable.”

MCCQE1 Objectives (Pediatrics > 77-5: Chronic Neurological Disorders):

“Candidates must assess discharge planning and coordinate home care support for children with long-term care needs.”

Palliative facility (B) is not appropriate unless end-of-life is imminent. School (C) is not feasible in this state. Hospital readmission for respite (D) is not standard. Rehabilitation (E) has little utility in persistent vegetative state.

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