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

Idiopathic hirsutism is the most likely diagnosis because this patient has isolated hirsutism with normal vital signs, normal BMI, and regular menstrual cycles , suggesting preserved ovulation and no clinically significant endocrine disturbance. MCCQE objectives emphasize that the most common causes of hirsutism are PCOS and idiopathic hirsutism; PCOS typically includes menstrual irregularity/oligo-ovulation and often metabolic features (overweight, insulin resistance), none of which are present here. Androgen-secreting ovarian tumors (hilar cell or Sertoli–Leydig cell tumors) usually cause rapid onset, severe hyperandrogenism and virilization (deepening voice, clitoromegaly, marked acne) and often disrupt menses—features not described. Nonclassic congenital adrenal hyperplasia can present with hirsutism, but it more commonly associates with acne, infertility, or menstrual abnormalities and requires biochemical suspicion rather than being the “most likely” with normal cycles. Therefore, idiopathic hirsutism—often due to increased peripheral androgen sensitivity or local 5-alpha reductase activity—is the best fit.

This patient has signs suggestive of decompensated liver cirrhosis (ascites, peripheral edema, low-normal BP, alcohol use, abdominal distension). Sodium restriction is the cornerstone of first-line management to prevent fluid retention in cirrhotic ascites.

Toronto Notes 2023 – Gastroenterology, “Cirrhosis and Ascites” Section:

“Sodium restriction ( < 2 g/day) is the most important non-pharmacologic management for ascites. Fluid restriction is added only in cases of severe hyponatremia.”

MCCQE1 Objectives (Internal Medicine > 76-5: Liver Disease):

“Candidates must manage ascites conservatively using sodium restriction, with diuretics added as needed.”

Lactulose (E) is used for hepatic encephalopathy, not ascites. Ramipril (B) may worsen renal function in cirrhosis. Nadolol (C) is used for variceal bleeding prophylaxis. Compression stockings (D) are not helpful in ascites-related edema.

====================================================

This patient is currently non-communicative and therefore likely lacks decision-making capacity. MCCQE ethics objectives emphasize that when a patient’s prior capable wishes are clearly known, clinicians must follow those expressed values and directives. He previously stated he did not want life-prolonging measures; escalation (hospital transfer) and potentially curative treatment aimed primarily at prolonging life would conflict with that directive. The immediate best step is to provide comfort-focused care, addressing symptoms such as fever and distress with antipyretics and other palliative measures.

Calling family to “consider antibiotics” risks substituting others’ preferences for the patient’s known wishes; substitute decision makers are meant to apply the patient’s prior expressed wishes, not override them. Starting antibiotics while waiting to contact family similarly risks initiating life-prolonging therapy inconsistent with the directive. Catheter change may be clinically useful in catheter-associated infection, but the question frames a clear limit on life-prolonging interventions; symptom relief is the priority. Ongoing care should include reassessment of comfort, clear documentation of goals of care, and communication with family about the patient’s previously stated wishes and the plan for palliative management.

Comprehensive and Detailed Explanation:

Physicians must avoid conflicts of interest and maintain professional boundaries with patients and their families. Accepting a personal financial gift, regardless of intent, is inappropriate and unethical.

Toronto Notes 2023 – Ethics and Professionalism:

“Personal gifts of significant value from patients or families should be declined to avoid real or perceived conflicts of interest.”

MCCQE1 Objectives (ELOM > 90-3: Professionalism and Boundaries):

“Candidates must maintain ethical boundaries and refuse financial incentives that could compromise or appear to compromise clinical judgment.”

Other options (A, B, E) still involve a conflict. D is helpful, but the ethical obligation is to decline the cheque directly.

—

The patient has clinical evidence of genital warts (condyloma acuminata), which are caused by low-risk HPV types. Even though she is not currently sexually active and has visible warts, HPV vaccination is still beneficial for protection against other oncogenic strains (especially types 16 and 18). Vaccination is safe and recommended up to age 45.

Toronto Notes 2023 – Gynecology, " STIs and HPV " :

“Vaccination is recommended up to age 45, regardless of prior exposure or visible warts. It may prevent reinfection with or acquisition of high-risk HPV strains.”

MCCQE1 Objectives (Gynecology > 83-3: STIs and HPV):

“Candidates must counsel patients appropriately on prevention, including the role of HPV vaccination, even after exposure or infection.”

Pap testing (B) is routine screening, not management of visible warts. Cryotherapy (D) is optional if the patient desires removal, but she declined treatment. Biopsy (A) is reserved for atypical lesions. Contact tracing (E) is not typically required for HPV warts.

====================================================

Living kidney donation is based on voluntary, informed consent and thorough medical and psychosocial evaluation of the donor. MCCQE ELOM objectives emphasize respect for autonomy and avoidance of unjustified discrimination. An ex-spouse may be considered as a potential donor if he meets medical criteria and demonstrates informed, voluntary decision-making free of coercion. Marital status or divorce is not a valid reason to exclude someone from donor assessment.

Concerns about the welfare of their child are important but are addressed during the standard donor evaluation process, which includes psychosocial assessment and discussion of risks. Donation cannot be automatically refused on speculative grounds. Instead, transplant programs conduct rigorous screening to ensure donor safety and voluntariness.

Therefore, the appropriate response is to allow him to proceed with formal donor assessment , where suitability, risks, motivations, and support systems will be evaluated comprehensively before any final decision is made.

Comprehensive and Detailed Explanation:

Middle-aged to older men with social isolation and substance use disorders (especially alcohol) are among the highest-risk groups for completed suicide. They are less likely to seek help and often use more lethal methods.

Toronto Notes 2023 – Psychiatry, “Suicide Risk Assessment”:

“High-risk demographics include older men, social isolation, comorbid alcohol use, and chronic illness. These patients have the highest rates of completed suicide.”

MCCQE1 Objectives (Psychiatry > 71-1: Suicide Risk):

“Candidates must recognize epidemiologic risk factors for completed suicide, including demographics and comorbidities.”

Although women and youth have higher rates of suicidal ideation and attempts, men over 50 have the highest completion rates.

This patient has classic signs of cardiac tamponade (Beck ' s triad: hypotension, muffled heart sounds, elevated JVP, plus pulsus paradoxus). However, she also has advanced metastatic cancer, functional decline, and has stopped active treatment. In this context, a goals-of-care discussion is the most appropriate next step to determine her wishes regarding interventions like pericardiocentesis.

Toronto Notes 2023 – Palliative Care:

“End-of-life care should prioritize quality of life and patient preferences. In patients with terminal illness and life-threatening conditions (e.g., tamponade), initiate a conversation about goals before aggressive intervention.”

MCCQE1 Objectives – Internal Medicine > Palliative and End-of-Life Care:

“Candidates must assess prognosis, patient values, and initiate appropriate end-of-life discussions before invasive treatment.”

Although pericardiocentesis (A) may relieve symptoms, it should follow consent based on the patient’s goals. ICU (E), fluids (B), or transfusion (D) are not appropriate without this discussion.

Complex regional pain syndrome (CRPS type I) is the most likely diagnosis because the child has persistent, function-limiting pain behavior and marked unwillingness to move the entire limb despite a minor fracture that is now healed radiographically and has a normal neurovascular exam. MCCQE objectives emphasize recognizing pain that is disproportionate to tissue injury and persists beyond expected healing, often accompanied by guarding and fear of movement. CRPS can occur after fractures or immobilization and may present with severe allodynia, hyperalgesia, edema, color/temperature changes, and motor dysfunction; however, early cases may primarily show avoidance of movement and pain with otherwise normal objective findings.

An unrecognized scaphoid fracture would cause localized wrist pain (classically snuffbox tenderness) rather than refusal to move elbow, wrist, and fingers, and would not be explained by a distal radius buckle fracture that has united. Ischemic (Volkmann) contracture would involve a tense forearm, fixed flexion deformity, and neurovascular compromise. Median nerve compression would produce sensory changes and thenar weakness. School avoidance alone does not explain the post-injury limb-protective pattern with normal healing. Management focuses on reassurance, early mobilization, physiotherapy, and multidisciplinary pain strategies.

Orchiopexy is the treatment of choice for cryptorchidism and should be performed between 6–18 months of age. Early surgery improves fertility outcomes and reduces malignancy risk.

Toronto Notes 2023 – Pediatrics, Urology:

“Undescended testes should be referred for orchiopexy ideally before 18 months of age. Observation beyond 6 months is not recommended.”

MCCQE1 Objectives – Pediatrics > Genitourinary Disorders:

“Candidates must recognize and refer for cryptorchidism early to optimize testicular function and reduce cancer risk.”

Hormonal therapies (C, D) are not recommended due to limited efficacy. Observation (A) is too late beyond