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Medical Council of Canada MCCQE Part 1 Sample Questions:

1. You are treating a 78-year-old man for recent onset of diarrhea, tenesmus, and minor bleeding when he wipes.
He has a history of prostate cancer that was treated by radiotherapy. Rectal examination findings are normal.
Colonoscopy reveals a pale rectum with ulcerations and areas of mucosal hemorrhage. Which one of the following is the most likely explanation for this clinical presentation?

A) Radiation proctitis
B) Ulcerative colitis
C) Rectal cancer
D) Diverticulosis
E) Recurrent prostate cancer

2. You are working in a busy family practice. Your colleague's 48-year-old female patient presents with a 6- month history of fatigue and gastrointestinal symptoms. A recent colonoscopy was normal. Her chart indicates multiple investigations for similar symptoms over the past 2 years, all of which have been non- revealing. Your working diagnosis is somatic symptom disorder. Which one of the following is the most appropriate treatment?

A) Citalopram 20 mg daily
B) Exposure and response prevention therapy
C) Cognitive behavioral therapy
D) Risperidone 0.5 mg daily
E) Amitriptyline 10 mg at bedtime

3. You are on duty in the Emergency Department when 5 patients are brought in by ambulance after a high- speed motor vehicle collision. Which one of the following patients requires the most urgent medical care?

A) A 32-year-old man with a swollen and angulated thigh, a blood pressure of 112/96 mm Hg, and a pulse of 122/min
B) A 13-month-old child who is screaming constantly and for whom the triage nurse finds no obvious explanation
C) A 23-year-old woman who lost consciousness for about 5 minutes and has a headache despite a normal neurological screening examination
D) A 72-year-old man with a history of myocardial infarction, with a blood pressure of 163/94 mm Hg, a heart rate of 92/min, and a capillary saturation of 95%
E) A 4-year-old girl with a visibly displaced ankle fracture, in great pain, with normal distal pulses and normal vital signs

4. You are asked to see a 30-year-old woman, gravida 8, para 4, aborta 1, for symptoms of postpartum depression. She immigrated to Canada 8 months ago. She has been reluctant to speak to members of the medical team without her family members, even when an interpreter is present. Which one of the following is the best next step?

A) Insist on conducting the interview with the patient alone
B) Interview the patient and the family together
C) Allow 1 family member to stay and act as the interpreter
D) Ask the patient to write down her history and have it translated

5. A 31-year-old man presents with nocturnal non-exertional chest pain. During an exercise stress test, he does not experience chest pain, and there are no significant ST segment changes on the electrocardiogram. He achieves 17 metabolic equivalent of task (MET), a blood pressure of 190/96 mm Hg (resting blood pressure of
130/80 mm Hg), and a maximum heart rate of 162/min (85% of age-predicted maximum). Which one of the following is the most appropriate next step?

A) Schedule cardiac catheterization
B) Prescribe acetylsalicylic acid and metoprolol
C) Prescribe hydrochlorothiazide
D) Advise against vigorous exercise
E) Offer reassurance

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