Free Medical Council of Canada MCCQE Practice Exam with Questions & Answers

The presentation is highly suspicious for acute aortic dissection — sudden chest/back pain and mediastinal widening on chest x-ray. The most definitive and widely available test is contrast-enhanced computed tomography (CT) of the chest.

Toronto Notes 2023 – Cardiology, Aortic Dissection:

“CT angiography of the chest is the gold standard for stable patients with suspected aortic dissection. Look for mediastinal widening on chest x-ray as a clue.”

MCCQE1 Objectives – Internal Medicine > Cardiovascular Disease:

“Candidates should recognize acute aortic dissection and select appropriate imaging, such as CT chest, for diagnosis in stable patients.”

Transthoracic echo (A) may miss dissections. ECG (C) helps rule out MI but not dissection. V/Q scan (D) and pulmonary angiography (E) are for suspected pulmonary embolism.

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This clinical presentation is highly suggestive of chronic pelvic inflammatory disease (PID), especially given the left lower quadrant pain and dyspareunia with a normal pelvic ultrasound. PID is often caused by sexually transmitted infections (STIs), such as Chlamydia trachomatis or Neisseria gonorrhoeae, which may not be evident on imaging.

Toronto Notes 2023 – Gynecology:

“Cervical swabs for N. gonorrhoeae and C. trachomatis are essential in the workup of suspected PID or cervicitis, even when imaging is normal. Dyspareunia and chronic pelvic pain with normal imaging should prompt testing for STIs.”

MCCQE1 Objectives (Obstetrics & Gynecology > 82-6: Pelvic Pain):

“Candidates must consider and investigate for infectious causes of pelvic pain, including PID, which requires cervical swab testing as an essential first-line investigation.”

Laparoscopy (A) is invasive and reserved for uncertain or refractory cases. Hysterosalpingography (C) is used in infertility workups, not acute pain. Endometrial biopsy (D) and MRI (E) are not first-line.

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The symptoms — visual hallucinations, attention deficits, gait instability — suggest dementia with Lewy bodies (DLB), which may show bilateral frontal or parietal atrophy on imaging.

Toronto Notes 2023 – Psychiatry, Neurocognitive Disorders:

“DLB presents with fluctuating cognition, visual hallucinations, parkinsonism, and attention deficits. Imaging may show frontal or parietal atrophy but is not always specific.”

MCCQE1 Objectives – Psychiatry > Neurocognitive Disorders:

“Candidates must recognize the characteristic features of DLB and support diagnosis with imaging when appropriate.”

Cerebellar atrophy (A) is linked to ataxia but not hallucinations. Subdural hematoma (B) causes abrupt decline. Mediotemporal atrophy (D) is typical of Alzheimer’s. Option E is incorrect — imaging can support the diagnosis.

In elderly women with long-term pessary use and signs of vaginal atrophy (thin epithelium, bleeding, odor), local estrogen is the most appropriate initial treatment to restore the vaginal epithelium and reduce inflammation and discharge. Vaginal estrogen improves mucosal integrity and reduces complications like ulceration, infection, and bleeding.

Toronto Notes 2023 – Gynecology, “Pelvic Organ Prolapse and Pessary Care” Section:

“Local vaginal estrogen therapy is recommended for postmenopausal women with vaginal atrophy who are using pessaries. It reduces the risk of erosions, bleeding, and infection, especially when pessary follow-up has been suboptimal.”

MCCQE1 Objectives (Obstetrics and Gynecology > 82-9: Vaginal Bleeding in Postmenopausal Women):

“Candidates should recognize vaginal atrophy as a common and treatable cause of bleeding in elderly women using pessaries.”

A biopsy (E) may be needed if symptoms persist after atrophy is treated. Hysteroscopy (A) is invasive and not first-line in this setting. Metronidazole (B) is not indicated without evidence of bacterial vaginosis. Daily saline douching (D) is not recommended and may irritate atrophic mucosa.

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Chronic mesenteric ischemia (also known as “intestinal angina”) presents as postprandial abdominal pain, leading to food avoidance and significant weight loss. GI exams may be normal. Imaging (e.g., angiography or CT angio) confirms the diagnosis.

Toronto Notes 2023 – Gastroenterology, “Chronic Mesenteric Ischemia”:

“Classic triad: postprandial abdominal pain, weight loss, and food aversion. Physical exam and GI series may be normal.”

MCCQE1 Objectives (Gastroenterology > 47-1: Abdominal Pain):

“Candidates must suspect mesenteric ischemia in older adults with risk factors and postprandial pain leading to weight loss.”

PUD (A) usually causes epigastric pain relieved by food. Cholelithiasis (B) causes RUQ pain. Colon cancer (D) presents with altered bowel habits or bleeding. Mesenteric adenitis (C) occurs in younger patients, often with infection.

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Providing information in the patient’s own language is a concrete way to improve access, cultural safety, and communication — key recommendations in the Truth and Reconciliation Commission’s Calls to Action. It moves beyond symbolic gestures and supports equitable care.

Toronto Notes 2023 – ELOM, “Indigenous Health and Cultural Safety” Section:

“Cultural safety includes removing language barriers, engaging with Elders, and using patient-centered practices that respect Indigenous values. Communication in the patient's first language improves trust and outcomes.”

MCCQE1 Objectives (ELOM > 99-2: Cultural Safety and Health Equity):

“Candidates must apply the principles of culturally safe care including removing barriers to access and effective communication, as highlighted in the Truth and Reconciliation Commission’s Calls to Action.”

Evaluating session enjoyment (A) is not impactful. Certificates (C) are symbolic. Intake questions about trauma (D) must be done with appropriate context and safety — not as a formality.

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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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This presentation describesnormal developmental dysfluency, which typically occurs between ages 2–5 and often worsens duringtimes of stress or change, such as a new sibling. It is characterized byword repetitionand does not require intervention unless it persists >6 months, worsens, or causes distress.

Toronto Notes 2023 – Pediatrics, "Developmental and Behavioral Pediatrics" Section:

“Developmental stuttering is common between 2–5 years and often resolves without intervention. Reassurance is appropriate unless there are signs of persistent or severe stuttering, secondary behaviors, or parental concern.”

MCCQE1 Objectives (Pediatrics > 78-1: Development and Behavior):

“Candidates must recognize typical patterns of developmental speech dysfluency and differentiate them from pathological speech disorders. Observation and reassurance are often the appropriate initial step.”

Because the child is otherwise developing normally and the onset coincides with a known psychosocial stressor,reassuranceis the most appropriate step. Formal speech or behavioral therapy is not indicated at this time.

Endocervical polyps are common and often benign. An ulcerated polyp may bleed but is not itself suspicious unless it shows atypical features. The appropriate management is to remove the polyp (polypectomy) and send it for histopathology to exclude malignancy.

Toronto Notes 2023 – Gynecology, Cervical Pathology:

“Endocervical polyps are removed by polypectomy and sent for histological analysis. Most are benign. Atypical or ulcerated appearance may raise concern, but biopsy is unnecessary if the entire lesion is excised.”

MCCQE1 Objectives – Gynecology > Abnormal Bleeding and Cervical Lesions:

“Candidates should recognize that cervical polyps causing intermenstrual bleeding should be removed and assessed histologically.”

Colposcopy (B) is reserved for abnormal cytology or high-risk lesions. Cryotherapy (A) is for cervical dysplasia. Punch biopsy (E) is used for lesions that are not amenable to polypectomy.

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The levonorgestrel-releasing intrauterine system (LNG-IUS) is the first-line treatment for heavy menstrual bleeding, particularly in women with risk factors for endometrial hyperplasia and contraindications to systemic hormones (e.g., morbid obesity, diabetes, OSA).

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

“The LNG-IUS is highly effective in reducing menstrual bleeding and improving hemoglobin levels. It is particularly recommended in women with obesity, chronic anovulation, or contraindications to estrogen.”

MCCQE1 Objectives (Obstetrics and Gynecology > 82-1: Abnormal Uterine Bleeding):

“Candidates must consider the LNG-IUS as a preferred non-surgical treatment for chronic heavy menstrual bleeding when endometrial pathology has been excluded.”

Oral contraceptives (C) are not first-line in morbid obesity due to increased thromboembolic risk. Cyclic medroxyprogesterone (D) is less effective than LNG-IUS. Hysterectomy (A) is definitive but should follow failure of conservative therapy.