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

It is essential to balance medical guidelines with trauma-informed, patient-centered care. This includes offering future discussion while respecting boundaries. Acknowledging distress and offering to explore more in the future (B) preserves trust and autonomy.

Toronto Notes 2023 – ELOM and LGBTQ2S+ Health Section:

“For transgender individuals, screening decisions should be personalized. Trauma-informed care includes validating distress and deferring invasive exams when not urgent.”

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

“Candidates must prioritize patient-centered communication and consent, particularly when distress or marginalization may influence healthcare interactions.”

Option A is coercive. Option C is documentation only and lacks engagement or exploration.

The presentation is consistent with rotator cuff tendinopathy or subacromial impingement. The painful arc between 30°–120° with preserved passive ROM suggests this. Ultrasound is the preferred initial imaging modality due to its availability, safety, and ability to visualize soft tissues dynamically.

Toronto Notes 2023 – Orthopedics, “Shoulder Pathologies” Section:

“In rotator cuff injuries or impingement syndromes, initial imaging with musculoskeletal ultrasound is appropriate. It can identify tendinopathy, partial tears, or subacromial bursitis.”

MCCQE1 Objectives (Surgery > 84-7: Musculoskeletal Pain):

“Candidates should initiate workup for rotator cuff or impingement syndromes with ultrasound as the first-line test, reserving more invasive or costly procedures for unresolved or complex cases.”

CT (A) is used for bony detail, not soft tissues. Arthroscopy (C) is invasive and therapeutic. Arthrography (D) is outdated and largely replaced by MRI or ultrasound.

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At the end of life, decreasing consciousness and unresponsiveness are common and expected physiologic changes. MCCQE ELOM objectives emphasize prioritizing patient comfort, respecting goals of care, and communicating clearly with families about prognosis and the dying process. The best next step is to explain that her reduced level of consciousness is most consistent with imminent dying and that she is unlikely to have the decision-making capacity required to execute legal documents (capacity requires understanding and appreciation of the decision and its consequences).

Withholding morphine to attempt to increase alertness risks causing pain and dyspnea, violating the duty to relieve suffering. Administering naloxone is inappropriate because it may precipitate acute pain and distress and is not indicated when opioids are being used appropriately for symptom control. A legal opinion or ethics consult may be considered later if conflict persists, but the immediate priority is compassionate communication, clarifying that “waking her to sign” is unlikely feasible or ethically justified, and supporting the son through anticipatory grief while continuing comfort-focused care.

This patient has a grade III splenic laceration successfully managed non-operatively. MCCQE surgical objectives emphasize that in hemodynamically stable patients, non-operative management (NOM) is standard for many blunt splenic injuries to preserve splenic function. Because the spleen remains intact, vaccination against encapsulated organisms is not required (this is indicated after splenectomy or functional asplenia).

Prior to discharge, the most important counseling point is activity restriction to reduce the risk of delayed splenic rupture. Patients are advised to avoid vigorous physical activity, contact sports, and heavy lifting for approximately 3 months , depending on injury severity and follow-up imaging protocols. This allows adequate healing of splenic parenchyma.

Routine interval splenectomy is not indicated after successful NOM. Angiography with embolization is reserved for ongoing bleeding or vascular blush on imaging. Weekly hemoglobin checks are not routinely required if the patient is clinically stable.

Thus, counseling regarding avoidance of vigorous activity is the key discharge recommendation.

This child presents with “red flag” features for malignancy: a firm, fixed, nontender supraclavicular lymph node > 2 cm in size, with associated hepatosplenomegaly and night sweats. These features are most concerning for lymphoma.

Toronto Notes 2023 – Pediatrics, “Lymphadenopathy in Children”:

“Malignant lymphadenopathy tends to be firm, fixed, painless, and located in supraclavicular areas. Systemic signs (fever, weight loss, hepatosplenomegaly, night sweats) are concerning for lymphoma.”

MCCQE1 Objectives (Pediatrics > 78-3: Hematology/Oncology):

“Candidates should differentiate between benign and malignant lymphadenopathy and recognize features suggestive of lymphoma.”

Cat-scratch disease (B) is usually tender and associated with cat exposure. Kawasaki disease (C) presents with fever and mucocutaneous findings. Acute bacterial lymphadenitis (D) is painful, warm, and rapid in onset. Viral lymphadenopathy (E) is often bilateral, small, and tender.

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The most important factor in determining the surveillance interval in Barrett esophagus is the presence and grade of dysplasia (e.g., none, low-grade, high-grade). High-grade dysplasia requires more frequent monitoring or intervention due to the risk of progression to esophageal adenocarcinoma.

Toronto Notes 2023 – Gastroenterology, Barrett Esophagus:

“Surveillance intervals depend on histologic findings. No dysplasia: q3–5 years; low-grade: q6–12 months; high-grade: consider endoscopic resection or ablation.”

MCCQE1 Objectives – Internal Medicine > Gastroenterology:

“Candidates must identify the risk of progression in Barrett esophagus and apply appropriate surveillance strategies based on dysplasia.”

Length of the segment (A) may influence risk but not surveillance frequency alone. Other options (B, C, E) are less determinative.

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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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Patient education is foundational in managing fibromyalgia. Understanding the chronic but non-progressive nature of the disease, reassurance, and emphasis on self-management are crucial. It helps set realistic expectations and enhances engagement in therapy.

Toronto Notes 2023 – Rheumatology, Fibromyalgia:

“Patient education is essential. Explain the nature of fibromyalgia, emphasizing that although it is chronic, it is non-deforming and can be managed through exercise, sleep hygiene, and cognitive strategies.”

MCCQE1 Objectives – Psychiatry & Rheumatology > Chronic Pain Syndromes:

“Candidates must recognize the value of education and behavioral interventions in managing functional syndromes.”

SSRIs (D) may be used if depression is present. Iron/B12 (B) are not indicated without evidence of deficiency. Cannabinoids (A) lack strong evidence in fibromyalgia.

Comprehensive and Detailed Explanation:

Osgood-Schlatter disease is a traction apophysitis of the tibial tubercle due to repetitive stress from the quadriceps during growth. It is common in active adolescents and presents with a tender, prominent tibial tuberosity and typical radiographic findings.

Toronto Notes 2023 – Pediatrics / MSK:

“Osgood-Schlatter disease presents with localized pain at the tibial tuberosity in adolescents involved in sports. X-ray may show ossicle or fragmentation.”

MCCQE1 Objectives (Pediatrics > 78-2: MSK Injuries and Overuse):

“Candidates must identify overuse syndromes like Osgood-Schlatter and distinguish from infections or malignancy.”

Osteomyelitis (A) is systemic. Osteosarcoma (B) causes deep pain, often at night. Chondromalacia (C) affects anterior knee and worsens with stairs. Patellar tendinitis (D) affects the inferior pole of patella, not tibial tubercle.

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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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