Free Medical Council of Canada MCCQE Practice Exam with Questions & Answers | Set: 10

In adolescents presenting with vague or potentially sensitive symptoms, it is critical to speak with them alone to obtain a complete and honest history, including mental health, sexual activity, substance use, and abuse screening.

Toronto Notes 2023 – Pediatrics, Adolescent Medicine:

“Private interviews are essential to obtain accurate histories in adolescents, especially when symptoms may have underlying psychosocial or reproductive causes.”

MCCQE1 Objectives – Pediatrics > Adolescent Health:

“Candidates must demonstrate adolescent-appropriate interviewing techniques, including private questioning to identify sensitive or risk-related concerns.”

Physical examination and pregnancy testing (A, B, D) may follow based on the private history. Vital signs (E) are standard but do not replace psychosocial assessment.

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Physicians should order investigations only when clinically indicated based on their own assessment and an evidence-based differential diagnosis, not solely at the request of a non-physician practitioner. The appropriate next step is to decline to order the requested tests as written and perform (or arrange) a proper evaluation of the patient’s chronic back pain, including red-flag screening, functional impact, and prior work-up/treatments. This aligns with MCCQE objectives on stewardship of health resources and professional accountability: unnecessary testing can cause harm (false positives, downstream procedures) and misuses publicly funded services. Sending results to a reflexologist as “other doctor” is also inappropriate without confirming the person’s role, ensuring relevance to care, and obtaining appropriate patient consent for disclosure; even with consent, the physician should not facilitate non-indicated testing. Reporting (A/B) or directing the patient to stop (E) is premature; the initial focus should be patient-centred care, education about evidence-based options, and collaborative planning while respecting patient autonomy and addressing potential safety concerns.

Dog bites from animals of unknown rabies status, especially from endemic regions and in patients with uncertain immunization status, require immediate post-exposure prophylaxis (PEP) including both rabies immunoglobulin and vaccine. The decision is urgent given the fatal nature of rabies.

Toronto Notes 2023 – Infectious Diseases, “Rabies Exposure”:

“Rabies PEP is indicated for bites from animals with unknown vaccination status or those showing abnormal behavior, particularly in endemic regions. PEP includes both vaccine and immunoglobulin.”

MCCQE1 Objectives (Public Health > 64-1: Rabies and Animal Bites):

“Candidates must recognize indications for rabies post-exposure prophylaxis.”

Ciprofloxacin (C) is not the antibiotic of choice (amoxicillin-clavulanate is preferred). Hydrogen peroxide (E) can be cytotoxic. Debridement (B) and CK (D) are not immediate priorities here.

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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 presentation is classic for an undiagnosed pheochromocytoma, which causes episodic or crisis-level hypertension due to excess catecholamines. Anesthesia or surgical manipulation can trigger massive catecholamine release, leading to hypertensive crisis. Phentolamine, an alpha-blocker, is the appropriate treatment.

Toronto Notes 2023 – Endocrinology, Pheochromocytoma:

“Pheochromocytomas may precipitate hypertensive crises during surgery. Elevated plasma catecholamines and urinary metanephrines confirm diagnosis.”

MCCQE1 Objectives – Internal Medicine > Endocrinology:

“Candidates should suspect pheochromocytoma in perioperative hypertensive crises and confirm with plasma or urine catecholamines/metanephrines.”

Low metanephrines (E) would argue against pheochromocytoma. TSH (A), cortisol (D), and renin (C) are unrelated to acute intraoperative hypertensive episodes of this nature.

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This patient’s symptoms are consistent with panic disorder with agoraphobia , characterized by recurrent panic attacks and avoidance of places where escape may be difficult. She has avoided leaving her home for 6 months due to fear of panic symptoms (palpitations, tremors, sweating, dyspnea, choking sensation), which is classic for agoraphobia.

MCCQE objectives emphasize that first-line management includes cognitive behavioral therapy (CBT) with graded exposure therapy , which involves gradual, systematic exposure to feared situations (e.g., short walks progressing to longer distances). Encouraging incremental exposure directly addresses avoidance behavior and reduces anxiety over time.

Lithium is used for bipolar disorder, not panic disorder. Chlorpromazine (an antipsychotic) is not first-line and carries unnecessary side effects. Reassurance alone is insufficient because panic disorder significantly impairs functioning. Hospitalization is not indicated unless there is suicidality or inability to care for oneself.

Therefore, gradual exposure through increasing walks is the most appropriate next step, consistent with evidence-based management of panic disorder with agoraphobia.

This is a known patient with intellectual disability and behavioral concerns. The presentation of alcohol intoxication in a calm patient who inadvertently broke bottles warrants prompt, nonjudgmental clinical assessment before escalating. De-escalation and safety assessment come first.

Toronto Notes 2023 – Psychiatry, " Psychiatric Emergencies and Crisis Management " :

“In agitated or intoxicated individuals with developmental disability, a calm approach and prompt physician assessment are essential to prevent escalation and assess for medical or psychiatric needs.”

MCCQE1 Objectives (Psychiatry > Crisis and Acute Presentations > 72-2):

“Candidates must assess potentially disruptive patients with dignity and caution before involving law enforcement or security. Physician engagement is often calming.”

Police intervention (A) is premature and may escalate matters. Ignoring (B) risks safety. Asking him to leave (C) without assessment is inappropriate. Social work (E) may help, but after medical triage.

This patient has classic acute pericarditis : pleuritic chest pain relieved by sitting forward, a pericardial friction rub, diffuse ST-segment elevation with PR depression on ECG, and a small pericardial effusion on echocardiogram. MCCQE objectives emphasize recognizing the characteristic clinical and ECG features that distinguish pericarditis from myocardial infarction (diffuse ST elevation rather than territorial changes).

First-line treatment for uncomplicated acute pericarditis is high-dose nonsteroidal anti-inflammatory therapy , such as acetylsalicylic acid (ASA) or ibuprofen, often combined with colchicine to reduce recurrence risk. ASA is particularly appropriate when ischemia is in the differential diagnosis.

Apixaban (anticoagulation) is not indicated and may worsen effusion. Pericardiocentesis is reserved for large effusions or cardiac tamponade. Levofloxacin is unnecessary without evidence of bacterial infection. Beta-blockers such as metoprolol do not treat pericardial inflammation.

Thus, high-dose acetylsalicylic acid is the most appropriate initial management for uncomplicated acute pericarditis.

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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Respecting patient autonomy requires understanding their perspective before offering persuasion or incentives. The best next step is to explore the reason for non-compliance. This builds rapport and informs a shared decision-making process.

Toronto Notes 2023 – ELOM, Patient-Centered Communication:

“When a patient refuses recommended treatment, explore the reason behind the refusal before proceeding. Shared decision-making is crucial.”

MCCQE1 Objectives – ELOM > Communication and Consent:

“Candidates must demonstrate an ability to explore reasons for treatment refusal before counseling or modifying management.”

Options B and C may follow later. Options D and E can undermine appropriate pharmacologic care or violate ethics if not consented.

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