Free Medical Council of Canada MCCQE Practice Exam with Questions & Answers | Set: 2

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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Recruiting participants from an autism seminar introduces selection bias. This non-random selection increases the likelihood of overestimating associations due to pre-existing beliefs or exposures in that subgroup.

Toronto Notes 2023 – Epidemiology:

“Selection bias occurs when participants are not representative of the general population, as in recruitment from disease-specific support groups.”

MCCQE1 Objectives (Population Health > 65-2: Study Design and Appraisal):

“Candidates must recognize sources of bias in epidemiologic studies, including selection bias due to non-representative recruitment.”

Recall bias (D) is more of a concern in retrospective studies. Sponsorship (B) may create perception bias but is not a flaw in methodology itself. Standard error reporting (A) is normal. Not accounting for confounders (E) matters but recruitment source is more directly biasing.

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Comprehensive and Detailed Explanation:

Rapid progression of pain out of proportion to exam, systemic symptoms (anxiety), and skinchanges without major swelling are classic for necrotizing fasciitis—a surgical emergency. Discoloration and extreme tenderness should raise immediate concern.

Toronto Notes 2023 – Emergency Medicine / Surgery:

“Necrotizing fasciitis presents with severe pain, systemic toxicity, rapid progression, and early skin changes (discoloration). Pain out of proportion is a key clue.”

MCCQE1 Objectives (Emergency Medicine > 51-1: Soft Tissue Infections):

“Candidates must recognize necrotizing fasciitis and initiate urgent surgical consultation.”

Plantaris rupture (A) is benign and localized. DVT (B) is more gradual and often with swelling. Cellulitis (C) progresses more slowly and is less painful. Baker’s cyst (D) causes posterior knee pain, not severe systemic illness.

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The symptoms described — haloes at night, monocular diplopia, and improved near vision (second sight) — are classic signs of nuclear sclerosis-type cataracts. On exam, the most consistent finding would be an altered red reflex due to lens opacification.

Toronto Notes 2023 – Ophthalmology, Cataracts:

“Cataracts can cause glare, monocular diplopia, and improved near vision. A diminished or irregular red reflex is commonly seen on direct ophthalmoscopy.”

MCCQE1 Objectives – Internal Medicine > Ophthalmologic Disorders:

“The candidate must recognize symptoms and physical findings of cataracts, including changes in red reflex and visual acuity.”

Options A and B are associated with lipid deposition and Wilson’s disease, respectively. Retinal exudates (D) suggest diabetic or hypertensive retinopathy. Increased intraocular pressure (E) suggests glaucoma but is not supported by this clinical picture.

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This patient presents with panic-like somatic symptoms triggered by bereavement. Normal investigations rule out cardiac pathology. Grief therapy is appropriate as the underlying stressor is unresolved grief and anxiety.

Toronto Notes 2023 – Psychiatry, Grief and Anxiety Disorders:

“Bereavement-related anxiety and somatization are common. Grief counseling can help reduce somatic and psychological symptoms when medical causes are ruled out.”

MCCQE1 Objectives – Psychiatry > Anxiety and Bereavement:

“Candidates should recognize psychological sequelae of grief, including panic and health anxiety, and provide appropriate psychological support.”

Metoprolol (C) is not indicated without confirmed cardiac cause. Lorazepam (B) may offer short-term relief but does not address the underlying grief. Stress testing (A) is unnecessary with repeated normal investigations.

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This case features hallmark traits of antisocial personality disorder: disregard for social norms, criminal behavior, lack of remorse, impulsivity, and a history of conduct disorder (suggested by childhood ADHD and likely early behavioral problems).

Toronto Notes 2023 – Psychiatry, Personality Disorders:

“Antisocial personality disorder is characterized by disregard for rights of others, impulsivity, deceitfulness, lack of remorse, and criminal activity beginning in adolescence.”

MCCQE1 Objectives – Psychiatry > Personality Disorders:

“Candidates must distinguish antisocial personality disorder by a pattern of behavior that violates the rights of others, with evidence of conduct disorder before age 15.”

Other options do not explain the full behavioral pattern, especially the criminality and lack of remorse.

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Children with a first-degree relative who has premature coronary artery disease or hypercholesterolemia should undergo fasting lipid screening between ages 2–10. Since the child is 10, screening is indicated.

Toronto Notes 2023 – Pediatrics, “Preventive Care in Children”:

“Lipid screening is recommended for children ≥2 years old with a family history of early cardiovascular disease or hypercholesterolemia.”

MCCQE1 Objectives (Pediatrics > 78-1: Preventive Medicine):

“Candidates must screen children at high risk of cardiovascular disease appropriately, including lipid profile for familial hyperlipidemia.”

Diet and exercise counseling may follow screening, but testing is the first step. Reassurance alone (C) is inappropriate. Homocysteine (E) and HbA1c are not first-line tests in this setting.

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When a competent patient declines dialysis, the next step is to support shared decision-making and explore options that align with their lifestyle. Peritoneal dialysis may allow more flexibility and autonomy compared to hemodialysis, making it more acceptable to patients with demanding schedules.

Toronto Notes 2023 – Nephrology, Chronic Kidney Disease Section:

“Peritoneal dialysis offers the advantage of home-based treatment and flexible scheduling. Patient education and peer support can improve acceptance and adherence to dialysis initiation.”

MCCQE1 Objectives – Internal Medicine > Nephrology:

“The candidate should explore treatment alternatives collaboratively, emphasizing patient autonomy, while addressing misconceptions and lifestyle concerns related to dialysis.”

Simply warning the patient or withdrawing engagement (Options B and C) may undermine rapport. Access to medical records (D) is a right, but does not actively address treatment planning. Exploring new employment (E) is inappropriate at this stage.

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This constellation of features—hypotonia, macroglossia, brachycephaly, single palmar crease, short broad hands with clinodactyly—is classic for Down syndrome (Trisomy 21).

Toronto Notes 2023 – Pediatrics, “Genetic Syndromes”:

“Trisomy 21 features include hypotonia, upslanting palpebral fissures, epicanthic folds, flat nasal bridge, brachycephaly, macroglossia, single palmar crease, and clinodactyly.”

MCCQE1 Objectives (Pediatrics > 78-3: Congenital and Genetic Disorders):

“Candidates must recognize key dysmorphic features associated with common genetic syndromes including Trisomy 21.”

Prader-Willi and congenital hypothyroidism may have hypotonia but lack the full phenotypic pattern. Turner syndrome is seen in females with short stature and webbed neck. Fetal alcohol syndrome presents with smooth philtrum and microcephaly.

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In a euthyroid patient with an asymptomatic goiter or thyroid enlargement, the next step is a thyroid ultrasound to evaluate nodule size, composition, and features suggestive of malignancy.

Toronto Notes 2023 – Endocrinology, Thyroid Nodules and Goiter:

“TSH should be obtained first. If normal and there is a palpable mass or enlargement, ultrasound is indicated to evaluate for nodules and guide further testing (e.g., FNA).”

MCCQE1 Objectives – Internal Medicine > Endocrinology:

“Candidates must use thyroid ultrasound as the initial imaging study in the evaluation of thyroid enlargement or palpable nodules.”

T3/T4 (A) are not needed with normal TSH. FNA (D) is done if nodules are identified. CT (C) is used for retrosternal goiters or compressive symptoms. Calcium (E) is irrelevant here.

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