Free Medical Council of Canada MCCQE Practice Exam with Questions & Answers | Set: 3

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.

Stimulants like methylphenidate can increase heart rate and blood pressure. In patients with cardiovascular risk (e.g., hypertension, nephropathy), stimulants should not be increased without first addressing elevated blood pressure.

Toronto Notes 2023 – Psychiatry, “ADHD in Adults”:

“Stimulants can exacerbate hypertension and must be used cautiously. Evaluate cardiovascular risk factors and control blood pressure before dose increases.”

MCCQE1 Objectives (Psychiatry > 71-1: ADHD):

“Candidates must consider the cardiovascular risks of stimulant therapy and monitor for hypertension prior to adjusting doses.”

While poor glycemic control (B) and renal disease (A) are important, BP control is most critical for immediate stimulant safety.

====================================================

Comprehensive and Detailed Explanation:

The patient is in a persistent vegetative state and medically stable, meaning he does not need continued hospitalization. The goal is to provide appropriate long-term care in the least restrictive setting, typically at home with robust home care support services. This approach aligns with ethical care, family-centered goals, and medical appropriateness.

Toronto Notes 2023 – Pediatrics / Neurodevelopment & Chronic Care:

“Home care with appropriate medical and caregiver support is often the best setting for children with severe neurological impairments who are medically stable.”

MCCQE1 Objectives (Pediatrics > 77-5: Chronic Neurological Disorders):

“Candidates must assess discharge planning and coordinate home care support for children with long-term care needs.”

Palliative facility (B) is not appropriate unless end-of-life is imminent. School (C) is not feasible in this state. Hospital readmission for respite (D) is not standard. Rehabilitation (E) has little utility in persistent vegetative state.

—

Given the lack of prenatal care, the mother's withdrawal, and prior involvement of child protection services, a newborn drug screen is warranted to assess for possible in utero exposure. This is part of the safety assessment.

Toronto Notes 2023 – Pediatrics, Newborn Assessment:

“Infants born to mothers with no prenatal care or prior social concerns should undergo a full newborn screening, including toxicology if indicated.”

MCCQE1 Objectives – Pediatrics > Newborn Care and Social Issues:

“Candidates must identify social risk factors and initiate appropriate newborn evaluations, including toxicology screens when substance use is suspected.”

The mother was previously immune to hepatitis B, so (A) is not immediately required. Skin-to-skin care (D) is beneficial but secondary to screening in this context. Donor milk (B) is not indicated unless breastfeeding is contraindicated.

====================================================

Comprehensive and Detailed Explanation:

While borderline personality disorder is challenging, symptoms (particularly impulsivity and suicidal behaviors) often attenuate with age and appropriate therapy (e.g., dialectical behavior therapy). Providing hope and clinical context to staff improves care and reduces stigma.

Toronto Notes 2023 – Psychiatry, “Personality Disorders”:

“BPD is associated with emotional dysregulation and impulsivity. Long-term prognosis is better than once believed, with many patients showing symptom remission over time.”

MCCQE1 Objectives (Psychiatry > 71-4: Personality Disorders):

“Candidates must provide appropriate education to patients and staff regarding prognosis and treatment of BPD.”

Statements A–D are false, stigmatizing, or dangerous.

Nonprescription opioid use during opioid agonist therapy is not uncommon. The response shouldbe supportive and not punitive. Increasing the frequency of follow-up enhances monitoring, supports adherence, and prevents relapse.

Toronto Notes 2023 – Psychiatry, “Substance Use Disorders”:

“Patients who relapse during opioid agonist treatment benefit from closer monitoring and increased support, including more frequent follow-up and psychosocial interventions.”

MCCQE1 Objectives (Psychiatry > 71-5: Substance Use and Addiction):

“Candidates must manage relapses in opioid use by optimizing follow-up and support, not by discontinuing or reducing therapy prematurely.”

Tapering or discontinuing therapy (A, E) risks destabilizing treatment. Removing take-home doses (B) may be warranted later but not first. Cannabinoids (D) are not first-line adjuncts.

====================================================

Wernicke encephalopathy is a medical emergency caused by thiamine (vitamin B1) deficiency, most often seen in chronic alcohol use. The classic triad is:

Confusion

Oculomotor dysfunction (e.g., nystagmus, cranial nerve palsies)

Ataxia

Toronto Notes 2023 – Neurology and Psychiatry, “Wernicke Encephalopathy” Section:

“Wernicke encephalopathy is diagnosed clinically. Symptoms include ophthalmoplegia (e.g., CN VI palsy), horizontal nystagmus, ataxia, and confusion. Immediate parenteral thiamine is indicated before glucose administration.”

MCCQE1 Objectives (Neurology > 75-1: Neurologic Emergencies):

“Candidates must recognize Wernicke encephalopathy in at-risk individuals and initiate urgent thiamine replacement.”

Other choices like cerebellar degeneration (A) and hepatic encephalopathy (D) are more chronic and lack the characteristic eye findings. Subdural hematoma (B) and hemorrhage (E) may mimic confusion but are less likely with these neurologic signs and history.

====================================================

For pregnant patients with opioid use disorder, opioid agonist therapy with methadone or buprenorphine is the standard of care. Detoxification is not recommended in pregnancy due to increased risk of fetal distress, preterm labor, and relapse. Methadone reduces illicit opioid use and stabilizes both mother and fetus.

Toronto Notes 2023 – Addiction Medicine / Obstetrics:

“Methadone maintenance therapy is the treatment of choice for pregnant patients with opioid use disorder. Detoxification is not advised during pregnancy due to relapse risk and potential harm to the fetus.”

MCCQE1 Objectives (Obstetrics > 80-3: Substance Use in Pregnancy):

“Candidates must manage opioid use disorder in pregnancy with evidence-based therapies, including referral for methadone or buprenorphine.”

Counselling alone (D) is insufficient as first-line therapy. Home detox (C) is unsafe. Inpatient detox (A) is not recommended in pregnancy.

====================================================

The first step in any MAID request is to explore the patient's motivations, psychosocial concerns, and mental health status. The request should be taken seriously and approached with compassion. Exploring the reasons is essential to determine eligibility and to distinguish suffering from other potentially treatable issues (e.g., depression, loss of hope).

Toronto Notes 2023 – ELOM, "Medical Assistance in Dying":

“Upon receiving a request for MAID, the physician must first explore the patient’s motivations, ensure understanding of their condition, and assess for coercion, depression, or other treatable factors.”

MCCQE1 Objectives (ELOM > Ethical Dilemmas > End-of-Life Care):

“Candidates must demonstrate understanding of the ethical and legal framework surrounding MAID and respond appropriately to requests by exploring reasons and providing necessary support and referrals.”

MAID is available to mature minors in some jurisdictions but not uniformly. Assuming the patient is ineligible or redirecting to other treatments without discussion is inappropriate.

====================================================

When elder neglect is suspected—especially in cases of self-neglect or unclear caregiver dynamics—the most important immediate step is to assess the patient’s decision-making capacity. If she lacks capacity, protective intervention is warranted.

Toronto Notes 2023 – Geriatrics, “Elder Abuse and Capacity Assessment”:

“Decision-making capacity must be assessed when a patient is refusing care despite evidence of harm or risk.”

MCCQE1 Objectives (ELOM > 90-1: Capacity and Consent):

“Candidates must assess capacity in elderly patients before attributing decisions to autonomy, particularly in complex care situations.”

Evaluating criminal records (B) or clutter (C) may be relevant later but do not take precedence over capacity assessment. Alcohol/substance use (D) and financial abuse (E) are differential concerns, not the critical first step.