Free Medical Council of Canada MCCQE Practice Exam with Questions & Answers | Set: 5

Comprehensive and Detailed Explanation:

Bronchiectasis is characterized by recurrent localized pneumonia, chronic productive cough, and hemoptysis. A linear infiltrate that persists in the same area suggests localized airway damage—typical of bronchiectasis.

Toronto Notes 2023 – Respirology:

“Bronchiectasis presents with recurrent infections in the same location, productive cough, and hemoptysis. Chest X-ray may show linear opacities; high-resolution CT is diagnostic.”

MCCQE1 Objectives (Respiratory > 45-1: Chronic Respiratory Symptoms):

“Candidates must investigate recurrent pneumonias and consider bronchiectasis, especially if localized.”

Chronic bronchitis (A) presents bilaterally. Mitral stenosis (B) may cause hemoptysis but not localized infiltrates. TB (E) usually affects upper lobes. Infarction (C) is acute and not recurrent.

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For women aged 25–69 years who have had adequate negative screening, the recommendation is to repeat cervical cytology (Pap test) every 3 years, regardless of family history. Cervical cancer is caused primarily by HPV infection, not hereditary genetics. Family history does not alter the screening interval.

Toronto Notes 2023 – Gynecology, Cervical Cancer Screening Section:

“Routine screening with Pap test is recommended every 3 years in women aged 25–69 who have had three consecutive negative tests. Family history of cervical cancer does not modify the screening interval.”

MCCQE1 Objectives – Obstetrics and Gynecology > Cancer Screening:

“Candidates must apply population-based cervical cancer screening guidelines. Family history is not a risk modifier for screening frequency in cervical cancer.”

Options A and B are inappropriate as they increase screening frequency without indication. HPV testing (D) or colposcopy (E) are not recommended without abnormal cytology.

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Physicians in Canada who have conscientious objections to procedures such as abortion are legally and ethically required to make an effective referral to another provider or service that can offer the treatment. The provider must not delay access to care.

Toronto Notes 2023 – ELOM, “Conscientious Objection”:

“A physician who objects to providing a service for reasons of conscience must make an effective referral to another provider or agency.”

MCCQE1 Objectives (ELOM > Professionalism > 90-1):

“Candidates must recognize the obligation to refer patients for services they themselves will not provide due to personal or religious beliefs.”

Delaying care (C), imposing personal beliefs (A), or suggesting alternatives like adoption (D) is inappropriate and may violate patient autonomy.

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The patient demonstrates signs of asymmetric sensorineural hearing loss (SNHL). In Weber test, sound localizes to the better ear in SNHL. Air conduction > bone conduction on Rinne test bilaterally supports SNHL. Audiometry is the best next diagnostic step to quantify and characterize the hearing loss.

Toronto Notes 2023 – ENT, "Hearing Loss":

“Audiometry is the first-line investigation to distinguish conductive from sensorineural hearing loss and to assess severity and frequency involvement.”

MCCQE1 Objectives (Medicine > ENT > 20-1):

“Candidates must know the approach to hearing loss and interpret Weber and Rinne tests to guide investigations such as audiometry.”

Imaging (A, C) is reserved for red flags such as unilateral persistent SNHL, which may later prompt MRI to rule out acoustic neuroma. Wax removal (D) is for conductive loss. Hearing aids (E) are management, not diagnostic, and come after audiologic evaluation.

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TENS has been shown to be effective for managing primary dysmenorrhea when pharmacological options are contraindicated or refused. It works by interfering with pain signal transmission and increasing endorphin levels.

Toronto Notes 2023 – Gynecology, Dysmenorrhea:

“High-frequency TENS is effective in managing primary dysmenorrhea and can be considered when NSAIDs or hormonal therapies are not acceptable to the patient.”

MCCQE1 Objectives – Gynecology > Menstrual Disorders:

“Candidates must be aware of non-pharmacological interventions for dysmenorrhea, including TENS and heat therapy.”

Options D and E involve hormonal or surgical intervention. Spinal manipulation and massage (B and C) lack consistent evidence for dysmenorrhea relief.

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This patient has signs suggestive of decompensated liver cirrhosis (ascites, peripheral edema, low-normal BP, alcohol use, abdominal distension). Sodium restriction is the cornerstone of first-line management to prevent fluid retention in cirrhotic ascites.

Toronto Notes 2023 – Gastroenterology, “Cirrhosis and Ascites” Section:

“Sodium restriction (<2 g/day) is the most important non-pharmacologic management for ascites. Fluid restriction is added only in cases of severe hyponatremia.”

MCCQE1 Objectives (Internal Medicine > 76-5: Liver Disease):

“Candidates must manage ascites conservatively using sodium restriction, with diuretics added as needed.”

Lactulose (E) is used for hepatic encephalopathy, not ascites. Ramipril (B) may worsen renal function in cirrhosis. Nadolol (C) is used for variceal bleeding prophylaxis. Compression stockings (D) are not helpful in ascites-related edema.

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This patient has classic features of exertional heat stroke—hyperthermia, hypotension, CNS symptoms (collapse), and hot, dry skin. A key complication of heat stroke is rhabdomyolysis, which can cause renal failure. Serum creatine kinase (CK) is the best next diagnostic step to confirm muscle breakdown.

Toronto Notes 2023 – Emergency Medicine, “Environmental Exposures”:

“In heat stroke, check for rhabdomyolysis (↑CK), renal impairment, and coagulopathy. Prompt cooling and hydration are critical.”

MCCQE1 Objectives (Internal Medicine > 59-3: Environmental and Toxic Exposures):

“Candidates must recognize heat-related illnesses and investigate for complications such as rhabdomyolysis and acute kidney injury.”

CT head (C) is not indicated unless persistent neurological symptoms. TSH (B), CRP (D), and blood cultures (E) are irrelevant to acute exertional hyperthermia.

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The presentation is consistent with cervical spondylosis — a degenerative condition. In the absence of neurologic findings, further imaging beyond plain radiography is not warranted. Management includes conservative measures such as physiotherapy and analgesia.

Toronto Notes 2023 – Rheumatology, Cervical Spondylosis:

“Patients with typical cervical spondylosis and no red flags (e.g., neurologic deficits) do not require MRI. Treatment is conservative. Radiographs showing disc space narrowing and osteophytes confirm diagnosis.”

MCCQE1 Objectives – Internal Medicine > Musculoskeletal Disorders:

“Candidates must recognize typical degenerative spine disorders and avoid unnecessary investigations when clinical findings are straightforward.”

MRI (B) is useful if myelopathy or radiculopathy is suspected. CT (A), EMG (C), and LP (D) are not indicated here.

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A tender, mobile lymph node following a recent localized infection (e.g., dental infection) is most likely reactive. In a young, otherwise well patient with no systemic symptoms or concerning features, observation is appropriate.

Toronto Notes 2023 – Internal Medicine, Lymphadenopathy:

“In patients with localized lymphadenopathy and a recent infection, observation for 4–8 weeks is often appropriate before further investigation.”

MCCQE1 Objectives – Internal Medicine > Hematology:

“Candidates should recognize benign features of lymphadenopathy (tender, mobile, <2 cm, localized) and manage conservatively unless red flags are present.”

Biopsy (B) and imaging (C, E) are premature. Bone marrow biopsy (D) is not relevant.

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In a non-lactating woman with a partially responsive breast mass after antibiotics, inflammatory breast cancer must be ruled out. A breast biopsy (core or excisional) is indicated to assess for malignancy. Inflammatory breast cancer may mimic mastitis but does not improve with antibiotics.

Toronto Notes 2023 – Breast Disorders:

“In non-lactating women, persistent breast inflammation should raise suspicion for inflammatory breast cancer. If symptoms persist after antibiotic therapy, proceed with imaging and biopsy.”

MCCQE1 Objectives – Gynecology > Breast Disease:

“Candidates must differentiate between mastitis and inflammatory breast cancer and initiate appropriate investigations such as biopsy when response to antibiotics is incomplete.”

Options A, D, and E may be appropriate for a confirmed abscess or infectious cause, but further investigation is mandatory in this scenario. NSAIDs (C) are symptomatic but do not address the diagnostic concern.

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