Free Medical Council of Canada MCCQE Practice Exam with Questions & Answers | Set: 6

Comprehensive and Detailed Explanation:

Decreased libido in elderly patients can be multifactorial, but depression is a common and important cause that must be ruled out before hormone therapy or other steps. A proper mental health screen should precede further interventions.

Toronto Notes 2023 – Psychiatry / Geriatrics:

“In elderly men, reduced libido may be linked to depression, medical illness, or medications. Depression screening is essential.”

MCCQE1 Objectives (Psychiatry > 71-1: Mood Disorders / Sexual Health):

“Candidates must consider depression as a common cause of decreased libido and assess accordingly before initiating hormone therapy.”

Testosterone testing (D) may follow. Prescribing (C) is premature. Couples counselling (B) may help if interpersonal issues are identified. Interviewing together (A) may inhibit disclosure.

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This presentation is classic for neuroleptic malignant syndrome (NMS), a rare but life-threatening reaction to antipsychotic drugs (particularly dopamine antagonists like risperidone). Features include hyperthermia, rigidity, altered mental status, and autonomic instability.

Toronto Notes 2023 – Psychiatry, “Neuroleptic Malignant Syndrome”:

“NMS is associated with antipsychotic use. Key features: hyperthermia, lead-pipe rigidity, altered consciousness, autonomic dysfunction. Elevated CK, leukocytosis often present.”

MCCQE1 Objectives (Psychiatry > 71-5: Adverse Effects of Psychotropics):

“Candidates must recognize and manage neuroleptic malignant syndrome and differentiate it from other drug toxicities.”

Amitriptyline (B) overdose causes anticholinergic symptoms. Lamotrigine (A) causes rash or seizures in toxicity. Lithium (D) leads to tremor, ataxia, and GI upset. Lorazepam (E) causes CNS depression, not rigidity or fever.

Comprehensive and Detailed Explanation:

A localized mass with tenderness at a recent surgical site, intact skin, low-grade temperature, and normal white count is most consistent with a wound hematoma. This is a common complication at saphenous vein graft harvest sites post-CABG.

Toronto Notes 2023 – Surgery / Cardiac:

“Wound hematoma presents as localized swelling and tenderness near recent surgical sites. Abscess is suggested by erythema, warmth, and systemic signs.”

MCCQE1 Objectives (Surgery > 50-2: Postoperative Complications):

“Candidates must identify and differentiate wound complications, including hematoma, seroma, and abscess.”

Abscess (E) would show redness, fluctuance, and fever. Aneurysm (B) is rare and pulsatile. Bleeding (A) would not form a stable mass 2 weeks post-op. Thrombophlebitis (C) usually involves superficial veins and erythema.

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This infant has evidence of urinary outflow obstruction on ultrasound. The most common cause in male infants is posterior urethral valves. Poor urinary stream is a hallmark symptom of bladder outlet obstruction in neonates.

Toronto Notes 2023 – Pediatrics, “Pediatric Urology” Section:

“Posterior urethral valves should be suspected in male infants with recurrent UTIs, hydronephrosis, and a weak urinary stream. Diagnosis is confirmed by voiding cystourethrogram.”

MCCQE1 Objectives (Pediatrics > 78-4: Urinary Tract Abnormalities):

“Candidates must identify congenital causes of urinary obstruction. Poor stream and hydronephrosis are classic features of posterior urethral valves.”

Crying with urination (E) is nonspecific. Hematuria (B) and malodorous urine (D) are common with infections. Circumcision (A) is unrelated.

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The image shows an asymmetrical light reflex (corneal light reflex not centered in both eyes), which is diagnostic of strabismus. This misalignment of the eyes must be treated early to prevent amblyopia (lazy eye).

Toronto Notes 2023 – Pediatrics, Ophthalmology:

“Strabismus presents with misaligned visual axes. The Hirschberg light reflex is off-center in the affected eye. Prompt referral is necessary to prevent amblyopia.”

MCCQE1 Objectives – Pediatrics > Vision and Developmental Disorders:

“Candidates must recognize strabismus on visual screening and refer early for correction to prevent permanent vision impairment.”

Pseudostrabismus (B) can be ruled out here because the light reflex is not symmetric. Ptosis (A) involves drooping of the eyelid, which is not evident. Cataracts (D) would typically present with a leukocoria (white reflex), not misalignment.

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The most appropriate and professional response is to focus on the current clinical situation and reassure the family that you will take responsibility for assessment and treatment. Criticizing a colleague (A, B, E) or deflecting to generalities (D) is unprofessional and unhelpful in crisis management.

Toronto Notes 2023 – Psychiatry, Physician-Patient-Family Communication:

“In emotionally charged or crisis situations, the physician must remain focused, empathetic, and professional. Avoid blaming colleagues; instead, offer a concrete plan of care.”

MCCQE1 Objectives – Psychiatry > Ethics and Professionalism:

“Candidates must demonstrate professionalism in managing conflicts, focusing on patient care while maintaining collegial respect.”

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Postoperative fever on day 1–2 is commonly caused by atelectasis, particularly in patients who are immobile. It is considered a self-limited cause of early fever after surgery and often resolves with mobilization and pulmonary exercises.

Toronto Notes 2023 – Surgery, Postoperative Complications:

“The ‘5 W’s’ of postoperative fever: Wind (atelectasis), Water (UTI), Wound (infection), Walking (DVT), and Wonder drugs. Atelectasis typically occurs in the first 48 hours and is due to hypoventilation or pain-limited breathing.”

MCCQE1 Objectives – Surgery > Postoperative Management:

“Candidates must recognize timing-specific causes of postoperative fever. Atelectasis is the most likely cause within the first 48 hours.”

PE (B) can cause fever but is less likely without respiratory compromise. Wound infection (C) and bowel trauma (D) typically present later or with more specific symptoms. Septic pelvic thrombophlebitis (A) usually presents later and with more systemic signs.

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Valproic acid is well known to cause thrombocytopenia, especially at higher serum concentrations or in patients over 60. Bruising with platelet count <100 × 10⁹/L is a classic manifestation.

Toronto Notes 2023 – Psychiatry, Mood Disorders & Pharmacology Section:

“Valproic acid is associated with hematologic side effects including thrombocytopenia. Platelet counts should be monitored regularly.”

MCCQE1 Objectives – Psychiatry > Pharmacotherapy:

“The candidate must recognize adverse effects of mood stabilizers including hematologic complications of valproic acid.”

Other listed medications (A–D) have no common or direct link with thrombocytopenia in this context.

Comprehensive and Detailed Explanation:

In X-linked recessive disorders such as hemophilia A, carrier mothers (usually asymptomatic) have a 50% chance of passing the affected X chromosome to each son, who would then express the disease. Each daughter has a 50% chance of being a carrier but is generally not affected.

Toronto Notes 2023 – Genetics:

“X-linked recessive inheritance: Carrier mother has a 50% chance of having an affected son and a 50% chance of having a carrier daughter.”

MCCQE1 Objectives (Genetics > 61-1: Inheritance Patterns):

“Candidates must apply principles of X-linked inheritance to assess risk in offspring.”

If the mother is a known carrier (as inferred from having an affected son), the chance of a second affected boy is 50%.

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Comprehensive and Detailed Explanation:

Providing clinical advice (particularly treatment advice) without formally seeing or evaluating the patient creates a physician-patient relationship, potentially establishing a duty of care. If the advice leads to harm, you could be found liable, even if you never saw the patient directly.

Toronto Notes 2023 – Legal Medicine:

“Giving specific medical advice about diagnosis or treatment may imply a physician-patient relationship and establish duty of care.”

MCCQE1 Objectives (ELOM > 90-2: Legal Risk Management):

“Candidates must understand that liability can arise from informal consultations where medical advice is given.”

Providing advice (D) is riskier than simply hearing about a case or patient (A, C). Recommending consultation (B) does not establish duty of care. Not seeing the patient (E) does not automatically shield from liability if treatment advice was given.

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