Free Medical Council of Canada MCCQE Practice Exam with Questions & Answers | Set: 7

Comprehensive and Detailed Explanation:

This patient has end-stage heart failure with frequent hospitalizations, progressive symptoms, and functional decline. The most appropriate next step is to initiate a goals-of-care conversation, including acknowledgment of the prognosis.

Toronto Notes 2023 – Cardiology / Palliative Care:

“In advanced heart failure with recurrent admissions and functional decline, a goals-of-care discussion should be initiated to align treatment with patient values.”

MCCQE1 Objectives (Cardiology > 34-4 / ELOM > 90-2):

“Candidates must recognize end-stage illness and provide appropriate communication and palliative care planning.”

Deactivating the defibrillator (B) may be appropriate later but should follow a goals-of-care conversation. Reassuring (C) ignores the true clinical trajectory.

Comprehensive and Detailed Explanation:

Physicians must avoid conflicts of interest and maintain professional boundaries with patients and their families. Accepting a personal financial gift, regardless of intent, is inappropriate and unethical.

Toronto Notes 2023 – Ethics and Professionalism:

“Personal gifts of significant value from patients or families should be declined to avoid real or perceived conflicts of interest.”

MCCQE1 Objectives (ELOM > 90-3: Professionalism and Boundaries):

“Candidates must maintain ethical boundaries and refuse financial incentives that could compromise or appear to compromise clinical judgment.”

Other options (A, B, E) still involve a conflict. D is helpful, but the ethical obligation is to decline the cheque directly.

—

Comprehensive and Detailed Explanation:

Lithium commonly causes hypothyroidism, which can lead to fatigue, cognitive slowing, weight gain, and memory impairment. Thyroid-stimulating hormone (TSH) levels are often elevated in such cases.

Toronto Notes 2023 – Psychiatry / Endocrinology:

“Lithium is associated with hypothyroidism and renal impairment. Monitor TSH regularly in patients on lithium therapy.”

MCCQE1 Objectives (Psychiatry > 71-5: Mood Stabilizers):

“Candidates must recognize the endocrine side effects of lithium, including hypothyroidism and the importance of TSH monitoring.”

Creatinine clearance (C) may also be affected but is less directly associated with memory issues. Liver function (A), sodium (D), and PTH (E) are not typically the first abnormal values in this presentation.

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

A varicocele is a dilatation of the pampiniform plexus that presents with a “bag of worms” appearance, worsens with standing, and improves when lying down. It is most common on the left side due to anatomical drainage differences.

Toronto Notes 2023 – Urology, Scrotal Disorders:

“Varicoceles often present with a dull, aching pain and scrotal swelling that worsens when upright and disappears when supine.”

MCCQE1 Objectives – Internal Medicine > Urology:

“Candidates must recognize and diagnose varicocele by physical exam findings and typical symptom history.”

Cryptorchidism (A) refers to undescended testes. Torsion (B) presents acutely with severe pain. Hydrocele (C) transilluminates and is not posture-dependent. "Spermatocyte" (D) is not a clinical diagnosis.

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

A confounder is a variable associated with both the exposure and the outcome but not in the causal pathway. In this study, coffee drinking is associated with smoking (the actual risk factor for lung cancer), but not independently associated with lung cancer.

Toronto Notes 2023 – Epidemiology Chapter:

“A confounder is a third variable that distorts the observed association between an exposure and an outcome. It must be associated with both the exposure and the outcome, but not a result of the exposure.”

MCCQE1 Objectives (Population Health > 97-3: Study Design and Bias):

“Recognize and control for confounding in the interpretation of observational study data.”

Coffee is not a risk factor (B) since it’s not independently associated with lung cancer, and it's not selection bias (C), which involves how participants are enrolled in a study.

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

This presentation suggests hereditary hemochromatosis. Common features include hyperpigmentation ("bronze diabetes"), hepatomegaly, diabetes, fatigue, and elevated liver enzymes. Serum ferritin is a screening test for iron overload, and elevated levels support the diagnosis.

Toronto Notes 2023 – Endocrinology / Gastroenterology:

“Hemochromatosis presents with skin hyperpigmentation, hepatomegaly, diabetes, fatigue. Diagnosis begins with serum ferritin and transferrin saturation.”

MCCQE1 Objectives (Internal Medicine > Metabolic and Endocrine > 37-1):

“Candidates must investigate iron overload syndromes using ferritin and transferrin saturation.”

Cortisol (B) is for adrenal insufficiency. A1AT (C) is a liver disease cause but not typical here. Amylase (E) is for pancreatitis. A1c (A) would confirm diabetes but not the underlying cause.

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

Patients with developmental disabilities must still be engaged directly unless clearly incapable. It is vital to first establish the companion’s relationship to the patient and give the patient the opportunity to communicate.

Toronto Notes 2023 – ELOM, Consent and Capacity:

“Presume capacity in adults with developmental disabilities unless proven otherwise. Direct communication with the patient is essential, and the identity of accompanying individuals should be clarified.”

MCCQE1 Objectives – ELOM > Patient Autonomy and Consent:

“Candidates must respect patient autonomy and include developmentally delayed individuals in medical discussions unless incapacity is determined.”

Options A and C delay establishing capacity and relationship. Option D is premature. Option E bypasses consent and interaction with the patient.

It is essential to balance medical guidelines with trauma-informed, patient-centered care. This includes offering future discussion while respecting boundaries. Acknowledging distress and offering to explore more in the future (B) preserves trust and autonomy.

Toronto Notes 2023 – ELOM and LGBTQ2S+ Health Section:

“For transgender individuals, screening decisions should be personalized. Trauma-informed care includes validating distress and deferring invasive exams when not urgent.”

MCCQE1 Objectives (ELOM > 99-2: Cultural Safety):

“Candidates must prioritize patient-centered communication and consent, particularly when distress or marginalization may influence healthcare interactions.”

Option A is coercive. Option C is documentation only and lacks engagement or exploration.

This patient’s headache is consistent with tension-type or stress-related headache. The symptoms are mild, responsive to over-the-counter medications, and without red flags (neurologic signs, worsening pattern, nocturnal pain). Reassurance is appropriate.

Toronto Notes 2023 – Neurology, “Headache” Section:

“In the absence of red flags (e.g., sudden onset, focal deficits, age >50, worsening pattern), reassurance is the best course. Tension headaches are often related to stress and improve with lifestyle modification and simple analgesia.”

MCCQE1 Objectives (Internal Medicine > 76-6: Neurologic Symptoms):

“Candidates should recognize benign headache patterns and avoid unnecessary investigations.”

CT head (B) is not indicated. Stronger analgesics (D) may cause rebound headache. Specialist or psychiatric referrals (A, E) are premature.