Free Medical Council of Canada MCCQE Practice Exam with Questions & Answers | Set: 9

This presentation is most consistent with somatic symptom disorder/illness anxiety : persistent distressing physical symptoms (abdominal pain/constipation) with excessive health-related anxiety, repeated reassurance-seeking, and “doctor shopping” despite normal investigations. MCCQE objectives emphasize avoiding iatrogenic harm from repeated testing and using a structured, therapeutic relationship to manage medically unexplained or disproportionate symptom concerns. The best next step is regularly scheduled follow-up visits with one consistent physician (e.g., monthly), focused on validating symptoms, addressing fears, monitoring for new objective findings, and gradually shifting toward coping strategies and functional goals. This approach reduces unnecessary investigations, reinforces continuity, and helps interrupt the cycle of anxiety-driven health-care utilization.

Repeating investigations (B) perpetuates reassurance-seeking and increases false positives and harm. Consulting additional specialists (A) without new red flags similarly reinforces maladaptive beliefs and fragmentation of care. Exercise (D) may be beneficial as an adjunct but is not the core management strategy. Therefore, planned, regular appointments are the most appropriate next step.

Sudden onset dyspnea and pleuritic chest pain in a postoperative patient with tachypnea and clear lung fields are classic features of a pulmonary embolism (PE). Recent orthopedic surgery significantly increases VTE risk. Clear lungs on auscultation support this over pneumonia or CHF.

Toronto Notes 2023 – Respiratory, “Pulmonary Embolism”:

“Presentation includes sudden dyspnea, pleuritic chest pain, and tachypnea. Risk factors include recent surgery and immobilization. Examination often reveals clear chest auscultation.”

MCCQE1 Objectives (Internal Medicine > Cardiopulmonary > 44-1):

“Candidates must recognize PE in patients with risk factors (e.g., surgery) and classic features and initiate appropriate diagnosis and management.”

Fat embolism (B) usually presents with petechiae, neurologic symptoms, and occurs within 24–72 hours post-op. Cholesterol emboli (E) are more chronic and systemic.

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This patient has a family history of both male breast cancer (father) and early-onset ovarian cancer (aunt), which are red flags for BRCA1/2 mutations. Genetic counseling and BRCA testing are the appropriate next steps to stratify cancer risk and guide screening and prevention.

Toronto Notes 2023 – Oncology, “Breast Cancer Risk” Section:

“BRCA testing is recommended for individuals with a strong family history of breast or ovarian cancer, particularly if involving male relatives or early-onset cases.”

MCCQE1 Objectives (Population Health > 97-5: Screening and Prevention):

“Candidates must identify high-risk individuals who require genetic counseling and screening beyond population guidelines.”

Tamoxifen (A) and prophylactic mastectomy (E) are only considered after confirming mutation status. Annual screening starting at 50 (D) is for average-risk women. Fine-needle sampling (C) is not a screening tool.

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The findings of exophthalmos (bulging eyes), conjunctival inflammation, and periorbital swelling are hallmark features of Graves ophthalmopathy, a manifestation of autoimmune hyperthyroidism.

Toronto Notes 2023 – Endocrinology, “Thyroid Disorders”:

“Graves ophthalmopathy: proptosis, periorbital edema, conjunctivitis, and diplopia due to extraocular muscle involvement. Often independent of thyroid levels.”

MCCQE1 Objectives (Internal Medicine > 36-1: Thyroid Disease):

“Candidates must recognize and manage Graves disease and its ocular manifestations.”

Myasthenia gravis may cause diplopia but not proptosis or swelling. Pseudotumor and cellulitis are painful and acute. Allergic conjunctivitis is itchy but lacks proptosis.

According to Canadian guidelines, women aged 50 to 74 at average risk for breast cancer should undergo routine screening mammography every 2 to 3 years. A great-aunt with breast cancer does not raise this patient ' s risk to high. Mammography is appropriate as she is now due for the next screen.

Toronto Notes 2023 – Population Health, “Screening Guidelines” Section:

“Routine mammography is recommended every 2 years for average-risk women aged 50 to 74. Family history in second-degree or more distant relatives (e.g., great-aunt) does not qualify for high-risk screening or MRI.”

MCCQE1 Objectives (Population Health > 97-5: Screening and Prevention):

“Candidates should apply Canadian screening recommendations including mammography for average-risk women ≥50 years old.”

Self-breast exams (C) are not recommended for screening. PET scan (D) and MRI (E) are reserved for high-risk populations or diagnostic clarification.

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This child experienced a first unprovoked generalized tonic-clonic seizure that resolved spontaneously and now has a normal neurologic examination and stable vital signs. MCCQE objectives emphasize that the immediate priority after a first seizure is to identify reversible metabolic causes , particularly hypoglycemia and electrolyte abnormalities (e.g., hyponatremia, hypocalcemia). Therefore, urgent serum electrolytes (and glucose) are indicated.

Neuroimaging (CT or MRI) is not urgently required in a neurologically normal child without focal deficits, trauma, persistent altered consciousness, or signs of increased intracranial pressure. MRI may be arranged later for further evaluation if clinically indicated. Electroencephalography is useful in outpatient follow-up to assess seizure type and recurrence risk but is not an emergency test. Lumbar puncture is reserved for suspected central nervous system infection (e.g., fever, meningeal signs, altered mental status), which are absent here.

Thus, immediate laboratory evaluation for metabolic derangements is the appropriate urgent investigation.

The key public health message from a physician’s perspective is the evidence-based health risks and adverse effects associated with nonprescribed stimulant use (e.g., insomnia, anxiety, cardiovascular events, and dependency). This is central to a harm-reduction approach.

Toronto Notes 2023 – Public Health & Psychiatry, Substance Use:

“Misuse of prescription stimulants is common among university students. Education campaigns should emphasize medical risks including cardiovascular complications, addiction potential, and psychiatric disturbances.”

MCCQE1 Objectives – Preventive Medicine > Health Promotion:

“Candidates should identify core messages in public education campaigns, prioritizing evidence-based risks and harm reduction.”

Legal and ethical issues (B, C) are important but secondary to the health implications. Prevalence data (D) informs the campaign design, but is not the message itself. Study habits (A) are relevant for academic counseling, not medical messaging.

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Comprehensive and Detailed Explanation:

This patient has secondary amenorrhea, galactorrhea, and worsening headaches—suggestive of hyperprolactinemia, possibly due to a pituitary adenoma (prolactinoma). Visual field defects (typically bitemporal hemianopia) can result from optic chiasm compression.

Toronto Notes 2023 – Endocrinology / Reproductive Health:

“Prolactinomas may cause amenorrhea, galactorrhea, headaches, and visual field defects. Evaluate with serum prolactin and visual field testing.”

MCCQE1 Objectives (Endocrinology > 37-2: Pituitary Disorders):

“Candidates must recognize clinical signs of prolactinomas and know when to assess visual fields.”

Hirsutism (D) suggests androgen excess. Low BMI (B) can cause hypothalamic amenorrhea but wouldn’t explain galactorrhea. Nodular breast findings (A) are not related.

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Low HDL is best managed with lifestyle changes such as increased aerobic physical activity, smoking cessation, and weight loss. Vigorous exercise has the strongest evidence for raising HDL levels.

Toronto Notes 2023 – Cardiology, Dyslipidemia:

“Increasing physical activity is among the most effective ways to raise HDL cholesterol. There is no consistent benefit to supplements such as garlic, nor does reducing salt or caffeine meaningfully raise HDL.”

MCCQE1 Objectives – Population Health > Cardiovascular Risk Management:

“Candidates should recommend evidence-based lifestyle interventions such as exercise to improve lipid profiles, particularly to increase HDL.”

Alcohol cessation (C) is generally beneficial for overall health but may actually lower HDL slightly. Garlic (D) and caffeine (E) are not evidence-based interventions for dyslipidemia.

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.

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