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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q214-Q219):

NEW QUESTION # 214
A 6-year-old girl is found to have a blood pressure of 130/75 mm Hg. She was born prematurely at 32 weeks' gestation and required ventilation. There is a family history of hypertension in 3 grandparents. Clinical examination reveals a grade 1/6 mid-systolic murmur, no renal bruits, and femoral pulses are difficult to feel.
Which one of the following is the most likely diagnosis?

A. Renal artery thrombosis
B. Reflux nephropathy
C. Essential hypertension
D. Ventricular septal defect
E. Aortic coarctation

Answer: E

Explanation:
Comprehensive and Detailed Explanation:
The combination of upper extremity hypertension and weak femoral pulses is classic for aortic coarctation. A soft systolic murmur may be present. This condition often becomes apparent during routine screening in school-aged children.
Toronto Notes 2023 - Pediatrics / Cardiology:
"Coarctation of the aorta presents with upper limb hypertension, diminished femoral pulses, and sometimes a systolic murmur. BP discrepancy is key." MCCQE1 Objectives (Pediatrics > 78-1: Congenital Heart Disease):
"Candidates must recognize signs of aortic coarctation, including weak lower limb pulses and systemic hypertension in children." VSD (A) typically presents with a louder murmur. Reflux nephropathy (B) may cause hypertension but without femoral pulse discrepancy. Renal artery thrombosis (C) is rare. Essential hypertension (D) is less likely in this age group with these findings.
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NEW QUESTION # 215
You are seeing a 78-year-old man for follow-up of metastatic cholangiocarcinoma diagnosed 8 months ago and currently being treated with thermotherapy. He has just completed his 2nd cycle and reports frequently feeling hopeless, worthless, and helpless, with no sense of a positive future. He states he is turning away invitations to socialize with family and friends. He feels like sleeping all the time and reports no appetite.
Which one of the following is the most likely diagnosis?

A. Brain metastasis
B. Side effects of chemotherapy
C. Major depressive episode
D. Normal grief reaction
E. Hepatic encephalopathy

Answer: C

Explanation:
This patient exhibits classic symptoms of a major depressive episode (MDE): anhedonia, low mood, social withdrawal, feelings of worthlessness, hypersomnia, and loss of appetite. These symptoms are persistent and pervasive beyond what is typical in grief.
Toronto Notes 2023 - Psychiatry, "Depressive Disorders" Section:
"MDE is characterized by #5 symptoms present nearly every day for #2 weeks including low mood, anhedonia, sleep/appetite disturbances, low energy, feelings of worthlessness, and suicidal ideation. It must cause significant impairment in functioning." MCCQE1 Objectives (Psychiatry > 79-1: Mood Disorders):
"Candidates must distinguish between grief, adjustment disorders, and major depression in patients with chronic illness and initiate appropriate management." Normal grief (A) may involve sadness and crying but does not involve pervasive hopelessness or worthlessness. Side effects of chemotherapy (C) and hepatic encephalopathy (E) have other specific physical signs. Brain metastasis (D) would more likely present with focal neurologic symptoms or cognitive impairment.

NEW QUESTION # 216
A 28-year-old woman presents to the office in great distress because she has no money for groceries or rent.
She is a single mother of a 7-year-old girl. She has a history of gambling disorder. She has felt unable to cope for the last 3 months and has started gambling again. Today, she is crying, and she shares that her boyfriend became violent with her yesterday. Which one of the following is the highest priority for assessment?

A. Define the extent of the patient's gambling disorder.
B. Determine the risk of violence to the patient and her child.
C. Evaluate for depression.
D. Investigate the patient's need for financial assistance.
E. Screen for recreational drug and alcohol use.

Answer: B

Explanation:
The highest priority is the immediate safety of the patient and her child. In the presence of domestic violence, risk assessment for harm or neglect must be conducted urgently, particularly since a child may be at risk.
Safety trumps psychiatric or social evaluations in triage.
Toronto Notes 2023 - Psychiatry, "Crisis and Risk Assessment" Section:
"When intimate partner violence (IPV) is disclosed, it is critical to assess immediate safety and consider mandatory reporting, especially when children are involved." MCCQE1 Objectives (Psychiatry > 79-6: Violence and Abuse):
"Candidates must assess for and respond to risk of harm in situations of domestic violence, especially when dependents are involved. This includes ensuring immediate safety and following legal obligations for child protection." Although the other concerns (e.g., gambling, depression, substance use, financial need) are valid, the presence of violence makes D the first and most urgent priority.

NEW QUESTION # 217
A 72-year-old man presents to your clinic accompanied by his 70-year-old husband. The patient reports that, over the last several months, his libido has been very low. Which one of the following would be the best next step?

A. Assess for depression
B. Order serum testosterone levels
C. Prescribe testosterone
D. Refer for couple's counselling
E. Interview the couple together

Answer: A

Explanation:
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.
-

NEW QUESTION # 218
A 3-year-old boy is brought to your office because his daycare teachers are concerned about his language development. His parents speak both English and French at home, and he can say around 15 words combined in both languages. His history reveals that he has minimal interest in playing with other children. Which one of the following is most appropriate?

A. Evaluate for attention deficit hyperactivity disorder.
B. Refer to a pediatric neurologist.
C. Reassure that no intervention is needed.
D. Recommend use of one language at home.
E. Screen for autism spectrum disorder.

Answer: E

Explanation:
A limited vocabulary (fewer than 50 words by age 2-3 years) and reduced social interaction (limited interest in peers) raise concern for autism spectrum disorder (ASD). Screening for ASD is the most appropriate next step.
Toronto Notes 2023 - Pediatrics, Development and Behaviour:
"Red flags for autism include delayed language, limited social reciprocity, and poor peer interaction.
Screening should be initiated early when clinical signs are present."
MCCQE1 Objectives - Pediatrics > Developmental Disorders:
"Candidates must identify key signs of ASD and initiate appropriate screening and early intervention." Multilingual households do not typically cause such delays (E is incorrect). ADHD (B) presents with attention
/hyperactivity issues, not language/social delay. Reassurance (A) is inappropriate. Neurology referral (C) may follow but is not first-line.

NEW QUESTION # 219
......

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