MCCQE Exam Dumps - Medical Council of Canada MCCQE Part 1 Questions and Answers

Radiation proctitis is a well-known complication of pelvic radiation therapy (e.g., for prostate cancer). It presents months to years after treatment with rectal bleeding, tenesmus, and mucosal ulceration on colonoscopy.

Toronto Notes 2023 – Gastroenterology, “Radiation-Induced GI Injury”:

“Radiation proctitis presents with rectal bleeding, tenesmus, urgency. Colonoscopy shows pale, friable mucosa, ulcerations, and telangiectasia.”

MCCQE1 Objectives (Gastroenterology > 47-2: GI Bleeding and Complications):

“Candidates must recognize radiation proctitis based on history of radiation and characteristic endoscopic findings.”

Ulcerative colitis (B) usually starts younger and is more diffuse. Diverticulosis (C) affects the left colon and causes painless bleeding. Recurrent prostate cancer (D) and rectal cancer (E) would show mass or infiltration.

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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Fibroadenomas can grow slightly or fluctuate in size. A minimal increase (from 1.5 cm to 1.7 cm) over six months is clinically insignificant. No malignant features are reported, and the previous biopsy confirmed benign nature. Annual follow-up is appropriate.

Toronto Notes 2023 – Obstetrics and Gynecology, “Breast Disorders” Section:

“Fibroadenomas are benign breast masses that may slightly enlarge. Routine imaging follow-up at 6 to 12 months is appropriate for lesions with benign imaging and histology.”

MCCQE1 Objectives (Obstetrics and Gynecology > 82-3: Breast Mass):

“Candidates must distinguish between benign and suspicious masses and determine appropriate intervals for follow-up imaging.”

Repeat biopsy (A) or surgery (B) is unwarranted without suspicious change. MRI (C) is not needed in stable, benign lesions. Tamoxifen (D) is not used for fibroadenomas.

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This presentation describesnormal developmental dysfluency, which typically occurs between ages 2–5 and often worsens duringtimes of stress or change, such as a new sibling. It is characterized byword repetitionand does not require intervention unless it persists >6 months, worsens, or causes distress.

Toronto Notes 2023 – Pediatrics, "Developmental and Behavioral Pediatrics" Section:

“Developmental stuttering is common between 2–5 years and often resolves without intervention. Reassurance is appropriate unless there are signs of persistent or severe stuttering, secondary behaviors, or parental concern.”

MCCQE1 Objectives (Pediatrics > 78-1: Development and Behavior):

“Candidates must recognize typical patterns of developmental speech dysfluency and differentiate them from pathological speech disorders. Observation and reassurance are often the appropriate initial step.”

Because the child is otherwise developing normally and the onset coincides with a known psychosocial stressor,reassuranceis the most appropriate step. Formal speech or behavioral therapy is not indicated at this time.

Comprehensive and Detailed Explanation:

In a workplace medical note, physicians are responsible for commenting on the patient’s functional capacity and any required accommodations—not providing detailed medical diagnoses or test results unless consented to. The goal is to support a safe return to work with appropriate modifications.

Toronto Notes 2023 – ELOM, “Documentation and Work Notes”:

“Physicians should focus on functional abilities and restrictions, rather than detailed diagnoses or treatments, in employer communications.”

MCCQE1 Objectives (ELOM > 90-2: Confidentiality and Occupational Fitness):

“Candidates must maintain patient confidentiality and document work-related limitations and accommodations in employer letters.”

Diagnosis (B), imaging (E), and treatment plans (A) are confidential medical details. C (physiotherapist’s evaluation) is not the physician’s documentation.

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Comprehensive and Detailed Explanation:

This is a classic presentation of polymyalgia rheumatica (PMR), characterized by pain and stiffness in the shoulders and hips in older adults. PMR is closely associated with giant cell arteritis (GCA), which presents with unilateral headache, jaw claudication, visual symptoms, and scalp tenderness. Given the risk of vision loss with GCA, it's critical to screen for these symptoms in all patients with suspected PMR.

Toronto Notes 2023 – Rheumatology, PMR and GCA:

“Patients with PMR should be assessed for symptoms of GCA such as headache, visual changes, and jaw claudication. GCA can result in permanent vision loss if not promptly treated.”

MCCQE1 Objectives – Internal Medicine > Rheumatology:

“Candidates must identify signs of GCA in patients with PMR and understand the need for prompt diagnosis and treatment.”

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Accurate dating is critical in pregnancies at high risk for preeclampsia and intrauterine growthrestriction. First-trimester ultrasound is used to establish gestational age, which guides monitoring and interventions.

Toronto Notes 2023 – Obstetrics, High-Risk Pregnancy:

“In women with a history of preeclampsia, early and accurate dating allows for appropriate fetal surveillance and timely delivery.”

MCCQE1 Objectives – Obstetrics > Prenatal Care:

“Candidates should recognize the importance of accurate pregnancy dating in high-risk pregnancies.”

Prophylactic labetalol (E) is not indicated in normotensive patients. Genetic testing (A, B) is not appropriate unless additional risk factors are present. Bed rest (D) is not evidence-based for preeclampsia prevention.

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Scaphoid fractures are often radiographically occult on initial presentation and can present later with persistent pain and swelling in the anatomical snuffbox. They typically occur following a fall on an outstretched hand. If missed, they can lead to avascular necrosis.

Toronto Notes 2023 – Orthopedics, Wrist Injuries:

“Scaphoid fractures are the most common carpal fractures. X-rays may be negative early, so high suspicion requires immobilization and repeat imaging after 10–14 days.”

MCCQE1 Objectives – Surgery > Musculoskeletal Trauma:

“Candidates must recognize that some fractures, such as scaphoid, may not appear on initial imaging but require clinical suspicion and follow-up imaging or immobilization.”

Other options (B and C) are less likely without radiographic evidence. De Quervain tenosynovitis (D) presents with radial wrist pain unrelated to trauma and worsens with thumb movement.

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The clinical picture is most consistent with acute pancreatitis (alcohol-related, epigastric pain radiating to back, vomiting, and ileus). CT abdomen with contrast is the best diagnostic tool if the diagnosis is uncertain or complications are suspected.

Toronto Notes 2023 – Gastroenterology, “Pancreatitis”:

“CT abdomen is indicated when diagnosis is unclear, symptoms are severe, or complications (e.g., necrosis, ileus) are suspected.”

MCCQE1 Objectives (Gastroenterology > 47-1: Acute Abdominal Pain):

“Candidates must investigate acute epigastric pain appropriately, especially in the context of alcohol use and systemic features.”

Ultrasound (B) is first-line for gallstones but not best here. Laparotomy (A) is not warranted without peritonitis or perforation. Endoscopy (D) is not indicated. Sengstaken-Blakemore (E) is for variceal bleeding, which is not suspected here.

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In a euthyroid patient with an asymptomatic goiter or thyroid enlargement, the next step is a thyroid ultrasound to evaluate nodule size, composition, and features suggestive of malignancy.

Toronto Notes 2023 – Endocrinology, Thyroid Nodules and Goiter:

“TSH should be obtained first. If normal and there is a palpable mass or enlargement, ultrasound is indicated to evaluate for nodules and guide further testing (e.g., FNA).”

MCCQE1 Objectives – Internal Medicine > Endocrinology:

“Candidates must use thyroid ultrasound as the initial imaging study in the evaluation of thyroid enlargement or palpable nodules.”

T3/T4 (A) are not needed with normal TSH. FNA (D) is done if nodules are identified. CT (C) is used for retrosternal goiters or compressive symptoms. Calcium (E) is irrelevant here.

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