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Medical Council of Canada MCCQE Part 1 Sample Questions:

1. A 79-year-old woman presents to the Emergency Department with sudden-onset severe chest and back pain that started 1 hour ago. She has a history of hypertension and looks unwell. Her vital signs are as follows:
blood pressure 168/108 mm Hg, heart rate 110/min, respiratory rate 22/min, temperature 36.7°C. Findings of a physical examination of the chest and abdomen are normal. An urgent computed tomography (CT) scan of the chest and abdomen shows an aortic dissection extending from the descending thoracic aorta to the upper abdominal aorta. The branches of the abdominal aorta are patent. Following initial resuscitation, which one of the following is the best next step?

A) Conduct open repair of the thoracic and abdominal aorta.
B) Admit the patient to the Intensive Care Unit and repeat CT in 6 hours.
C) Perform endovascular repair of the thoracic and abdominal aorta.
D) Start intravenous heparin.
E) Initiate intravenous labetalol.

2. You are asked to see a 34-year-old patient at his long-term care facility for a 2-day history of fever. You diagnose a urinary tract infection. He has multiple sclerosis diagnosed 5 years ago and has lived in this long- term care facility for the past 2 years. He is bedbound and has an indwelling urinary catheter. For the past 3 months, he has been non-communicative. Prior to this, he had made it clear that he did not want any life- prolonging measures. Which one of the following is the best next step?

A) Change his urinary catheter.
B) Prescribe antipyretics.
C) Transfer him to the hospital.
D) Start antibiotics while waiting to contact the family.
E) Call his family to consider antibiotics.

3. An 83-year-old woman presents to your office with a 2-day history of confusion. Her past medical history is significant for lung cancer, and she is being treated with radiation. On physical examination, she is euvolemic.
Her blood work reveals a serum sodium of 118 mmol/L (135-140) as compared with 134 mmol/L (8 days ago). Which one of the following will be most helpful in establishing the cause of her laboratory abnormality?

A) Serum osmolality
B) Creatinine clearance
C) Urinalysis
D) Parathyroid hormone-related peptide
E) Urine sodium

4. A 56-year-old man is admitted to hospital with pyelonephritis and started on intravenous antibiotics. On day 2 of his hospitalization, he continues to report right flank pain, but he is able to walk. His vital signs are as follows:
Temperature: 38.5°C
Blood pressure: 90/60 mm Hg
Heart rate: 105/min
The patient is mentating well but is concerned about his dog that is home alone due to his unexpected hospitalization. He requests to be released from hospital as he needs to make arrangements for his dog. Which one of the following is the best next step?

A) Offer to stop by his apartment on your way home, if he is agreeable to it and gives you the key.
B) Discharge the patient, but ensure he signs an " Against Medical Advice " form.
C) Change him to oral antibiotics, and finish his treatment as an outpatient.
D) Ensure he understands the risk and accept his decision to leave for a few hours while you hold his bed.
E) Explain that his health is a priority and insist that he stay.

5. A 42-year-old man presents with a history of fatigue and weight loss. He looks unwell, has a darker than usual complexion and his liver is enlarged. He is also found to have marked glycosuria. Which one of the following is the most useful diagnostic test?

A) Serum alpha-1 antitrypsin
B) Serum amylase
C) Serum cortisol
D) Hemoglobin A1c
E) Serum ferritin

Solutions: