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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q277-Q282):

NEW QUESTION # 277
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?

Answer: D

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 # 278
A 28-year-old nulligravid woman presents to your clinic with grey-green vaginal discharge that has a "fishy- type odour." Microscopy reveals superficial squamous cells with blurred borders caused by adherent bacteria.
The patient's symptoms abate after therapy with vaginal metronidazole. Which one of the following is the most likely cause of this clinical presentation?

Answer: B

Explanation:
This presentation is classic for bacterial vaginosis (BV) . MCCQE objectives emphasize recognition of BV by its typical features: thin grey/grey-green discharge , fishy (amine) odour , and microscopy showing clue cells
-vaginal epithelial (superficial squamous) cells with blurred borders from adherent bacteria. BV results from a shift in vaginal flora away from lactobacilli toward anaerobes, with Gardnerella vaginalis commonly implicated and often present in polymicrobial overgrowth. Improvement with metronidazole further supports BV, as it is first-line therapy.
Other options do not match: HPV causes genital warts/cervical dysplasia, not malodorous discharge with clue cells. Trichomonas typically causes frothy yellow-green discharge, "strawberry cervix," and motile trichomonads on wet mount (not clue cells). Chlamydia and gonorrhea cause cervicitis/PID with mucopurulent discharge and pelvic symptoms rather than fishy odour and clue cells. Therefore, Gardnerella vaginalis is the most likely cause.


NEW QUESTION # 279
You are caring for a 78-year-old man admitted to hospital for heart failure. On your rounds, he asks why he is not getting better. He has a history of heart failure, hypertension, and type 2 diabetes. He has an implantable cardioverter-defibrillator. This is his fourth admission in the past 6 months for acute decompensation of his heart failure. Between hospital admissions, he reports worsening shortness of breath and a progressive decline in function. Which one of the following is the next best step?

Answer: B

Explanation:
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.


NEW QUESTION # 280
A health authority implements the first-ever colon cancer screening program in its territory. Which one of the following colon cancer indices will likely increase?

Answer: E

Explanation:
When a screening program is introduced, the incidence rate appears to rise because more cases (including subclinical ones) are identified earlier. This is known as "lead-time bias" or "ascertainment bias." Toronto Notes 2023 - Public Health, Screening and Epidemiology:
"Screening increases the apparent incidence of disease as more early or latent cases are detected." MCCQE1 Objectives - Preventive Medicine > Screening:
"Candidates should understand how implementation of screening programs affects disease incidence and epidemiologic metrics." Case fatality rate (A) may decrease. PPV (B) depends on prevalence. Positive biopsy rate (C) may remain stable. Treatment rate (E) could increase, but incidence is the most directly and consistently affected.


NEW QUESTION # 281
You are providing medical care to a 78-year-old man and notice a skin lesion which you suspect is malignant melanoma. He has been living in a long-term care facility for 2 years because of incontinence, mobility and vision problems. He is well-liked by facility staff and residents, manages his own affairs and communicates clearly. He has designated his daughter to be his substitute decision-maker and has signed a Do Not Resuscitate (DNR) order. Which one of the following is the best next step in providing care to this patient for his skin lesion?

Answer: C

Explanation:
This patient is competent and capable of making his own health decisions. A DNR order and naming a substitute decision-maker apply only when a patient lacks capacity. The next step is to discuss the suspected diagnosis with the patient and explore his preferences.
Toronto Notes 2023 - ELOM, Consent and Capacity:
"Competent patients retain full decision-making authority. Substitute decision-makers are only engaged when the patient lacks capacity. DNR applies to resuscitation, not other medical decisions." MCCQE1 Objectives - ELOM > Capacity, Consent, Advance Directives:
"Candidates must recognize that capable patients should be directly involved in decisions. Substitute decision- makers are not invoked unless the patient is incapable." Option A implies a breach of confidentiality without permission. Option C is premature. Option D bypasses informed consent. Option E misinterprets the DNR's scope.


NEW QUESTION # 282
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