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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q80-Q85):

NEW QUESTION # 80
A 67-year-old man presents to the clinic because of elevated liver enzymes. He is asymptomatic.His medical history is significant for type 2 diabetes, which is being treated with metformin. On physical examination, he looks well. His blood pressure is 125/75 mm Hg, his heart rate is 80/min, and his BMI is 35. Findings of the remainder of the examination are normal. His blood work results are as follows:
* Platelet count: 170 × 10#/L (130-380)
* Creatinine: normal
* GGT: 75 µmol/L (49-93)
* ALT: 146 IU/L (15-85)
* AST: 101 IU/L (17-63)
* Bilirubin (total): 17 µmol/L (3-17)
* INR: 1.2 (0.9-1.2)
Which one of the following is the most likely diagnosis?

A. Carcinoma of the pancreas
B. Metformin effect
C. Acute hepatitis B infection
D. Hepatocellular carcinoma
E. Nonalcoholic steatohepatitis

Answer: E

Explanation:
The patient is obese (BMI 35), has type 2 diabetes, and shows a hepatocellular pattern of transaminitis (elevated ALT > AST). These are typical features of nonalcoholic steatohepatitis (NASH), the inflammatory subtype of nonalcoholic fatty liver disease (NAFLD).
Toronto Notes 2023 - Gastroenterology, NAFLD and NASH:
"NASH should be suspected in patients with metabolic syndrome, obesity, and type 2 diabetes, especially with elevated transaminases and normal bilirubin or INR." MCCQE1 Objectives - Internal Medicine > Hepatology:
"Candidates should recognize the clinical profile of NAFLD/NASH, particularly in asymptomatic patients with metabolic risk factors and isolated liver enzyme elevations." Acute hepatitis B (A) typically has higher ALT and symptoms. Pancreatic carcinoma (B) affects biliary enzymes or bilirubin. Metformin (D) does not elevate liver enzymes. HCC (E) would often present with systemic or localized symptoms and abnormal imaging.

NEW QUESTION # 81
A 38-year-old woman presents with diffuse nodularity in the outer upper quadrant of her right breast. There is no obvious dominant mass, nipple discharge, or skin dimpling. There are no palpable lymph nodes. Which one of the following is the most likely diagnosis?

A. Benign phyllodes tumour
B. Intraductal carcinoma
C. Mastitis
D. Paget disease
E. Fibrocystic change

Answer: E

Explanation:
Fibrocystic change is the most common benign breast condition in women of reproductive age. It typically presents with diffuse nodularity or "lumpy" areas, especially in the upper outer quadrant, and varies with the menstrual cycle. No dominant mass or systemic signs are expected.
Toronto Notes 2023 - Gynecology, "Benign Breast Conditions":
"Fibrocystic changes often present with bilateral or unilateral nodularity, most commonly in the upper outer quadrants, without discrete masses." MCCQE1 Objectives (Gynecology > 81-1: Breast Conditions):
"Candidates must differentiate benign breast conditions from malignant ones based on presentation and physical exam findings." Paget disease (B) presents with nipple changes. Intraductal carcinoma (C) typically shows a discrete mass or suspicious features. Phyllodes tumours are usually well-circumscribed. Mastitis (E) is inflammatory and associated with erythema, fever, and tenderness.

NEW QUESTION # 82
A 29-year-old concert pianist with severe chronic kidney disease presents with a 6-month history of loss of appetite and pruritus. Although the issue of initiating dialysis has been discussed with him and his questions answered, he has declined dialysis thus far. You understand his concerns that it will interfere with his concert tour and recording schedule. Which one of the following is the best next step?

A. Explain to him you will see him again when he decides to start dialysis.
B. Offer to arrange for him to meet patients in the peritoneal dialysis clinic.
C. Warn him of the consequences of refusing dialysis.
D. Provide him access to his medical records and full chart.
E. Explore employment alternatives that would better accommodate the dialysis schedule.

Answer: B

Explanation:
When a competent patient declines dialysis, the next step is to support shared decision-making and explore options that align with their lifestyle. Peritoneal dialysis may allow more flexibility and autonomy compared to hemodialysis, making it more acceptable to patients with demanding schedules.
Toronto Notes 2023 - Nephrology, Chronic Kidney Disease Section:
"Peritoneal dialysis offers the advantage of home-based treatment and flexible scheduling. Patient education and peer support can improve acceptance and adherence to dialysis initiation." MCCQE1 Objectives - Internal Medicine > Nephrology:
"The candidate should explore treatment alternatives collaboratively, emphasizing patient autonomy, while addressing misconceptions and lifestyle concerns related to dialysis." Simply warning the patient or withdrawing engagement (Options B and C) may undermine rapport. Access to medical records (D) is a right, but does not actively address treatment planning. Exploring new employment (E) is inappropriate at this stage.

NEW QUESTION # 83
A 48-year-old woman presents with a 2-year history of regular, heavy menstrual flow. She has a BMI of 54, poorly controlled type 2 diabetes, and obstructive sleep apnea. Laboratory results are as follows:
Hemoglobin: 82 g/L (123-157)
Ferritin: 6 µg/L (11-307)
Endometrial biopsy: Absence of hyperplasia or malignancy
Transvaginal ultrasound:
* Uterus: 12 cm × 8.2 cm × 6 cm
* Intramural fibroids
* Endometrial thickness: 14 mm
* Ovaries: Normal
Which one of the following is the best next step?

A. Hysterectomy
B. Cyclic medroxyprogesterone
C. Levonorgestrel-releasing intrauterine system
D. Continuous combined oral contraception

Answer: C

Explanation:
The levonorgestrel-releasing intrauterine system (LNG-IUS) is the first-line treatment for heavy menstrual bleeding, particularly in women with risk factors for endometrial hyperplasia and contraindications to systemic hormones (e.g., morbid obesity, diabetes, OSA).
Toronto Notes 2023 - Gynecology, "Abnormal Uterine Bleeding" Section:
"The LNG-IUS is highly effective in reducing menstrual bleeding and improving hemoglobin levels. It is particularly recommended in women with obesity, chronic anovulation, or contraindications to estrogen." MCCQE1 Objectives (Obstetrics and Gynecology > 82-1: Abnormal Uterine Bleeding):
"Candidates must consider the LNG-IUS as a preferred non-surgical treatment for chronic heavy menstrual bleeding when endometrial pathology has been excluded." Oral contraceptives (C) are not first-line in morbid obesity due to increased thromboembolic risk. Cyclic medroxyprogesterone (D) is less effective than LNG-IUS. Hysterectomy (A) is definitive but should follow failure of conservative therapy.

NEW QUESTION # 84
A 20-year-old nulligravid woman presents with severe pain during menstruation. She is unable to take nonsteroidal anti-inflammatory drugs (NSAIDs) and is adamant about not taking any hormonal therapy. She has questions about non-medicinal therapeutic options. Which one of the following recommendations is the most appropriate?

A. Laparoscopic uterine nerve ablation (LUNA)
B. High-frequency transcutaneous electrical nerve stimulation (TENS)
C. Massage therapy
D. Spinal manipulation
E. Progesterone-releasing intrauterine device

Answer: B

Explanation:
TENS has been shown to be effective for managing primary dysmenorrhea when pharmacological options are contraindicated or refused. It works by interfering with pain signal transmission and increasing endorphin levels.
Toronto Notes 2023 - Gynecology, Dysmenorrhea:
"High-frequency TENS is effective in managing primary dysmenorrhea and can be considered when NSAIDs or hormonal therapies are not acceptable to the patient." MCCQE1 Objectives - Gynecology > Menstrual Disorders:
"Candidates must be aware of non-pharmacological interventions for dysmenorrhea, including TENS and heat therapy." Options D and E involve hormonal or surgical intervention. Spinal manipulation and massage (B and C) lack consistent evidence for dysmenorrhea relief.

NEW QUESTION # 85
......

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