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Medical Council of Canada MCCQE Part 1 Sample Questions:

1. A 68-year-old man with a history of diabetes, hypertension, delirium tremens, and tobacco addiction comes to the Emergency Department with his daughter. She tells you that his behavior has become unmanageable and she feels he may require an increased level of care. His vital signs are:
Blood pressure: 162/105 mm Hg
Heart rate: 112/min, regular
Temperature: 37.8°C
On history, his daughter explains she had to confiscate a half-empty bottle of alcohol from his room yesterday. He is now convinced that there are bugs crawling all over him and he will not relax. He appears pale, sweaty, and shaky. His most recent blood glucose is 7.8 mmol/L (3.8-11.1). Which one of the following is the best next step?

A) Administer benzodiazepines and intravenous hydration.
B) Consult a Geriatric Psychiatrist to assess the patient.
C) Provide the family member with a prescription of antipsychotics for the patient.
D) Interview the patient in private to ensure this is not a case of elder abuse.


2. A 62-year-old man, who has not seen a physician in 20 years, presents to your clinic with a burning sensation in his feet. The symptoms have been progressing slowly over the last 6 months. There is no associated motor weakness or skin changes. He reports no significant past medical history and takes no medications. His alcohol intake is minimal. On examination, he has reduced pinprick/vibration sensation and proprioception in the ankles with absent ankle reflexes. Which one of the following blood tests would you expect to be abnormal?

A) Hemoglobin A1c
B) Anti-acetylcholine receptor antibodies
C) Folate
D) Uric acid
E) Ferritin


3. A 42-year-old man presents to your clinic for follow-up regarding his anxiety. He lost his job 1 year ago.
Since then, he constantly thinks about what happened, trying to understand what went wrong and how he could fix it or prevent it in the future. He is unable to sleep because of this. He has become socially isolated and when he does see friends, he worries constantly that he may say something hurtful. He wishes he could get past what happened and find another job but feels consumed by the fear that he may offend someone in the future. On history, his symptoms did not respond to escitalopram, sertraline, fluvoxamine, or venlafaxine, all at maximum tolerated doses. Which one of the following medications is the most appropriate?

A) Quetiapine
B) Amitriptyline
C) Paroxetine
D) Clomipramine
E) Vortioxetine


4. A 24-year-old woman presents with rapidly increasing lower leg pain. Less than 24 hours ago, she fell off her bicycle and had some minor abrasions. On examination, she is in severe pain and appears anxious. Local examination of her leg reveals mild discoloration with marked tenderness but no swelling in her calf. Which one of the following is the most likely diagnosis?

A) Cellulitis
B) Deep vein thrombosis
C) Necrotizing fasciitis
D) Baker ' s cyst
E) Plantaris rupture


5. A 69-year-old man presents with a 4-day history of a painful right knee. On history, he denies any trauma or similar previous episodes. Examination reveals effusion of the right knee that is warm to the touch. Which one of the following is the best next step?

A) Serum uric acid level
B) Nonsteroidal anti-inflammatory drugs
C) Right knee radiography
D) Joint aspiration
E) Intravenous antibiotics


Solutions:

Question # 1
Answer: A
Question # 2
Answer: A
Question # 3
Answer: D
Question # 4
Answer: C
Question # 5
Answer: D

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