Pass the Medical Council of Canada MCCQE Part 1 MCCQE Questions and answers with ValidTests

The presence of suicidal ideation in a minor mandates urgent assessment to ensure safety and access mental health care. Disclosure of sexual orientation should be handled delicately and is not urgent compared to suicidal risk.

Toronto Notes 2023 – Psychiatry, “Child and Adolescent Psychiatry” Section:

“Any adolescent disclosing suicidal ideation should be referred for urgent mental health evaluation. Concurrent issues such as sexual orientation may contribute to distress and should be addressed with appropriate support over time.”

MCCQE1 Objectives (Psychiatry > 79-2: Suicide Risk Assessment):

“Candidates must immediately refer for psychiatric assessment when a minor reports suicidal ideation, regardless of other social or developmental concerns.”

Antidepressants (A) may be appropriate but must follow specialist evaluation. Encouraging disclosure (B) or peer groups (C) is premature without ensuring safety.

This patient has secondary amenorrhea, infertility, and a history of multiple uterine curettages, which strongly points toward Asherman syndrome (intrauterine adhesions or synechiae). The hysterosalpingogram shows an obliterated uterine cavity and no tubal dye spill—classic for intrauterine synechiae. Her midluteal progesterone level is normal, indicating ovulation.

Toronto Notes 2023 – Gynecology, “Infertility” section:

“Asherman syndrome results from intrauterine adhesions due to curettage, leading to amenorrhea and infertility. HSG shows an obliterated or irregular uterine cavity.”

MCCQE1 Objectives (Gynecology > 82-1: Infertility):

“Candidates should evaluate secondary amenorrhea and interpret imaging such as hysterosalpingogram in the diagnosis of intrauterine abnormalities.”

Other options are ruled out by the presence of normal ovulation (rules out hypothalamic and PCOS) and by imaging (not suggestive of fibroids or perimenopause).

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This patient has clinical signs of an eating disorder — fatigue, low BMI, hypotension, and hypokalemia — likely secondary to nutritional deficiencies or purging. The first step is to sensitively explore the patient ' s perception of weight and body image. Effective management requires rapport and careful conversation.

Toronto Notes 2023 – Psychiatry, Eating Disorders:

“Approach patients with suspected eating disorders non-judgmentally. Begin with permission to discuss weight or body image. Screening tools like SCOFF can help guide further assessment.”

MCCQE1 Objectives – Psychiatry > Eating Disorders:

“Candidates must recognize signs of eating disorders and initiate a respectful and effective patient-centered discussion.”

Referring to the ED (B) is not urgent without hemodynamic instability. Advising caloric intake (C) bypasses assessment. GI referral (D) is not appropriate at this stage.

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This constellation of features—hypotonia, macroglossia, brachycephaly, single palmar crease, short broad hands with clinodactyly—is classic for Down syndrome (Trisomy 21).

Toronto Notes 2023 – Pediatrics, “Genetic Syndromes”:

“Trisomy 21 features include hypotonia, upslanting palpebral fissures, epicanthic folds, flat nasal bridge, brachycephaly, macroglossia, single palmar crease, and clinodactyly.”

MCCQE1 Objectives (Pediatrics > 78-3: Congenital and Genetic Disorders):

“Candidates must recognize key dysmorphic features associated with common genetic syndromes including Trisomy 21.”

Prader-Willi and congenital hypothyroidism may have hypotonia but lack the full phenotypic pattern. Turner syndrome is seen in females with short stature and webbed neck. Fetal alcohol syndrome presents with smooth philtrum and microcephaly.

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Stimulants like methylphenidate can increase heart rate and blood pressure. In patients with cardiovascular risk (e.g., hypertension, nephropathy), stimulants should not be increased without first addressing elevated blood pressure.

Toronto Notes 2023 – Psychiatry, “ADHD in Adults”:

“Stimulants can exacerbate hypertension and must be used cautiously. Evaluate cardiovascular risk factors and control blood pressure before dose increases.”

MCCQE1 Objectives (Psychiatry > 71-1: ADHD):

“Candidates must consider the cardiovascular risks of stimulant therapy and monitor for hypertension prior to adjusting doses.”

While poor glycemic control (B) and renal disease (A) are important, BP control is most critical for immediate stimulant safety.

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The patient with the angulated thigh, hypotension relative to baseline, and tachycardia likely has a femoral shaft fracture with concealed hemorrhage. This poses an immediate risk of hypovolemic shock and requires urgent assessment and stabilization.

Toronto Notes 2023 – Emergency Medicine, “Trauma Triage and Prioritization”:

“Patients with long bone fractures, especially femoral fractures, are at high risk for hemorrhage and should be prioritized for stabilization and hemorrhage control.”

MCCQE1 Objectives (Surgery > 51-1: Trauma):

“Candidates must prioritize trauma patients based on signs of instability or risk of deterioration, such as tachycardia and occult bleeding.”

When encountering vaccine hesitancy, the first and most effective step is to open a non-judgmental conversation and explore the patient’s reasons. This helps build trust and tailor subsequent education and counseling.

Toronto Notes 2023 – Public Health and Preventive Medicine, Immunization:

“Addressing vaccine hesitancy requires understanding parental concerns. Begin with open-ended questions to identify underlying beliefs and information gaps.”

MCCQE1 Objectives – Preventive Medicine > Immunization:

“Candidates must demonstrate effective communication with vaccine-hesitant parents, beginning with eliciting their rationale before providing evidence-based recommendations.”

Jumping to education (B) or punitive measures (C, D) may close communication. The patient is an adult; speaking with her parents (E) violates her autonomy.

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This clinical presentation is highly suggestive of chronic pelvic inflammatory disease (PID), especially given the left lower quadrant pain and dyspareunia with a normal pelvic ultrasound. PID is often caused by sexually transmitted infections (STIs), such as Chlamydia trachomatis or Neisseria gonorrhoeae, which may not be evident on imaging.

Toronto Notes 2023 – Gynecology:

“Cervical swabs for N. gonorrhoeae and C. trachomatis are essential in the workup of suspected PID or cervicitis, even when imaging is normal. Dyspareunia and chronic pelvic pain with normal imaging should prompt testing for STIs.”

MCCQE1 Objectives (Obstetrics & Gynecology > 82-6: Pelvic Pain):

“Candidates must consider and investigate for infectious causes of pelvic pain, including PID, which requires cervical swab testing as an essential first-line investigation.”

Laparoscopy (A) is invasive and reserved for uncertain or refractory cases. Hysterosalpingography (C) is used in infertility workups, not acute pain. Endometrial biopsy (D) and MRI (E) are not first-line.

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The presentation is consistent with rotator cuff tendinopathy or subacromial impingement. The painful arc between 30°–120° with preserved passive ROM suggests this. Ultrasound is the preferred initial imaging modality due to its availability, safety, and ability to visualize soft tissues dynamically.

Toronto Notes 2023 – Orthopedics, “Shoulder Pathologies” Section:

“In rotator cuff injuries or impingement syndromes, initial imaging with musculoskeletal ultrasound is appropriate. It can identify tendinopathy, partial tears, or subacromial bursitis.”

MCCQE1 Objectives (Surgery > 84-7: Musculoskeletal Pain):

“Candidates should initiate workup for rotator cuff or impingement syndromes with ultrasound as the first-line test, reserving more invasive or costly procedures for unresolved or complex cases.”

CT (A) is used for bony detail, not soft tissues. Arthroscopy (C) is invasive and therapeutic. Arthrography (D) is outdated and largely replaced by MRI or ultrasound.

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Comprehensive and Detailed Explanation:

This patient is likely experiencing extrapyramidal symptoms (dysphagia/dystonia) due to haloperidol. Switching to an atypical antipsychotic (like quetiapine), which has a lower risk of EPS, is appropriate. Dysphagia in the context of antipsychotic use requires prompt medication review.

Toronto Notes 2023 – Psychiatry, “Antipsychotics and Extrapyramidal Effects”:

“Dysphagia can be a sign of extrapyramidal side effects. Consider switching to an atypical antipsychotic with lower EPS risk.”

MCCQE1 Objectives (Psychiatry > 71-5: Antipsychotic Adverse Effects):

“Candidates must recognize and manage EPS, including drug-induced dysphagia.”

Dantrolene (C) is for neuroleptic malignant syndrome, not isolated dysphagia. Laryngoscopy (B) may be useful later but not first-line. Reassurance (D) is unsafe. Lorazepam (E) may help in dystonia but doesn ' t address the root cause.