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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q56-Q61):
NEW QUESTION # 56
A 40-year-old woman presents to the Emergency Department with confusion and fever (38.5°C). She has a history of hypothyroidism managed with levothyroxine. Key findings include:
Blood pressure
114/78 mm Hg
Heart rate
85/min
Temperature
38.5°C
Hemoglobin
90 g/L123-157 g/L
Platelet count
25 × 10#/L130-400 × 10#/L
Peripheral blood film
Schistocytes present
Creatinine
200 #mol/L50-90 #mol/L
Answer: C
Explanation:
This patient presents with fever, confusion, anemia with schistocytes, thrombocytopenia, and renal impairment - fulfilling the classic pentad of thrombotic thrombocytopenic purpura (TTP). TTP is a hematologic emergency requiring plasma exchange.
Toronto Notes 2023 - Hematology, "Microangiopathic Hemolytic Anemia" Section:
"TTP is a medical emergency. Features include MAHA, thrombocytopenia, renal failure, neurologic symptoms, and fever. Schistocytes on blood film are diagnostic." MCCQE1 Objectives (Internal Medicine > 76-7: Hematologic Disorders):
"Candidates must urgently recognize TTP and initiate emergent plasma exchange therapy." AML (B) does not present with schistocytes. HIV (C) can cause thrombocytopenia but not MAHA. ITP (D) causes isolated thrombocytopenia without anemia or schistocytes.
NEW QUESTION # 57
A 63-year-old woman presents to your office with a history of progressive abdominal discomfort over the past five months. She reports bloating and difficult digestion with constipation. She has no urinary symptoms and denies vaginal or rectal bleeding. An abdominal ultrasound shows a large complex pelvic mass with internal multiloculation and moderate ascites. The cancer antigen 125 (CA 125) is elevated at 1023 U/mL (< 35 U
/mL). Which one of the following is the most likely diagnosis?
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
Postmenopausal women with abdominal distension, bloating, a complex pelvic mass, and elevated CA-125 are highly suggestive of epithelial ovarian cancer, especially serous cystadenocarcinoma-the most common type.
Toronto Notes 2023 - Gynecology / Oncology:
"Serous epithelial ovarian carcinoma presents with vague abdominal symptoms, ascites, complex pelvic mass, and elevated CA-125." MCCQE1 Objectives (Gynecology > 82-5: Ovarian Masses):
"Candidates must recognize signs and investigations of ovarian cancer, including elevated tumor markers and imaging findings." Ovarian hyperstimulation (A) occurs in fertility treatments. Colorectal cancer (C) may mimic these symptoms but typically causes rectal bleeding and has lower CA-125 levels. Uterine adenocarcinoma (D) usually causes bleeding. Hematosalpinx (E) presents with pelvic pain, not ascites.
NEW QUESTION # 58
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?
Answer: D
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 # 59
You have been asked to develop a program in your hospital for people who are at the highest risk of death by suicide. The hospital administrator asks you to describe the types of patients they should expect in the program. Which one of the following groups is the most likely prominent demographic?
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
Middle-aged to older men with social isolation and substance use disorders (especially alcohol) are among the highest-risk groups for completed suicide. They are less likely to seek help and often use more lethal methods.
Toronto Notes 2023 - Psychiatry, "Suicide Risk Assessment":
"High-risk demographics include older men, social isolation, comorbid alcohol use, and chronic illness. These patients have the highest rates of completed suicide." MCCQE1 Objectives (Psychiatry > 71-1: Suicide Risk):
"Candidates must recognize epidemiologic risk factors for completed suicide, including demographics and comorbidities." Although women and youth have higher rates of suicidal ideation and attempts, men over 50 have the highest completion rates.
NEW QUESTION # 60
A 2.5-year-old boy is brought to the Emergency Department after he consumed a button-shaped battery. Chest and abdomen radiographies are performed. Which one of the following locations mandates urgent removal of the battery?
Answer: E
Explanation:
Button batteries lodged in the esophagus require urgent endoscopic removal due to risk of tissue necrosis, perforation, and tracheoesophageal fistula within hours. Batteries beyond the esophagus may pass spontaneously if the child is asymptomatic.
Toronto Notes 2023 - Pediatrics, "Foreign Body Ingestion":
"Button batteries in the esophagus are medical emergencies and must be removed immediately. Batteries in the stomach or intestines may be observed if the child is asymptomatic." MCCQE1 Objectives (Pediatrics > 78-2: Gastrointestinal Emergencies):
"Candidates must identify when foreign body ingestion poses immediate risk and requires emergency intervention." Batteries in the stomach or intestines (A-C, E) usually pass without complication, especially if the child is asymptomatic and the battery is <2 cm.
NEW QUESTION # 61
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