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Medical Council of Canada MCCQE Part 1 Sample Questions:

1. A 45-year-old man presents to your clinic for follow-up regarding his obsessive-compulsive disorder. He currently takes a high dosage of paroxetine, which he would like to discontinue because he feels well. His condition has been stable taking this medication since he was discharged from inpatient care 2 years ago.
Which one of the following is the most appropriate recommendation?

A) Switch paroxetine to sertraline.
B) Reduce the dosage of paroxetine by 50%.
C) Maintain the current dosage of paroxetine.
D) Discontinue paroxetine and refer for supportive psychotherapy.

2. A 79-year-old woman presents to the Emergency Department with sudden-onset severe chest and back pain that started 1 hour ago. She has a history of hypertension and looks unwell. Her vital signs are as follows:
blood pressure 168/108 mm Hg, heart rate 110/min, respiratory rate 22/min, temperature 36.7°C. Findings of a physical examination of the chest and abdomen are normal. An urgent computed tomography (CT) scan of the chest and abdomen shows an aortic dissection extending from the descending thoracic aorta to the upper abdominal aorta. The branches of the abdominal aorta are patent. Following initial resuscitation, which one of the following is the best next step?

A) Admit the patient to the Intensive Care Unit and repeat CT in 6 hours.
B) Conduct open repair of the thoracic and abdominal aorta.
C) Initiate intravenous labetalol.
D) Perform endovascular repair of the thoracic and abdominal aorta.
E) Start intravenous heparin.

3. A 45-year-old man with confusion is brought to the Emergency Department by ambulance. He has end-stage renal disease and has missed his last 3 dialysis appointments. He also has a past medical history of antisocial personality disorder and hepatitis C. On examination, he is in respiratory distress. His blood pressure is 170
/90 mm Hg, and his oxygen saturation is 84% on room air. His jugular venous pressure is 8 cm above the sternal angle, and he has crackles in his lungs bilaterally. A venous blood gas shows a bicarbonate of 11 mmol
/L (24-30) and potassium of 7.1 mmol/L (3.5-5.0). Which one of the following is the best next step?

A) Call psychiatry to evaluate his capacity to consent.
B) Prescribe morphine and furosemide.
C) Attempt to contact his family for consent to start dialysis.
D) Start urgent dialysis.
E) Discuss with his nephrologist the reasons why he missed his dialysis appointments.

4. An 88-year-old man is admitted to hospital with an upper gastrointestinal bleed. He is confused on admission, but his sensorium clears with resuscitation and stabilization. The patient lives in his own home with assistance from his children. Work-up shows metastatic gastric carcinoma for which no curative treatment can be offered. The family insists that the patient not be told the diagnosis because they fear he will have a "mental breakdown." Which one of the following is the best next step?

A) Be direct and tell the patient the diagnosis.
B) Ask the patient if he wants to know the diagnosis.
C) Accept the family's request and do not tell the patient the diagnosis.
D) Consult palliative care.

5. A 12-year-old boy is brought by his mother to your clinic with a history of attention-deficit/hyperactivity disorder. His mother reports that he has been taking immediate-release methylphenidate for 2 years. Although the medication was initially effective, it no longer seems to work. The teachers say he is disorganized and fidgety, verbally interrupts class, and does not complete his work. His mother tells you that he does listen at home. Which one of the following is the most important next step in management?

A) Complete rating scales and increase methylphenidate.
B) Add risperidone and see the patient in 2 weeks.
C) Switch the methylphenidate to atomoxetine and see the patient in 2 weeks.
D) Order an electroencephalogram.
E) Increase the methylphenidate and see the patient in 2 weeks.

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