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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q136-Q141):

NEW QUESTION # 136
A 70-year-old woman had a total abdominal hysterectomy with bilateral salpingo-oophorectomy 2 days ago.
On examination today, her vital signs are as follows: She has been immobile since her operation. She is fatigued but is tolerating a full diet. Which one of the following is the most likely cause of this patient's fever?

A. Septic pelvic thrombophlebitis.
B. Bowel trauma during the operation.
C. Atelectasis
D. Wound infection.
E. Pulmonary embolism.

Answer: C

Explanation:
Postoperative fever on day 1-2 is commonly caused by atelectasis, particularly in patients who are immobile.
It is considered a self-limited cause of early fever after surgery and often resolves with mobilization and pulmonary exercises.
Toronto Notes 2023 - Surgery, Postoperative Complications:
"The '5 W's' of postoperative fever: Wind (atelectasis), Water (UTI), Wound (infection), Walking (DVT), and Wonder drugs. Atelectasis typically occurs in the first 48 hours and is due to hypoventilation or pain- limited breathing." MCCQE1 Objectives - Surgery > Postoperative Management:
"Candidates must recognize timing-specific causes of postoperative fever. Atelectasis is the most likely cause within the first 48 hours." PE (B) can cause fever but is less likely without respiratory compromise. Wound infection (C) and bowel trauma (D) typically present later or with more specific symptoms. Septic pelvic thrombophlebitis (A) usually presents later and with more systemic signs.

NEW QUESTION # 137
A 26-year-old man presents with pain, numbness, and weakness in his right upper extremity. He works as a computer programmer, and his BMI is 32. Symptoms have worsened since he started spending more time on the keyboard. He reports that his right hand feels clumsier while he is typing. Physical examination reveals mild weakness in the intrinsic muscles of that hand, with a positive Tinel sign at the ulnar nerve. Which one of the following is the best next step?

A. Magnetic resonance imaging of the cervical spine.
B. Elbow extension brace for use during sleep.
C. Physiotherapy.
D. Nerve conduction studies to localize the level of the lesion.
E. Wrist splint to test for carpal tunnel.

Answer: D

Explanation:
This patient presents with symptoms and signs of ulnar neuropathy-most likely at the elbow (cubital tunnel).
Weakness in the intrinsic hand muscles and positive Tinel sign at the ulnar nerve are suggestive. Nerve conduction studies are the gold standard to confirm and localize the lesion.
Toronto Notes 2023 - Neurology, "Peripheral Nerve Disorders":
"In cases of suspected mononeuropathy such as ulnar nerve compression, nerve conduction studies confirm the diagnosis and localize the lesion." MCCQE1 Objectives (Medicine > Neurology > 35-2):
"Candidates should identify and investigate focal mononeuropathies using nerve conduction studies to confirm the diagnosis and location." Splinting (A, C) may help after diagnosis. Physiotherapy (B) is adjunctive. MRI (D) is not the first-line investigation.

NEW QUESTION # 138
A 30-year-old man (assigned female at birth) presents to your clinic for a periodic health examination. He declines a gynecologic examination because such examinations lead to intense emotional distress for him. He also believes that he does not require a Papanicolaou (Pap) test because he is not in a sexual relationship with a man. After acknowledging the patient's distress and providing education regarding the need for Pap screening, which one of the following would be the best next step?

A. Ask permission to learn more about his distress in a subsequent appointment.
B. Record his directives in the chart.
C. Advise him to reconsider his decision and to allow the examination to proceed.

Answer: A

Explanation:
It is essential to balance medical guidelines with trauma-informed, patient-centered care. This includes offering future discussion while respecting boundaries. Acknowledging distress and offering to explore more in the future (B) preserves trust and autonomy.
Toronto Notes 2023 - ELOM and LGBTQ2S+ Health Section:
"For transgender individuals, screening decisions should be personalized. Trauma-informed care includes validating distress and deferring invasive exams when not urgent." MCCQE1 Objectives (ELOM > 99-2: Cultural Safety):
"Candidates must prioritize patient-centered communication and consent, particularly when distress or marginalization may influence healthcare interactions." Option A is coercive. Option C is documentation only and lacks engagement or exploration.

NEW QUESTION # 139
An 18-year-old woman comes to the office because of fatigue. She tells you she is struggling in her first year of university. She mentions that she spends much of her time rewriting her notes and filing and organizing her study materials. She is doing all the work in her group assignments because she feels others cannot do the work to a high enough standard. She has abandoned all enjoyable activities and seems to be constantly working and worrying about her grades. Which one of the following is the most likely diagnosis?

A. Obsessive-compulsive disorder.
B. Generalized anxiety disorder.
C. Major depressive disorder.
D. Obsessive-compulsive personality disorder.

Answer: D

Explanation:
This patient exhibits perfectionism, preoccupation with order and control, and reluctance to delegate - classic features of obsessive-compulsive personality disorder (OCPD). Unlike OCD, there are no intrusive thoughts or compulsions; rather, behaviors are ego-syntonic.
Toronto Notes 2023 - Psychiatry, Personality Disorders:
"OCPD is marked by perfectionism, rigidity, and preoccupation with productivity. It differs from OCD in lacking obsessions or compulsions." MCCQE1 Objectives - Psychiatry > Personality Disorders:
"Candidates must distinguish OCPD by traits of excessive perfectionism, control, and inflexibility, particularly when these interfere with functioning." Major depression (A) is marked by pervasive low mood, which is not reported. OCD (B) involves distressing obsessions and compulsions. GAD (C) is more generalized worry without the perfectionism and rigidity.

NEW QUESTION # 140
A surgical clinic would like to respond to the Truth and Reconciliation Commission of Canada: Calls to Action report. The clinic has implemented a mandatory cultural safety course for all employees and ongoing faculty development that includes teachings from Elders and Knowledge Keepers and teaching sessions about harm reduction, trauma-informed care, and antiracism. Which one of the following steps would further the clinic's goal of responding to this report?

A. Display the cultural safety certificate in the waiting room.
B. Provide clinic information in the languages spoken by the community.
C. Include trauma disclosure on the clinic's intake form.
D. Evaluate how the staff enjoyed the teaching session.

Answer: B

Explanation:
Providing information in the patient's own language is a concrete way to improve access, cultural safety, and communication - key recommendations in the Truth and Reconciliation Commission's Calls to Action. It moves beyond symbolic gestures and supports equitable care.
Toronto Notes 2023 - ELOM, "Indigenous Health and Cultural Safety" Section:
"Cultural safety includes removing language barriers, engaging with Elders, and using patient-centered practices that respect Indigenous values. Communication in the patient's first language improves trust and outcomes." MCCQE1 Objectives (ELOM > 99-2: Cultural Safety and Health Equity):
"Candidates must apply the principles of culturally safe care including removing barriers to access and effective communication, as highlighted in the Truth and Reconciliation Commission's Calls to Action." Evaluating session enjoyment (A) is not impactful. Certificates (C) are symbolic. Intake questions about trauma (D) must be done with appropriate context and safety - not as a formality.

NEW QUESTION # 141
......

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