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Medical Council of Canada MCCQE Part 1 Sample Questions:

1. A 43-year-old man comes to your office for the first time. He has not seen a doctor in over 5 years and has no known past medical history. On examination, his blood pressure is 120/70 mm Hg, and the remainder of his examination is normal. As part of the initial visit, you order some screening blood work that reveals a fasting blood glucose of 6.3 mmol/L (3.3-5.8) and a hemoglobin A1c of 6.1% (4-6). Which one of the following is the best next step?

A) Order thyrotroph (thyroid-stimulating hormone) level.
B) Order an exercise stress test.
C) Test capillary blood glucose 4 times a day.
D) Perform a 75 g oral glucose tolerance test.
E) Order a urine albumin:creatinine ratio.

2. A 37-year-old man presents with chronic back, neck, and shoulder pain following a workplace injury 4 years ago. He has a history of alcohol misuse and PTSD related to the incident. Current medications (acetaminophen, naproxen, amitriptyline, gabapentin) provide inadequate pain relief. He requests oxycodone after self-trialing it with temporary benefit. After history and physical assessment, which one of the following is the best next step?

A) Prescribing a low-dose, long-acting opioid and reassessing in 1 week for effectiveness.
B) Referring the patient to substance use and mental health support services.
C) Prescribing cannabis.
D) Prescribing a short course of a short-acting opioid to be used only as needed.
E) Ordering repeat imaging of the spine and shoulder to confirm the diagnosis.

3. A young man and woman who are in a relationship present to the office for prenatal counselling. During the visit, you observe that the man's lips appear as shown in the referenced photo.

[Image shows grouped vesicular lesions on erythematous base affecting the lips-classic for herpes labialis (HSV-1).] Which one of the following is the best advice?

A) The woman must have a cesarean delivery
B) The man needs herpes simplex virus type-specific serology
C) The man should avoid performing oral sex during her pregnancy
D) The woman should take acyclovir throughout her pregnancy
E) The woman should have viral cultures of her cervix

4. A 64-year-old man presents with a 3-month history of gradually increasing neck pain and stiffness. The pain radiates into his upper back, and he is having difficulty driving because of limitation of neck rotation secondary to pain. Physical examination shows restricted neck motion in all directions and neck muscle spasms. There is no abnormality on neurologic examination. A radiograph shows narrowing of all of the cervical disc spaces with prominent osteophytes. Which one of the following is the most appropriate next step?

A) Lumbar puncture.
B) Electromyography of upper limbs.
C) Magnetic resonance imaging of the neck.
D) Computed tomography of neck.
E) No further investigation.

5. You are providing medical care to a 78-year-old man and notice a skin lesion which you suspect is malignant melanoma. He has been living in a long-term care facility for 2 years because of incontinence, mobility and vision problems. He is well-liked by facility staff and residents, manages his own affairs and communicates clearly. He has designated his daughter to be his substitute decision-maker and has signed a Do Not Resuscitate (DNR) order. Which one of the following is the best next step in providing care to this patient for his skin lesion?

A) Perform a biopsy to ensure an accurate diagnosis before discussing diagnosis and treatment.
B) Ask him whether you can discuss your diagnosis and care with his daughter.
C) Discuss your tentative diagnosis with him and ask about his preferences regarding investigations.
D) Contact the daughter to inform her of your findings and discuss possible investigations.
E) Respect his DNR wishes, and do nothing about the skin lesion.

Solutions: