Online Medical Council of Canada MCCQE Practice Test Engine & Evaluate Yourself

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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q290-Q295):

NEW QUESTION # 290
A 1-month-old boy is brought to your clinic after being born with asymmetric intrauterine growth restriction (third percentile at birth). He was born at 36 weeks' gestation. He has been breastfeeding well and continues to grow around the third percentile. Which one of the following would be the best next step?

Answer: B

Explanation:
This infant was born late preterm (36 weeks) with asymmetric intrauterine growth restriction (IUGR) and remains at the 3rd percentile. Although he is breastfeeding well, infants with IUGR and late prematurity often require enhanced caloric intake to support catch-up growth. MCCQE objectives emphasize optimizing postnatal nutrition in growth-restricted infants to promote appropriate weight gain while monitoring growth velocity.
Caloric fortification of expressed breast milk (or use of higher-calorie formula if needed) increases energy density without increasing feeding volume, supporting growth in infants who are small for gestational age.
Simply continuing standard feeds may not provide sufficient calories for catch-up growth.
High-dose vitamin D is not indicated; routine supplementation (400 IU daily) is appropriate for breastfed infants. Early introduction of solids is not recommended before about 6 months of age. Switching to hydrolyzed formula is unnecessary without evidence of milk protein allergy.
Therefore, caloric-fortified feeding is the most appropriate next step to promote optimal growth in this infant.


NEW QUESTION # 291
A 58-year-old woman presents to your office with refractory bipolar I disorder. She is on the following medications: lithium carbonate, valproic acid, and olanzapine. She also takes acetaminophen for osteoarthritis and pantoprazole for gastroesophageal reflux. Lately, she has noticed she bruises very easily. Laboratory work displays a platelet count of 70 × 10#/L (normal 130-400). Which one of the following is most likely to induce this side effect?

Answer: D

Explanation:
Valproic acid is well known to cause thrombocytopenia, especially at higher serum concentrations or in patients over 60. Bruising with platelet count <100 × 10#/L is a classic manifestation.
Toronto Notes 2023 - Psychiatry, Mood Disorders & Pharmacology Section:
"Valproic acid is associated with hematologic side effects including thrombocytopenia. Platelet counts should be monitored regularly." MCCQE1 Objectives - Psychiatry > Pharmacotherapy:
"The candidate must recognize adverse effects of mood stabilizers including hematologic complications of valproic acid." Other listed medications (A-D) have no common or direct link with thrombocytopenia in this context.


NEW QUESTION # 292
A 55-year-old man with alcohol use disorder presents with a 2-day history of confusion. Onexamination, you note a sixth nerve palsy and a horizontal nystagmus. Which one of the following is the most likely diagnosis?

Answer: E

Explanation:
Wernicke encephalopathy is a medical emergency caused by thiamine (vitamin B1) deficiency, most often seen in chronic alcohol use. The classic triad is:
* Confusion
* Oculomotor dysfunction (e.g., nystagmus, cranial nerve palsies)
* Ataxia
Toronto Notes 2023 - Neurology and Psychiatry, "Wernicke Encephalopathy" Section:
"Wernicke encephalopathy is diagnosed clinically. Symptoms include ophthalmoplegia (e.g., CN VI palsy), horizontal nystagmus, ataxia, and confusion. Immediate parenteral thiamine is indicated before glucose administration." MCCQE1 Objectives (Neurology > 75-1: Neurologic Emergencies):
"Candidates must recognize Wernicke encephalopathy in at-risk individuals and initiate urgent thiamine replacement." Other choices like cerebellar degeneration (A) and hepatic encephalopathy (D) are more chronic and lack the characteristic eye findings. Subdural hematoma (B) and hemorrhage (E) may mimic confusion but are less likely with these neurologic signs and history.


NEW QUESTION # 293
Your colleague's receptionist asks you to assess her 4-year-old daughter who has had 2 episodesof acute otitis media in the last month. The mother wants you to arrange a consultation with an ear, nose and throat (ENT) specialist to get a tympanostomy before her daughter starts school. You do not believe there is a surgical indication at this time. Which one of the following is the best next step?

Answer: E

Explanation:
Referrals should be medically indicated. Physicians are not obligated to refer simply because a patient (or colleague) requests it, especially when it may lead to unnecessary care. The ethical and appropriate action is to explain your medical reasoning and decline an unwarranted referral.
Toronto Notes 2023 - ELOM, "Professionalism and Resource Stewardship" Section:
"Physicians have a responsibility to act as gatekeepers to specialist services and should not refer patients when criteria are not met. Explaining the reasoning and declining the request respectfully is appropriate." MCCQE1 Objectives (ELOM > 99-1: Professionalism and Clinical Judgment):
"Candidates must demonstrate ethical reasoning in managing requests for unwarranted interventions." Involving the emergency department (B) or another physician (C) is not appropriate unless there's a true conflict of interest. Calling a consultant (E) may be unnecessary if no medical reason exists.


NEW QUESTION # 294
A 70-year-old woman consults you for progressive vision problems. She describes seeing haloes at night around street lights and having double vision. Her near vision has improved. Which one of the following is an ophthalmologic examination most likely to uncover?

Answer: E

Explanation:
The symptoms described - haloes at night, monocular diplopia, and improved near vision (second sight) - are classic signs of nuclear sclerosis-type cataracts. On exam, the most consistent finding would be an altered red reflex due to lens opacification.
Toronto Notes 2023 - Ophthalmology, Cataracts:
"Cataracts can cause glare, monocular diplopia, and improved near vision. A diminished or irregular red reflex is commonly seen on direct ophthalmoscopy." MCCQE1 Objectives - Internal Medicine > Ophthalmologic Disorders:
"The candidate must recognize symptoms and physical findings of cataracts, including changes in red reflex and visual acuity." Options A and B are associated with lipid deposition and Wilson's disease, respectively. Retinal exudates (D) suggest diabetic or hypertensive retinopathy. Increased intraocular pressure (E) suggests glaucoma but is not supported by this clinical picture.


NEW QUESTION # 295
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