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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q170-Q175):

NEW QUESTION # 170
A 30-year-old man comes to the office and asks you to write him a note for his employer that recommends a stress leave. He says he feels entitled to a rest. He comes across as irritable and impulsive. He appears to show little regard for the law and admits to recently embezzling $5,000 from his employer. He justifies his actions and shows no remorse. He has a history of attention-deficit/hyperactivity disorder as a child. Which one of the following is the most likely diagnosis?

A. Klinefelter syndrome.
B. Antisocial personality disorder.
C. Bipolar II disorder.
D. Borderline personality disorder.
E. Narcissistic personality disorder.

Answer: B

Explanation:
This case features hallmark traits of antisocial personality disorder: disregard for social norms, criminal behavior, lack of remorse, impulsivity, and a history of conduct disorder (suggested by childhood ADHD and likely early behavioral problems).
Toronto Notes 2023 - Psychiatry, Personality Disorders:
"Antisocial personality disorder is characterized by disregard for rights of others, impulsivity, deceitfulness, lack of remorse, and criminal activity beginning in adolescence." MCCQE1 Objectives - Psychiatry > Personality Disorders:
"Candidates must distinguish antisocial personality disorder by a pattern of behavior that violates the rights of others, with evidence of conduct disorder before age 15." Other options do not explain the full behavioral pattern, especially the criminality and lack of remorse.

NEW QUESTION # 171
A 60-year-old man presents because of a 6-month history of involuntary lip smacking and tongue movements.
His medical history is significant for schizophrenia, which has been very stable with haloperidol for the past
20 years. When educating the patient about these particular symptoms, which one of the following statements is accurate?

A. The symptoms will gradually decrease in intensity as he gets older
B. Anticholinergics are effective treatments for this condition
C. These movements occur in the majority of patients who are taking antipsychotics
D. His condition is potentially irreversible

Answer: D

Explanation:
Comprehensive and Detailed Explanation:
This patient has tardive dyskinesia, a late-onset, often irreversible movement disorder caused by chronic dopamine receptor blockade (e.g., haloperidol). It is especially common in older adults and may not resolve after stopping the drug.
Toronto Notes 2023 - Psychiatry, "Extrapyramidal Symptoms":
"Tardive dyskinesia is often irreversible and typically occurs after prolonged antipsychotic use. Elderly patients are at greater risk." MCCQE1 Objectives (Psychiatry > 71-5: Side Effects of Psychotropics):
"Candidates must recognize tardive dyskinesia and understand that it can persist or worsen even after discontinuation of antipsychotics." Anticholinergics may worsen it (D). The condition does not reliably improve with age (C). It does not affect a majority of patients (A).

NEW QUESTION # 172
A 30-year-old woman presents to your office for a follow-up assessment of a sports-related musculoskeletal injury to her right leg. She requests a letter for her employer regarding her return to work. You feel she should be able to manage some aspects of her factory work. Which one of the following is most appropriate to include in your medical note to this patient's employer?

A. Physiotherapist's evaluation
B. Medical imaging results
C. Diagnosis
D. Treatment options
E. Required workplace accommodations

Answer: E

Explanation:
Comprehensive and Detailed Explanation:
In a workplace medical note, physicians are responsible for commenting on the patient's functional capacity and any required accommodations-not providing detailed medical diagnoses or test results unless consented to. The goal is to support a safe return to work with appropriate modifications.
Toronto Notes 2023 - ELOM, "Documentation and Work Notes":
"Physicians should focus on functional abilities and restrictions, rather than detailed diagnoses or treatments, in employer communications." MCCQE1 Objectives (ELOM > 90-2: Confidentiality and Occupational Fitness):
"Candidates must maintain patient confidentiality and document work-related limitations and accommodations in employer letters." Diagnosis (B), imaging (E), and treatment plans (A) are confidential medical details. C (physiotherapist's evaluation) is not the physician's documentation.
-

NEW QUESTION # 173
A 34-year-old woman, gravida 2, para 1, aborta 0, presents to the labor and delivery ward at 32 weeks' gestation with a 24-hour history of worsening frontal headache, photophobia, and neck stiffness. Vitals:
* BP: 121/78 mm Hg
* HR: 90 bpm
* Temp: 38°C
Neuro exam reveals a 2-beat ankle clonus. Tone and power are otherwise normal. No localizing signs or papilledema. Abdomen is soft, fetus is cephalic.
Which one of the following is the best next investigation?

A. Amniocentesis with culture
B. Urine protein to creatinine ratio
C. Computed tomography of the head
D. Fetal ultrasonography
E. Lumbar puncture

Answer: B

Explanation:
Comprehensive and Detailed Explanation:
This patient is pregnant and febrile with a new headache, photophobia, and clonus - all features concerning for preeclampsia with neurologic involvement. Clonus is a key finding suggestive of central nervous system irritability. Urine protein/creatinine ratio helps confirm the diagnosis of preeclampsia.
Toronto Notes 2023 - Obstetrics, Hypertensive Disorders in Pregnancy:
"Headache, clonus, and visual disturbances are concerning for severe preeclampsia. A urine protein/creatinine ratio or 24-hour urine collection confirms diagnosis." MCCQE1 Objectives - Obstetrics > Hypertension in Pregnancy:
"Candidates must recognize signs of preeclampsia and assess with appropriate biochemical testing." CT (A) or LP (B) are not indicated unless focal neurologic signs or seizures are present. Fetal imaging and amniocentesis (C, D) do not address maternal symptoms.

NEW QUESTION # 174
You are caring for a 17-year-old girl who has end-stage renal disease. She is receiving dialysis at the hospital
3 times a week. She requests medical assistance in dying (MAID). Which of the following is the best next step?

A. Inform the patient that she will need parental consent to be assessed for MAID.
B. Suggest a trial of home dialysis.
C. Explain to the patient that she is not terminally ill.
D. Refer the patient to a psychiatrist.
E. Explore the reasons for the patient's request for MAID.

Answer: E

Explanation:
The first step in any MAID request is to explore the patient's motivations, psychosocial concerns, and mental health status. The request should be taken seriously and approached with compassion. Exploring the reasons is essential to determine eligibility and to distinguish suffering from other potentially treatable issues (e.g., depression, loss of hope).
Toronto Notes 2023 - ELOM, "Medical Assistance in Dying":
"Upon receiving a request for MAID, the physician must first explore the patient's motivations, ensure understanding of their condition, and assess for coercion, depression, or other treatable factors." MCCQE1 Objectives (ELOM > Ethical Dilemmas > End-of-Life Care):
"Candidates must demonstrate understanding of the ethical and legal framework surrounding MAID and respond appropriately to requests by exploring reasons and providing necessary support and referrals." MAID is available to mature minors in some jurisdictions but not uniformly. Assuming the patient is ineligible or redirecting to other treatments without discussion is inappropriate.

NEW QUESTION # 175
......

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