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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q191-Q196):

NEW QUESTION # 191
A 61-year-old man presents to the office for follow-up of recent laboratory test results. He has hypertension for which he takes amlodipine daily. His blood pressure is 148/94 mm Hg. His creatinine level is 140 µmol/L (normal 70-120), and his urine protein-to-creatinine ratio is persistently elevated. You would like to prescribe ramipril, but he refuses to take any additional medication. Which one of the following is the best next step?

A. Inform the patient that he eventually may need dialysis if he refuses the medication.
B. Determine why the patient is refusing to take more medication.
C. Agree to stop the patient's amlodipine if he takes ramipril.
D. Explain to the patient the importance of preventing the progression of his chronic kidney disease.
E. Provide the patient with free samples of ramipril.

Answer: B

Explanation:
Respecting patient autonomy requires understanding their perspective before offering persuasion or incentives. The best next step is to explore the reason for non-compliance. This builds rapport and informs a shared decision-making process.
Toronto Notes 2023 - ELOM, Patient-Centered Communication:
"When a patient refuses recommended treatment, explore the reason behind the refusal before proceeding.
Shared decision-making is crucial."
MCCQE1 Objectives - ELOM > Communication and Consent:
"Candidates must demonstrate an ability to explore reasons for treatment refusal before counseling or modifying management." Options B and C may follow later. Options D and E can undermine appropriate pharmacologic care or violate ethics if not consented.

NEW QUESTION # 192
A 30-year-old woman presents to your office with a 6-week history of left lower quadrant pain and dyspareunia. A pelvic ultrasound is normal. Which one of the following is the most important immediate investigation?

A. Laparoscopy
B. Cervical swabs
C. Hysterosalpingography
D. Magnetic resonance imaging
E. Endometrial biopsy

Answer: B

Explanation:
This clinical presentation is highly suggestive of chronic pelvic inflammatory disease (PID), especially given the left lower quadrant pain and dyspareunia with a normal pelvic ultrasound. PID is often caused by sexually transmitted infections (STIs), such as Chlamydia trachomatis or Neisseria gonorrhoeae, which may not be evident on imaging.
Toronto Notes 2023 - Gynecology:
"Cervical swabs for N. gonorrhoeae and C. trachomatis are essential in the workup of suspected PID or cervicitis, even when imaging is normal. Dyspareunia and chronic pelvic pain with normal imaging should prompt testing for STIs." MCCQE1 Objectives (Obstetrics & Gynecology > 82-6: Pelvic Pain):
"Candidates must consider and investigate for infectious causes of pelvic pain, including PID, which requires cervical swab testing as an essential first-line investigation." Laparoscopy (A) is invasive and reserved for uncertain or refractory cases. Hysterosalpingography (C) is used in infertility workups, not acute pain. Endometrial biopsy (D) and MRI (E) are not first-line.

NEW QUESTION # 193
A same-sex couple asks to join a family physician's practice. The physician tells them that shedoes not treat same-sex couples and will refer them to a physician with more clinical experience with same-sex couples.
Which one of the following best describes the physician's obligation under the Canadian Charter of Rights and Freedoms?

A. No obligation to accept this couple because of her inexperience caring for same-sex patients.
B. No obligation to accept this couple, but does need to refer to a colleague who will.
C. An obligation to accept this couple as patients because physicians must treat all patients.
D. An obligation to accept this couple, as not doing so constitutes discrimination based on sexual orientation.
E. No obligation to accept this couple because of her right not to act in a manner contrary to her personal values.

Answer: D

Explanation:
Refusing care based on sexual orientation constitutes discrimination under the Canadian Charter of Rights and Freedoms and violates professional standards. Physicians must not deny care based on personal bias or prejudice.
Toronto Notes 2023 - ELOM, Equity in Care and Professionalism:
"Denying care based on sexual orientation violates both human rights legislation and professional obligations.
Physicians must ensure equitable access for all patients."
MCCQE1 Objectives - ELOM > Professionalism and Patient Rights:
"Candidates must act in accordance with patients' rights to equitable, non-discriminatory access to care regardless of race, gender, or sexual orientation." Referral (Option B) does not excuse discriminatory refusal. Personal discomfort or inexperience (Options D and E) do not justify discrimination.

NEW QUESTION # 194
A 63-year-old woman presents to your office with a history of progressive abdominal discomfort over the past five months. She reports bloating and difficult digestion with constipation. She has no urinary symptoms and denies vaginal or rectal bleeding. An abdominal ultrasound shows a large complex pelvic mass with internal multiloculation and moderate ascites. The cancer antigen 125 (CA 125) is elevated at 1023 U/mL (< 35 U
/mL). Which one of the following is the most likely diagnosis?

A. Rectosigmoid adenocarcinoma
B. Metastatic uterine adenocarcinoma
C. Serous carcinoma of the ovary
D. Ovarian hyperstimulation syndrome
E. Chronic hematosalpinx

Answer: C

Explanation:
Comprehensive and Detailed Explanation:
Postmenopausal women with abdominal distension, bloating, a complex pelvic mass, and elevated CA-125 are highly suggestive of epithelial ovarian cancer, especially serous cystadenocarcinoma-the most common type.
Toronto Notes 2023 - Gynecology / Oncology:
"Serous epithelial ovarian carcinoma presents with vague abdominal symptoms, ascites, complex pelvic mass, and elevated CA-125." MCCQE1 Objectives (Gynecology > 82-5: Ovarian Masses):
"Candidates must recognize signs and investigations of ovarian cancer, including elevated tumor markers and imaging findings." Ovarian hyperstimulation (A) occurs in fertility treatments. Colorectal cancer (C) may mimic these symptoms but typically causes rectal bleeding and has lower CA-125 levels. Uterine adenocarcinoma (D) usually causes bleeding. Hematosalpinx (E) presents with pelvic pain, not ascites.

NEW QUESTION # 195
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. These movements occur in the majority of patients who are taking antipsychotics
B. Anticholinergics are effective treatments for this condition
C. His condition is potentially irreversible
D. The symptoms will gradually decrease in intensity as he gets older

Answer: C

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 # 196
......

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