MCCQE Medical Council of Canada MCCQE Part 1 Exam Free Practice Exam Questions (2025 Updated)

Scaphoid fractures are often radiographically occult on initial presentation and can present later with persistent pain and swelling in the anatomical snuffbox. They typically occur following a fall on an outstretched hand. If missed, they can lead to avascular necrosis.

Toronto Notes 2023 – Orthopedics, Wrist Injuries:

“Scaphoid fractures are the most common carpal fractures. X-rays may be negative early, so high suspicion requires immobilization and repeat imaging after 10–14 days.”

MCCQE1 Objectives – Surgery > Musculoskeletal Trauma:

“Candidates must recognize that some fractures, such as scaphoid, may not appear on initial imaging but require clinical suspicion and follow-up imaging or immobilization.”

Other options (B and C) are less likely without radiographic evidence. De Quervain tenosynovitis (D) presents with radial wrist pain unrelated to trauma and worsens with thumb movement.

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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.

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Comprehensive and Detailed Explanation:

In X-linked recessive disorders such as hemophilia A, carrier mothers (usually asymptomatic) have a 50% chance of passing the affected X chromosome to each son, who would then express the disease. Each daughter has a 50% chance of being a carrier but is generally not affected.

Toronto Notes 2023 – Genetics:

“X-linked recessive inheritance: Carrier mother has a 50% chance of having an affected son and a 50% chance of having a carrier daughter.”

MCCQE1 Objectives (Genetics > 61-1: Inheritance Patterns):

“Candidates must apply principles of X-linked inheritance to assess risk in offspring.”

If the mother is a known carrier (as inferred from having an affected son), the chance of a second affected boy is 50%.

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This patient is competent and capable of making his own health decisions. A DNR order and naming a substitute decision-maker apply only when a patient lacks capacity. The next step is to discuss the suspected diagnosis with the patient and explore his preferences.

Toronto Notes 2023 – ELOM, Consent and Capacity:

“Competent patients retain full decision-making authority. Substitute decision-makers are only engaged when the patient lacks capacity. DNR applies to resuscitation, not other medical decisions.”

MCCQE1 Objectives – ELOM > Capacity, Consent, Advance Directives:

“Candidates must recognize that capable patients should be directly involved in decisions. Substitute decision-makers are not invoked unless the patient is incapable.”

Option A implies a breach of confidentiality without permission. Option C is premature. Option D bypasses informed consent. Option E misinterprets the DNR’s scope.

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In elderly women with long-term pessary use and signs of vaginal atrophy (thin epithelium, bleeding, odor), local estrogen is the most appropriate initial treatment to restore the vaginal epithelium and reduce inflammation and discharge. Vaginal estrogen improves mucosal integrity and reduces complications like ulceration, infection, and bleeding.

Toronto Notes 2023 – Gynecology, “Pelvic Organ Prolapse and Pessary Care” Section:

“Local vaginal estrogen therapy is recommended for postmenopausal women with vaginal atrophy who are using pessaries. It reduces the risk of erosions, bleeding, and infection, especially when pessary follow-up has been suboptimal.”

MCCQE1 Objectives (Obstetrics and Gynecology > 82-9: Vaginal Bleeding in Postmenopausal Women):

“Candidates should recognize vaginal atrophy as a common and treatable cause of bleeding in elderly women using pessaries.”

A biopsy (E) may be needed if symptoms persist after atrophy is treated. Hysteroscopy (A) is invasive and not first-line in this setting. Metronidazole (B) is not indicated without evidence of bacterial vaginosis. Daily saline douching (D) is not recommended and may irritate atrophic mucosa.

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Comprehensive and Detailed Explanation:

Mid-cycle acute onset pelvic pain with localized adnexal tenderness in a reproductive-age woman suggests a hemorrhagic ovarian cyst, particularly a ruptured one. The hemodynamic parameters are stable, but elevated HR supports acute pain and possible blood loss.

Toronto Notes 2023 – Gynecology / Acute Pelvic Pain:

“Hemorrhagic ovarian cysts present with sudden unilateral pelvic pain, mid-cycle, with guarding and rebound tenderness. Ultrasound is key.”

MCCQE1 Objectives (Gynecology > 82-4: Acute Pelvic Pain):

“Candidates must recognize common causes of acute pelvic pain, including ovarian cysts.”

Diverticulitis (A) is rare in young women and usually LLQ. Appendicitis (B) is more likely RLQ. Adenomyosis (C) and endometriosis (D) cause chronic cyclical pain, not acute tenderness.

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This infant has evidence of urinary outflow obstruction on ultrasound. The most common cause in male infants is posterior urethral valves. Poor urinary stream is a hallmark symptom of bladder outlet obstruction in neonates.

Toronto Notes 2023 – Pediatrics, “Pediatric Urology” Section:

“Posterior urethral valves should be suspected in male infants with recurrent UTIs, hydronephrosis, and a weak urinary stream. Diagnosis is confirmed by voiding cystourethrogram.”

MCCQE1 Objectives (Pediatrics > 78-4: Urinary Tract Abnormalities):

“Candidates must identify congenital causes of urinary obstruction. Poor stream and hydronephrosis are classic features of posterior urethral valves.”

Crying with urination (E) is nonspecific. Hematuria (B) and malodorous urine (D) are common with infections. Circumcision (A) is unrelated.

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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.

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