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The Medical Council of Canada Qualifying Examination Part 1 (MCCQE1) is a vital part of the journey to becoming a licensed physician in Canada. This comprehensive exam assesses knowledge, clinical skills, and professional behaviors required of physicians in Canada. To help you prepare for the MCCQE1, we have summarized key objectives and provided three sample questions with multiple-choice options.

Good luck!

Key MCCQE1 Objectives

The MCCQE1 covers a wide range of topics and clinical scenarios. Enhancing the proficiency of test-taking is crucial for aspiring physicians, as it complements their medical expertise. To excel in this examination, we recommend engaging in extensive practice with a diverse range of case scenarios. The more your practice the format of the test, the more likely you are to succeed!

It is important to be familiar with the different objectives as the questions are based directly off of these topics.

To view a full list of objectives, visit the official MCCQE1 site here.

MCCQE1 Practice Questions

Question 1: A 28-year-old female with a history of Crohn’s disease presents with a 5-day history of right lower quadrant pain, fever, and vomiting. Physical examination reveals tenderness, guarding, and rebound tenderness in the right lower quadrant. Laboratory findings include a leukocytosis of 18,000 cells/µL. What is the most appropriate diagnostic test to perform next?

A. Abdominal ultrasound

B. Abdominal CT scan with contrast

C. Barium enema

D. Colonoscopy

E. Magnetic resonance enterography (MRE)

Question 2: A 62-year-old male with a history of smoking presents with progressive dyspnea, chronic cough, and yellowish sputum production. Pulmonary function tests reveal an FEV1/FVC ratio of 0.68 and a significant bronchodilator response. Which of the following is the most likely diagnosis and initial pharmacological management?

A. Chronic obstructive pulmonary disease (COPD), inhaled short-acting bronchodilator

B. Asthma, inhaled corticosteroid and long-acting bronchodilator

C. Bronchiectasis, inhaled corticosteroid

D. Pulmonary fibrosis, pirfenidone

E. Pulmonary embolism, anticoagulation therapy

Question 3: A 54-year-old female with a history of hypertension presents with sudden onset of severe headache, nausea, vomiting, and neck stiffness. Her blood pressure is 185/110 mmHg. A non-contrast CT scan of the head is negative for any acute intracranial hemorrhage or mass effect. Which of the following is the most appropriate next step in the management of this patient?

A. Lumbar puncture

B. MRI of the brain

C. CT angiography of the head and neck

D. Administration of antihypertensive medications

E. Immediate neurosurgical consultation

Answer Key and Explanations:

Question 1:

Answer B. Abdominal CT scan with contrast

Explanation: The presentation and physical examination findings in this patient are suggestive of acute appendicitis, a common surgical emergency that requires prompt management. The laboratory findings of leukocytosis further support this diagnosis.

An abdominal CT scan with contrast is the most sensitive and specific imaging modality for the diagnosis of acute appendicitis. It can help to confirm the diagnosis, determine the location and size of the inflamed appendix, and identify potential complications such as perforation or abscess formation. Abdominal ultrasound can also be used in some cases, but it may not be as accurate in identifying appendiceal inflammation in adults as it is in children.

Barium enema and colonoscopy are not appropriate diagnostic tests for acute appendicitis as they involve visualization of the colon and rectum, which are not typically involved in this condition. Magnetic resonance enterography (MRE) may be useful in evaluating the extent and severity of Crohn’s disease in the small bowel, but it is not a first-line diagnostic test for acute appendicitis.

Question 2:

Answer A. Chronic obstructive pulmonary disease (COPD), inhaled short-acting bronchodilator

Explanation: The most likely diagnosis in this patient is A) Chronic obstructive pulmonary disease (COPD), and the initial pharmacological management should be an inhaled short-acting bronchodilator.

The patient’s history of smoking, progressive dyspnea, chronic cough, and sputum production are all suggestive of COPD, which is a common and progressive respiratory condition that is caused primarily by smoking. The pulmonary function tests reveal an FEV1/FVC ratio of 0.68, which is consistent with airflow limitation, and the significant bronchodilator response indicates that the patient is likely to benefit from bronchodilator therapy.

The initial pharmacological management of COPD involves the use of inhaled bronchodilators, such as short-acting beta-agonists (SABAs) or anticholinergics, to relieve bronchospasm and improve airflow. Inhaled corticosteroids may also be added to the treatment regimen for patients with more severe disease or frequent exacerbations.

Bronchiectasis may also present with chronic cough and sputum production, but it is typically associated with a productive cough that produces copious amounts of purulent sputum. Inhaled corticosteroids may be used in the management of bronchiectasis, but they are not the initial pharmacological therapy.

Pulmonary fibrosis is characterized by the progressive scarring of lung tissue, which results in irreversible loss of lung function. Pirfenidone is an antifibrotic medication that is approved for the treatment of idiopathic pulmonary fibrosis, but it is not indicated for the treatment of COPD.

Pulmonary embolism is a medical emergency that presents with acute-onset dyspnea, chest pain, and hemoptysis. Anticoagulation therapy is the primary treatment for pulmonary embolism, but it is not indicated in the management of COPD.

Question 3:

Answer A. Lumbar Puncture

Explanation: Based on the patient’s presentation and history, the most likely diagnosis is subarachnoid hemorrhage, which is a medical emergency that requires prompt management. The most appropriate next step in the management of this patient is A) Lumbar puncture.

A lumbar puncture can help to confirm the diagnosis of subarachnoid hemorrhage by detecting the presence of blood in the cerebrospinal fluid (CSF). If the lumbar puncture confirms the diagnosis, the patient should undergo further imaging studies, such as CT angiography or MRI of the brain, to determine the location and extent of the hemorrhage.

In the meantime, it is important to control the patient’s blood pressure to prevent re-bleeding and to provide symptomatic relief. Antihypertensive medications should be administered cautiously, as they can decrease cerebral perfusion and worsen outcomes in patients with subarachnoid hemorrhage. Therefore, antihypertensive medications should only be administered if the patient has severe hypertension (e.g. systolic blood pressure > 220 mmHg or diastolic blood pressure > 120 mmHg) or signs of end-organ damage.

Immediate neurosurgical consultation may be required if there is evidence of significant mass effect, hydrocephalus, or clinical deterioration despite medical management.

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