[2025] Pass Key features of MCCQE Course with Updated 232 Questions
MCCQE Sample Practice Exam Questions 2025 Updated Verified
NEW QUESTION # 30
A 52-year-old man presents to the Emergency Department with a history of back, neck, and shoulder pain sustained from a workplace incident 4 years ago. He is under observation by a multidisciplinary pain clinic, and his next appointment is not for another 4 weeks. He does not report any recent change in his symptoms.
His medications are as follows:
Acetaminophen
1000 mg orally 4 times daily
Naproxen
500 mg orally twice daily
Amitriptyline
25 mg orally at bedtime
* Acetaminophen 1000 mg orally four times daily
* Naproxen 500 mg orally twice daily
* Amitriptyline 25 mg orally at bedtime
The patient has not taken his medications for several weeks because he thinks they are not working. He requests a prescription for oxycodone because he tried some that a friend sold him, and it worked very well.
After completing an assessment and providing counseling, which one of the following is the best next step?
- A. Prescribe a short course of tramadol.
- B. Offer to prescribe cannabis.
- C. Obtain a urine toxicology screen.
- D. Provide a naloxone kit.
Answer: C
Explanation:
Given the request for opioids and history of non-prescribed opioid use (oxycodone obtained from a friend), the next appropriate step is to conduct a urine drug screen. This helps assess current substance use and guides safe prescribing decisions.
Toronto Notes 2023 - Pain Management and Addiction Medicine:
"Urine drug screening is recommended before initiating opioid therapy or when there is suspicion of substance misuse. A history of using non-prescribed opioids mandates assessment for opioid use disorder and further risk stratification." MCCQE1 Objectives - Internal Medicine > Chronic Pain:
"Candidates must assess for opioid misuse and dependence before initiating opioid therapy. Urine drug testing is a standard tool in this assessment." Providing naloxone (A) may be appropriate later if opioids are prescribed, but the priority is evaluation.
Cannabis (B) is not first-line and lacks controlled evidence in chronic pain. Tramadol (D) is an opioid-like agent and not appropriate until misuse risk is evaluated.
NEW QUESTION # 31
A 17-year-old boy is brought by his 2 roommates to the emergency department (ED) after a party where he had been drinking and smoking cannabis. He reportedly was having a good time when he suddenly wanted to jump out of a window. His roommates describe him as "normal prior to a breakup with his girlfriend a week ago." He has since become anxious and unable to sleep. On examination, he is somnolent and appears intoxicated. Which one of the following is the most appropriate initial management?
- A. Arrange for an involuntary admission to psychiatry.
- B. Call the patient's parents to take him home.
- C. Prescribe chlordiazepoxide and start an intravenous line.
- D. Observe the patient in the ED for several hours.
Answer: A
Explanation:
This adolescent exhibited acute suicidal behavior (attempted to jump out of a window), which is a psychiatric emergency. Regardless of intoxication or cause, such behavior mandates a safety-first approach: involuntary psychiatric assessment and protection from self-harm.
Toronto Notes 2023 - Psychiatry, "Suicide and Crisis Intervention" Section:
"Involuntary psychiatric admission is indicated when a patient poses a danger to themselves or others.
Suicidal ideation or attempts require immediate evaluation and monitoring." MCCQE1 Objectives (Psychiatry > 79-2: Suicide and Risk Management):
"Candidates must identify suicidal behavior and initiate appropriate action, including involuntary admission if necessary for safety." Observation (B) may miss the window for action. Parents (A) should be contacted but are not a substitute for admission. Chlordiazepoxide (C) is not first-line in this scenario.
NEW QUESTION # 32
A 68-year-old man with a history of diabetes, hypertension, delirium tremens, and tobacco addiction comes to the Emergency Department with his daughter. She tells you that his behavior has become unmanageable and she feels he may require an increased level of care. His vital signs are:
Blood pressure: 162/105 mm Hg
Heart rate: 112/min, regular
Temperature: 37.8°C
On history, his daughter explains she had to confiscate a half-empty bottle of alcohol from his room yesterday. He is now convinced that there are bugs crawling all over him and he will not relax. He appears pale, sweaty, and shaky. His most recent blood glucose is 7.8 mmol/L (3.8-11.1). Which one of the following is the best next step?
- A. Provide the family member with a prescription of antipsychotics for the patient.
- B. Consult a Geriatric Psychiatrist to assess the patient.
- C. Administer benzodiazepines and intravenous hydration.
- D. Interview the patient in private to ensure this is not a case of elder abuse.
Answer: C
Explanation:
The presentation is consistent with acute alcohol withdrawal with delirium tremens: autonomic instability, agitation, visual hallucinations (formication), and recent alcohol reduction. This is a medical emergency requiring immediate treatment with benzodiazepines and supportive care.
Toronto Notes 2023 - Psychiatry, Substance Use Disorders:
"Delirium tremens is a life-threatening complication of alcohol withdrawal. Clinical features include agitation, hallucinations, tachycardia, hypertension, and diaphoresis. Management includes high-dose benzodiazepines and IV fluids." MCCQE1 Objectives - Psychiatry > Substance Use Disorders:
"Candidates must recognize and treat alcohol withdrawal delirium promptly with benzodiazepines and supportive measures." Antipsychotics (B) are not first-line in withdrawal states. Private interviews (A) and psychiatric consults (D) delay life-saving treatment.
NEW QUESTION # 33
You are called to attend an 18-year-old woman, gravida 2, para 1, aborta 0, who is in precipitous labour. She did not realize she was pregnant and has not had any prenatal care. After the delivery, you examine the newborn boy; he is vigorous, and it appears that he was born at full term. Physical examination findings of the newborn are normal. Review of the prenatal record from the mother's last pregnancy shows the following:
* HIV: Negative
* Hepatitis B surface antibody: Positive
* Hepatitis C: Negative
* Syphilis serology: Negative
The mother's previous child was placed in foster care. The mother is withdrawn and uncommunicative after delivery. Which one of the following is the best next step?
- A. Administer hepatitis B vaccine to the newborn
- B. Initiate feeding with donor breast milk
- C. Collect urine from the newborn for a drug screen
- D. Recommend immediate skin-to-skin care
Answer: C
Explanation:
Given the lack of prenatal care, the mother's withdrawal, and prior involvement of child protection services, a newborn drug screen is warranted to assess for possible in utero exposure. This is part of the safety assessment.
Toronto Notes 2023 - Pediatrics, Newborn Assessment:
"Infants born to mothers with no prenatal care or prior social concerns should undergo a full newborn screening, including toxicology if indicated." MCCQE1 Objectives - Pediatrics > Newborn Care and Social Issues:
"Candidates must identify social risk factors and initiate appropriate newborn evaluations, including toxicology screens when substance use is suspected." The mother was previously immune to hepatitis B, so (A) is not immediately required. Skin-to-skin care (D) is beneficial but secondary to screening in this context. Donor milk (B) is not indicated unless breastfeeding is contraindicated.
NEW QUESTION # 34
A 78-year-old man presents to the Emergency Department with chest pain. His electrocardiogram and blood work confirm an acute myocardial infarction. He is admitted to the Intensive Care Unit. Three days later, he develops right-sided abdominal pain. An ultrasonogram reveals an inflamed gallbladder with no evidence of stones. He does not improve after 48 hours of antibiotics. Which one of the following is the best next step?
- A. Broaden antibiotic therapy
- B. Arrange for percutaneous cholecystostomy
- C. Arrange for endoscopic retrograde cholangiopancreatography
- D. Send for laparoscopic cholecystectomy
- E. Send for hepatobiliary iminodiacetic acid (HIDA) scan
Answer: B
Explanation:
This presentation is consistent with acute acalculous cholecystitis, often seen in critically ill or post-MI patients. If unresponsive to antibiotics, percutaneous cholecystostomy is the preferred next step in those who are poor surgical candidates.
Toronto Notes 2023 - General Surgery, "Hepatobiliary Disorders" Section:
"Acalculous cholecystitis occurs in critically ill patients and is often managed with percutaneous cholecystostomy if the patient is not a candidate for surgery." MCCQE1 Objectives (Surgery > 84-3: Biliary Disease):
"Candidates must be able to diagnose and manage acalculous cholecystitis. Management includes antibiotics and drainage via percutaneous cholecystostomy in unstable patients." Laparoscopic cholecystectomy (C) is standard but not suitable in acutely ill ICU patients. Broadening antibiotics (A) alone is insufficient after failure of initial therapy. ERCP (B) is for biliary obstruction or cholangitis. HIDA scan (E) is diagnostic, not therapeutic.
NEW QUESTION # 35
A 54-year-old woman presents to your office to discuss breast cancer screening. She is asymptomatic with no history of breast cancer. She had a fibroadenoma removed when she was 24 years old. The patient is not on any medications. Her family history is significant for a great-aunt with breast cancer. The patient has not had genetic testing but had normal breast screening 2 years ago. Which one of the following is the best next step?
- A. Reassurance.
- B. Monthly self-breast examination.
- C. Breast magnetic resonance imaging.
- D. Mammography.
- E. Positron emission tomography scan.
Answer: D
Explanation:
According to Canadian guidelines, women aged 50 to 74 at average risk for breast cancer should undergo routine screening mammography every 2 to 3 years. A great-aunt with breast cancerdoes not raise this patient's risk to high. Mammography is appropriate as she is now due for the next screen.
Toronto Notes 2023 - Population Health, "Screening Guidelines" Section:
"Routine mammography is recommended every 2 years for average-risk women aged 50 to 74. Family history in second-degree or more distant relatives (e.g., great-aunt) does not qualify for high-risk screening or MRI." MCCQE1 Objectives (Population Health > 97-5: Screening and Prevention):
"Candidates should apply Canadian screening recommendations including mammography for average-risk women #50 years old." Self-breast exams (C) are not recommended for screening. PET scan (D) and MRI (E) are reserved for high- risk populations or diagnostic clarification.
NEW QUESTION # 36
An intoxicated 28-year-old man is brought to the Emergency Department after being found in the snow. His vital signs are as follows:
Temperature: 33°C
Respiratory rate: 22/min
Heart rate: 123/min
The patient is shivering and displays some dysarthria and ataxia. After his wet clothing is removed, he is provided with a warm blanket. The results of the subsequent physical examination are unremarkable, except for frostbite of the ears and fingers. Which one of the following is the best next step?
- A. Apply heating pads to extremities.
- B. Start continuous arteriovenous rewarming.
- C. Set the room temperature to 28°C.
- D. Perform a peritoneal lavage.
- E. Continuous warm bladder irrigation.
Answer: C
Explanation:
This patient is experiencing mild hypothermia (32-35°C), evidenced by shivering, ataxia, and tachycardia.
First-line management includes passive external rewarming - removing wet clothing, providing warm blankets, and ensuring a warm environment (ambient temperature ~28°C).
Toronto Notes 2023 - Emergency Medicine, Environmental Injuries:
"Mild hypothermia (32-35°C): Treatment includes passive rewarming (warm blankets, warm environment).
Avoid active rewarming methods to extremities due to risk of afterdrop." MCCQE1 Objectives - Internal Medicine > Environmental Exposure:
"Candidates must recognize appropriate levels of hypothermia and select evidence-based rewarming strategies based on severity." Options A, C, and D are used in moderate to severe hypothermia (<32°C or unconscious patients). Heating pads (B) may cause tissue damage, especially with frostbite.
NEW QUESTION # 37
A 2-year-old boy is brought by his parents to your clinic because of sudden onset of high fever, refusal to drink, and drooling. Examination reveals cervical lymphadenopathy as well as multiple ulcers on the inner lips, tongue, and gums. Which one of the following is the most likely diagnosis?
- A. Hand-foot and mouth disease
- B. Infectious mononucleosis
- C. Kawasaki disease
- D. Acute epiglottitis
- E. Herpetic gingivostomatitis
Answer: E
Explanation:
Primary herpetic gingivostomatitis caused by HSV-1 is common in toddlers. It presents with high fever, irritability, drooling, refusal to eat, and painful oral ulcers on the lips, gums, and tongue. Cervical lymphadenopathy is common.
Toronto Notes 2023 - Pediatrics, "Infectious Conditions in Children":
"Primary HSV-1 infection in children presents with high fever, cervical lymphadenopathy, and painful oral ulcers (gingivostomatitis)." MCCQE1 Objectives (Pediatrics > 75-2: Infectious Diseases):
"Candidates must recognize viral exanthems and enanthems, including herpetic gingivostomatitis, based on clinical findings." Kawasaki (A) includes conjunctivitis, strawberry tongue, and extremity changes. Epiglottitis (B) presents with drooling but without oral ulcers. Mono (C) lacks the ulcerative pattern. Hand-foot-mouth (D) affects palms and soles, not inner lips and gums predominantly.
NEW QUESTION # 38
A 66-year-old woman suffering from a progressive neurological disease is admitted to a long-term care centre. Her husband does not wish to participate in discussions about the seriousness of his wife's disease and is convinced that she will soon come back home. During his 2nd visit to the centre, he gives you a cheque for a substantial sum made out to you, the treating physician, for your own research. Which one of the following is the best response to your patient's husband?
- A. Suggest he donate to your medical group
- B. Inform him you would only be able to accept a smaller amount of money
- C. Refer the husband to the centre's social worker
- D. Decline to accept the cheque
- E. Accept the money as a contribution to the long-term care centre's fundraising campaign
Answer: D
Explanation:
Comprehensive and Detailed Explanation:
Physicians must avoid conflicts of interest and maintain professional boundaries with patients and their families. Accepting a personal financial gift, regardless of intent, is inappropriate and unethical.
Toronto Notes 2023 - Ethics and Professionalism:
"Personal gifts of significant value from patients or families should be declined to avoid real or perceived conflicts of interest." MCCQE1 Objectives (ELOM > 90-3: Professionalism and Boundaries):
"Candidates must maintain ethical boundaries and refuse financial incentives that could compromise or appear to compromise clinical judgment." Other options (A, B, E) still involve a conflict. D is helpful, but the ethical obligation is to decline the cheque directly.
-
NEW QUESTION # 39
A 24-year-old woman has had several episodes of left lower lobe pneumonia. She has a chronic productive cough with occasional blood-streaked sputum. Physical examination is normal except for rales at the left base.
Chest radiograph shows a linear infiltrate in this area. Which one of the following is the most likely diagnosis?
- A. Pulmonary tuberculosis
- B. Bronchiectasis
- C. Mitral stenosis
- D. Chronic bronchitis
- E. Pulmonary infarction
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
Bronchiectasis is characterized by recurrent localized pneumonia, chronic productive cough, and hemoptysis.
A linear infiltrate that persists in the same area suggests localized airway damage-typical of bronchiectasis.
Toronto Notes 2023 - Respirology:
"Bronchiectasis presents with recurrent infections in the same location, productive cough, and hemoptysis.
Chest X-ray may show linear opacities; high-resolution CT is diagnostic." MCCQE1 Objectives (Respiratory > 45-1: Chronic Respiratory Symptoms):
"Candidates must investigate recurrent pneumonias and consider bronchiectasis, especially if localized." Chronic bronchitis (A) presents bilaterally. Mitral stenosis (B) may cause hemoptysis but not localized infiltrates. TB (E) usually affects upper lobes. Infarction (C) is acute and not recurrent.
NEW QUESTION # 40
A 27-year-old woman presents with an enlarged thyroid. She had not noticed it herself until her mother brought it to her attention. She is asymptomatic from an endocrine perspective, and her serum thyroid- stimulating hormone (TSH) is normal.
Which one of the following is the most appropriate next step?
- A. Computed tomography of the neck
- B. Serum T3 and T4
- C. Ultrasound of the thyroid
- D. Serum calcium
- E. Fine-needle aspiration of the thyroid
Answer: C
Explanation:
In a euthyroid patient with an asymptomatic goiter or thyroid enlargement, the next step is a thyroid ultrasound to evaluate nodule size, composition, and features suggestive of malignancy.
Toronto Notes 2023 - Endocrinology, Thyroid Nodules and Goiter:
"TSH should be obtained first. If normal and there is a palpable mass or enlargement, ultrasound is indicated to evaluate for nodules and guide further testing (e.g., FNA)." MCCQE1 Objectives - Internal Medicine > Endocrinology:
"Candidates must use thyroid ultrasound as the initial imaging study in the evaluation of thyroid enlargement or palpable nodules." T3/T4 (A) are not needed with normal TSH. FNA (D) is done if nodules are identified. CT (C) is used for retrosternal goiters or compressive symptoms. Calcium (E) is irrelevant here.
NEW QUESTION # 41
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. Diagnosis
- B. Physiotherapist's evaluation
- C. Treatment options
- D. Required workplace accommodations
- E. Medical imaging results
Answer: D
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 # 42
A 28-year-old woman presents to the office in great distress because she has no money for groceries or rent.
She is a single mother of a 7-year-old girl. She has a history of gambling disorder. She has felt unable to cope for the last 3 months and has started gambling again. Today, she is crying, and she shares that her boyfriend became violent with her yesterday. Which one of the following is the highest priority for assessment?
- A. Determine the risk of violence to the patient and her child.
- B. Define the extent of the patient's gambling disorder.
- C. Investigate the patient's need for financial assistance.
- D. Screen for recreational drug and alcohol use.
- E. Evaluate for depression.
Answer: A
Explanation:
The highest priority is the immediate safety of the patient and her child. In the presence of domestic violence, risk assessment for harm or neglect must be conducted urgently, particularly since a child may be at risk.
Safety trumps psychiatric or social evaluations in triage.
Toronto Notes 2023 - Psychiatry, "Crisis and Risk Assessment" Section:
"When intimate partner violence (IPV) is disclosed, it is critical to assess immediate safety and consider mandatory reporting, especially when children are involved." MCCQE1 Objectives (Psychiatry > 79-6: Violence and Abuse):
"Candidates must assess for and respond to risk of harm in situations of domestic violence, especially when dependents are involved. This includes ensuring immediate safety and following legal obligations for child protection." Although the other concerns (e.g., gambling, depression, substance use, financial need) are valid, the presence of violence makes D the first and most urgent priority.
NEW QUESTION # 43
An 18-year-old woman comes to the office because of fatigue. She tells you she is struggling in her first year of university. She mentions that she spends much of her time rewriting her notes and filing and organizing her study materials. She is doing all the work in her group assignments because she feels others cannot do the work to a high enough standard. She has abandoned all enjoyable activities and seems to be constantly working and worrying about her grades. Which one of the following is the most likely diagnosis?
- A. Major depressive disorder.
- B. Generalized anxiety disorder.
- C. Obsessive-compulsive disorder.
- D. Obsessive-compulsive personality disorder.
Answer: D
Explanation:
This patient exhibits perfectionism, preoccupation with order and control, and reluctance to delegate - classic features of obsessive-compulsive personality disorder (OCPD). Unlike OCD, there are no intrusive thoughts or compulsions; rather, behaviors are ego-syntonic.
Toronto Notes 2023 - Psychiatry, Personality Disorders:
"OCPD is marked by perfectionism, rigidity, and preoccupation with productivity. It differs from OCD in lacking obsessions or compulsions." MCCQE1 Objectives - Psychiatry > Personality Disorders:
"Candidates must distinguish OCPD by traits of excessive perfectionism, control, and inflexibility, particularly when these interfere with functioning." Major depression (A) is marked by pervasive low mood, which is not reported. OCD (B) involves distressing obsessions and compulsions. GAD (C) is more generalized worry without the perfectionism and rigidity.
NEW QUESTION # 44
A 32-year-old man presents to the clinic for assessment of a dog bite sustained 3 days ago while traveling in another country. He recalls having seen the dog eat where he was staying, and the animal did not appear well.
On examination, the patient has 2 distinct deep puncture wounds on his left leg. There is an erythematous border but no exudate. He is unsure of his immunization status. Which one of the following is the most appropriate management?
- A. Irrigate the wounds with hydrogen peroxide
- B. Give rabies immunoglobulin and vaccine
- C. Start antibiotic treatment with ciprofloxacin
- D. Arrange for wound debridement
- E. Order serum creatine kinase
Answer: B
Explanation:
Dog bites from animals of unknown rabies status, especially from endemic regions and in patients with uncertain immunization status, require immediate post-exposure prophylaxis (PEP) including both rabies immunoglobulin and vaccine. The decision is urgent given the fatal nature of rabies.
Toronto Notes 2023 - Infectious Diseases, "Rabies Exposure":
"Rabies PEP is indicated for bites from animals with unknown vaccination status or those showing abnormal behavior, particularly in endemic regions. PEP includes both vaccine and immunoglobulin." MCCQE1 Objectives (Public Health > 64-1: Rabies and Animal Bites):
"Candidates must recognize indications for rabies post-exposure prophylaxis." Ciprofloxacin (C) is not the antibiotic of choice (amoxicillin-clavulanate is preferred). Hydrogen peroxide (E) can be cytotoxic. Debridement (B) and CK (D) are not immediate priorities here.
NEW QUESTION # 45
A 31-year-old man presents to the office with concerns about his heart. Three months ago, his father died of a myocardial infarction at age 58 years. He states that since the death of his father, he has experienced episodes in which his heart will start racing, causing him to feel short of breath, dizzy, and nauseous. He is afraid that he will die during these episodes. Findings from a physical examination, electrocardiogram, Holter monitoring, echocardiogram, and complete blood count are normal. Serum electrolyte level, troponin level, and thyroid function studies are all within normal limits. Which one of the following options is the most appropriate?
- A. Metoprolol
- B. Grief therapy
- C. Lorazepam at bedtime
- D. Cardiac stress test
Answer: B
Explanation:
This patient presents with panic-like somatic symptoms triggered by bereavement. Normal investigations rule out cardiac pathology. Grief therapy is appropriate as the underlying stressor is unresolved grief and anxiety.
Toronto Notes 2023 - Psychiatry, Grief and Anxiety Disorders:
"Bereavement-related anxiety and somatization are common. Grief counseling can help reduce somatic and psychological symptoms when medical causes are ruled out." MCCQE1 Objectives - Psychiatry > Anxiety and Bereavement:
"Candidates should recognize psychological sequelae of grief, including panic and health anxiety, and provide appropriate psychological support." Metoprolol (C) is not indicated without confirmed cardiac cause. Lorazepam (B) may offer short-term relief but does not address the underlying grief. Stress testing (A) is unnecessary with repeated normal investigations.
NEW QUESTION # 46
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. Explain to the patient that she is not terminally ill.
- B. Suggest a trial of home dialysis.
- C. Explore the reasons for the patient's request for MAID.
- D. Refer the patient to a psychiatrist.
- E. Inform the patient that she will need parental consent to be assessed for MAID.
Answer: C
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 # 47
A 33-year-old man with severe bacterial meningitis is intubated and unresponsive in the Intensive Care Unit.
If he receives immediate treatment, his prognosis is excellent. If he does not, he will likely die. Three years ago, the patient had Huntington disease diagnosed, but he has been asymptomatic since then. His advance directive, which was made before this hospitalization, states that he should be allowed to die if he contracts a life-threatening illness. His parents demand that he be treated for the meningitis. Which one of the following is the best next step?
- A. Ask for a current mental capacity assessment
- B. Do not provide any treatment other than comfort measures
- C. Initiate treatment, using the parents as substitute decision-makers
- D. Consult a second physician for an opinion on emergent treatment
- E. Order an electroencephalography
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
An advance directive is a legally binding document that outlines a competent person's preferences regarding future medical care. If the patient clearly stated a refusal of treatment in the event of a life-threatening condition, this directive must be followed, even if the patient is currently incapacitated and family disagrees.
Toronto Notes 2023 - Ethics and Law:
"Advance directives must be respected when valid, clear, and applicable. Substitute decision-makers cannot override them." MCCQE1 Objectives (ELOM > 90-4: Informed Consent and Advance Directives):
"Candidates must apply valid advance directives to guide care for incapacitated patients." B (parents as SDMs) is incorrect if an advance directive exists. A and D are irrelevant-capacity has already been documented. C is unnecessary when an advance directive is clear.
-
NEW QUESTION # 48
A 53-year-old man presents to the Emergency Department with a 3-week history of believing his neighbor is poisoning him by pumping gas through his home's air vent. He appears distracted, irritable, and is speaking very quickly. He has a family history of depression. Which one of the following is the most likely diagnosis?
- A. Psychotic disorder secondary to traumatic brain injury
- B. Delirium
- C. Malingering
- D. Bipolar I disorder
- E. Brief psychotic disorder
Answer: D
Explanation:
This man exhibits a classic manic episode with psychotic features: persecutory delusions, distractibility, pressured speech, irritability, and possible grandiosity. The chronicity and mood symptoms are most consistent with Bipolar I disorder.
Toronto Notes 2023 - Psychiatry, "Mood Disorders" Section:
"Bipolar I disorder is characterized by episodes of mania, often with psychotic features.Symptoms include grandiosity, decreased need for sleep, distractibility, and mood-congruent delusions." MCCQE1 Objectives (Psychiatry > 79-1: Mood Disorders):
"Candidates must recognize mania and differentiate from brief psychosis or organic causes." Delirium (A) is acute, fluctuating, and involves impaired attention. Malingering (B) requires external gain.
Brief psychotic disorder (C) resolves within 1 month. Brain injury-related psychosis (E) would require a supporting history or findings.
(Part 2 )
NEW QUESTION # 49
A 35-year-old maintenance worker presents to your office because he thinks he has been exposed to asbestos and is afraid of developing asbestosis. He has no respiratory symptoms and is a non-smoker. Which one of the following is the best next step?
- A. Ask him further about his work.
- B. Refer him to a respirologist.
- C. Provide reassurance, since he is asymptomatic.
- D. Order pulmonary function testing.
- E. Order a chest radiograph.
Answer: A
Explanation:
In any suspected occupational exposure, the first step is a detailed occupational history to assess the nature, intensity, and duration of the exposure. This determines whether surveillance or further testing is appropriate.
Toronto Notes 2023 - Respiratory Medicine, "Occupational Lung Diseases" Section:
"When a patient presents with concerns about exposure to occupational hazards such as asbestos, detailed history is essential. Ask about job tasks, duration of exposure, use of personal protective equipment, and prior workplace assessments." MCCQE1 Objectives (Population Health > 97-2: Environmental and Occupational Health):
"Candidates must be able to obtain a detailed environmental and occupational history and determine the risk of exposure before ordering investigations." Ordering a chest radiograph (B) or PFTs (E) without confirming meaningful exposure is premature. Referral to a specialist (D) and reassurance (A) come only after the exposure risk is assessed.
NEW QUESTION # 50
An 83-year-old woman presents to your office with a 2-day history of confusion. Her past medical history is significant for lung cancer, and she is being treated with radiation. On physical examination, she is euvolemic.
Her blood work reveals a serum sodium of 118 mmol/L (135-140) as compared with 134 mmol/L (8 days ago). Which one of the following will be most helpful in establishing the cause of her laboratory abnormality?
- A. Creatinine clearance
- B. Serum osmolality
- C. Urinalysis
- D. Urine sodium
- E. Parathyroid hormone-related peptide
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
Hyponatremia in a patient with lung cancer and euvolemia strongly suggests syndrome of inappropriate antidiuretic hormone secretion (SIADH), especially from small cell carcinoma. Serum osmolality is the best initial test to confirm hypotonic hyponatremia and distinguish true hyponatremia from pseudohyponatremia or other causes.
Toronto Notes 2023 - Endocrinology, "Hyponatremia":
"Serum osmolality helps classify hyponatremia as hypotonic, isotonic, or hypertonic. SIADH typically causes hypotonic hyponatremia in euvolemic patients." MCCQE1 Objectives (Endocrinology > 37-1: Electrolyte Disorders):
"Candidates must evaluate the type and cause of hyponatremia using clinical status and laboratory tests including serum osmolality." Urine sodium (B) is useful after confirming hypotonicity. PTHrP (E) is associated with hypercalcemia of malignancy, not hyponatremia. Urinalysis (A) and CrCl (D) are less directly informative.
NEW QUESTION # 51
The parents of a 12-year-old boy present to your clinic to discuss their son's submersion injury. The patient was seen in hospital for 6 months after being pulled unresponsive from a lake at his friend's house; he had been submerged for an estimated 20 minutes. After extended resuscitation and a 2-month stay in the intensive care unit, he remains in a persistent vegetative state but needs no respiratory or cardiac support. When evaluating the discharge from hospital, which one of the following is most appropriate?
- A. Continue intensive rehabilitation in the acute care hospital for the best chance of recovery
- B. Organize scheduled readmissions to hospital to provide the family with respite care
- C. Plan for a progressive return to school with a home caregiver
- D. Advocate for home care support so that the parents can care for their son safely at home
- E. Recommend placement in a palliative care facility
Answer: D
Explanation:
Comprehensive and Detailed Explanation:
The patient is in a persistent vegetative state and medically stable, meaning he does not need continued hospitalization. The goal is to provide appropriate long-term care in the least restrictive setting, typically at home with robust home care support services. This approach aligns with ethical care, family-centered goals, and medical appropriateness.
Toronto Notes 2023 - Pediatrics / Neurodevelopment & Chronic Care:
"Home care with appropriate medical and caregiver support is often the best setting for children with severe neurological impairments who are medically stable." MCCQE1 Objectives (Pediatrics > 77-5: Chronic Neurological Disorders):
"Candidates must assess discharge planning and coordinate home care support for children with long-term care needs." Palliative facility (B) is not appropriate unless end-of-life is imminent. School (C) is not feasible in this state.
Hospital readmission for respite (D) is not standard. Rehabilitation (E) has little utility in persistent vegetative state.
-
NEW QUESTION # 52
......
The New MCCQE 2025 Updated Verified Study Guides & Best Courses: https://actualanswers.pass4surequiz.com/MCCQE-exam-quiz.html