2026 Medical Council of Canada MCCQE High Hit-Rate Pdf Version

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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q188-Q193):

NEW QUESTION # 188
A 40-year-old woman presents to the Emergency Department with confusion and fever (38.5°C). She has a history of hypothyroidism managed with levothyroxine. Key findings include:
Blood pressure
114/78 mm Hg
Heart rate
85/min
Temperature
38.5°C
Hemoglobin
90 g/L123-157 g/L
Platelet count
25 × 10#/L130-400 × 10#/L
Peripheral blood film
Schistocytes present
Creatinine
200 #mol/L50-90 #mol/L

  • A. Human immunodeficiency virus
  • B. Cirrhosis
  • C. Idiopathic thrombocytopenic purpura
  • D. Acute myelogenous leukemia
  • E. Thrombotic thrombocytopenic purpura

Answer: E

Explanation:
This patient presents with fever, confusion, anemia with schistocytes, thrombocytopenia, and renal impairment - fulfilling the classic pentad of thrombotic thrombocytopenic purpura (TTP). TTP is a hematologic emergency requiring plasma exchange.
Toronto Notes 2023 - Hematology, "Microangiopathic Hemolytic Anemia" Section:
"TTP is a medical emergency. Features include MAHA, thrombocytopenia, renal failure, neurologic symptoms, and fever. Schistocytes on blood film are diagnostic." MCCQE1 Objectives (Internal Medicine > 76-7: Hematologic Disorders):
"Candidates must urgently recognize TTP and initiate emergent plasma exchange therapy." AML (B) does not present with schistocytes. HIV (C) can cause thrombocytopenia but not MAHA. ITP (D) causes isolated thrombocytopenia without anemia or schistocytes.


NEW QUESTION # 189
A 32-year-old primigravid woman is receiving magnesium sulfate for tocolysis. Her pregnancy is at 26 weeks' gestation. You suspect magnesium sulfate toxicity. Which one of the following is the first sign of magnesium sulfate toxicity?

  • A. Absent patellar reflexes
  • B. Tachycardia
  • C. Hypotension
  • D. Tachypnea
  • E. Oliguria

Answer: A

Explanation:
Magnesium sulfate toxicity is dose-dependent. The earliest and most sensitive clinical sign is theloss of deep tendon reflexes (especially patellar), which occurs before respiratory depression or cardiac changes.
Toronto Notes 2023 - Obstetrics Chapter:
"Toxicity from magnesium sulfate is progressive and typically presents first with loss of deep tendon reflexes.
Respiratory depression and cardiac arrest occur at higher serum levels. Regular monitoring of reflexes, respiratory rate, and urine output is essential." MCCQE1 Objectives (Obstetrics > 83-3: Preterm Labour and Tocolysis):
"The candidate must recognize early signs of magnesium sulfate toxicity including areflexia and respiratory depression." Tachycardia (B), hypotension (C), and tachypnea (D) are not typical early signs. Oliguria (E) may be a risk factor for accumulation but is not the first sign of toxicity.


NEW QUESTION # 190
A 45-year-old woman presents with a 2-week history of a sore left breast. It has become red and swollen. She was previously well, and her menstrual cycles are regular. She has no history of breast cancer, and she has no children. On examination, she has a red, tender, indurated area in her left breast that has only partially responded to oral antibiotics after 10 days. Which one of the following is the most appropriate next step?

  • A. Start nonsteroidal anti-inflammatory agents.
  • B. Perform a breast biopsy.
  • C. Change the oral antibiotic.
  • D. Proceed with incision and drainage.
  • E. Start intravenous antibiotics.

Answer: B

Explanation:
In a non-lactating woman with a partially responsive breast mass after antibiotics, inflammatory breast cancer must be ruled out. A breast biopsy (core or excisional) is indicated to assess for malignancy. Inflammatory breast cancer may mimic mastitis but does not improve with antibiotics.
Toronto Notes 2023 - Breast Disorders:
"In non-lactating women, persistent breast inflammation should raise suspicion for inflammatory breast cancer. If symptoms persist after antibiotic therapy, proceed with imaging and biopsy." MCCQE1 Objectives - Gynecology > Breast Disease:
"Candidates must differentiate between mastitis and inflammatory breast cancer and initiate appropriate investigations such as biopsy when response to antibiotics is incomplete." Options A, D, and E may be appropriate for a confirmed abscess or infectious cause, but further investigation is mandatory in this scenario. NSAIDs (C) are symptomatic but do not address the diagnostic concern.


NEW QUESTION # 191
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. Explore the reasons for the patient's request for MAID.
  • C. Suggest a trial of home dialysis.
  • D. Inform the patient that she will need parental consent to be assessed for MAID.
  • E. Refer the patient to a psychiatrist.

Answer: B

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 # 192
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. Perform a peritoneal lavage.
  • C. Set the room temperature to 28°C.
  • D. Start continuous arteriovenous rewarming.
  • 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 # 193
......

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