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Medical Council of Canada MCCQE Part 1 Sample Questions:

1. A 58-year-old woman presents to your office with heavy vaginal bleeding. She has a history of type 2 diabetes and hypertension. Some active bleeding is visible on speculum examination. Ultrasound reveals an endometrial thickness of 12 mm. Endometrial biopsy shows complex hyperplasia with atypia. Which one of the following is the best next step?

A) Organize hysteroscopy
B) Obtain consent for dilatation and curettage
C) Prescribe topical progesterone
D) Arrange endometrial ablation
E) Refer for hysterectomy and bilateral salpingo-oophorectomy

2. A 58-year-old woman presents to your office with refractory bipolar I disorder. She is on the following medications: lithium carbonate, valproic acid, and olanzapine. She also takes acetaminophen for osteoarthritis and pantoprazole for gastroesophageal reflux. Lately, she has noticed she bruises very easily. Laboratory work displays a platelet count of 70 × 10#/L (normal 130-400). Which one of the following is most likely to induce this side effect?

A) Acetaminophen
B) Lithium carbonate
C) Olanzapine
D) Valproic acid
E) Pantoprazole

3. A 3-year-old boy is brought to the office because he is not using his right arm after a fall from a swing.
Radiographs reveal a new fracture and old healing fractures. The parents deny any previous injuries. In addition to providing care for the fracture, which one of the following is the best next step?

A) Advise the parents to better supervise the patient.
B) Refer the family to the social work department.
C) Investigate the patient to rule out metabolic or endocrine disorders.
D) Monitor the patient for future injuries.
E) Notify child protection services.

4. You are examining a newborn in the delivery room. He was born at full term by spontaneous vaginal delivery.
On examination, he is active, and his vital signs are within normal range. His head circumference is at the third percentile, with height and weight at the 10th percentile. Auscultation of his chest is clear with normal cardiovascular examination findings. The abdomen is protuberant with a liver edge palpable at 4 cm below the costal margin and mild splenomegaly. Which one of the following is the most likely diagnosis?

A) Cystic fibrosis
B) Cephalic molding
C) Lipid storage disease
D) Trisomy 21
E) Congenital viral infection

5. A 94-year-old woman with severe dementia is referred for vaginal bleeding and a persistent foul odour from the vagina. She lives in a long-term care facility. She has been using a ring pessary for the past 15 years. Her current pessary has not been replaced in 2 years. On examination, there is moderate vaginal atrophy. After removing the pessary, which one of the following is the best next step?

A) Perform a vaginal biopsy.
B) Arrange for a hysteroscopy and endometrial biopsy.
C) Start vaginal estrogen.
D) Wash the pessary and recommend a daily saline douche.
E) Prescribe vaginal metronidazole gel.

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