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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q144-Q149):

NEW QUESTION # 144
A 42-year-old man presents to your office with acute left knee pain and difficulty walking. He denies any trauma. He reports 2 painful episodes involving his right great toe in the last year. He smokes half a pack of cigarettes a day and drinks at least 3 beers daily. He has a temperature of 38.2°C and has a red, swollen and warm left knee. Which one of the following is the best next step?

A. Start indomethacin.
B. Order radiography of the knee.
C. Start acetaminophen.
D. Aspirate the knee joint.
E. Order blood cultures.

Answer: D

Explanation:
The patient presents with an acutely inflamed joint and fever, raising concern for septic arthritis. A history of gout does not exclude infection. The first and most urgent step in any monoarthritis with systemic signs (fever) is joint aspiration to assess for crystals, white cells, and organisms.
Toronto Notes 2023 - Rheumatology, "Monoarthritis":
"Always rule out septic arthritis in a hot, swollen joint, especially when fever is present. Joint aspiration is essential to differentiate infection from crystal arthropathy." MCCQE1 Objectives (Medicine > Rheumatology > 49-1):
"Candidates must identify red flags for septic arthritis and understand that arthrocentesis is the first step in diagnosis and management." Initiating NSAIDs or acetaminophen without diagnosis (C, D) can delay appropriate care. Radiographs (B) do not help differentiate gout from infection acutely. Blood cultures (E) may help, but aspiration is more diagnostic.

NEW QUESTION # 145
A 22-year-old woman is brought to the Emergency Department by her boyfriend, who says that she is experiencing a fentanyl overdose. She is unresponsive and cyanotic. She regains consciousness after naloxone is injected intravenously and demonstrates no further respiratory depression during 8 hours of observation.
She states that she is 22 weeks' pregnant and wants to stop using opioids. Which one of the following is the best next step?

A. Refer the patient for opioid use disorder counselling
B. Refer the patient for initiation of methadone
C. Prescribe medications for symptom control so that the patient can detoxify at home
D. Admit the patient for medically supervised detoxification

Answer: B

Explanation:
For pregnant patients with opioid use disorder, opioid agonist therapy with methadone or buprenorphine is the standard of care. Detoxification is not recommended in pregnancy due to increased risk of fetal distress, preterm labor, and relapse. Methadone reduces illicit opioid use and stabilizes both mother and fetus.
Toronto Notes 2023 - Addiction Medicine / Obstetrics:
"Methadone maintenance therapy is the treatment of choice for pregnant patients with opioid use disorder.
Detoxification is not advised during pregnancy due to relapse risk and potential harm to the fetus." MCCQE1 Objectives (Obstetrics > 80-3: Substance Use in Pregnancy):
"Candidates must manage opioid use disorder in pregnancy with evidence-based therapies, including referral for methadone or buprenorphine." Counselling alone (D) is insufficient as first-line therapy. Home detox (C) is unsafe. Inpatient detox (A) is not recommended in pregnancy.

NEW QUESTION # 146
A 24-year-old woman presents with rapidly increasing lower leg pain. Less than 24 hours ago, she fell off her bicycle and had some minor abrasions. On examination, she is in severe pain and appears anxious. Local examination of her leg reveals mild discoloration with marked tenderness but no swelling in her calf. Which one of the following is the most likely diagnosis?

A. Baker's cyst
B. Deep vein thrombosis
C. Necrotizing fasciitis
D. Plantaris rupture
E. Cellulitis

Answer: C

Explanation:
Comprehensive and Detailed Explanation:
Rapid progression of pain out of proportion to exam, systemic symptoms (anxiety), and skinchanges without major swelling are classic for necrotizing fasciitis-a surgical emergency. Discoloration and extreme tenderness should raise immediate concern.
Toronto Notes 2023 - Emergency Medicine / Surgery:
"Necrotizing fasciitis presents with severe pain, systemic toxicity, rapid progression, and early skin changes (discoloration). Pain out of proportion is a key clue." MCCQE1 Objectives (Emergency Medicine > 51-1: Soft Tissue Infections):
"Candidates must recognize necrotizing fasciitis and initiate urgent surgical consultation." Plantaris rupture (A) is benign and localized. DVT (B) is more gradual and often with swelling. Cellulitis (C) progresses more slowly and is less painful. Baker's cyst (D) causes posterior knee pain, not severe systemic illness.

NEW QUESTION # 147
A 19-year-old woman presents to the office. She is a new mother. She shares that she does not intend to vaccinate her son. Which one of the following is the best next step?

A. Provide education on the risks and benefits of vaccination.
B. Tell the patient you cannot follow her in your practice but will refer her to a colleague.
C. Explore with the patient her rationale for not vaccinating her child.
D. Ask to speak with the patient's parents.
E. Contact child protection services.

Answer: C

Explanation:
When encountering vaccine hesitancy, the first and most effective step is to open a non-judgmental conversation and explore the patient's reasons. This helps build trust and tailor subsequent education and counseling.
Toronto Notes 2023 - Public Health and Preventive Medicine, Immunization:
"Addressing vaccine hesitancy requires understanding parental concerns. Begin with open-ended questions to identify underlying beliefs and information gaps." MCCQE1 Objectives - Preventive Medicine > Immunization:
"Candidates must demonstrate effective communication with vaccine-hesitant parents, beginning with eliciting their rationale before providing evidence-based recommendations." Jumping to education (B) or punitive measures (C, D) may close communication. The patient is an adult; speaking with her parents (E) violates her autonomy.

NEW QUESTION # 148
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. Order pulmonary function testing.
C. Refer him to a respirologist.
D. Provide reassurance, since he is asymptomatic.
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 # 149
......

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Pass Guaranteed Quiz Medical Council of Canada - MCCQE - High-quality MCCQE Part 1 Exam Valid Exam Objectives

Reliable Medical Council of Canada MCCQE Test Pass4sure & MCCQE Passed

Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q144-Q149):

Pass Guaranteed 2025 Medical Council of Canada MCCQE –Valid Valid Exam Objectives

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