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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q57-Q62):

NEW QUESTION # 57
An otherwise healthy 43-year-old woman presents to your clinic for a left breast mass. Six months ago, she underwent a bilateral breast magnetic resonance imaging (MRI) after watching a television program on breast cancer prevention. An ultrasound-guided biopsy of a 1.5 cm massconfirmed, at the time, that she had fibroadenoma. The follow-up ultrasound now reveals a mass measuring 1.7 cm. Which one of the following is the best next step in the management of this patient?

A. Proceed with needle-localized left lumpectomy.
B. Order a MRI of both breasts to rule out anything else.
C. Reassure the patient and reassess in 12 months.
D. Administer prophylactic tamoxifen to decrease the risk of cancer.
E. Repeat the biopsy to confirm the diagnosis.

Answer: C

Explanation:
Fibroadenomas can grow slightly or fluctuate in size. A minimal increase (from 1.5 cm to 1.7 cm) over six months is clinically insignificant. No malignant features are reported, and the previous biopsy confirmed benign nature. Annual follow-up is appropriate.
Toronto Notes 2023 - Obstetrics and Gynecology, "Breast Disorders" Section:
"Fibroadenomas are benign breast masses that may slightly enlarge. Routine imaging follow-up at 6 to 12 months is appropriate for lesions with benign imaging and histology." MCCQE1 Objectives (Obstetrics and Gynecology > 82-3: Breast Mass):
"Candidates must distinguish between benign and suspicious masses and determine appropriate intervals for follow-up imaging." Repeat biopsy (A) or surgery (B) is unwarranted without suspicious change. MRI (C) is not needed in stable, benign lesions. Tamoxifen (D) is not used for fibroadenomas.

NEW QUESTION # 58
A 37-year-old man comes to the office for follow-up of his opioid use disorder. He receives opioid agonist treatment, including some take-home doses. At this follow-up visit, he reports some nonprescription opioid use since his last visit. Which one of the following is the best next step?

A. Slowly taper and discontinue the opioid agonist
B. Prescribe a cannabinoid
C. Taper the dosage of the opioid agonist
D. Increase the frequency of follow-up visits
E. Discontinue take-home doses

Answer: D

Explanation:
Nonprescription opioid use during opioid agonist therapy is not uncommon. The response shouldbe supportive and not punitive. Increasing the frequency of follow-up enhances monitoring, supports adherence, and prevents relapse.
Toronto Notes 2023 - Psychiatry, "Substance Use Disorders":
"Patients who relapse during opioid agonist treatment benefit from closer monitoring and increased support, including more frequent follow-up and psychosocial interventions." MCCQE1 Objectives (Psychiatry > 71-5: Substance Use and Addiction):
"Candidates must manage relapses in opioid use by optimizing follow-up and support, not by discontinuing or reducing therapy prematurely." Tapering or discontinuing therapy (A, E) risks destabilizing treatment. Removing take-home doses (B) may be warranted later but not first. Cannabinoids (D) are not first-line adjuncts.

NEW QUESTION # 59
A 42-year-old woman, gravida 2, para 2, aborta 0, comes to the office for the first time. She reports a 6-month history of thirst, urinary frequency, and recurrent vaginitis. Aside from a BMI of 28, her physical examination findings are unremarkable. She takes no medications. Which one of the following would support the most likely diagnosis?

A. Recent antibiotic use.
B. Dry eyes.
C. Family history of hypertension.
D. High-risk sexual behaviours.
E. Delivery of a macrosomic newborn.

Answer: E

Explanation:
This patient's symptoms of polyuria, polydipsia, and recurrent vaginitis are classic for type 2 diabetes mellitus (T2DM) . Recurrent vaginal candidiasis occurs due to glycosuria promoting yeast overgrowth. MCCQE objectives emphasize identifying risk factors and historical features supporting diabetes. A prior delivery of a macrosomic infant ( > 4000-4500 g) is strongly associated with gestational diabetes mellitus (GDM) , which significantly increases the future risk of developing T2DM. Therefore, a history of macrosomia supports undiagnosed or previous gestational hyperglycemia and increases suspicion for current diabetes.
High-risk sexual behaviors relate to sexually transmitted infections, not diabetes. Family history of hypertension is a cardiovascular risk factor but does not specifically support diabetes. Recent antibiotic use may predispose to candidiasis but would not explain polyuria and polydipsia. Dry eyes are more suggestive of autoimmune conditions (e.g., Sjogren syndrome).
Thus, prior delivery of a macrosomic newborn strengthens the likelihood that her current symptoms are due to type 2 diabetes mellitus.

NEW QUESTION # 60
A 32-year-old woman presents to your outpatient clinic with concerns regarding a 6-month history of both a pulsatile buzzing sound in her ears and headaches. There is no history of hearing loss, vertigo, ear pain, or discharge from the ears. There is a long-standing history of prolonged exposure to occupational noise. She has a BMI of 32. Otoscopic examination is unremarkable, and there are no neck masses present. You determine that the buzzing sound is synchronous with her radial pulse. Which of the following investigations should be ordered next?

A. Audiogram
B. Electroencephalography
C. C-reactive protein
D. Magnetic resonance imaging of the brain

Answer: D

Explanation:
Comprehensive and Detailed Explanation:
Pulsatile tinnitus synchronous with the pulse may be vascular in origin. The association with headaches and elevated BMI (a risk factor for idiopathic intracranial hypertension, IIH) warrants neuroimaging to assess for cerebral venous sinus thrombosis, vascular malformations, or raised intracranial pressure.
Toronto Notes 2023 - Neurology / ENT:
"Pulsatile tinnitus requires investigation for vascular causes including idiopathic intracranial hypertension.
MRI or MRV is the next step."
MCCQE1 Objectives (Neurology > 35-1: Headache and Tinnitus):
"Candidates must investigate pulsatile tinnitus with neuroimaging when vascular causes are suspected." Audiogram (A) is for hearing loss. EEG (C) is not useful for tinnitus. CRP (D) is irrelevant.

NEW QUESTION # 61
A 37-year-old woman diagnosed with schizophrenia comes to her family physician because she has been choking on her food lately. She has a history of mild spasmodic dysphonia. She was recently started on haloperidol for auditory hallucinations. Which one of the following is the best short-term management?

A. Arrange for an urgent laryngoscopy
B. Begin dantrolene
C. Start lorazepam
D. Provide reassurance
E. Change the haloperidol to quetiapine

Answer: E

Explanation:
Comprehensive and Detailed Explanation:
This patient is likely experiencing extrapyramidal symptoms (dysphagia/dystonia) due to haloperidol.
Switching to an atypical antipsychotic (like quetiapine), which has a lower risk of EPS, is appropriate.
Dysphagia in the context of antipsychotic use requires prompt medication review.
Toronto Notes 2023 - Psychiatry, "Antipsychotics and Extrapyramidal Effects":
"Dysphagia can be a sign of extrapyramidal side effects. Consider switching to an atypical antipsychotic with lower EPS risk." MCCQE1 Objectives (Psychiatry > 71-5: Antipsychotic Adverse Effects):
"Candidates must recognize and manage EPS, including drug-induced dysphagia." Dantrolene (C) is for neuroleptic malignant syndrome, not isolated dysphagia. Laryngoscopy (B) may be useful later but not first-line. Reassurance (D) is unsafe. Lorazepam (E) may help in dystonia but doesn't address the root cause.

NEW QUESTION # 62
......

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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q57-Q62):

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