[Sep 17, 2025] Latest MCCQE Part 1 MCCQE Actual Free Exam Questions
MCCQE Part 1 MCCQE Dumps Updated Practice Test and 232 unique questions
NEW QUESTION # 88
A 67-year-old man underwent his first endoscopy. He has long-term reflux and heartburn, treatedintermittently with antacids. Biopsies of the distal esophagus reveal Barrett epithelium. Which one of the following is most important in determining the frequency of surveillance endoscopy?
- A. Grade of dysplasia
- B. Stricture formation
- C. Family history of gastrointestinal malignancy
- D. Depth of intestinal metaplasia
- E. Length of Barrett segment
Answer: A
Explanation:
The most important factor in determining the surveillance interval in Barrett esophagus is the presence and grade of dysplasia (e.g., none, low-grade, high-grade). High-grade dysplasia requires more frequent monitoring or intervention due to the risk of progression to esophageal adenocarcinoma.
Toronto Notes 2023 - Gastroenterology, Barrett Esophagus:
"Surveillance intervals depend on histologic findings. No dysplasia: q3-5 years; low-grade: q6-12 months; high-grade: consider endoscopic resection or ablation." MCCQE1 Objectives - Internal Medicine > Gastroenterology:
"Candidates must identify the risk of progression in Barrett esophagus and apply appropriate surveillance strategies based on dysplasia." Length of the segment (A) may influence risk but not surveillance frequency alone. Other options (B, C, E) are less determinative.
NEW QUESTION # 89
A 24-year-old man presents to your clinic with a 6-month history of fatigue. On examination, he is pale. His BMI is 16, and his blood pressure is 92/58 mm Hg. Initial laboratory work shows the following:
* Creatinine: 64 µmol/L (49-93)
* Potassium: 3.0 mmol/L (3.5-5.1)
* Sodium: 138 mmol/L (136-146)
* TSH: 2.40 mIU/L (0.34-5.60)
* CBC: Normal
Which one of the following is the best next step?
- A. Consult gastroenterology
- B. Ask permission to discuss the patient's weight
- C. Advise increased caloric intake
- D. Refer the patient to the emergency department
Answer: B
Explanation:
This patient has clinical signs of an eating disorder - fatigue, low BMI, hypotension, and hypokalemia - likely secondary to nutritional deficiencies or purging. The first step is to sensitively explore the patient's perception of weight and body image. Effective management requires rapport and careful conversation.
Toronto Notes 2023 - Psychiatry, Eating Disorders:
"Approach patients with suspected eating disorders non-judgmentally. Begin with permission to discuss weight or body image. Screening tools like SCOFF can help guide further assessment." MCCQE1 Objectives - Psychiatry > Eating Disorders:
"Candidates must recognize signs of eating disorders and initiate a respectful and effective patient-centered discussion." Referring to the ED (B) is not urgent without hemodynamic instability. Advising caloric intake (C) bypasses assessment. GI referral (D) is not appropriate at this stage.
NEW QUESTION # 90
A 22-year-old woman presents to the office for episodic mood changes that her boyfriend has noticed. During such episodes, she cries suddenly, is irritable and sad, and withdraws from socializing. Which one of the following would be most useful in establishing a diagnosis?
- A. Mood journal.
- B. Interviewing the boyfriend alone.
- C. Trial of lorazepam.
- D. Personality testing.
- E. Urine drug screen.
Answer: A
Explanation:
A mood journal is a structured tool that allows the patient to record mood fluctuations, triggers, and timing. It is particularly helpful in identifying mood disorders such as premenstrual dysphoric disorder, bipolar disorder, or cyclothymia.
Toronto Notes 2023 - Psychiatry, Mood Disorders:
"Mood diaries are useful in identifying temporal patterns, such as menstrual cycle-linked mood changes, and in distinguishing between affective disorders." MCCQE1 Objectives - Psychiatry > Diagnostic Evaluation:
"Candidates should use clinical tools such as symptom diaries to assist in establishing the pattern and nature of psychiatric symptoms." Personality testing (A) is not first-line. Urine drug screen (B) is only indicated with suspicion of substance use. Lorazepam (D) treats symptoms, not diagnosis. Interviewing the boyfriend (E) may help, but only as a supplement to direct observation and self-report.
NEW QUESTION # 91
A 24-year-old nulligravid woman presents to the office with an absence of menstruation since discontinuing her oral contraceptives 8 months ago. She previously had a regular menstrual cycle when taking oral contraceptives for the past 10 years but stopped because of headaches, which have only gotten worse since.
She also noticed mild breast discharge for the past several months. Which one of the following examination findings is most likely?
- A. Abnormal visual field testing results
- B. Low BMI
- C. Nodular breast irregularities
- D. Presence of severe hirsutism
Answer: A
Explanation:
Comprehensive and Detailed Explanation:
This patient has secondary amenorrhea, galactorrhea, and worsening headaches-suggestive of hyperprolactinemia, possibly due to a pituitary adenoma (prolactinoma). Visual field defects (typically bitemporal hemianopia) can result from optic chiasm compression.
Toronto Notes 2023 - Endocrinology / Reproductive Health:
"Prolactinomas may cause amenorrhea, galactorrhea, headaches, and visual field defects. Evaluate with serum prolactin and visual field testing." MCCQE1 Objectives (Endocrinology > 37-2: Pituitary Disorders):
"Candidates must recognize clinical signs of prolactinomas and know when to assess visual fields." Hirsutism (D) suggests androgen excess. Low BMI (B) can cause hypothalamic amenorrhea but wouldn't explain galactorrhea. Nodular breast findings (A) are not related.
NEW QUESTION # 92
An 18-year-old man presents to your clinic with a history of intermittent, dull, achy pain on the left side of his scrotum, and he has now noted left scrotal enlargement. On examination, you note a swelling in the left scrotum when he is standing that disappears when he is supine. Which one of the following is the most likely diagnosis?
- A. Intermittent testicular torsion.
- B. Cryptorchidism.
- C. Hydrocele.
- D. Varicocele.
- E. Spermatocyte.
Answer: D
Explanation:
A varicocele is a dilatation of the pampiniform plexus that presents with a "bag of worms" appearance, worsens with standing, and improves when lying down. It is most common on the left side due to anatomical drainage differences.
Toronto Notes 2023 - Urology, Scrotal Disorders:
"Varicoceles often present with a dull, aching pain and scrotal swelling that worsens when upright and disappears when supine." MCCQE1 Objectives - Internal Medicine > Urology:
"Candidates must recognize and diagnose varicocele by physical exam findings and typical symptom history." Cryptorchidism (A) refers to undescended testes. Torsion (B) presents acutely with severe pain. Hydrocele (C) transilluminates and is not posture-dependent. "Spermatocyte" (D) is not a clinical diagnosis.
NEW QUESTION # 93
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. Start vaginal estrogen.
- B. Arrange for a hysteroscopy and endometrial biopsy.
- C. Prescribe vaginal metronidazole gel.
- D. Perform a vaginal biopsy.
- E. Wash the pessary and recommend a daily saline douche.
Answer: A
Explanation:
In elderly women with long-term pessary use and signs of vaginal atrophy (thin epithelium, bleeding, odor), local estrogen is the most appropriate initial treatment to restore the vaginal epithelium and reduce inflammation and discharge. Vaginal estrogen improves mucosal integrity and reduces complications like ulceration, infection, and bleeding.
Toronto Notes 2023 - Gynecology, "Pelvic Organ Prolapse and Pessary Care" Section:
"Local vaginal estrogen therapy is recommended for postmenopausal women with vaginal atrophy who are using pessaries. It reduces the risk of erosions, bleeding, and infection, especially when pessary follow-up has been suboptimal." MCCQE1 Objectives (Obstetrics and Gynecology > 82-9: Vaginal Bleeding in Postmenopausal Women):
"Candidates should recognize vaginal atrophy as a common and treatable cause of bleeding in elderly women using pessaries." A biopsy (E) may be needed if symptoms persist after atrophy is treated. Hysteroscopy (A) is invasive and not first-line in this setting. Metronidazole (B) is not indicated without evidence of bacterial vaginosis. Daily saline douching (D) is not recommended and may irritate atrophic mucosa.
NEW QUESTION # 94
A 60-year-old man has a strong family history of aortic aneurysms. Screening abdominal ultrasonography reveals an incidental <1 cm mass in his left kidney. Computed tomography confirms that the mass is consistent with renal adenocarcinoma. Which one of the following is the most appropriate step in management?
- A. Organize angiographic ablation of the renal mass
- B. Refer to radiation oncology
- C. Arrange magnetic resonance imaging of the abdomen
- D. Plan partial nephrectomy
- E. Repeat computed tomography in 6 months
Answer: D
Explanation:
Comprehensive and Detailed Explanation:
For small renal masses (<4 cm), partial nephrectomy (nephron-sparing surgery) is the standard of care in patients who are surgical candidates. It preserves renal function and provides oncologic control.
Toronto Notes 2023 - Urology / Oncology:
"Small renal tumors <4 cm should be treated with partial nephrectomy. Active surveillance or ablation may be alternatives in poor surgical candidates." MCCQE1 Objectives (Urology > 59-2: Renal Masses):
"Candidates must manage small renal tumors with nephron-sparing surgery when feasible." MRI (A) is unnecessary after CT confirmation. Radiation (B) is not first-line. Surveillance (D) may be appropriate for elderly or frail patients, not this one. Ablation (E) is for high-risk surgical patients.
-
NEW QUESTION # 95
A 62-year-old woman is referred to your clinic for evaluation of hypercalcemia. She has a history of hypertension and vitamin D deficiency. Her medications include hydrochlorothiazide and vitamin D supplements. Laboratory investigations are as follows:
* Calcium: 2.72 mmol/L (#)
* Phosphate: 0.9 mmol/L (#)
* Parathyroid hormone (PTH): 0.9 pmol/L (#)
* 25-hydroxy vitamin D: 80 nmol/L (normal)
Which one of the following is the best next step?
- A. Start calcitriol
- B. Refer for consideration of parathyroidectomy
- C. Order 24-hour urine calcium
- D. Switch to a different antihypertensive medication
- E. Order serum protein electrophoresis and urine for light chains
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
This patient has hypercalcemia with suppressed PTH, ruling out primary hyperparathyroidism. The differential includes malignancy-associated hypercalcemia, vitamin D intoxication, and medications. Given the low PTH and normal vitamin D level, malignancy (e.g., multiple myeloma) is a leading concern. Serum protein electrophoresis and urine for Bence-Jones proteins (light chains) are appropriate next steps.
Toronto Notes 2023 - Endocrinology, "Hypercalcemia":
"PTH-independent hypercalcemia should prompt investigation for malignancy. Multiple myeloma is a common cause in older adults-order SPEP and UPEP." MCCQE1 Objectives (Endocrinology > 37-1: Calcium Disorders):
"Candidates must investigate non-PTH mediated hypercalcemia, including consideration of multiple myeloma." A (urine calcium) helps in familial hypocalciuric hypercalcemia, but this is unlikely given low PTH. B (calcitriol) would worsen hypercalcemia. C is inappropriate because PTH is suppressed. D (changing HCTZ) may help, but malignancy must be ruled out first.
NEW QUESTION # 96
You have been asked to develop a program in your hospital for people who are at the highest risk of death by suicide. The hospital administrator asks you to describe the types of patients they should expect in the program. Which one of the following groups is the most likely prominent demographic?
- A. Patients of both sexes who have psychotic disorders
- B. Women aged 20 to 40 years who have cluster B personality disorders and experience relationship losses
- C. Men aged 50 to 70 years who have limited social supports and alcohol use disorder
- D. Women aged 14 to 20 years who have histories of being abused and who are experiencing financial hardships
- E. Men aged 11 to 20 years who have histories of juvenile delinquency and narcotic use
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
Middle-aged to older men with social isolation and substance use disorders (especially alcohol) are among the highest-risk groups for completed suicide. They are less likely to seek help and often use more lethal methods.
Toronto Notes 2023 - Psychiatry, "Suicide Risk Assessment":
"High-risk demographics include older men, social isolation, comorbid alcohol use, and chronic illness. These patients have the highest rates of completed suicide." MCCQE1 Objectives (Psychiatry > 71-1: Suicide Risk):
"Candidates must recognize epidemiologic risk factors for completed suicide, including demographics and comorbidities." Although women and youth have higher rates of suicidal ideation and attempts, men over 50 have the highest completion rates.
NEW QUESTION # 97
A 12-year-old boy initially presents with a 4-month history of left knee pain. He denies any obvious history of trauma, but he plays basketball frequently and notes his pain is worse after playing. On physical examination the patient has a prominent tibial tubercle, which is swollen and tender. There is full range of motion in the knee. A radiograph of the left knee reveals an ossicle anterior to the tibial tuberosity. Which one of the following is the most likely diagnosis?
- A. Patellar tendinitis
- B. Chondromalacia patellae
- C. Osteosarcoma
- D. Osteomyelitis
- E. Osgood-Schlatter disease
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
Osgood-Schlatter disease is a traction apophysitis of the tibial tubercle due to repetitive stress from the quadriceps during growth. It is common in active adolescents and presents with a tender, prominent tibial tuberosity and typical radiographic findings.
Toronto Notes 2023 - Pediatrics / MSK:
"Osgood-Schlatter disease presents with localized pain at the tibial tuberosity in adolescents involved in sports. X-ray may show ossicle or fragmentation." MCCQE1 Objectives (Pediatrics > 78-2: MSK Injuries and Overuse):
"Candidates must identify overuse syndromes like Osgood-Schlatter and distinguish from infections or malignancy." Osteomyelitis (A) is systemic. Osteosarcoma (B) causes deep pain, often at night. Chondromalacia (C) affects anterior knee and worsens with stairs. Patellar tendinitis (D) affects the inferior pole of patella, not tibial tubercle.
NEW QUESTION # 98
During an office visit, your 14-year-old patient requests a prescription for oral contraceptives. The province where you are working does not have a statutory age of consent. Which one of the following is the best next step?
- A. Advise her to return with her parents so that legal consent can be obtained.
- B. Determine her understanding of the medical issues before prescribing the pills.
- C. Give her the prescription and book a follow-up appointment.
- D. Notify child protective services because of the possibility of sexual abuse.
- E. Refuse to prescribe the pills because she is less than 18 years of age.
Answer: B
Explanation:
In Canada, a minor may consent to medical care if the physician believes they have the capacity to understand the nature, benefits, and risks. This is known as the "mature minor doctrine." Capacity is based on understanding, not age.
Toronto Notes 2023 - ELOM, "Consent and Capacity" Section:
"A minor may consent to treatment if they demonstrate sufficient maturity and understanding. It is the physician's responsibility to assess capacity prior to prescribing." MCCQE1 Objectives (ELOM > 99-3: Consent and Confidentiality):
"Candidates must assess the patient's ability to understand and make informed decisions, regardless of age." Prescribing without assessment (B) is premature. Reporting to child services (A) is only necessary if there are signs of abuse or coercion. Parental involvement (C) is not mandatory. Refusal based on age (E) contradicts legal and ethical practice.
NEW QUESTION # 99
A 20-year-old man is brought by a friend to the emergency department with an elevated temperature, generalized muscle rigidity, hypovolemia, a fluctuating level of consciousness, and impaired attention. The patient also may be responding to auditory hallucinations. The friend informs you that the patient overdosed with a prescribed medication. Which one of the following medications is most likely to cause these symptoms?
- A. Lamotrigine
- B. Lithium carbonate
- C. Risperidone
- D. Lorazepam
- E. Amitriptyline
Answer: C
Explanation:
This presentation is classic for neuroleptic malignant syndrome (NMS), a rare but life-threatening reaction to antipsychotic drugs (particularly dopamine antagonists like risperidone). Features include hyperthermia, rigidity, altered mental status, and autonomic instability.
Toronto Notes 2023 - Psychiatry, "Neuroleptic Malignant Syndrome":
"NMS is associated with antipsychotic use. Key features: hyperthermia, lead-pipe rigidity, altered consciousness, autonomic dysfunction. Elevated CK, leukocytosis often present." MCCQE1 Objectives (Psychiatry > 71-5: Adverse Effects of Psychotropics):
"Candidates must recognize and manage neuroleptic malignant syndrome and differentiate it from other drug toxicities." Amitriptyline (B) overdose causes anticholinergic symptoms. Lamotrigine (A) causes rash or seizures in toxicity. Lithium (D) leads to tremor, ataxia, and GI upset. Lorazepam (E) causes CNS depression, not rigidity or fever.
NEW QUESTION # 100
You are conducting a virtual appointment by voice-only call with a 68-year-old man regarding back pain.
When he answers, you ask for him by name and identify yourself and the clinic from which you are calling.
Which one of the following is the best next step?
- A. Establish the reason for the virtual care visit.
- B. Confirm the name of the patient's primary care provider.
- C. Ask for additional confirmation of the patient's identity.
Answer: C
Explanation:
Before proceeding with any virtual consultation, particularly by voice-only, it is essential to confirm the patient's identity beyond name alone - for example, by verifying date of birth or health card number. This protects privacy and ensures medical confidentiality.
Toronto Notes 2023 - ELOM, Virtual Care Section:
"Virtual care must begin by verifying patient identity using at least two identifiers (e.g., full name and date of birth) to prevent disclosure of personal health information to unintended individuals." MCCQE1 Objectives - Ethical, Legal, and Professionalism > Virtual Care:
"The candidate must confirm patient identity and consent before initiating any virtual medical encounter, especially when video is not available." Option A (reason for visit) should follow identity confirmation. Option B (confirming primary care provider) is irrelevant to identity verification.
NEW QUESTION # 101
A 61-year-old man presents to the office for follow-up of recent laboratory test results. He has hypertension for which he takes amlodipine daily. His blood pressure is 148/94 mm Hg. His creatinine level is 140 µmol/L (normal 70-120), and his urine protein-to-creatinine ratio is persistently elevated. You would like to prescribe ramipril, but he refuses to take any additional medication. Which one of the following is the best next step?
- A. Provide the patient with free samples of ramipril.
- B. Agree to stop the patient's amlodipine if he takes ramipril.
- C. Explain to the patient the importance of preventing the progression of his chronic kidney disease.
- D. Determine why the patient is refusing to take more medication.
- E. Inform the patient that he eventually may need dialysis if he refuses the medication.
Answer: D
Explanation:
Respecting patient autonomy requires understanding their perspective before offering persuasion or incentives. The best next step is to explore the reason for non-compliance. This builds rapport and informs a shared decision-making process.
Toronto Notes 2023 - ELOM, Patient-Centered Communication:
"When a patient refuses recommended treatment, explore the reason behind the refusal before proceeding.
Shared decision-making is crucial."
MCCQE1 Objectives - ELOM > Communication and Consent:
"Candidates must demonstrate an ability to explore reasons for treatment refusal before counseling or modifying management." Options B and C may follow later. Options D and E can undermine appropriate pharmacologic care or violate ethics if not consented.
NEW QUESTION # 102
A 42-year-old man presents with a history of fatigue and weight loss. He looks unwell, has a darker than usual complexion and his liver is enlarged. He is also found to have marked glycosuria. Which one of the following is the most useful diagnostic test?
- A. Serum ferritin
- B. Serum alpha-1 antitrypsin
- C. Serum amylase
- D. Hemoglobin A1c
- E. Serum cortisol
Answer: A
Explanation:
This presentation suggests hereditary hemochromatosis. Common features include hyperpigmentation ("bronze diabetes"), hepatomegaly, diabetes, fatigue, and elevated liver enzymes. Serum ferritin is a screening test for iron overload, and elevated levels support the diagnosis.
Toronto Notes 2023 - Endocrinology / Gastroenterology:
"Hemochromatosis presents with skin hyperpigmentation, hepatomegaly, diabetes, fatigue. Diagnosis begins with serum ferritin and transferrin saturation." MCCQE1 Objectives (Internal Medicine > Metabolic and Endocrine > 37-1):
"Candidates must investigate iron overload syndromes using ferritin and transferrin saturation." Cortisol (B) is for adrenal insufficiency. A1AT (C) is a liver disease cause but not typical here. Amylase (E) is for pancreatitis. A1c (A) would confirm diabetes but not the underlying cause.
NEW QUESTION # 103
A 32-year-old woman, gravida 0, comes to your office for contraception counselling, specifically about insertion of a levonorgestrel-releasing intrauterine device. She has a past history of breast cancer and is presently on tamoxifen. Which one of the following is the best advice for your patient?
- A. This device will increase her risk of future infertility
- B. She has a high risk of irregular bleeding following insertion
- C. It may increase her risk of breast cancer recurrence
- D. She will require pre-procedure antibiotics
- E. After consultation with her oncologist, she may choose this option
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
The levonorgestrel-releasing intrauterine device (LNG-IUD) is generally contraindicated in current or recent breast cancer due to the progestin component, but may be considered in selectpatients on tamoxifen, especially if non-hormonal options are unsuitable. Consultation with the oncologist is required to evaluate risks and benefits.
Toronto Notes 2023 - Gynecology, "Contraception in Special Populations":
"Levonorgestrel IUDs are generally avoided in patients with a history of hormone-sensitive cancers; however, decisions should be made collaboratively with oncology." MCCQE1 Objectives (Gynecology > 82-2: Contraception):
"Candidates must tailor contraceptive advice to patients with medical comorbidities, including cancer survivors." Irregular bleeding (A) is a common but not contraindicating side effect. No pre-procedure antibiotics (D) are typically needed. The IUD does not cause infertility (E). Risk of recurrence (C) is unconfirmed and must be individualized.
-
NEW QUESTION # 104
......
Verified MCCQE dumps Q&As - 100% Pass from PassLeader: https://examcertify.passleader.top/Medical-Council-of-Canada/MCCQE-exam-braindumps.html