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[Hardware] MCCQE Exam Cram & MCCQE Certification Exam

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【Hardware】 MCCQE Exam Cram & MCCQE Certification Exam

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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q119-Q124):NEW QUESTION # 119
A 67-year-old man presents to the clinic because of elevated liver enzymes. He is asymptomatic.His medical history is significant for type 2 diabetes, which is being treated with metformin. On physical examination, he looks well. His blood pressure is 125/75 mm Hg, his heart rate is 80/min, and his BMI is 35. Findings of the remainder of the examination are normal. His blood work results are as follows:
* Platelet count: 170 × 10#/L (130-380)
* Creatinine: normal
* GGT: 75 µmol/L (49-93)
* ALT: 146 IU/L (15-85)
* AST: 101 IU/L (17-63)
* Bilirubin (total): 17 µmol/L (3-17)
* INR: 1.2 (0.9-1.2)
Which one of the following is the most likely diagnosis?
  • A. Hepatocellular carcinoma
  • B. Nonalcoholic steatohepatitis
  • C. Metformin effect
  • D. Acute hepatitis B infection
  • E. Carcinoma of the pancreas
Answer: B
Explanation:
The patient is obese (BMI 35), has type 2 diabetes, and shows a hepatocellular pattern of transaminitis (elevated ALT > AST). These are typical features of nonalcoholic steatohepatitis (NASH), the inflammatory subtype of nonalcoholic fatty liver disease (NAFLD).
Toronto Notes 2023 - Gastroenterology, NAFLD and NASH:
"NASH should be suspected in patients with metabolic syndrome, obesity, and type 2 diabetes, especially with elevated transaminases and normal bilirubin or INR." MCCQE1 Objectives - Internal Medicine > Hepatology:
"Candidates should recognize the clinical profile of NAFLD/NASH, particularly in asymptomatic patients with metabolic risk factors and isolated liver enzyme elevations." Acute hepatitis B (A) typically has higher ALT and symptoms. Pancreatic carcinoma (B) affects biliary enzymes or bilirubin. Metformin (D) does not elevate liver enzymes. HCC (E) would often present with systemic or localized symptoms and abnormal imaging.

NEW QUESTION # 120
An 85-year-old man is transferred from an acute care hospital to your long-term care (LTC) facility. He has a fever, fatigue, myalgia, and malaise. His test result is positive for influenza A virus. Two other residents and 1 LTC staff member have experienced the same symptoms. Which one of the following is the best next step to prevent further infections at the LTC facility?
  • A. Order symptomatic LTC staff to stay home.
  • B. Ask all visitors to wear a mask.
  • C. Enforce mandatory influenza vaccination for LTC staff.
  • D. Ensure that all visitors are immunized.
Answer: A
Explanation:
During an outbreak in a long-term care facility, prompt control measures include keeping symptomatic staff at home to prevent spread. Staff are often vectors of infection, and exclusion is a key public health intervention.
Toronto Notes 2023 - Infectious Diseases, "Infection Control and Prevention":
"During influenza outbreaks in institutional settings, exclusion of symptomatic staff is critical to controlling spread." MCCQE1 Objectives (Population Health > 63-2: Outbreak Management):
"Candidates must understand outbreak control, including staff exclusion, cohorting, and surveillance in congregate settings." Vaccination (B) is preventive but not immediately effective during an outbreak. Masking and visitor vaccination are supportive but secondary measures.

NEW QUESTION # 121
A 22-year-old woman, gravida 1, para 0, aborta 0, comes to the office at 10 weeks' gestation for her first prenatal visit. When you ask how she is doing, she becomes tearful and says she has had severe nausea and vomiting. She is not taking her prenatal vitamins regularly and feels very guilty about it. She is worried that she is harming the fetus. Which one of the following is the most appropriate management of this patient's case?
  • A. Suggest that she take cannabinoids 30 minutes before taking her prenatal vitamins
  • B. Refer her for counselling to manage her feelings of guilt
  • C. Tell her she should continue to take her prenatal vitamins daily regardless of nausea
  • D. Advise her to replace her vitamin with folic acid only until her nausea improves
  • E. Prescribe ginger tablets to be taken 4 times daily
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
Ginger is a first-line, evidence-based non-pharmacologic treatment for nausea and vomiting in pregnancy. It's well tolerated and effective. Addressing nausea will help her resume vitamin use and reduce distress.
Toronto Notes 2023 - Obstetrics, "Nausea and Vomiting in Pregnancy":
"Ginger 250 mg four times daily is safe and effective for mild to moderate nausea." MCCQE1 Objectives (Obstetrics > 80-1: Early Pregnancy Management):
"Candidates must treat nausea and vomiting in pregnancy using safe and effective options." Folic acid alone (A) is less effective than a full prenatal vitamin. B may help, but nausea should be addressed first. C lacks empathy for her symptoms. D (cannabinoids) is not recommended in pregnancy.

NEW QUESTION # 122
A 6-year-old boy is brought to the Emergency Department by his daycare provider because he has an injured left arm. Physical examination findings show a swollen left arm just below the shoulder and bruising around both knees and the upper right arm. Radiographs of the left arm show a fracture with early callus formation around the proximal humeral shaft. Which one of the following is the most important next step?
  • A. Inform the hospital social worker.
  • B. Inform child protection services.
  • C. Contact the child's parents.
  • D. Call the local police.
  • E. Question the child about what happened to him.
Answer: B
Explanation:
This presentation is classic for Zenker diverticulum, characterized by progressive dysphagia, regurgitation of undigested food, coughing, and halitosis due to food retention in a pharyngoesophageal pouch. Symptoms are chronic and episodic, often involving regurgitation hours after eating. MCCQE objectives emphasize selecting the safest and most appropriate diagnostic test. The best initial test is a barium swallow (contrast esophagram), which clearly visualizes the posterior outpouching above the upper esophageal sphincter.
Endoscopy is not the first step because there is a risk of perforation if a large diverticulum is present. pH monitoring and PPI trials are used for gastroesophageal reflux disease, which does not explain regurgitation of undigested food and halitosis. CT chest is unnecessary for diagnosis.
Therefore, a barium swallow is the safest and most informative investigation to confirm suspected Zenker diverticulum before considering surgical or endoscopic management.

NEW QUESTION # 123
A 62-year-old man (wealthy philanthropist) with emphysema from smoking and a 21-year-old woman (elementary teacher) with cystic fibrosis are both compatible matches for a lung transplant. Which criterion determines organ allocation?
  • A. The clinical severity of the patient's pulmonary disease.
  • B. The date the patient was placed on the waiting list.
  • C. The patient's value and contributions to society.
  • D. The patient has family members who rely on them for income.
  • E. Whether the underlying condition is due to self-induced illness.
Answer: A

NEW QUESTION # 124
......
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