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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q149-Q154):

NEW QUESTION # 149
A 31-year-old woman, gravida 4, para 3, aborta 0, presents at 8 weeks' gestation with scant vaginal bleeding and no abdominal pain. Her heart rate is 90/min and blood pressure is 100/70 mm Hg. A speculum examination reveals a closed cervix. The beta-human chorionic gonadotropin level is 300,000 IU/L. Which one of the following is the most likely diagnosis?

A. Incomplete abortion.
B. Tubal pregnancy.
C. Molar pregnancy.
D. Implantation bleeding.
E. Threatened abortion.

Answer: C

Explanation:
A molar pregnancy (gestational trophoblastic disease) is the most likely diagnosis because the #-hCG level is markedly elevated (300,000 IU/L) for an 8-week gestation, far exceeding typical levels for a normal intrauterine pregnancy. MCCQE objectives highlight that unusually high #-hCG-often accompanied by first- trimester bleeding-should raise strong suspicion for a hydatidiform mole. Bleeding is common due to abnormal trophoblastic proliferation and placental separation. A closed cervix does not exclude a molar pregnancy; it simply indicates that products of conception are not being expelled at the time of exam.
Ectopic (tubal) pregnancy more often presents with abdominal/pelvic pain and typically has lower or inappropriately rising #-hCG. Incomplete abortion usually features heavier bleeding, cramping, and an open cervix. Threatened abortion involves bleeding with a closed cervix but does not explain an extremely high #- hCG. Implantation bleeding occurs earlier (around the time of missed menses), not at 8 weeks, and would not be associated with very high #-hCG.

NEW QUESTION # 150
A 56-year-old man is admitted to hospital with pyelonephritis and started on intravenous antibiotics. On day 2 of his hospitalization, he continues to report right flank pain, but he is able to walk. His vital signs are as follows:
Temperature: 38.5°C
Blood pressure: 90/60 mm Hg
Heart rate: 105/min
The patient is mentating well but is concerned about his dog that is home alone due to his unexpected hospitalization. He requests to be released from hospital as he needs to make arrangements for his dog. Which one of the following is the best next step?

A. Discharge the patient, but ensure he signs an "Against Medical Advice" form.
B. Explain that his health is a priority and insist that he stay.
C. Offer to stop by his apartment on your way home, if he is agreeable to it and gives you the key.
D. Ensure he understands the risk and accept his decision to leave for a few hours while you hold his bed.
E. Change him to oral antibiotics, and finish his treatment as an outpatient.

Answer: D

Explanation:
The patient is alert and capable of making his own decisions. The most ethical and respectful approach is to ensure he understands the risks and accept his choice. Holding his bed maintains continuity of care. Forcing him to stay (C) or discharging him AMA (A) is inappropriate if he intends to return.
Toronto Notes 2023 - ELOM, Consent and Autonomy:
"Capable patients have the right to refuse or leave treatment. Physicians must ensure informed decision- making and maintain therapeutic rapport." MCCQE1 Objectives - ELOM > Capacity and Patient Autonomy:
"Candidates must respect a capable patient's right to leave care after informed discussion of risks and alternatives." Offering to enter his apartment (E) is inappropriate and unethical. Oral antibiotics (B) may not be clinically appropriate given hypotension.

NEW QUESTION # 151
A couple is diagnosed with primary infertility secondary to azoospermia. They are not interested in in vitro fertilization techniques, so you recommend insemination with a sperm donor. The male partner is hesitant. He thinks he might have difficulty accepting raising a child who is not biologically his. Which one of the following is the best next step?

A. Suggest transfer of care to another physician
B. Arranging a consultation with a psychologist
C. Tell the couple adoption is a better option
D. Recommend that the donor be a person who is known and significant to the couple
E. Propose a trial of ovulation induction with gonadotropins

Answer: B

Explanation:
When couples face infertility-related decisions-particularly involving donor insemination-psychosocial counseling is essential. A mental health consultation helps explore emotional concerns, expectations, and readiness for non-biological parenting.
Toronto Notes 2023 - Gynecology, "Infertility and ART":
"Psychological counseling is recommended for couples considering donor gametes to address emotional, ethical, and identity issues before proceeding." MCCQE1 Objectives (ELOM > Reproductive Ethics > 83-1):
"Candidates must understand the ethical and psychosocial considerations of assisted reproductive techniques and provide appropriate referrals." Suggesting adoption or switching care dismisses valid concerns (B, C). Ovulation induction (D) does not address azoospermia.

NEW QUESTION # 152
A surgical clinic would like to respond to the Truth and Reconciliation Commission of Canada: Calls to Action report. The clinic has implemented a mandatory cultural safety course for all employees and ongoing faculty development that includes teachings from Elders and Knowledge Keepers and teaching sessions about harm reduction, trauma-informed care, and antiracism. Which one of the following steps would further the clinic's goal of responding to this report?

A. Provide clinic information in the languages spoken by the community.
B. Display the cultural safety certificate in the waiting room.
C. Evaluate how the staff enjoyed the teaching session.
D. Include trauma disclosure on the clinic's intake form.

Answer: A

Explanation:
Providing information in the patient's own language is a concrete way to improve access, cultural safety, and communication - key recommendations in the Truth and Reconciliation Commission's Calls to Action. It moves beyond symbolic gestures and supports equitable care.
Toronto Notes 2023 - ELOM, "Indigenous Health and Cultural Safety" Section:
"Cultural safety includes removing language barriers, engaging with Elders, and using patient-centered practices that respect Indigenous values. Communication in the patient's first language improves trust and outcomes." MCCQE1 Objectives (ELOM > 99-2: Cultural Safety and Health Equity):
"Candidates must apply the principles of culturally safe care including removing barriers to access and effective communication, as highlighted in the Truth and Reconciliation Commission's Calls to Action." Evaluating session enjoyment (A) is not impactful. Certificates (C) are symbolic. Intake questions about trauma (D) must be done with appropriate context and safety - not as a formality.

NEW QUESTION # 153
A 26-year-old woman, gravida 1, para 0, aborta 0, presents to your office at 10 weeks' gestation to review the results of her antenatal blood work. She tested positive for hepatitis C. Which one of the following is most advisable to share with her regarding the risks to her and her unborn child?

A. She should terminate the pregnancy.
B. Pregnancy will increase her viral load.
C. It is safe to breastfeed.
D. She will likely develop hepatocellular carcinoma.
E. The infant will need to be treated with an antiviral.

Answer: C

Explanation:
For pregnant women with hepatitis C infection , vertical transmission risk is approximately 5-6% and is higher with high maternal viral load or HIV coinfection. However, MCCQE objectives emphasize that breastfeeding is not contraindicated in mothers with hepatitis C, as HCV is not transmitted through breast milk. Breastfeeding should only be temporarily avoided if there are cracked or bleeding nipples, which could expose the infant to blood.
Termination of pregnancy is not recommended solely due to hepatitis C infection. Pregnancy does not reliably increase viral load in a clinically significant way, and routine antiviral therapy during pregnancy is generally not recommended because current direct-acting antivirals are not yet standard in pregnancy. The infant does not automatically require antiviral treatment; instead, postnatal monitoring with HCV RNA testing and/or antibody testing at the appropriate age is recommended. While chronic hepatitis C increases long-term risk of cirrhosis and hepatocellular carcinoma, this is not an inevitable outcome.
Therefore, reassuring her that breastfeeding is safe is the most appropriate counselling point.

NEW QUESTION # 154
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