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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q276-Q281):

NEW QUESTION # 276
You are asked to see a 50-year-old man 2 hours after he underwent a laparotomy for gastric resection. Lab results are as follows:
pH
7.28 (7.35-7.45)
PaCO#
60 mm Hg (35-40)
PaO#
60 mm Hg (85-105) with 4 L/min via nasal prongs
Bicarbonate (HCO#)
24 mmol/L (24-30)
Which one of the following is most consistent with this clinical presentation?

Answer: A

Explanation:
This ABG reveals primary respiratory acidosis (#pH, #PaCO#, normal HCO#), likely from hypoventilation due to postoperative pain, sedation, or narcotics. PaO# is also low, suggesting inadequate oxygenation.
Toronto Notes 2023 - Respiratory, "Postoperative Respiratory Complications":
"Postoperative respiratory acidosis results from hypoventilation, often due to pain, sedatives, or poor respiratory effort. Assess airway, breathing, and support oxygenation." MCCQE1 Objectives (Internal Medicine > 44-3: Acid-Base Disturbances):
"Candidates must recognize respiratory acidosis on ABG and relate findings to common postoperative complications." Metabolic acidosis (C) would show #HCO#. Compensated alkalosis (D) would show opposite ABG changes.
Hypermetabolic states increase respiratory drive, not decrease it.


NEW QUESTION # 277
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?

Answer: C

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 # 278
A 79-year-old woman is brought by a long-term care (LTC) facility staff member to your clinic with concerning behaviours. On history, she was admitted to an LTC facility 6 months ago with vascular dementia.
Three days ago, she became very aggressive towards her caregivers. There is no clear pattern to her aggression. Some staff members report that she is quieter than usual, whereas others report that she is agitated, talks to herself, and picks at her clothes. On examination, she appears very confused. She does not finish her answers and seems to "drift off" during conversation. Which one of the following is the most likely diagnosis?

Answer: B

Explanation:
Delirium is the most likely diagnosis because the change is acute (3 days) with fluctuating level of activity (quiet at times, agitated at others) and prominent inattention (does not finish answers, "drifts off" during conversation). MCCQE objectives emphasize distinguishing delirium from dementia: dementia is typically chronic and progressive , whereas delirium is a sudden, reversible syndrome characterized by disturbed attention and awareness, often with altered sleep-wake cycle, perceptual disturbances, and psychomotor changes (hyperactive, hypoactive, or mixed). This patient's new aggression, confusion, and variable behavior strongly suggest delirium superimposed on existing vascular dementia-a common and high-risk scenario in LTC residents. Major depressive disorder can cause apathy and reduced concentration but does not typically cause a fluctuating course with acute confusion. Lewy body dementia is associated with chronic cognitive fluctuations and visual hallucinations/parkinsonism, not a sudden 3-day deterioration. Late-onset delusional disorder would feature fixed delusions with otherwise clearer consciousness. The next clinical priority is to search for and treat underlying causes (infection, medications, metabolic disturbance, pain, dehydration) while ensuring safety and supportive care.


NEW QUESTION # 279
A 3-month-old girl is brought by her parents to the emergency department with a 3-day history of cough, coryza, and low-grade fever; she was previously well. In the last 24 hours, she has been noted to have rapid breathing with audible wheezing. Which one of the following pathogens is the most likely cause of the patient' s symptoms?

Answer: D

Explanation:
This presentation is most consistent with acute bronchiolitis, which classically affects infants under 2 years (peak 2-6 months) and begins with upper respiratory symptoms (coryza, cough, low-grade fever) followed by increased work of breathing, tachypnea, and wheeze. The most common causative agent is respiratory syncytial virus (RSV), making it the best answer. Parainfluenza virus is more strongly associated with croup (barking cough, inspiratory stridor, hoarseness). Chlamydia trachomatis pneumonia typically occurs in young infants with a staccato cough, afebrile course, and may be associated with conjunctivitis rather than acute wheezing after coryza. Human metapneumovirus can cause bronchiolitis-like illness but is less common than RSV. Influenza A often produces higher fever and systemic symptoms and is not the leading cause of bronchiolitis in this age group. MCCQE objectives emphasize recognizing bronchiolitis clinically and identifying RSV as the predominant pathogen in infants with this classic progression of symptoms.


NEW QUESTION # 280
A 38-year-old woman presents with diffuse nodularity in the outer upper quadrant of her right breast. There is no obvious dominant mass, nipple discharge, or skin dimpling. There are no palpable lymph nodes. Which one of the following is the most likely diagnosis?

Answer: D

Explanation:
Fibrocystic change is the most common benign breast condition in women of reproductive age. It typically presents with diffuse nodularity or "lumpy" areas, especially in the upper outer quadrant, and varies with the menstrual cycle. No dominant mass or systemic signs are expected.
Toronto Notes 2023 - Gynecology, "Benign Breast Conditions":
"Fibrocystic changes often present with bilateral or unilateral nodularity, most commonly in the upper outer quadrants, without discrete masses." MCCQE1 Objectives (Gynecology > 81-1: Breast Conditions):
"Candidates must differentiate benign breast conditions from malignant ones based on presentation and physical exam findings." Paget disease (B) presents with nipple changes. Intraductal carcinoma (C) typically shows a discrete mass or suspicious features. Phyllodes tumours are usually well-circumscribed. Mastitis (E) is inflammatory and associated with erythema, fever, and tenderness.


NEW QUESTION # 281
......

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