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2025 Efficient MCCQE: MCCQE Part 1 Exam Reliable Mock Test
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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q168-Q173):
NEW QUESTION # 168
A 27-year-old woman presents with an enlarged thyroid. She had not noticed it herself until her mother brought it to her attention. She is asymptomatic from an endocrine perspective, and her serum thyroid- stimulating hormone (TSH) is normal.
Which one of the following is the most appropriate next step?
- A. Ultrasound of the thyroid
- B. Fine-needle aspiration of the thyroid
- C. Serum calcium
- D. Computed tomography of the neck
- E. Serum T3 and T4
Answer: A
Explanation:
In a euthyroid patient with an asymptomatic goiter or thyroid enlargement, the next step is a thyroid ultrasound to evaluate nodule size, composition, and features suggestive of malignancy.
Toronto Notes 2023 - Endocrinology, Thyroid Nodules and Goiter:
"TSH should be obtained first. If normal and there is a palpable mass or enlargement, ultrasound is indicated to evaluate for nodules and guide further testing (e.g., FNA)." MCCQE1 Objectives - Internal Medicine > Endocrinology:
"Candidates must use thyroid ultrasound as the initial imaging study in the evaluation of thyroid enlargement or palpable nodules." T3/T4 (A) are not needed with normal TSH. FNA (D) is done if nodules are identified. CT (C) is used for retrosternal goiters or compressive symptoms. Calcium (E) is irrelevant here.
NEW QUESTION # 169
An intoxicated 28-year-old man is brought to the Emergency Department after being found in the snow. His vital signs are as follows:
Temperature: 33°C
Respiratory rate: 22/min
Heart rate: 123/min
The patient is shivering and displays some dysarthria and ataxia. After his wet clothing is removed, he is provided with a warm blanket. The results of the subsequent physical examination are unremarkable, except for frostbite of the ears and fingers. Which one of the following is the best next step?
- A. Start continuous arteriovenous rewarming.
- B. Perform a peritoneal lavage.
- C. Apply heating pads to extremities.
- D. Set the room temperature to 28°C.
- E. Continuous warm bladder irrigation.
Answer: D
Explanation:
This patient is experiencing mild hypothermia (32-35°C), evidenced by shivering, ataxia, and tachycardia.
First-line management includes passive external rewarming - removing wet clothing, providing warm blankets, and ensuring a warm environment (ambient temperature ~28°C).
Toronto Notes 2023 - Emergency Medicine, Environmental Injuries:
"Mild hypothermia (32-35°C): Treatment includes passive rewarming (warm blankets, warm environment).
Avoid active rewarming methods to extremities due to risk of afterdrop." MCCQE1 Objectives - Internal Medicine > Environmental Exposure:
"Candidates must recognize appropriate levels of hypothermia and select evidence-based rewarming strategies based on severity." Options A, C, and D are used in moderate to severe hypothermia (<32°C or unconscious patients). Heating pads (B) may cause tissue damage, especially with frostbite.
NEW QUESTION # 170
A 39-year-old man presents to a psychiatrist. He says, "It often seems to me that I am not part of this world.
My voice sounds strange to me, and other people seem like figures in a dream." He has had these feelings intermittently for about 2 years. There is no history of hallucinations, and there are no current indications of disorganized thinking. Which one of the following is the most likely diagnosis?
- A. Persistent depressive disorder.
- B. Schizophrenia.
- C. Depersonalization/derealization disorder.
- D. Delusional disorder.
- E. Conversion disorder.
Answer: C
Explanation:
The patient describes classic symptoms of depersonalization ("my voice sounds strange to me") and derealization ("others seem like figures in a dream"), which define depersonalization/derealization disorder.
There is preserved reality testing and no psychosis.
Toronto Notes 2023 - Psychiatry, "Dissociative Disorders" Section:
"Depersonalization/derealization disorder involves persistent or recurrent experiences of detachment from oneself (depersonalization) or surroundings (derealization), with intact reality testing and no delusions or hallucinations." MCCQE1 Objectives (Psychiatry > 79-4: Dissociative Disorders):
"Candidates must identify depersonalization/derealization disorder as a dissociative disorder distinct from psychosis or mood disorders." Schizophrenia (A) would include hallucinations or disorganized thinking. Conversion disorder (B) presents with neurological symptoms inconsistent with known diseases. Persistent depressive disorder (D) involves chronic low mood. Delusional disorder (E) would involve fixed false beliefs, which are not present here.
NEW QUESTION # 171
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. Urine drug screen.
- B. Trial of lorazepam.
- C. Interviewing the boyfriend alone.
- D. Personality testing.
- E. Mood journal.
Answer: E
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 # 172
A 14-year-old girl is brought to the Emergency Department with a 20-minute history of difficulty breathing that started during a school assembly. She has had similar symptoms 3 times in the last 2 weeks. These episodes develop rapidly and resolve gradually over several minutes. She reports tingling in her fingers and toes. On examination, her vital signs are as follows:
Blood pressure
120/80 mm Hg
Heart rate
100/min
Respiratory rate
22/min
Oxygen saturation on room air
95%
Temperature
36.9 °C, orally
Apart from mildly dilated pupils, her examination is otherwise normal. Which one of the following is the most likely diagnosis?
- A. Panic attack
- B. Asthma
- C. Cocaine use
- D. Paroxysmal supraventricular tachycardia
- E. Pericarditis
Answer: A
Explanation:
This teenager presents with acute-onset dyspnea, paresthesias, and normal physical findings, consistent with a panic attack. Panic attacks often mimic cardiopulmonary pathology but are marked by symptoms like hyperventilation, tingling in the extremities, palpitations, and subjective air hunger with normal vitals and oxygenation.
Toronto Notes 2023 - Psychiatry:
"Panic attacks are characterized by sudden onset of intense fear or discomfort, accompanied by somatic symptoms such as dyspnea, paresthesias, tachycardia, and fear of losing control." MCCQE1 Objectives (Psychiatry > 71-3: Anxiety Disorders):
"Candidates must recognize panic attacks based on clinical features and differentiate them from cardiopulmonary conditions." Normal O2 saturation and physical exam rule out asthma or pericarditis. Cocaine use would present with more systemic toxicity. PSVT would cause consistent tachycardia.
NEW QUESTION # 173
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