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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q117-Q122):

NEW QUESTION # 117
A 65-year-old man presents to your clinic with a 2-month history of persistent erectile dysfunction. He reports having difficulties maintaining an erection. His last hemoglobin A1c level result was 6.4% (4.8-6.0). He had a negative result on his cardiac stress test 1 month ago. He has been taking stable dosages of citalopram, metformin, and ramipril for the past 2 years. His physical examination findings are normal, and his mood appears euthymic. Which one of the following investigations should be ordered before initiating treatment with sildenafil?

Answer: B

Explanation:
Erectile dysfunction (ED) in older men is commonly vascular, medication-related, or associated with diabetes.
This patient has well-controlled diabetes (HbA1c 6.4%) and a recent negative cardiac stress test , suggesting he is at low cardiovascular risk for sexual activity. MCCQE objectives emphasize cardiovascular risk stratification prior to prescribing phosphodiesterase-5 (PDE-5) inhibitors. Patients who are stable and cleared for moderate physical exertion (e.g., recent negative stress test) do not require additional cardiac testing before initiating sildenafil.
There is no indication for routine CBC, urine culture, PSA, or echocardiography in the absence of relevant symptoms or findings. PSA screening is unrelated to ED management and should follow age-appropriate shared decision-making guidelines. Echocardiography is unnecessary without cardiac symptoms or abnormal exam.
The key contraindication to sildenafil is concurrent nitrate therapy or unstable cardiovascular disease, neither of which is present. Therefore, no additional investigations are required before initiating treatment.
Counseling should include discussion of medication interactions, side effects (e.g., headache, flushing), and avoidance with nitrates.


NEW QUESTION # 118
A 10-year-old girl is brought to the Emergency Department by her mother because her daughter is crying and says she "can't pee." Her daughter fell on the monkey bars at school earlier that day. On examination, there is a large vulvar bruise anteriorly. Which one of the following is the best next step?

Answer: B

Explanation:
In pediatric trauma, inability to void with perineal bruising raises concern for urethral injury or urinary retention due to soft tissue swelling. The most immediate step is to attempt bladder catheterization. If unsuccessful, consult gynecology or urology urgently to avoid bladder overdistension.
Toronto Notes 2023 - Pediatrics, Genitourinary Trauma:
"In females, perineal trauma can lead to urinary retention due to labial hematomas or urethral injury. If catheterization is difficult, consult gynecology or urology for assistance." MCCQE1 Objectives - Pediatrics > Trauma and Emergency Care:
"Candidates must recognize when specialist consultation is required in pediatric genitourinary trauma, especially in cases of failed catheterization." Options B and D delay necessary care. Coagulation studies (C) may be considered if bleeding is unexplained.
Abuse assessment (E) may be necessary later but does not address immediate retention.


NEW QUESTION # 119
A 26-year-old woman, gravida 2, para 1, presents with a positive pregnancy test. Her previous pregnancy was associated with preeclampsia, and she delivered a 1000 g boy at 34 weeks' gestation. Her blood pressure is 130
/86 mm Hg. Which one of the following is the best recommendation for this pregnancy?

Answer: D

Explanation:
Accurate dating is critical in pregnancies at high risk for preeclampsia and intrauterine growthrestriction. First- trimester ultrasound is used to establish gestational age, which guides monitoring and interventions.
Toronto Notes 2023 - Obstetrics, High-Risk Pregnancy:
"In women with a history of preeclampsia, early and accurate dating allows for appropriate fetal surveillance and timely delivery." MCCQE1 Objectives - Obstetrics > Prenatal Care:
"Candidates should recognize the importance of accurate pregnancy dating in high-risk pregnancies." Prophylactic labetalol (E) is not indicated in normotensive patients. Genetic testing (A, B) is not appropriate unless additional risk factors are present. Bed rest (D) is not evidence-based for preeclampsia prevention.


NEW QUESTION # 120
A 4-month-old girl is brought by a parent to your clinic with a history of recurrent vomiting since birth. She cries with feeding and has not gained weight in the last 2 weeks. Her hemoglobin level is 95 g/L (100-125).
The patient is currently being fed thickened hypoallergenic formula. Which one of the following is the most appropriate therapy?

Answer: A

Explanation:
This infant has persistent vomiting with feeding-associated distress and poor weight gain, despite appropriate initial nonpharmacologic measures (thickened feeds and hypoallergenic formula). MCCQE pediatrics objectives emphasize distinguishing physiologic reflux ("happy spitter") from gastroesophageal reflux disease (GERD), which is suggested by feeding aversion/crying and failure to thrive. When conservative strategies fail and GERD is causing significant symptoms or complications (e.g., poor growth, suspected esophagitis contributing to irritability and possibly anemia), escalation to acid suppression is appropriate; a proton pump inhibitor such as omeprazole is used to treat acid-related esophageal injury and improve symptoms in selected infants with suspected erosive disease.
Metoclopramide is not preferred due to limited benefit and risk of extrapyramidal adverse effects. Calcium carbonate antacids are not recommended as ongoing therapy in infants due to safety concerns and inferior efficacy for esophagitis. Bismuth sulfate is not indicated. Loperamide is inappropriate and potentially harmful in infants. Continued monitoring of growth and reassessment for alternative diagnoses or alarm features is essential.


NEW QUESTION # 121
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: A

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 # 122
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