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Medical Council of Canada MCCQE Part 1 Sample Questions:

1. A 70-year-old hypertensive woman with a history of congestive heart failure (CHF) secondary to left ventricular dysfunction presents to your office with a persistent dry hacking cough. She claims it began when she was started on ramipril. Which one of the following medications would be most appropriate to replace ramipril, to ensure that the risk of morbidity associated with CHF remains low?

A) Angiotensin II receptor blocker
B) Cox-2 inhibitor
C) Calcium channel blocker
D) Alpha-blocker
E) Nitrates

2. 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) Apply heating pads to extremities.
B) Start continuous arteriovenous rewarming.
C) Perform a peritoneal lavage.
D) Continuous warm bladder irrigation.
E) Set the room temperature to 28°C.

3. A 64-year-old man presents with a 3-month history of gradually increasing neck pain and stiffness. The pain radiates into his upper back, and he is having difficulty driving because of limitation of neck rotation secondary to pain. Physical examination shows restricted neck motion in all directions and neck muscle spasms. There is no abnormality on neurologic examination. A radiograph shows narrowing of all of the cervical disc spaces with prominent osteophytes. Which one of the following is the most appropriate next step?

A) Lumbar puncture.
B) Magnetic resonance imaging of the neck.
C) Computed tomography of neck.
D) Electromyography of upper limbs.
E) No further investigation.

4. You are seeing a 5-month-old infant who has had intermittent stridor since age 2 months. He is otherwise healthy. He has been drinking well and has been reaching all the age-specific developmental milestones.
Which one of the following is the most likely diagnosis?

A) Laryngomalacia.
B) Aspiration of a foreign body.
C) Subglottic hemangioma.
D) Vascular ring.
E) Tracheoesophageal fistula.

5. A 35-year-old woman presents to your clinic for follow-up regarding her persistent primary immune thrombocytopenic purpura. She was admitted to hospital with a relapse and received treatment with dexamethasone, intravenous immunoglobulin, and rituximab. She was recently discharged from hospital with a platelet count of 55 × 10#/L (130-360), and also continues to take 10 mg of prednisone once daily. She is scheduled for a splenectomy in 4 weeks. Which one of the following is the best next step in preparation for the patient's surgical procedure?

A) Arrange for preoperative vaccination
B) Start calcium and vitamin D supplementation
C) Prescribe daily azithromycin 1 week preoperatively
D) Stop prednisone 2 weeks preoperatively
E) Transfuse 5 units of platelets 1 week preoperatively

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