Clear Medical Council of Canada MCCQE Exam | MCCQE Latest Guide Files
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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q44-Q49):
NEW QUESTION # 44
A 1-month-old boy is brought to your clinic after being born with asymmetric intrauterine growth restriction (third percentile at birth). He was born at 36 weeks' gestation. He has been breastfeeding well and continues to grow around the third percentile. Which one of the following would be the best next step?
- A. Switch to a hydrolyzed formula.
- B. High-dose vitamin D supplementation.
- C. Caloric-fortified feeding.
- D. Early introduction of solid foods.
Answer: C
Explanation:
This infant was born late preterm (36 weeks) with asymmetric intrauterine growth restriction (IUGR) and remains at the 3rd percentile. Although he is breastfeeding well, infants with IUGR and late prematurity often require enhanced caloric intake to support catch-up growth. MCCQE objectives emphasize optimizing postnatal nutrition in growth-restricted infants to promote appropriate weight gain while monitoring growth velocity.
Caloric fortification of expressed breast milk (or use of higher-calorie formula if needed) increases energy density without increasing feeding volume, supporting growth in infants who are small for gestational age.
Simply continuing standard feeds may not provide sufficient calories for catch-up growth.
High-dose vitamin D is not indicated; routine supplementation (400 IU daily) is appropriate for breastfed infants. Early introduction of solids is not recommended before about 6 months of age. Switching to hydrolyzed formula is unnecessary without evidence of milk protein allergy.
Therefore, caloric-fortified feeding is the most appropriate next step to promote optimal growth in this infant.
NEW QUESTION # 45
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?
- A. Chlamydia trachomatis.
- B. Human metapneumovirus.
- C. Human parainfluenzavirus 3.
- D. Human respiratory syncytial virus.
- E. Influenzavirus A.
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 # 46
A 28-year-old woman, gravida 1, para 0, aborta 0, presents to your clinic for a prenatal visit. Her pregnancy is at 20 weeks' gestation. Her ultrasonogram shows a normal fetus and a low-lying placenta. Which one of the following is the best next step?
- A. Advise the patient not to work for the remainder of the pregnancy.
- B. Tell the patient that she will need a cesarean delivery.
- C. Suggest acupuncture to help with placental migration.
- D. Explain to the patient that she is at high risk for bleeding.
- E. Repeat ultrasonography at 32 weeks' gestation.
Answer: E
Explanation:
A low-lying placenta identified at the routine 20-week anatomy scan is common and often resolves as the pregnancy progresses. As the uterus enlarges, the lower uterine segment stretches and the placenta typically
"migrates" upward relative to the internal cervical os. Therefore, immediate intervention is not indicated in an asymptomatic patient. The appropriate next step is repeat ultrasonography in the third trimester, commonly around 32 weeks' gestation, to reassess placental location. Early recommendation of cesarean delivery is premature because many low-lying placentas identified at mid-pregnancy resolve before term. Routine activity restriction or stopping work is not indicated in the absence of bleeding. Acupuncture has no evidence- based role in placental positioning. While placenta previa is associated with painless third-trimester bleeding, at 20 weeks most cases are transient findings. MCCQE objectives emphasize appropriate follow-up of incidental ultrasound findings, avoidance of unnecessary interventions, patient reassurance, and evidence- based monitoring in obstetric care.
NEW QUESTION # 47
A 24-year-old nulligravid woman presents to the office with an absence of menstruation since discontinuing her oral contraceptives 8 months ago. She previously had a regular menstrual cycle when taking oral contraceptives for the past 10 years but stopped because of headaches, which have only gotten worse since.
She also noticed mild breast discharge for the past several months. Which one of the following examination findings is most likely?
- A. Low BMI
- B. Nodular breast irregularities
- C. Abnormal visual field testing results
- D. Presence of severe hirsutism
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
This patient has secondary amenorrhea, galactorrhea, and worsening headaches-suggestive of hyperprolactinemia, possibly due to a pituitary adenoma (prolactinoma). Visual field defects (typically bitemporal hemianopia) can result from optic chiasm compression.
Toronto Notes 2023 - Endocrinology / Reproductive Health:
"Prolactinomas may cause amenorrhea, galactorrhea, headaches, and visual field defects. Evaluate with serum prolactin and visual field testing." MCCQE1 Objectives (Endocrinology > 37-2: Pituitary Disorders):
"Candidates must recognize clinical signs of prolactinomas and know when to assess visual fields." Hirsutism (D) suggests androgen excess. Low BMI (B) can cause hypothalamic amenorrhea but wouldn't explain galactorrhea. Nodular breast findings (A) are not related.
NEW QUESTION # 48
A 25-year-old woman who is at 8 weeks' gestation plans to travel to rural Cambodia to care for her ill mother.
Which one of the following treatments should be provided to her before the trip?
- A. Tetanus and diphtheria booster if last received more than 5 years ago
- B. Antimalarial chemoprophylaxis
- C. Ciprofloxacin for travellers' diarrhea
- D. Hepatitis B immunoglobulin
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
Travel to rural Cambodia poses a high risk of malaria, which can be life-threatening in pregnancy.
Antimalarial prophylaxis is strongly recommended for pregnant women traveling to endemic regions.
Chloroquine or mefloquine (depending on resistance patterns) may be used in pregnancy under specialist guidance.
Toronto Notes 2023 - Infectious Disease / Travel Medicine:
"Malaria prophylaxis is indicated in pregnant women traveling to endemic regions. The risk of severe malaria and poor fetal outcomes is high." MCCQE1 Objectives (Public Health > 65-3: Travel Medicine and Pregnancy):
"Candidates must provide preventive care to pregnant travelers including vaccination and malaria prophylaxis." Tetanus boosters (D) are given every 10 years. Hep B Ig (B) is for acute post-exposure prophylaxis.
Ciprofloxacin (C) is contraindicated in pregnancy.
NEW QUESTION # 49
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