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Standard MCCQE Answers - MCCQE Exam Learning

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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q85-Q90):

NEW QUESTION # 85
A 29-year-old woman, gravida 1, para 0, aborta 0, presents to your clinic. Her pregnancy is at 22 weeks' gestation. Her blood pressure is 158/96 mm Hg. Which one of the following antihypertensive medications is contraindicated for this patient?

Answer: C

Explanation:
Ramipril, an ACE inhibitor, is contraindicated in pregnancy due to risks of fetal renal dysgenesis, oligohydramnios, and fetal death, especially in the second and third trimesters.
Toronto Notes 2023 - Obstetrics, Hypertensive Disorders of Pregnancy:
"ACE inhibitors and ARBs are contraindicated in pregnancy due to their teratogenic potential and adverse fetal effects." MCCQE1 Objectives - Obstetrics > Hypertension in Pregnancy:
"Candidates must identify safe antihypertensives during pregnancy and contraindicated medications such as ACE inhibitors and ARBs." Methyldopa, labetalol, nifedipine, and hydralazine are considered safe and are commonly used in pregnancy.


NEW QUESTION # 86
An 83-year-old woman presents to your office with a 2-day history of confusion. Her past medical history is significant for lung cancer, and she is being treated with radiation. On physical examination, she is euvolemic.
Her blood work reveals a serum sodium of 118 mmol/L (135-140) as compared with 134 mmol/L (8 days ago). Which one of the following will be most helpful in establishing the cause of her laboratory abnormality?

Answer: E

Explanation:
Comprehensive and Detailed Explanation:
Hyponatremia in a patient with lung cancer and euvolemia strongly suggests syndrome of inappropriate antidiuretic hormone secretion (SIADH), especially from small cell carcinoma. Serum osmolality is the best initial test to confirm hypotonic hyponatremia and distinguish true hyponatremia from pseudohyponatremia or other causes.
Toronto Notes 2023 - Endocrinology, "Hyponatremia":
"Serum osmolality helps classify hyponatremia as hypotonic, isotonic, or hypertonic. SIADH typically causes hypotonic hyponatremia in euvolemic patients." MCCQE1 Objectives (Endocrinology > 37-1: Electrolyte Disorders):
"Candidates must evaluate the type and cause of hyponatremia using clinical status and laboratory tests including serum osmolality." Urine sodium (B) is useful after confirming hypotonicity. PTHrP (E) is associated with hypercalcemia of malignancy, not hyponatremia. Urinalysis (A) and CrCl (D) are less directly informative.


NEW QUESTION # 87
A 35-year-old maintenance worker presents to your office because he thinks he has been exposed to asbestos and is afraid of developing asbestosis. He has no respiratory symptoms and is a non-smoker. Which one of the following is the best next step?

Answer: A

Explanation:
In any suspected occupational exposure, the first step is a detailed occupational history to assess the nature, intensity, and duration of the exposure. This determines whether surveillance or further testing is appropriate.
Toronto Notes 2023 - Respiratory Medicine, "Occupational Lung Diseases" Section:
"When a patient presents with concerns about exposure to occupational hazards such as asbestos, detailed history is essential. Ask about job tasks, duration of exposure, use of personal protective equipment, and prior workplace assessments." MCCQE1 Objectives (Population Health > 97-2: Environmental and Occupational Health):
"Candidates must be able to obtain a detailed environmental and occupational history and determine the risk of exposure before ordering investigations." Ordering a chest radiograph (B) or PFTs (E) without confirming meaningful exposure is premature. Referral to a specialist (D) and reassurance (A) come only after the exposure risk is assessed.


NEW QUESTION # 88
A 19-year-old woman with a long-standing history of abuse and borderline personality disorder presents to your office. She has a number of superficial lacerations over her arms and legs. They look like they were caused by a sharp edge such as a knife. They are at various stages of healing, and some look like they are a few hours old, though none require stitches. Which one of the following is the most likely comment she would make about the injuries?

Answer: B

Explanation:
Patients with borderline personality disorder commonly engage in non-suicidal self-injury (NSSI) such as superficial cutting. According to MCCQE objectives in psychiatry, this behavior is typically a maladaptive coping mechanism used to regulate intense emotional distress, feelings of emptiness, anger, or dissociation.
The act of cutting often produces a transient sense of relief due to reduction of psychological tension and may be reinforced by endogenous opioid release. Therefore, patients frequently report that they "feel better afterward." It is important to distinguish NSSI from suicidal intent. Although individuals with borderline personality disorder are at increased risk of suicide, superficial cutting behavior is most often performed to relieve affective dysregulation rather than to die. It is not primarily attention-seeking, obsession with blood, or body modification. Management priorities include thorough suicide risk assessment, validation of emotional distress, establishing safety, and referral for evidence-based psychotherapy such as dialectical behavior therapy (DBT), which specifically targets emotional regulation and self-harm behaviors.


NEW QUESTION # 89
A 10-year-old boy and his mother present to your office with a concern about handwashing. The mother explains that her son has been at a new school for the past month and that teachers have noticed that he is washing his hands all day. He has also hidden hand sanitizer in his desk. The hand-cleaning is a response to a constant anxiety that his hands are dirty, and that he might pass an infection to someone. Which one of the following is the most appropriate initial management?

Answer: A

Explanation:
This child demonstrates classic features of obsessive-compulsive disorder (OCD): intrusive contamination fears (obsession) and repetitive handwashing behaviors (compulsion) performed to reduce anxiety. The symptoms are excessive, impairing school function, and persist beyond normal developmental concerns.
According to MCCQE objectives, first-line treatment for mild to moderate pediatric OCD is cognitive- behavioral therapy (CBT) with exposure and response prevention (ERP). ERP involves gradual exposure to feared contaminants while preventing the compulsive handwashing response, thereby reducing anxiety through habituation and cognitive restructuring. Pharmacologic treatment with selective serotonin reuptake inhibitors (e.g., fluoxetine) is indicated for moderate to severe cases or when CBT alone is insufficient, but it is not the preferred initial intervention when psychotherapy is accessible. Risperidone is not first-line and may be considered only as augmentation in refractory cases. Changing schools or providing a teaching assistant does not address the underlying anxiety disorder. Early evidence-based intervention improves prognosis and functional outcomes in pediatric OCD.


NEW QUESTION # 90
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