MCCQE Part 1 MCCQE Real Exam Questions and Answers FREE Updated on Jun 21, 2026
MCCQE Ultimate Study Guide - 2Pass4sure
NEW QUESTION # 168
A 3-year-old boy is brought to your office because his daycare teachers are concerned about his language development. His parents speak both English and French at home, and he can say around 15 words combined in both languages. His history reveals that he has minimal interest in playing with other children. Which one of the following is most appropriate?
- A. Evaluate for attention deficit hyperactivity disorder.
- B. Screen for autism spectrum disorder.
- C. Recommend use of one language at home.
- D. Refer to a pediatric neurologist.
- E. Reassure that no intervention is needed.
Answer: B
Explanation:
A limited vocabulary (fewer than 50 words by age 2-3 years) and reduced social interaction (limited interest in peers) raise concern for autism spectrum disorder (ASD). Screening for ASD is the most appropriate next step.
Toronto Notes 2023 - Pediatrics, Development and Behaviour:
"Red flags for autism include delayed language, limited social reciprocity, and poor peer interaction.
Screening should be initiated early when clinical signs are present."
MCCQE1 Objectives - Pediatrics > Developmental Disorders:
"Candidates must identify key signs of ASD and initiate appropriate screening and early intervention." Multilingual households do not typically cause such delays (E is incorrect). ADHD (B) presents with attention
/hyperactivity issues, not language/social delay. Reassurance (A) is inappropriate. Neurology referral (C) may follow but is not first-line.
NEW QUESTION # 169
An 8-year-old girl is brought by her father to the office with a 2-week history of red, itchy, and watery eyes.
She is otherwise healthy. On examination, there is no discharge or difficulty with vision. Pupil examination findings are normal. The patient's eyes are shown in the referenced photo. Which one of the following topical therapies is the best recommendation?
- A. Antiviral.
- B. Antihistamine.
- C. Antibiotic.
- D. Glucocorticoid.
- E. Antifungal.
Answer: B
Explanation:
This child presents with bilateral red, itchy, watery eyes for 2 weeks without purulent discharge, pain, or visual changes-classic features of allergic conjunctivitis . MCCQE objectives emphasize distinguishing allergic conjunctivitis from infectious causes. Allergic conjunctivitis is characterized by pruritus (key symptom), tearing, conjunctival injection, and often a history of atopy or seasonal triggers. Vision remains normal, and there is no mucopurulent discharge (which would suggest bacterial infection) or vesicular lesions
/dendritic ulcers (suggesting viral/herpetic causes).
Topical antihistamines (often combined with mast cell stabilizers) are first-line therapy and effectively reduce itching and redness by blocking histamine-mediated inflammation.
Topical antibiotics are unnecessary without bacterial features. Antivirals are reserved for suspected herpetic disease. Antifungals are rarely indicated in routine conjunctivitis. Topical glucocorticoids are not first-line and may cause adverse effects (e.g., increased intraocular pressure) and should only be used under ophthalmologic supervision.
Therefore, a topical antihistamine is the most appropriate initial treatment.
NEW QUESTION # 170
A 63-year-old woman presents to your office with a history of progressive abdominal discomfort over the past five months. She reports bloating and difficult digestion with constipation. She has no urinary symptoms and denies vaginal or rectal bleeding. An abdominal ultrasound shows a large complex pelvic mass with internal multiloculation and moderate ascites. The cancer antigen 125 (CA 125) is elevated at 1023 U/mL (< 35 U
/mL). Which one of the following is the most likely diagnosis?
- A. Ovarian hyperstimulation syndrome
- B. Serous carcinoma of the ovary
- C. Rectosigmoid adenocarcinoma
- D. Metastatic uterine adenocarcinoma
- E. Chronic hematosalpinx
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
Postmenopausal women with abdominal distension, bloating, a complex pelvic mass, and elevated CA-125 are highly suggestive of epithelial ovarian cancer, especially serous cystadenocarcinoma-the most common type.
Toronto Notes 2023 - Gynecology / Oncology:
"Serous epithelial ovarian carcinoma presents with vague abdominal symptoms, ascites, complex pelvic mass, and elevated CA-125." MCCQE1 Objectives (Gynecology > 82-5: Ovarian Masses):
"Candidates must recognize signs and investigations of ovarian cancer, including elevated tumor markers and imaging findings." Ovarian hyperstimulation (A) occurs in fertility treatments. Colorectal cancer (C) may mimic these symptoms but typically causes rectal bleeding and has lower CA-125 levels. Uterine adenocarcinoma (D) usually causes bleeding. Hematosalpinx (E) presents with pelvic pain, not ascites.
NEW QUESTION # 171
You have been asked to develop a program in your hospital for people who are at the highest risk of death by suicide. The hospital administrator asks you to describe the types of patients they should expect in the program. Which one of the following groups is the most likely prominent demographic?
- A. Men aged 11 to 20 years who have histories of juvenile delinquency and narcotic use
- B. Men aged 50 to 70 years who have limited social supports and alcohol use disorder
- C. Women aged 20 to 40 years who have cluster B personality disorders and experience relationship losses
- D. Women aged 14 to 20 years who have histories of being abused and who are experiencing financial hardships
- E. Patients of both sexes who have psychotic disorders
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
Middle-aged to older men with social isolation and substance use disorders (especially alcohol) are among the highest-risk groups for completed suicide. They are less likely to seek help and often use more lethal methods.
Toronto Notes 2023 - Psychiatry, "Suicide Risk Assessment":
"High-risk demographics include older men, social isolation, comorbid alcohol use, and chronic illness. These patients have the highest rates of completed suicide." MCCQE1 Objectives (Psychiatry > 71-1: Suicide Risk):
"Candidates must recognize epidemiologic risk factors for completed suicide, including demographics and comorbidities." Although women and youth have higher rates of suicidal ideation and attempts, men over 50 have the highest completion rates.
NEW QUESTION # 172
A 39-year-old man presents to your clinic 4 months after a motor vehicle collision. He is trying to return to work but is having a difficult time because his job requires him to drive. He used to love his job, but he is worried about going back because every time he gets into a car, he is filled with dread, gets dizzy, and feels faint. He has regular nightmares about the incident. Which one of the following is the most likely diagnosis?
- A. Posttraumatic stress disorder.
- B. Malingering.
- C. Generalized anxiety disorder.
- D. Panic disorder.
Answer: A
Explanation:
Posttraumatic stress disorder (PTSD) is most likely because the patient has symptoms persisting more than 1 month after a traumatic event (motor vehicle collision) with functional impairment (difficulty returning to work/driving). MCCQE objectives emphasize PTSD core symptom clusters: intrusion (recurrent distressing dreams/nightmares), avoidance (fear and distress when attempting to drive or be in a car), negative alterations in cognition/mood, and hyperarousal. His intense dread and autonomic-type symptoms (dizziness, feeling faint) triggered by car exposure fit trauma-related reactivity and avoidance.
Panic disorder requires recurrent unexpected panic attacks with ongoing concern or maladaptive behavior; here, the episodes are situationally triggered by reminders of the trauma and accompanied by trauma nightmares, supporting PTSD over panic disorder. Generalized anxiety disorder involves excessive worry about multiple domains for at least 6 months, not specifically tied to a trauma cue with nightmares.
Malingering implies intentional symptom fabrication for external gain and is not supported by the consistent trauma-linked symptoms and re-experiencing.
NEW QUESTION # 173
A 25-year-old woman, gravida 1, para 1, aborta 0, gave birth to a newborn who is hypotonic with a large protruding tongue and brachycephaly. The newborn has a single palmar crease bilaterally and short, broad hands with a curved fifth digit. These features best support a clinical diagnosis of which one of the following?
- A. Turner syndrome.
- B. Fetal alcohol syndrome.
- C. Prader-Willi syndrome.
- D. Trisomy 21.
- E. Congenital hypothyroidism.
Answer: D
Explanation:
This constellation of features-hypotonia, macroglossia, brachycephaly, single palmar crease, short broad hands with clinodactyly-is classic for Down syndrome (Trisomy 21).
Toronto Notes 2023 - Pediatrics, "Genetic Syndromes":
"Trisomy 21 features include hypotonia, upslanting palpebral fissures, epicanthic folds, flat nasal bridge, brachycephaly, macroglossia, single palmar crease, and clinodactyly." MCCQE1 Objectives (Pediatrics > 78-3: Congenital and Genetic Disorders):
"Candidates must recognize key dysmorphic features associated with common genetic syndromes including Trisomy 21." Prader-Willi and congenital hypothyroidism may have hypotonia but lack the full phenotypic pattern. Turner syndrome is seen in females with short stature and webbed neck. Fetal alcohol syndrome presents with smooth philtrum and microcephaly.
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NEW QUESTION # 174
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?
- A. Order a chest radiograph.
- B. Provide reassurance, since he is asymptomatic.
- C. Order pulmonary function testing.
- D. Ask him further about his work.
- E. Refer him to a respirologist.
Answer: D
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 # 175
You are asked to see a 50-year-old man 2 hours after he underwent a laparotomy for gastric resection. Lab results are as follows:
pH
7.28 (7.35-7.45)
PaCO#
60 mm Hg (35-40)
PaO#
60 mm Hg (85-105) with 4 L/min via nasal prongs
Bicarbonate (HCO#)
24 mmol/L (24-30)
Which one of the following is most consistent with this clinical presentation?
- A. Postoperative hypermetabolic period
- B. Normal recovery from an inhalation anesthetic
- C. Metabolic acidosis
- D. Respiratory insufficiency
- E. Compensatory respiratory alkalosis
Answer: D
Explanation:
This ABG reveals primary respiratory acidosis (#pH, #PaCO#, normal HCO#), likely from hypoventilation due to postoperative pain, sedation, or narcotics. PaO# is also low, suggesting inadequate oxygenation.
Toronto Notes 2023 - Respiratory, "Postoperative Respiratory Complications":
"Postoperative respiratory acidosis results from hypoventilation, often due to pain, sedatives, or poor respiratory effort. Assess airway, breathing, and support oxygenation." MCCQE1 Objectives (Internal Medicine > 44-3: Acid-Base Disturbances):
"Candidates must recognize respiratory acidosis on ABG and relate findings to common postoperative complications." Metabolic acidosis (C) would show #HCO#. Compensated alkalosis (D) would show opposite ABG changes.
Hypermetabolic states increase respiratory drive, not decrease it.
NEW QUESTION # 176
You are asked to see a 34-year-old patient at his long-term care facility for a 2-day history of fever. You diagnose a urinary tract infection. He has multiple sclerosis diagnosed 5 years ago and has lived in this long- term care facility for the past 2 years. He is bedbound and has an indwelling urinary catheter. For the past 3 months, he has been non-communicative. Prior to this, he had made it clear that he did not want any life- prolonging measures. Which one of the following is the best next step?
- A. Call his family to consider antibiotics.
- B. Prescribe antipyretics.
- C. Start antibiotics while waiting to contact the family.
- D. Transfer him to the hospital.
- E. Change his urinary catheter.
Answer: B
Explanation:
This patient is currently non-communicative and therefore likely lacks decision-making capacity. MCCQE ethics objectives emphasize that when a patient's prior capable wishes are clearly known, clinicians must follow those expressed values and directives. He previously stated he did not want life-prolonging measures; escalation (hospital transfer) and potentially curative treatment aimed primarily at prolonging life would conflict with that directive. The immediate best step is to provide comfort-focused care, addressing symptoms such as fever and distress with antipyretics and other palliative measures.
Calling family to "consider antibiotics" risks substituting others' preferences for the patient's known wishes; substitute decision makers are meant to apply the patient's prior expressed wishes, not override them. Starting antibiotics while waiting to contact family similarly risks initiating life-prolonging therapy inconsistent with the directive. Catheter change may be clinically useful in catheter-associated infection, but the question frames a clear limit on life-prolonging interventions; symptom relief is the priority. Ongoing care should include reassessment of comfort, clear documentation of goals of care, and communication with family about the patient's previously stated wishes and the plan for palliative management.
NEW QUESTION # 177
A 54-year-old man presents to the office because of progressively severe frontal headaches that are worse in the morning. He also has a chronic productive cough. He has a 30 pack-year history of smoking tobacco cigarettes. His blood pressure is 160/95 mm Hg. Which one of the following is the best next step?
- A. Start a calcium channel blocker.
- B. Give a prescription for serotonin 5-HT receptor agonist (Triptan).
- C. Refer for urgent temporal artery biopsy.
- D. Arrange for serial home blood pressure monitoring.
- E. Order computed tomography of the head.
Answer: E
Explanation:
This presentation has "red flags" for raised intracranial pressure: headaches that are progressive, worse in the morning, and worsened by coughing/valsalva. In MCCQE objectives, these features require urgent evaluation for secondary causes (e.g., intracranial mass, hemorrhage, obstructive hydrocephalus) rather than empiric treatment for primary headache. His chronic cough and heavy smoking increase concern for an underlying malignancy with possible brain metastasis or paraneoplastic processes, further strengthening the indication for neuroimaging. Therefore, the best next step is CT head (often the fastest initial test to identify mass effect, hemorrhage, or hydrocephalus; MRI may follow depending on findings).
Treating presumed migraine with a triptan is inappropriate when secondary headache is possible and could also pose vascular risk. His blood pressure is elevated but not in a hypertensive emergency and does not explain these classic intracranial pressure features; serial BP monitoring or starting antihypertensives should not delay imaging. Temporal arteritis is less likely without temporal tenderness, jaw claudication, visual symptoms, or systemic inflammatory clues.
NEW QUESTION # 178
A 36-year-old woman, gravida 1, para 0, aborta 0, presents to the Labour and Delivery unit of a primary care hospital. She is at 40 weeks' gestation. She is having contractions and leaking fluid. She is fearful and does not want to deliver vaginally. Which one of the following is the best next step?
- A. Explore her concerns and explain pain management options.
- B. Ask a colleague for a second opinion.
- C. Suggest intravenous analgesia.
- D. Offer to organize a cesarean delivery.
- E. Explain that a cesarean delivery is not an option.
Answer: A
Explanation:
The most appropriate next step is to explore her concerns and provide counselling regarding labour and pain management options . MCCQE objectives emphasize patient-centered care, informed decision-making, and respect for autonomy while ensuring that patients receive appropriate information about risks and benefits.
This patient is in active labour at term with ruptured membranes and expresses fear about vaginal delivery.
The immediate priority is to assess the source of her fear (pain, complications, prior trauma, misinformation) and provide education about available analgesia options (e.g., epidural, intravenous opioids, nonpharmacologic methods) and the relative risks and benefits of cesarean versus vaginal delivery.
Automatically arranging a cesarean without discussion is inappropriate, particularly in a primary care setting without clear medical indication. Conversely, refusing cesarean outright is paternalistic and fails to address her concerns. Analgesia may be appropriate but should follow exploration of her preferences. Therefore, empathetic discussion and shared decision-making are the best initial approach.
NEW QUESTION # 179
A 43-year-old man comes to your office for the first time. He has not seen a doctor in over 5 years and has no known past medical history. On examination, his blood pressure is 120/70 mm Hg, and the remainder of his examination is normal. As part of the initial visit, you order some screening blood work that reveals a fasting blood glucose of 6.3 mmol/L (3.3-5.8) and a hemoglobin A1c of 6.1% (4-6). Which one of the following is the best next step?
- A. Order a urine albumin:creatinine ratio.
- B. Perform a 75 g oral glucose tolerance test.
- C. Test capillary blood glucose 4 times a day.
- D. Order an exercise stress test.
- E. Order thyrotroph (thyroid-stimulating hormone) level.
Answer: B
Explanation:
This patient's lab results suggest impaired fasting glucose and an elevated A1c just below the threshold for diabetes. The gold standard to confirm diabetes in such intermediate cases is the 75 g oral glucose tolerance test (OGTT).
Toronto Notes 2023 - Endocrinology, "Diabetes Mellitus" Section:
"If A1c is in the 6.0-6.4% range or fasting glucose 6.1-6.9 mmol/L, a 75 g OGTT is recommended to establish the diagnosis of diabetes or confirm impaired glucose tolerance." MCCQE1 Objectives (Internal Medicine > 76-4: Diabetes):
"Candidates must correctly apply diabetes screening and diagnostic criteria and follow up abnormal results with appropriate confirmatory testing." Urine ACR (C) is useful in diagnosed diabetes, not for initial screening. TSH (A), capillary glucose testing (B), and exercise testing (E) are not indicated at this stage.
NEW QUESTION # 180
A 24-year-old woman has had several episodes of left lower lobe pneumonia. She has a chronic productive cough with occasional blood-streaked sputum. Physical examination is normal except for rales at the left base.
Chest radiograph shows a linear infiltrate in this area. Which one of the following is the most likely diagnosis?
- A. Mitral stenosis
- B. Pulmonary tuberculosis
- C. Pulmonary infarction
- D. Chronic bronchitis
- E. Bronchiectasis
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
Bronchiectasis is characterized by recurrent localized pneumonia, chronic productive cough, and hemoptysis.
A linear infiltrate that persists in the same area suggests localized airway damage-typical of bronchiectasis.
Toronto Notes 2023 - Respirology:
"Bronchiectasis presents with recurrent infections in the same location, productive cough, and hemoptysis.
Chest X-ray may show linear opacities; high-resolution CT is diagnostic." MCCQE1 Objectives (Respiratory > 45-1: Chronic Respiratory Symptoms):
"Candidates must investigate recurrent pneumonias and consider bronchiectasis, especially if localized." Chronic bronchitis (A) presents bilaterally. Mitral stenosis (B) may cause hemoptysis but not localized infiltrates. TB (E) usually affects upper lobes. Infarction (C) is acute and not recurrent.
NEW QUESTION # 181
You are examining a newborn in the delivery room. He was born at full term by spontaneous vaginal delivery.
On examination, he is active, and his vital signs are within normal range. His head circumference is at the third percentile, with height and weight at the 10th percentile. Auscultation of his chest is clear with normal cardiovascular examination findings. The abdomen is protuberant with a liver edge palpable at 4 cm below the costal margin and mild splenomegaly. Which one of the following is the most likely diagnosis?
- A. Cephalic molding
- B. Trisomy 21
- C. Congenital viral infection
- D. Lipid storage disease
- E. Cystic fibrosis
Answer: C
Explanation:
Microcephaly, intrauterine growth restriction, hepatosplenomegaly, and normal vital signs in a term newborn strongly suggest congenital viral infection (e.g., CMV, toxoplasmosis, rubella).
Toronto Notes 2023 - Pediatrics, Congenital Infections:
"Signs of congenital TORCH infections include microcephaly, hepatosplenomegaly, and growth restriction.
Early identification is key."
MCCQE1 Objectives - Pediatrics > Infectious Disease:
"Candidates must recognize signs suggestive of congenital infections and distinguish from genetic or structural abnormalities." Cephalic molding (A) is benign and resolves spontaneously. Lipid storage diseases (B) are not present at birth. Cystic fibrosis (C) does not cause microcephaly or hepatosplenomegaly at birth. Trisomy 21 (D) has distinct dysmorphic features not described here.
NEW QUESTION # 182
A 59-year-old woman is referred to you because of a 2-month history of left nipple discharge. She is otherwise healthy and is not on any medication. There are no palpable lesions on breast examination. She is able to express a small amount of blood-tinged liquid from her breast. Which one of the following would be the best next step?
- A. Magnetic resonance imaging of breast.
- B. Mammography.
- C. Biopsy of nipple complex.
- D. Galactography.
- E. Serum prolactin.
Answer: B
Explanation:
Spontaneous, unilateral, blood-tinged nipple discharge in a postmenopausal woman is considered pathologic and warrants imaging to rule out intraductal pathology including malignancy. The best initial test is diagnostic mammography, often with ultrasound if indicated.
Toronto Notes 2023 - Breast Disorders:
"Unilateral, spontaneous, bloody nipple discharge should be evaluated with mammography and targeted ultrasound. Further tests such as MRI or duct excision are based on findings." MCCQE1 Objectives (Gynecology > 81-1: Breast Conditions):
"Candidates must recognize red flags for breast malignancy and apply appropriate initial diagnostic imaging." Serum prolactin (C) is indicated in galactorrhea. Galactography (D) and MRI (E) are second-line. Biopsy (A) is premature without imaging.
NEW QUESTION # 183
A 33-year-old woman presents to a walk-in clinic with a severe right-sided facial paralysis that started suddenly this morning. She denies any numbness or limb weakness. She has no headache or fever. Which one of the following findings on history/physical examination would suggest a more concerning diagnosis?
- A. Inability to close the eye on affected side.
- B. Ability to wrinkle forehead on affected side.
- C. Recent viral illness.
- D. Hyperacusis on affected side.
- E. Loss of corneal reflex on affected side.
Answer: B
Explanation:
This patient presents with acute unilateral facial paralysis, most consistent with Bell palsy , a peripheral (lower motor neuron) facial nerve palsy. MCCQE objectives emphasize distinguishing peripheral facial palsy from central (upper motor neuron) causes , such as stroke.
In a peripheral lesion (e.g., Bell palsy), the entire ipsilateral face is affected, including the forehead, because the facial nucleus receives ipsilateral input. Therefore, patients cannot wrinkle their forehead, close their eye, or smile on the affected side. Associated findings may include hyperacusis and loss of corneal reflex. A recent viral illness supports Bell palsy and is not concerning.
In contrast, a central lesion (e.g., stroke) spares the forehead due to bilateral cortical innervation of the upper facial muscles. Thus, ability to wrinkle the forehead on the affected side suggests a central cause, which is more concerning and requires urgent evaluation for cerebrovascular disease. Recognizing forehead sparing is critical in differentiating stroke from Bell palsy in acute facial paralysis.
NEW QUESTION # 184
A 22-year-old woman, gravida 1, para 0, aborta 0, comes to the office at 10 weeks' gestation for her first prenatal visit. When you ask how she is doing, she becomes tearful and says she has had severe nausea and vomiting. She is not taking her prenatal vitamins regularly and feels very guilty about it. She is worried that she is harming the fetus. Which one of the following is the most appropriate management of this patient's case?
- A. Advise her to replace her vitamin with folic acid only until her nausea improves
- B. Prescribe ginger tablets to be taken 4 times daily
- C. Tell her she should continue to take her prenatal vitamins daily regardless of nausea
- D. Suggest that she take cannabinoids 30 minutes before taking her prenatal vitamins
- E. Refer her for counselling to manage her feelings of guilt
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
Ginger is a first-line, evidence-based non-pharmacologic treatment for nausea and vomiting in pregnancy. It's well tolerated and effective. Addressing nausea will help her resume vitamin use and reduce distress.
Toronto Notes 2023 - Obstetrics, "Nausea and Vomiting in Pregnancy":
"Ginger 250 mg four times daily is safe and effective for mild to moderate nausea." MCCQE1 Objectives (Obstetrics > 80-1: Early Pregnancy Management):
"Candidates must treat nausea and vomiting in pregnancy using safe and effective options." Folic acid alone (A) is less effective than a full prenatal vitamin. B may help, but nausea should be addressed first. C lacks empathy for her symptoms. D (cannabinoids) is not recommended in pregnancy.
NEW QUESTION # 185
A 60-year-old man has a strong family history of aortic aneurysms. Screening abdominal ultrasonography reveals an incidental <1 cm mass in his left kidney. Computed tomography confirms that the mass is consistent with renal adenocarcinoma. Which one of the following is the most appropriate step in management?
- A. Plan partial nephrectomy
- B. Refer to radiation oncology
- C. Repeat computed tomography in 6 months
- D. Organize angiographic ablation of the renal mass
- E. Arrange magnetic resonance imaging of the abdomen
Answer: A
Explanation:
Comprehensive and Detailed Explanation:
For small renal masses (<4 cm), partial nephrectomy (nephron-sparing surgery) is the standard of care in patients who are surgical candidates. It preserves renal function and provides oncologic control.
Toronto Notes 2023 - Urology / Oncology:
"Small renal tumors <4 cm should be treated with partial nephrectomy. Active surveillance or ablation may be alternatives in poor surgical candidates." MCCQE1 Objectives (Urology > 59-2: Renal Masses):
"Candidates must manage small renal tumors with nephron-sparing surgery when feasible." MRI (A) is unnecessary after CT confirmation. Radiation (B) is not first-line. Surveillance (D) may be appropriate for elderly or frail patients, not this one. Ablation (E) is for high-risk surgical patients.
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NEW QUESTION # 186
An 18-year-old woman comes to the office because of fatigue. She tells you she is struggling in her first year of university. She mentions that she spends much of her time rewriting her notes and filing and organizing her study materials. She is doing all the work in her group assignments because she feels others cannot do the work to a high enough standard. She has abandoned all enjoyable activities and seems to be constantly working and worrying about her grades. Which one of the following is the most likely diagnosis?
- A. Obsessive-compulsive disorder.
- B. Generalized anxiety disorder.
- C. Obsessive-compulsive personality disorder.
- D. Major depressive disorder.
Answer: C
Explanation:
This patient exhibits perfectionism, preoccupation with order and control, and reluctance to delegate - classic features of obsessive-compulsive personality disorder (OCPD). Unlike OCD, there are no intrusive thoughts or compulsions; rather, behaviors are ego-syntonic.
Toronto Notes 2023 - Psychiatry, Personality Disorders:
"OCPD is marked by perfectionism, rigidity, and preoccupation with productivity. It differs from OCD in lacking obsessions or compulsions." MCCQE1 Objectives - Psychiatry > Personality Disorders:
"Candidates must distinguish OCPD by traits of excessive perfectionism, control, and inflexibility, particularly when these interfere with functioning." Major depression (A) is marked by pervasive low mood, which is not reported. OCD (B) involves distressing obsessions and compulsions. GAD (C) is more generalized worry without the perfectionism and rigidity.
NEW QUESTION # 187
An investigator interested in the etiology of neonatal jaundice conducted a study where he selected 150 children diagnosed with this condition and 150 children born in the same time period and in the same hospital who did not have a diagnosis of neonatal jaundice. He then reviewed the delivery records of their mothers to determine various prenatal and perinatal exposures. This is an example of which one of the following?
- A. Cross-sectional study
- B. Ecological study
- C. Cohort study
- D. Case-control study
- E. Clinical trial
Answer: D
Explanation:
In a case-control study, participants are selected based on outcome (e.g., presence or absence of neonatal jaundice), and then past exposures are evaluated. This is consistent with the described methodology.
Toronto Notes 2023 - Epidemiology, "Study Designs":
"Case-control studies start with the outcome and look backward to assess exposures. They are efficient for studying rare conditions or those with long latency." MCCQE1 Objectives (Population Health > 65-2: Epidemiology and Study Design):
"Candidates must distinguish between common study designs and recognize the correct classification based on study structure." Cross-sectional studies (A) assess exposure and outcome at the same time. Cohort studies (C) begin with exposure and follow forward. Clinical trials (D) are interventional. Ecological studies (E) analyze population- level data.
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NEW QUESTION # 188
A 68-year-old man presents with a 3-day history of multiple tender joints. On examination, he has a temperature of 38.2°C and swelling and redness of his left large toe. Which one of the following is the most likely diagnosis?
- A. Crystal-induced arthropathy.
- B. Osteoarthritis.
- C. Rheumatoid arthritis.
- D. Viral arthritis.
- E. Psoriatic arthritis.
Answer: A
Explanation:
This patient presents with acute onset of joint pain, fever, and classic involvement of the first metatarsophalangeal joint (podagra) with swelling and erythema. MCCQE objectives emphasize recognizing the characteristic presentation of crystal-induced arthropathy , particularly gout. Gout commonly affects older men and presents with sudden, severe monoarthritis, often involving the great toe. Systemic symptoms such as low-grade fever may occur during acute attacks.
Viral arthritis typically causes symmetric polyarthritis without marked erythema of a single joint.
Osteoarthritis presents with chronic, non-inflammatory joint pain and minimal warmth or redness. Psoriatic arthritis is usually associated with psoriasis, nail pitting, or dactylitis. Rheumatoid arthritis typically presents as chronic, symmetric small-joint polyarthritis rather than acute podagra.
Although this patient reports multiple tender joints, the prominent inflamed great toe is classic for gout, and polyarticular involvement can occur, especially in older individuals. Diagnosis is ideally confirmed by joint aspiration showing monosodium urate crystals. Initial management includes NSAIDs, colchicine, or corticosteroids.
NEW QUESTION # 189
A 33-year-old man with severe bacterial meningitis is intubated and unresponsive in the Intensive Care Unit.
If he receives immediate treatment, his prognosis is excellent. If he does not, he will likely die. Three years ago, the patient had Huntington disease diagnosed, but he has been asymptomatic since then. His advance directive, which was made before this hospitalization, states that he should be allowed to die if he contracts a life-threatening illness. His parents demand that he be treated for the meningitis. Which one of the following is the best next step?
- A. Initiate treatment, using the parents as substitute decision-makers
- B. Ask for a current mental capacity assessment
- C. Consult a second physician for an opinion on emergent treatment
- D. Do not provide any treatment other than comfort measures
- E. Order an electroencephalography
Answer: D
Explanation:
Comprehensive and Detailed Explanation:
An advance directive is a legally binding document that outlines a competent person's preferences regarding future medical care. If the patient clearly stated a refusal of treatment in the event of a life-threatening condition, this directive must be followed, even if the patient is currently incapacitated and family disagrees.
Toronto Notes 2023 - Ethics and Law:
"Advance directives must be respected when valid, clear, and applicable. Substitute decision-makers cannot override them." MCCQE1 Objectives (ELOM > 90-4: Informed Consent and Advance Directives):
"Candidates must apply valid advance directives to guide care for incapacitated patients." B (parents as SDMs) is incorrect if an advance directive exists. A and D are irrelevant-capacity has already been documented. C is unnecessary when an advance directive is clear.
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NEW QUESTION # 190
A 70-year-old woman consults you for progressive vision problems. She describes seeing haloes at night around street lights and having double vision. Her near vision has improved. Which one of the following is an ophthalmologic examination most likely to uncover?
- A. Retinal exudates.
- B. Arcus senilis.
- C. Altered red reflex.
- D. Increased intra-ocular pressure.
- E. Kayser-Fleischer ring.
Answer: C
Explanation:
The symptoms described - haloes at night, monocular diplopia, and improved near vision (second sight) - are classic signs of nuclear sclerosis-type cataracts. On exam, the most consistent finding would be an altered red reflex due to lens opacification.
Toronto Notes 2023 - Ophthalmology, Cataracts:
"Cataracts can cause glare, monocular diplopia, and improved near vision. A diminished or irregular red reflex is commonly seen on direct ophthalmoscopy." MCCQE1 Objectives - Internal Medicine > Ophthalmologic Disorders:
"The candidate must recognize symptoms and physical findings of cataracts, including changes in red reflex and visual acuity." Options A and B are associated with lipid deposition and Wilson's disease, respectively. Retinal exudates (D) suggest diabetic or hypertensive retinopathy. Increased intraocular pressure (E) suggests glaucoma but is not supported by this clinical picture.
NEW QUESTION # 191
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