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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q108-Q113):

NEW QUESTION # 108
A 3-year-old boy is brought to the office because he is not using his right arm after a fall from a swing.
Radiographs reveal a new fracture and old healing fractures. The parents deny any previous injuries. In addition to providing care for the fracture, which one of the following is the best next step?

A. Monitor the patient for future injuries.
B. Notify child protection services.
C. Refer the family to the social work department.
D. Investigate the patient to rule out metabolic or endocrine disorders.
E. Advise the parents to better supervise the patient.

Answer: B

Explanation:
The clinical presentation ofmultiple fractures at different stages of healingin a young child raisesstrong suspicion of physical abuse(non-accidental trauma). In such situations,mandatory reporting to child protection services is legally and ethically required, even in the absence of parental admission or clear history.
Toronto Notes 2023 - Pediatrics, Child Maltreatment Section:
"Red flags include inconsistent history, delay in seeking care, multiple injuries in various stages of healing, and injuries not consistent with developmental level. Health care professionals arelegally obligatedto report suspected child abuse or neglect to child protection authorities without delay." MCCQE1 Objectives (Medical Expert > Pediatrics > 77-2):
"The candidate must be able to recognize when the findings are consistent with child abuse... When child abuse is suspected,the physician has a legal obligation to report to the appropriate child protection agency immediately." Options B, C, D, and E do not address the immediate child safety risk and legal duty. Social work involvement (E) is supportive but must follow or accompany notification to child protection, not replace it.

NEW QUESTION # 109
A 72-year-old man presents to your clinic accompanied by his 70-year-old husband. The patient reports that, over the last several months, his libido has been very low. Which one of the following would be the best next step?

A. Prescribe testosterone
B. Assess for depression
C. Refer for couple's counselling
D. Interview the couple together
E. Order serum testosterone levels

Answer: B

Explanation:
Comprehensive and Detailed Explanation:
Decreased libido in elderly patients can be multifactorial, but depression is a common and important cause that must be ruled out before hormone therapy or other steps. A proper mental health screen should precede further interventions.
Toronto Notes 2023 - Psychiatry / Geriatrics:
"In elderly men, reduced libido may be linked to depression, medical illness, or medications. Depression screening is essential." MCCQE1 Objectives (Psychiatry > 71-1: Mood Disorders / Sexual Health):
"Candidates must consider depression as a common cause of decreased libido and assess accordingly before initiating hormone therapy." Testosterone testing (D) may follow. Prescribing (C) is premature. Couples counselling (B) may help if interpersonal issues are identified. Interviewing together (A) may inhibit disclosure.
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NEW QUESTION # 110
An otherwise well 18-month-old girl is brought to your family practice office for routine immunization. Her mouth is as shown in the attached image. She has no symptoms. Which one of the following is the most likely cause of this presentation?

Image description: Severe black and brown decay of multiple upper front teeth, with relatively spared lower teeth.

A. Use of oral iron supplements.
B. Repeated courses of antibiotics.
C. Lack of fluoride in drinking water.
D. Vitamin D deficiency.
E. Putting the child to bed with a bottle.

Answer: E

Explanation:
The image shows classic features of "early childhood caries" (ECC), often called " baby bottle tooth decay." This typically affects upper incisors first due to prolonged exposure to milk/formula or sugary drinks during sleep.
Toronto Notes 2023 - Pediatrics, "Dental Health" Section:
"ECC is most commonly caused by prolonged nighttime bottle feeding with milk or juice. It affects upper anterior teeth due to pooling and lack of protective salivary flow." MCCQE1 Objectives (Pediatrics > 78-2: Preventive Care):
"Candidates must recognize risk factors for dental caries in young children, including nighttime bottle use and sugary liquid exposure." Antibiotics (C) or iron (D) can stain but do not cause this pattern of decay. Vitamin D (A) causes enamel hypoplasia or delayed eruption. Fluoride deficiency (B) causes diffuse decay, not selective anterior tooth loss.

NEW QUESTION # 111
A 60-year-old man presents to the office with concerns regarding a pruritic rash, which he has had for several years. He reports a "crawling" sensation on his skin. He is concerned that this rash may be caused by a parasite he may have picked up while serving in the military overseas. On examination, you note multiple crusted lesions on his forearms, neck, chest, scalp, and thighs. There is a complete sparing of the skin on his back. He brought a bottle with fibrous material of different colours that he picked from his wounds. He is otherwise healthy and reports no other symptoms except some chronic fatigue and insomnia related to the itching. Which one of the following treatments is the most appropriate?

A. Ivermectin
B. Butenafine
C. Permethrin
D. Doxycycline
E. Fluconazole

Answer: A

Explanation:
This case describes classic signs of delusional parasitosis (also known as Morgellons syndrome).However, the presence of widespread crusted lesions raises suspicion for crusted scabies, particularly in older adults.
Crusted scabies may be misinterpreted as chronic dermatitis or psychocutaneous disorder. The most effective treatment is oral ivermectin.
Toronto Notes 2023 - Dermatology:
"Crusted scabies presents as widespread hyperkeratotic plaques with crusting. First-line treatment is oral ivermectin, often with topical permethrin." MCCQE1 Objectives (Medicine > Dermatology > 23-1):
"Candidates must recognize presentations of ectoparasitic infections, including scabies, and provide appropriate treatment." Permethrin (B) is for typical scabies, but crusted scabies often requires systemic ivermectin due to severity and spread.

NEW QUESTION # 112
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. Early introduction of solid foods.
C. Caloric-fortified feeding.
D. High-dose vitamin D supplementation.

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 # 113
......

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