MCCQE Exam Dumps - Medical Council of Canada Qualifying Examination Part 1 Exam

In a patient with a pelvic fracture and blood at the urethral meatus, urethral injury must be strongly suspected. Other signs may include perineal hematoma, high-riding prostate, or inability to void. The key principle is do not insert a Foley catheter until urethral integrity is confirmed, as blind catheterization may worsen a partial tear into a complete disruption. The appropriate next diagnostic step is retrograde urethrography (RUG), which evaluates the urethra for extravasation of contrast and identifies the site and extent of injury.

Voiding cystography evaluates bladder injury and is performed after urethral integrity is confirmed or via suprapubic access. Transrectal ultrasound and penile sonography are not appropriate in acute trauma assessment of suspected urethral disruption. Continuous bladder irrigation is contraindicated until urethral injury is excluded.

MCCQE objectives emphasize recognition of urethral injury in pelvic trauma and adherence to trauma principles: stabilize first, suspect urethral injury when blood is present at the meatus, and perform retrograde urethrography prior to catheterization.

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.

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The most appropriate next step is to screen for postpartum depression . MCCQE objectives emphasize the importance of assessing maternal mental health at routine infant visits, particularly in the first months postpartum. This mother reports exhaustion, difficulty coping, and limited social support (husband deployed), all of which are risk factors for postpartum depression. Although infant growth is normal and frequent crying at 1 month can be physiologic (e.g., colic/normal infant behavior), the key clinical issue is maternal distress and functional impairment.

Postpartum depression can present with fatigue, irritability, sleep disturbance beyond expected newborn care, feelings of being overwhelmed, and impaired bonding. Early identification through targeted questioning or validated screening tools (e.g., Edinburgh Postnatal Depression Scale) allows timely intervention, which benefits both mother and infant.

Simply reassuring her may miss significant depressive symptoms. Increasing feeds or switching formula is not indicated with normal growth and no allergy signs. Lactation referral may help feeding mechanics but does not address maternal psychological well-being. Therefore, screening for depression is the priority.

Alpha blockers such as tamsulosin can facilitate the passage of ureteral stones, especially those between 5–10 mm. This is part of medical expulsive therapy.

Toronto Notes 2023 – Urology, Nephrolithiasis:

“Alpha blockers help relax the ureteral smooth muscle and improve stone passage in symptomatic distal ureteral stones.”

MCCQE1 Objectives – Surgery > Urologic Emergencies:

“Candidates should initiate medical expulsive therapy for ureteral stones under 10 mm with alpha blockers.”

Reassurance alone (A) is inadequate. Antibiotics (B) are not indicated without infection. IV fluids (E) do not significantly aid stone passage. Urology consult (D) is not needed unless there’s infection, intractable pain, or obstruction.

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Comprehensive and Detailed Explanation:

The levonorgestrel-releasing intrauterine device (LNG-IUD) is generally contraindicated in current or recent breast cancer due to the progestin component, but may be considered in select patients on tamoxifen, especially if non-hormonal options are unsuitable. Consultation with the oncologist is required to evaluate risks and benefits.

Toronto Notes 2023 – Gynecology, “Contraception in Special Populations”:

“Levonorgestrel IUDs are generally avoided in patients with a history of hormone-sensitive cancers; however, decisions should be made collaboratively with oncology.”

MCCQE1 Objectives (Gynecology > 82-2: Contraception):

“Candidates must tailor contraceptive advice to patients with medical comorbidities, including cancer survivors.”

Irregular bleeding (A) is a common but not contraindicating side effect. No pre-procedure antibiotics (D) are typically needed. The IUD does not cause infertility (E). Risk of recurrence (C) is unconfirmed and must be individualized.

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The findings of exophthalmos (bulging eyes), conjunctival inflammation, and periorbital swelling are hallmark features of Graves ophthalmopathy, a manifestation of autoimmune hyperthyroidism.

Toronto Notes 2023 – Endocrinology, “Thyroid Disorders”:

“Graves ophthalmopathy: proptosis, periorbital edema, conjunctivitis, and diplopia due to extraocular muscle involvement. Often independent of thyroid levels.”

MCCQE1 Objectives (Internal Medicine > 36-1: Thyroid Disease):

“Candidates must recognize and manage Graves disease and its ocular manifestations.”

Myasthenia gravis may cause diplopia but not proptosis or swelling. Pseudotumor and cellulitis are painful and acute. Allergic conjunctivitis is itchy but lacks proptosis.

The presentation is highly suspicious for acute aortic dissection — sudden chest/back pain and mediastinal widening on chest x-ray. The most definitive and widely available test is contrast-enhanced computed tomography (CT) of the chest.

Toronto Notes 2023 – Cardiology, Aortic Dissection:

“CT angiography of the chest is the gold standard for stable patients with suspected aortic dissection. Look for mediastinal widening on chest x-ray as a clue.”

MCCQE1 Objectives – Internal Medicine > Cardiovascular Disease:

“Candidates should recognize acute aortic dissection and select appropriate imaging, such as CT chest, for diagnosis in stable patients.”

Transthoracic echo (A) may miss dissections. ECG (C) helps rule out MI but not dissection. V/Q scan (D) and pulmonary angiography (E) are for suspected pulmonary embolism.

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This patient has a family history of both male breast cancer (father) and early-onset ovarian cancer (aunt), which are red flags for BRCA1/2 mutations. Genetic counseling and BRCA testing are the appropriate next steps to stratify cancer risk and guide screening and prevention.

Toronto Notes 2023 – Oncology, “Breast Cancer Risk” Section:

“BRCA testing is recommended for individuals with a strong family history of breast or ovarian cancer, particularly if involving male relatives or early-onset cases.”

MCCQE1 Objectives (Population Health > 97-5: Screening and Prevention):

“Candidates must identify high-risk individuals who require genetic counseling and screening beyond population guidelines.”

Tamoxifen (A) and prophylactic mastectomy (E) are only considered after confirming mutation status. Annual screening starting at 50 (D) is for average-risk women. Fine-needle sampling (C) is not a screening tool.

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