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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q259-Q264):

NEW QUESTION # 259
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. Assess for depression
B. Refer for couple's counselling
C. Interview the couple together
D. Prescribe testosterone
E. Order serum testosterone levels

Answer: A

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.
-

NEW QUESTION # 260
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. Generalized anxiety disorder.
B. Panic disorder.
C. Posttraumatic stress disorder.
D. Malingering.

Answer: C

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 # 261
A 66-year-old woman with metastatic breast cancer presents with hard, difficult-to-pass stools. She has been experiencing this issue since starting morphine to control her pain. Which one of the following is the best next step?

A. Suggest increasing her physical activity
B. Lower her morphine dose
C. Add a bulk-forming fiber supplement to her diet
D. Start docusate
E. Prescribe senna

Answer: E

Explanation:
Comprehensive and Detailed Explanation:
Opioid-induced constipation is best managed with stimulant laxatives like senna or bisacodyl. Stool softeners such as docusate are insufficient as monotherapy. Senna stimulates peristalsis, making it more effective.
Toronto Notes 2023 - Palliative Care:
"Opioid-induced constipation requires stimulant laxatives such as senna. Stool softeners alone are not adequate." MCCQE1 Objectives (Palliative Care > 92-1: Symptom Management):
"Candidates must treat opioid-related side effects appropriately, including use of stimulant laxatives for constipation." Bulk agents (C) can worsen symptoms. Reducing morphine (D) may compromise pain control. Activity (E) helps but is insufficient as first-line management.
-

NEW QUESTION # 262
A previously well 4-year-old boy is brought to your office by his mother. She is concerned by his behaviour.
Shortly after falling asleep, he awakens, screams loudly and cries. He appears frightened and does not respond to his mother's efforts to calm him. During these episodes, he appears agitated and flushed. After 15-20 minutes, he settles back to sleep. Physical examination is unremarkable. Which one of the following is the most likely diagnosis?

A. Panic disorder.
B. Non-rapid eye movement sleep arousal disorder.
C. Nocturnal seizures.
D. Temper tantrums.
E. Nightmare disorder.

Answer: B

Explanation:
This presentation is characteristic of a non-rapid eye movement (NREM) sleep arousal disorder (sleep terror)
. MCCQE objectives highlight that sleep terrors typically occur in children aged 3-7 years and arise during the first third of the night , shortly after sleep onset, during deep NREM (slow-wave) sleep. Children abruptly awaken screaming, appear terrified, flushed, and autonomically aroused, and are inconsolable and minimally responsive to caregivers. Episodes usually last 10-20 minutes and resolve spontaneously, with the child returning to sleep and having no memory of the event the next morning.
Nightmares, in contrast, occur during REM sleep (later in the night); the child is awake, alert, consolable, and can recall the dream. Nocturnal seizures are typically brief, stereotyped, and may include tonic-clonic activity or a postictal state. Panic disorder occurs during wakefulness. Temper tantrums occur while awake and are behaviorally triggered.
Management is reassurance and ensuring safety; most children outgrow sleep terrors without intervention.

NEW QUESTION # 263
You are being consulted for a 79-year-old man who is about to undergo a total hip arthroplasty. His orthopedic surgeon is aware of the diagnosis of Alzheimer disease and would like your suggestions to help avoid acute postsurgical delirium. To that end, which one of the following is the most effective strategy?

A. Keep family visits to a minimum to avoid postsurgical overstimulation
B. Treat postsurgical insomnia with benzodiazepines
C. Screen the patient with the Mini-Mental Status Examination prior to surgery
D. Refrain from prescribing opiate analgesics to treat postoperative pain
E. Avoid medications with anticholinergic potential

Answer: E

Explanation:
One of the strongest modifiable risk factors for postoperative delirium in older adults is exposure to anticholinergic medications (e.g., diphenhydramine, certain antidepressants). Avoiding these can reduce delirium risk.
Toronto Notes 2023 - Geriatrics, "Delirium Prevention":
"Avoid high-risk medications including anticholinergics, benzodiazepines, and narcotics if possible. Maintain orientation cues and adequate pain control." MCCQE1 Objectives (Medicine > Geriatrics > 41-1: Cognitive Impairment):
"Candidates must recognize predisposing factors for delirium and apply prevention strategies, including medication review." Opiates (B) should be used judiciously; untreated pain can also cause delirium. Cognitive screening (C) is helpful for baseline but does not prevent delirium. Benzodiazepines (D) increase delirium risk. Family involvement is actually helpful (E).

NEW QUESTION # 264
......

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MCCQE Torrent | Certification MCCQE Test Answers

Certification MCCQE Test Answers - Detailed MCCQE Study Plan

Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q259-Q264):

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