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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q353-Q358):
NEW QUESTION # 353
A 38-year-old woman presents with diffuse nodularity in the outer upper quadrant of her right breast. There is no obvious dominant mass, nipple discharge, or skin dimpling. There are no palpable lymph nodes. Which one of the following is the most likely diagnosis?
- A. Mastitis
- B. Intraductal carcinoma
- C. Benign phyllodes tumour
- D. Paget disease
- E. Fibrocystic change
Answer: E
Explanation:
Fibrocystic change is the most common benign breast condition in women of reproductive age. It typically presents with diffuse nodularity or "lumpy" areas, especially in the upper outer quadrant, and varies with the menstrual cycle. No dominant mass or systemic signs are expected.
Toronto Notes 2023 - Gynecology, "Benign Breast Conditions":
"Fibrocystic changes often present with bilateral or unilateral nodularity, most commonly in the upper outer quadrants, without discrete masses." MCCQE1 Objectives (Gynecology > 81-1: Breast Conditions):
"Candidates must differentiate benign breast conditions from malignant ones based on presentation and physical exam findings." Paget disease (B) presents with nipple changes. Intraductal carcinoma (C) typically shows a discrete mass or suspicious features. Phyllodes tumours are usually well-circumscribed. Mastitis (E) is inflammatory and associated with erythema, fever, and tenderness.
NEW QUESTION # 354
A 28-year-old nulligravid woman presents to your clinic with grey-green vaginal discharge that has a "fishy- type odour." Microscopy reveals superficial squamous cells with blurred borders caused by adherent bacteria.
The patient's symptoms abate after therapy with vaginal metronidazole. Which one of the following is the most likely cause of this clinical presentation?
- A. Neisseria gonorrhoeae.
- B. Chlamydia trachomatis.
- C. Human papillomavirus.
- D. Trichomonas vaginalis.
- E. Gardnerella vaginalis.
Answer: E
Explanation:
This presentation is classic for bacterial vaginosis (BV) . MCCQE objectives emphasize recognition of BV by its typical features: thin grey/grey-green discharge , fishy (amine) odour , and microscopy showing clue cells
-vaginal epithelial (superficial squamous) cells with blurred borders from adherent bacteria. BV results from a shift in vaginal flora away from lactobacilli toward anaerobes, with Gardnerella vaginalis commonly implicated and often present in polymicrobial overgrowth. Improvement with metronidazole further supports BV, as it is first-line therapy.
Other options do not match: HPV causes genital warts/cervical dysplasia, not malodorous discharge with clue cells. Trichomonas typically causes frothy yellow-green discharge, "strawberry cervix," and motile trichomonads on wet mount (not clue cells). Chlamydia and gonorrhea cause cervicitis/PID with mucopurulent discharge and pelvic symptoms rather than fishy odour and clue cells. Therefore, Gardnerella vaginalis is the most likely cause.
NEW QUESTION # 355
A 46-year-old woman presents with concerns because she has not had a period for the past 13 months. She has not had any hot flashes or night sweats, but she has noted some problems staying asleep for the past 6 months. She feels "foggy," which has made her work more difficult. She is in a same-sex relationship and has no pain with sexual activity. In discussing options with her, which one of the following is most appropriate?
- A. Explain she is menopausal and her symptoms should resolve with time.
- B. Order serum estrogen and progesterone levels.
- C. Initiate selective serotonin reuptake inhibitor therapy.
- D. Refer for investigations of possible sleep apnea.
- E. Arrange for pelvic ultrasound and endometrial biopsy.
Answer: A
Explanation:
Amenorrhea for #12 consecutive months in a woman over age 45 is diagnostic of menopause and does not require laboratory confirmation in the absence of atypical features. MCCQE objectives emphasize that routine measurement of estrogen or progesterone levels is unnecessary in typical cases, as hormone levels fluctuate widely during the perimenopausal transition. This patient has mild menopausal symptoms (sleep disturbance and cognitive "fog") without vasomotor symptoms, abnormal bleeding, or pelvic pain.
Pelvic ultrasound or endometrial biopsy is not indicated because she has no postmenopausal bleeding. SSRI therapy may be considered for significant vasomotor or mood symptoms but is not first-line for mild cognitive or sleep complaints in otherwise healthy menopausal women. Sleep apnea investigation is not suggested by the history.
Therefore, the most appropriate step is to explain that she is menopausal and provide reassurance, along with education about lifestyle strategies for sleep and cognitive symptoms, and discussion of treatment options if symptoms become bothersome.
NEW QUESTION # 356
On screening for dyslipidemia, a 45-year-old man is found to have a low high-density lipoprotein (HDL) cholesterol level. Which one of the following recommendations is the most appropriate?
- A. Garlic supplementation.
- B. Vigorous exercise program.
- C. Elimination of caffeine.
- D. Alcohol cessation.
- E. Low-salt diet.
Answer: B
Explanation:
Low HDL is best managed with lifestyle changes such as increased aerobic physical activity, smoking cessation, and weight loss. Vigorous exercise has the strongest evidence for raising HDL levels.
Toronto Notes 2023 - Cardiology, Dyslipidemia:
"Increasing physical activity is among the most effective ways to raise HDL cholesterol. There is no consistent benefit to supplements such as garlic, nor does reducing salt or caffeine meaningfully raise HDL." MCCQE1 Objectives - Population Health > Cardiovascular Risk Management:
"Candidates should recommend evidence-based lifestyle interventions such as exercise to improve lipid profiles, particularly to increase HDL." Alcohol cessation (C) is generally beneficial for overall health but may actually lower HDL slightly. Garlic (D) and caffeine (E) are not evidence-based interventions for dyslipidemia.
NEW QUESTION # 357
A patient's mother comes to you with a prospective cohort study linking autism to the measles, mumps and rubella vaccine. After reviewing the study carefully, you question the results because of problems with the study design and execution. Which one of the following sources of error would be most important in the study design or execution?
- A. Reporting standard error with point estimates of difference
- B. Not accounting for all potential confounders during recruitment
- C. Vaccine company sponsorship of study
- D. Recruitment of study families at an autism seminar
- E. Parental recall of vaccine administration
Answer: D
Explanation:
Recruiting participants from an autism seminar introduces selection bias. This non-random selection increases the likelihood of overestimating associations due to pre-existing beliefs or exposures in that subgroup.
Toronto Notes 2023 - Epidemiology:
"Selection bias occurs when participants are not representative of the general population, as in recruitment from disease-specific support groups." MCCQE1 Objectives (Population Health > 65-2: Study Design and Appraisal):
"Candidates must recognize sources of bias in epidemiologic studies, including selection bias due to non- representative recruitment." Recall bias (D) is more of a concern in retrospective studies. Sponsorship (B) may create perception bias but is not a flaw in methodology itself. Standard error reporting (A) is normal. Not accounting for confounders (E) matters but recruitment source is more directly biasing.
NEW QUESTION # 358
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