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

The most likely diagnosis is acute anterior uveitis (iritis). The key MCCQE clinical pattern is painful red eye with ciliary flush (injection worst adjacent to the iris/limbus) and marked photophobia, especially consensual photophobia, which strongly points to inflammation of the iris and ciliary body. The sluggish light response and miosis (smaller pupil) are also typical of iritis due to sphincter spasm and inflammation. Intraocular pressure is normal, helping to rule out acute angle-closure glaucoma, which usually presents with elevated IOP, corneal haze, and a mid-dilated fixed pupil. Optic neuritis classically causes decreased color vision and pain with eye movement rather than ciliary flush. Viral conjunctivitis causes diffuse conjunctival injection and irritation/grittiness, not severe pain with consensual photophobia. Scleritis causes deep “boring” pain and violaceous scleral hue, not miosis/consensual photophobia as dominant features. Difficulty visualizing the fundus can occur with significant miosis.

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.

The presentation is consistent with rotator cuff tendinopathy or subacromial impingement. The painful arc between 30°–120° with preserved passive ROM suggests this. Ultrasound is the preferred initial imaging modality due to its availability, safety, and ability to visualize soft tissues dynamically.

Toronto Notes 2023 – Orthopedics, “Shoulder Pathologies” Section:

“In rotator cuff injuries or impingement syndromes, initial imaging with musculoskeletal ultrasound is appropriate. It can identify tendinopathy, partial tears, or subacromial bursitis.”

MCCQE1 Objectives (Surgery > 84-7: Musculoskeletal Pain):

“Candidates should initiate workup for rotator cuff or impingement syndromes with ultrasound as the first-line test, reserving more invasive or costly procedures for unresolved or complex cases.”

CT (A) is used for bony detail, not soft tissues. Arthroscopy (C) is invasive and therapeutic. Arthrography (D) is outdated and largely replaced by MRI or ultrasound.

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