Free MCCQE Medical Council of Canada Updates

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).

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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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Comprehensive and Detailed Explanation:

This patient is pregnant and febrile with a new headache, photophobia, and clonus — all features concerning for preeclampsia with neurologic involvement. Clonus is a key finding suggestive of central nervous system irritability. Urine protein/creatinine ratio helps confirm the diagnosis of preeclampsia.

Toronto Notes 2023 – Obstetrics, Hypertensive Disorders in Pregnancy:

“Headache, clonus, and visual disturbances are concerning for severe preeclampsia. A urine protein/creatinine ratio or 24-hour urine collection confirms diagnosis.”

MCCQE1 Objectives – Obstetrics > Hypertension in Pregnancy:

“Candidates must recognize signs of preeclampsia and assess with appropriate biochemical testing.”

CT (A) or LP (B) are not indicated unless focal neurologic signs or seizures are present. Fetal imaging and amniocentesis (C, D) do not address maternal symptoms.

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Comprehensive and Detailed Explanation:

Infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse in women under 35 years. Since she has been trying for only 5 months, reassurance is appropriate.

Toronto Notes 2023 – Gynecology:

“Investigations for infertility in women under 35 should begin after 12 months of attempting to conceive, unless other risk factors are present.”

MCCQE1 Objectives (Gynecology > 82-1: Infertility):

“Candidates must apply appropriate timing and indications for infertility investigations based on patient age and history.”

Earlier testing is not warranted here. Options A–D are part of the infertility work-up but not before 12 months.

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