Medical Council of Canada Updated MCCQE Exam Questions and Answers by alayah

The clinical presentation ofmultiple fractures at different stages of healingin a young child raisesstrong suspicion of physical abuse(non-accidental trauma). In such situations,mandatory reporting to child protection services is legally and ethically required, even in the absence of parental admission or clear history.

Toronto Notes 2023 – Pediatrics, Child Maltreatment Section:

“Red flags include inconsistent history, delay in seeking care, multiple injuries in various stages of healing, and injuries not consistent with developmental level. Health care professionals arelegally obligatedto report suspected child abuse or neglect to child protection authorities without delay.”

MCCQE1 Objectives (Medical Expert > Pediatrics > 77-2):

"The candidate must be able to recognize when the findings are consistent with child abuse... When child abuse is suspected,the physician has a legal obligation to report to the appropriate child protection agencyimmediately."

Options B, C, D, and E do not address the immediate child safety risk and legal duty. Social work involvement (E) is supportive but must follow or accompany notification to child protection, not replace it.

Patients with developmental disabilities must still be engaged directly unless clearly incapable. It is vital to first establish the companion’s relationship to the patient and give the patient the opportunity to communicate.

Toronto Notes 2023 – ELOM, Consent and Capacity:

“Presume capacity in adults with developmental disabilities unless proven otherwise. Direct communication with the patient is essential, and the identity of accompanying individuals should be clarified.”

MCCQE1 Objectives – ELOM > Patient Autonomy and Consent:

“Candidates must respect patient autonomy and include developmentally delayed individuals in medical discussions unless incapacity is determined.”

Options A and C delay establishing capacity and relationship. Option D is premature. Option E bypasses consent and interaction with the patient.

The patient is alert and capable of making his own decisions. The most ethical and respectful approach is to ensure he understands the risks and accept his choice. Holding his bed maintains continuity of care. Forcing him to stay (C) or discharging him AMA (A) is inappropriate if he intends to return.

Toronto Notes 2023 – ELOM, Consent and Autonomy:

“Capable patients have the right to refuse or leave treatment. Physicians must ensure informed decision-making and maintain therapeutic rapport.”

MCCQE1 Objectives – ELOM > Capacity and Patient Autonomy:

“Candidates must respect a capable patient’s right to leave care after informed discussion of risks and alternatives.”

Offering to enter his apartment (E) is inappropriate and unethical. Oral antibiotics (B) may not be clinically appropriate given hypotension.

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Before proceeding with any virtual consultation, particularly by voice-only, it is essential to confirm the patient’s identity beyond name alone — for example, by verifying date of birth or health card number. This protects privacy and ensures medical confidentiality.

Toronto Notes 2023 – ELOM, Virtual Care Section:

“Virtual care must begin by verifying patient identity using at least two identifiers (e.g., full name and date of birth) to prevent disclosure of personal health information to unintended individuals.”

MCCQE1 Objectives – Ethical, Legal, and Professionalism > Virtual Care:

“The candidate must confirm patient identity and consent before initiating any virtual medical encounter, especially when video is not available.”

Option A (reason for visit) should follow identity confirmation. Option B (confirming primary care provider) is irrelevant to identity verification.

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