MCCQE Part I Population Health and Ethics Questions: 10 Free Practice MCQs

Ten MCCQE Part I-style population health and ethics questions with the answer and the reasoning behind it. They come from the CA.med bank, which has 80 population health and ethics questions and many more across every topic.

1. 1 / 10

   A 45-year-old man is admitted for investigation of unintentional weight loss. His sister telephones the ward asking for his test results. He is capable and has not authorized any disclosure to her.

   What should the physician tell the sister?

   • A. Provide the results because she is a close relative.
   • B. Decline to give information unless the patient consents.
   • C. Provide a summary if she agrees to keep it confidential.
   • D. Refer her to the hospital's public relations office.
   Show answer

   Answer: B. Decline to give information unless the patient consents.

   Why: Guidance from the CMPA states that other than a patient's substitute decision-maker, family members are not within the circle of care and are not entitled to information about a patient's care without the patient's express consent, and that a patient capable of consenting to treatment can also authorize release of confidential information. Because this patient is capable and has not authorized disclosure, the results must not be given to his sister.

   • A. Apart from a substitute decision-maker, family members are not within the circle of care.
   • C. A relative's promise of confidentiality does not create authority to disclose.
   • D. The information office cannot authorize disclosure; only the patient or a lawful exception can.

   Sources: Canadian Medical Protective Association. Privacy and confidentiality (Good practices).

2. 2 / 10

   A 52-year-old woman is referred by her family physician to a gastroenterologist for investigation of iron deficiency anaemia. The gastroenterologist requests her previous blood work and imaging from the family physician's office.

   On what basis may the family physician share the records with the gastroenterologist?

   • A. Acceptance of the referral implies consent to share relevant information within the circle of care.
   • B. Express written consent is needed each time one physician consults another physician.
   • C. The entire record may be shared because the record belongs to the practice.
   • D. The patient's family may authorize the exchange on her behalf.
   Show answer

   Answer: A. Acceptance of the referral implies consent to share relevant information within the circle of care.

   Why: The concept of the circle of care allows health information to be shared between providers who are providing care to the patient without seeking express consent every time information is exchanged, and a patient who accepts a referral implies consent to share relevant information. The right to privacy does not require a fresh written authorization for each exchange, and the physician must still limit disclosure to what is reasonably necessary. Family members are not part of the circle of care.

   • B. Fresh written consent for each exchange is not required within the circle of care.
   • C. Disclosure must still be limited to what is relevant to the purpose.
   • D. Family members are outside the circle of care and cannot authorize the exchange.

   Sources: Canadian Medical Protective Association. Privacy and confidentiality (Good practices).

3. 3 / 10

   A 55-year-old woman is incapable with respect to a proposed wound debridement. Her son, who is 17 years old and lives with her, is available and willing to make the decision. Her spouse has died and no other relative can be reached.

   May the son give or refuse consent on his mother's behalf?

   • A. Yes, because a person at least 16 years old may act, and no higher-ranked person qualifies.
   • B. No, because a substitute decision-maker must be at least 18 years old in Ontario.
   • C. No, because a child may not decide for a parent.
   • D. Yes, but only if the Consent and Capacity Board appoints him first.
   Show answer

   Answer: A. Yes, because a person at least 16 years old may act, and no higher-ranked person qualifies.

   Why: Under the Health Care Consent Act, 1996, a person may give or refuse consent if they are capable with respect to the treatment, at least 16 years old (unless they are the incapable person's parent), not prohibited by a court order or separation agreement, available, and willing. A child of the patient ranks in the hierarchy, and the son satisfies the age and availability requirements, so he may act without any board appointment.

   • B. The statutory minimum age is 16, not 18, unless the person is the patient's parent.
   • C. A child may act for a parent when the statutory requirements are satisfied.
   • D. No board appointment is needed; the hierarchy operates for qualifying persons.

   Sources: Government of Ontario. Health Care Consent Act, 1996, S.O. 1996, c. 2, Sched. A.

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5. 4 / 10

   A 66-year-old man with mild cognitive impairment is able to discuss and decide about cataract surgery but becomes overwhelmed when asked to decide about a complex bowel operation. The resident suggests that because he is capable for the cataract surgery, he must also be capable for the bowel operation.

   Which statement about capacity is correct for this patient?

   • A. Capacity is a global attribute that cannot differ between proposed treatments.
   • B. A person may be incapable with respect to some treatments and capable with respect to others.
   • C. Once capable, a patient remains capable for all later decisions until formally reassessed.
   • D. Capacity can be determined only by a specialist in the relevant field.
   Show answer

   Answer: B. A person may be incapable with respect to some treatments and capable with respect to others.

   Why: The Health Care Consent Act, 1996 provides that a person may be incapable with respect to some treatments and capable with respect to others, and may be incapable at one time and capable at another. Capacity is therefore not a single global judgement and is not fixed permanently by an earlier assessment. The physician proposing each treatment assesses capacity in relation to that specific decision, and no specialist opinion is legally required.

   • A. The legislation expressly allows capacity to differ between treatments.
   • C. Capacity may also change over time, so an earlier finding does not govern later decisions.
   • D. The practitioner proposing the treatment makes the finding; specialist referral is not required.

   Sources: Government of Ontario. Health Care Consent Act, 1996, S.O. 1996, c. 2, Sched. A.

6. 5 / 10

   A 30-year-old woman moves from one province to another for work and applies for coverage under her new province's health care insurance plan. She has heard that there may be a waiting period before she becomes entitled to insured health services and asks her new family physician what the law allows.

   What does the portability criterion of the Canada Health Act permit?

   • A. A waiting period of up to twelve months before coverage begins.
   • B. No minimum period of residence or waiting period of any length.
   • C. A waiting period of up to six months, set by the province.
   • D. A minimum period of residence or waiting period of no more than three months.
   Show answer

   Answer: D. A minimum period of residence or waiting period of no more than three months.

   Why: The portability criterion in section 11 of the Canada Health Act provides that a provincial health care insurance plan must not impose any minimum period of residence in the province, or waiting period, in excess of three months before residents of the province are eligible for or entitled to insured health services. Portability also requires the plan to provide for payment for insured health services received while temporarily absent from the province, and during any waiting period imposed by another province for people who have moved there. Waiting periods of six or twelve months, or the absence of any limit at all, are inconsistent with the three-month ceiling the Act sets.

   • A. Twelve months exceeds the limit set by the Act, so a plan imposing it would not satisfy the portability criterion.
   • B. The Act does permit a province to impose a minimum period of residence or waiting period, although not one longer than three months.
   • C. Six months is longer than the Act allows, and the limit is fixed by the Act rather than left to the province.

   Sources: Canada Health Act, R.S.C., 1985, c. C-6

7. 6 / 10

   A 45-year-old woman attends her family physician for a routine visit. She is asymptomatic, has no previous abnormal cervical screening results, and has been sexually active. She asks how often she should have cervical screening, which she has had regularly for several years.

   According to the Canadian Task Force on Preventive Health Care final recommendations, what should the physician advise for her age group?

   • A. Routine screening every 3 years, a strong recommendation based on high quality evidence.
   • B. Routine screening every year, because annual testing detects changes sooner.
   • C. Routine screening every 5 years, because the test is highly sensitive.
   • D. Screening only if she develops symptoms.
   Show answer

   Answer: A. Routine screening every 3 years, a strong recommendation based on high quality evidence.

   Why: For women aged 30 to 69, the Canadian Task Force on Preventive Health Care recommends routine cervical cancer screening every 3 years, as a strong recommendation based on high quality evidence. Women aged 25 to 29 are also screened every 3 years, but that recommendation is weak and rests on moderate quality evidence. The recommendations are presented for asymptomatic women who are or have been sexually active and do not apply to women with symptoms of cervical cancer, previous abnormal screening results until they have been cleared to resume normal screening, those who do not have a cervix because of hysterectomy, or those who are immunosuppressed. Annual testing, a 5-year interval, and symptom-triggered screening all depart from the recommendation.

   • B. The guideline specifies a 3-year interval for this age band rather than annual testing.
   • C. A 5-year interval is longer than the interval the guideline recommends for women in this age band.
   • D. The recommendations are presented for asymptomatic women who are or have been sexually active, so waiting for symptoms does not follow the guideline.

   Sources: Canadian Task Force on Preventive Health Care - Cervical Cancer Screening Recommendations (final)

8. 7 / 10

   A 73-year-old man with a serious, incurable illness asks his physician how the requirement for a grievous and irremediable medical condition is assessed.

   Which statement reflects the definition in the Criminal Code?

   • A. It requires a diagnosis that will shorten life expectancy to less than one year
   • B. It requires that every available treatment has been tried and has failed
   • C. It requires a serious and incurable illness, disease or disability, an advanced state of irreversible decline in capability, and enduring suffering that is intolerable to the person and cannot be relieved under conditions the person considers acceptable
   • D. It requires that the person be dependent on others for all activities of daily living, that every available treatment has been tried and has failed, and that death is expected within one year according to two independent physicians
   Show answer

   Answer: C. It requires a serious and incurable illness, disease or disability, an advanced state of irreversible decline in capability, and enduring suffering that is intolerable to the person and cannot be relieved under conditions the person considers acceptable

   Why: Under subsection 241.2(2), a person has a grievous and irremediable medical condition only if they have a serious and incurable illness, disease or disability; are in an advanced state of irreversible decline in capability; and that illness, disease, disability or state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable. Subsection 241.2(2.1) provides that, for the purposes of the first element, a mental illness is not considered to be an illness, disease or disability. No fixed prognosis, no requirement to exhaust treatment, and no measure of functional dependence appears in the definition.

   • A. The legislation does not set a life-expectancy threshold, because it focuses on the nature of the condition, the trajectory and the suffering.
   • B. The criteria do not require that all treatments be tried, because they turn on an incurable condition, an advanced decline and intolerable suffering that cannot be relieved under conditions the person considers acceptable.
   • D. Functional dependence is not part of the statutory definition, which turns on incurability, decline and intolerable suffering.

   Sources: Criminal Code, R.S.C., 1985, c. C-46, s. 241.2 (Department of Justice)

9. 8 / 10

   A 62-year-old woman asks about colorectal cancer screening. She has no symptoms, but she has a personal history of colorectal polyps and a brother who was diagnosed with colorectal cancer at age 55. She attends a clinic that offers average-risk screening.

   According to the Canadian Task Force on Preventive Health Care final recommendations, how do they apply to her?

   • A. They apply, because she is over 50 years of age.
   • B. They apply only until she has had a normal colonoscopy, after which average risk screening resumes.
   • C. They do not apply, because she has previous polyps and a first degree relative with colorectal cancer.
   • D. They do not apply because she is a woman.
   Show answer

   Answer: C. They do not apply, because she has previous polyps and a first degree relative with colorectal cancer.

   Why: The Canadian Task Force on Preventive Health Care states that its colorectal cancer screening recommendations apply to adults aged 50 years and over who are not at high risk for colorectal cancer, and they do not apply to those with previous colorectal cancer or polyps, inflammatory bowel disease, signs or symptoms of colorectal cancer, a history of colorectal cancer in one or more first degree relatives, or hereditary syndromes predisposing to colorectal cancer such as familial adenomatous polyposis or Lynch syndrome. This patient has previous polyps and a first degree relative with colorectal cancer, so she falls outside the population the recommendations address and needs assessment on a different pathway. Age alone does not bring her within them, a normal colonoscopy does not make them apply, and sex is not an exclusion.

   • A. Being over 50 is not sufficient, because she has features that place her outside the population for which the recommendations are written.
   • B. The recommendations define a population for screening, and they do not become applicable once a colonoscopy has been normal.
   • D. Sex is not part of the exclusion criteria in this guideline.

   Sources: Canadian Task Force on Preventive Health Care - Colorectal Cancer Screening Recommendations (final)

10. 9 / 10

    A 66-year-old woman with an advanced illness asks about medical assistance in dying, and her physician reviews the eligibility criteria with her before any assessment proceeds.

    Which criteria must she meet under the Criminal Code?

    • A. She must be eligible for government-funded health services, be at least 18 and capable of making decisions about her health, have a grievous and irremediable medical condition, have made a voluntary request, and give informed consent
    • B. She must have a terminal illness with a prognosis of less than six months
    • C. She must be over 65 and have no remaining treatment options
    • D. She must have the agreement of her substitute decision-maker and her family physician, a terminal illness with a prognosis of less than six months, and a psychiatric assessment confirming she has no treatable mental illness
    Show answer

    Answer: A. She must be eligible for government-funded health services, be at least 18 and capable of making decisions about her health, have a grievous and irremediable medical condition, have made a voluntary request, and give informed consent

    Why: Section 241.2(1) of the Criminal Code states that a person may receive medical assistance in dying only if they meet all of five criteria: they are eligible, or would be but for a waiting period, for health services funded by a government in Canada; they are at least 18 years of age and capable of making decisions with respect to their health; they have a grievous and irremediable medical condition; they have made a voluntary request that in particular was not made as a result of external pressure; and they give informed consent after having been informed of the means available to relieve their suffering, including palliative care. A fixed prognosis, a higher age threshold, exhaustion of all options, and substitute decision-maker agreement are not part of the criteria.

    • B. A person does not need a fatal or terminal condition, and the criteria do not require any particular prognosis.
    • C. The age threshold in the legislation is 18, and the criteria do not require that treatment options be exhausted.
    • D. Eligibility rests on the person's own criteria and consent, and a substitute decision-maker cannot consent to medical assistance in dying for a patient who is incapable.

    Sources: Criminal Code, R.S.C., 1985, c. C-46, s. 241.2 (Department of Justice)

11. 10 / 10

    A 65-year-old man attends for a routine visit. He is asymptomatic, has no personal or family history of colorectal cancer or polyps, no inflammatory bowel disease, and no hereditary syndrome predisposing to colorectal cancer. He asks which colorectal cancer screening test he should have.

    According to the Canadian Task Force on Preventive Health Care final recommendations, what should the physician offer?

    • A. Screening colonoscopy every 10 years from age 50.
    • B. Screening colonoscopy every 5 years.
    • C. No screening, because he has no symptoms or risk factors.
    • D. FOBT every 2 years or flexible sigmoidoscopy every 10 years.
    Show answer

    Answer: D. FOBT every 2 years or flexible sigmoidoscopy every 10 years.

    Why: For adults aged 60 to 74, the Canadian Task Force on Preventive Health Care recommends screening for colorectal cancer with FOBT, either gFOBT or FIT, every 2 years, or flexible sigmoidoscopy every 10 years, as a strong recommendation based on moderate quality evidence. For adults aged 50 to 59, the same screening options are recommended, but as a weak recommendation based on moderate quality evidence. The guideline recommends not using colonoscopy as a screening test, so colonoscopy at a 10-year or 5-year interval is not one of the offered options. Because the recommendations address asymptomatic adults who are not at high risk, the absence of symptoms does not remove the offer of screening.

    • A. The guideline recommends not using colonoscopy as a screening test, so it is not offered even at a 10-year interval.
    • B. Colonoscopy is not recommended as a screening test at any interval in this guideline.
    • C. The recommendations apply to adults aged 50 and over who are not at high risk, so the absence of symptoms is expected and does not remove the offer of screening.

    Sources: Canadian Task Force on Preventive Health Care - Colorectal Cancer Screening Recommendations (final)

Exam-style questions written by MedHub for practice. They are not official exam questions.