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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Dimensions of Care | 50% | - Acute Care - Health Promotion and Illness Prevention - Assessment and Diagnosis - Chronic Care |
| Topic 2: Physician Activities | 50% | - Communication - Psychosocial Aspects - Professional Behaviours - Management |
>> Medical Council of Canada MCCQE英語版 <<
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質問 # 241
A 35-year-old woman presents to your clinic for follow-up regarding her persistent primary immune thrombocytopenic purpura. She was admitted to hospital with a relapse and received treatment with dexamethasone, intravenous immunoglobulin, and rituximab. She was recently discharged from hospital with a platelet count of 55 × 10#/L (130-360), and also continues to take 10 mg of prednisone once daily. She is scheduled for a splenectomy in 4 weeks. Which one of the following is the best next step in preparation for the patient ' s surgical procedure?
正解：B
解説：
Comprehensive and Detailed Explanation:
Patients undergoing splenectomy are at lifelong risk for overwhelming post-splenectomy infection (OPSI), particularly from encapsulated organisms. Vaccination against Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis is recommended at least 2 weeks prior to elective splenectomy.
Toronto Notes 2023 - Hematology / Surgery:
"Patients undergoing elective splenectomy should receive vaccines against pneumococcus, H. influenzae type b, and meningococcus at least 2 weeks before surgery." MCCQE1 Objectives (Hematology > 38-2: Thrombocytopenia and Splenectomy):
"Candidates must ensure vaccination prior to splenectomy to prevent postsplenectomy sepsis." Calcium (B) may be considered in chronic steroid users but is not the priority. Azithromycin (C) is not indicated. D is unsafe without tapering. E is only for acute bleeding or extremely low platelets.
質問 # 242
A 19-year-old primigravid woman presents to the office with a rapid increase of abdominal girth and shortness of breath. Her pregnancy is at 27 weeks' gestation, as confirmed by early ultrasonogram. The symphysis-fundal height is 45 cm. The fetal heart rate is 150/min (110-160). Which one of the following is the most likely diagnosis?
正解：B
解説：
Polyhydramnios is the most likely diagnosis given the rapid increase in abdominal girth , maternal shortness of breath , and a symphysis-fundal height (45 cm) significantly greater than expected for 27 weeks' gestation.
MCCQE objectives emphasize that fundal height should approximately correspond (±2-3 cm) to gestational age in weeks after 20 weeks. A discrepancy this large suggests excessive amniotic fluid volume.
Polyhydramnios leads to uterine overdistension, which explains dyspnea and rapid abdominal enlargement.
Twin pregnancy can cause a large fundal height, but early ultrasound confirmation of gestational age would likely have identified multiple gestation. Partial mole is typically associated with abnormal bleeding and abnormal fetal findings. Fetal macrosomia increases fundal height but usually not to this degree at 27 weeks and is more gradual. Ovarian tumor with ascites is less likely in a confirmed intrauterine pregnancy with normal fetal heart rate. Polyhydramnios is commonly associated with maternal diabetes or fetal anomalies affecting swallowing and requires further evaluation with ultrasound and glucose screening.
質問 # 243
A 1-week-old boy born at full term is brought by his parents to the office with a 2-day history of eye swelling and watery discharge. This morning, the discharge became thick and yellow. On physical exam, he is afebrile and fussy with bilateral eyelid edema, purulent discharge, and erythematous conjunctivae. After taking appropriate cultures of the eyes, which one of the following is the best next step?
正解：E
質問 # 244
A 35-year-old patient presents to your clinic for assessment of a chronic rash. With the patient's consent, you take a photo of the rash and upload it to their electronic medical record. You explain that you would like to consult with a specialist. That evening, you post a description of the rash to your online physicians' group, being careful to anonymize the details. You get a direct message from a physician who says they have extra training in dermatology and they ask you for a photo of the rash. Which one of the following is the best next step?
正解：A
解説：
The key issue is patient confidentiality and informed consent for disclosure of identifiable information .
Although the patient consented to having the image taken and uploaded to the medical record, consent for photography does not automatically extend to sharing the image with external parties , especially through informal channels. MCCQE objectives emphasize that physicians must obtain specific consent for disclosure , including the purpose, recipient, and method of transmission, unless the information is fully anonymized and non-identifiable. Clinical photographs may still be identifiable even if names are removed.
Texting the image, even if anonymized, risks breaching privacy and may not meet security standards. Simply refusing to share any photos is unnecessary because consultation is appropriate with consent. Even sending through a secure portal requires proper patient authorization for that specific disclosure.
Therefore, the appropriate next step is to contact the patient and obtain explicit consent to share the photograph with the identified physician for consultation, ensuring documentation of that consent and use of secure transmission methods thereafter.
質問 # 245
A surgical clinic would like to respond to the Truth and Reconciliation Commission of Canada: Calls to Action report. The clinic has implemented a mandatory cultural safety course for all employees and ongoing faculty development that includes teachings from Elders and Knowledge Keepers and teaching sessions about harm reduction, trauma-informed care, and antiracism. Which one of the following steps would further the clinic's goal of responding to this report?
正解：B
解説：
Providing information in the patient's own language is a concrete way to improve access, cultural safety, and communication - key recommendations in the Truth and Reconciliation Commission's Calls to Action. It moves beyond symbolic gestures and supports equitable care.
Toronto Notes 2023 - ELOM, "Indigenous Health and Cultural Safety" Section:
"Cultural safety includes removing language barriers, engaging with Elders, and using patient-centered practices that respect Indigenous values. Communication in the patient's first language improves trust and outcomes." MCCQE1 Objectives (ELOM > 99-2: Cultural Safety and Health Equity):
"Candidates must apply the principles of culturally safe care including removing barriers to access and effective communication, as highlighted in the Truth and Reconciliation Commission's Calls to Action." Evaluating session enjoyment (A) is not impactful. Certificates (C) are symbolic. Intake questions about trauma (D) must be done with appropriate context and safety - not as a formality.
質問 # 246
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