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| Section | Objectives |
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| Physician Roles (CanMEDS Framework) | - Scholar
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>> MCCQE Exam Questions Answers <<
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NEW QUESTION # 179
A 31-year-old woman, gravida 1, para 0, presents to Labour and Delivery with regular contractions at approximately 24 weeks' gestation. As you review her prenatal records, which one of the following is the most reliable way of establishing gestational age?
Answer: E
Explanation:
Accurate determination of gestational age is essential, particularly in suspected preterm labour at 24 weeks.
MCCQE objectives emphasize that first-trimester ultrasound , specifically measurement of the crown-rump length (CRL) at 8-12 weeks , is the most reliable method for dating a pregnancy. In early gestation, biological variation in fetal size is minimal, making CRL highly accurate (±3-5 days).
Dating by last menstrual period (LMP) is less reliable due to recall error, irregular cycles, or ovulation variability. Second-trimester ultrasound provides reasonable accuracy but is less precise than first-trimester CRL (±7-10 days). Third-trimester ultrasound is the least accurate for dating because fetal growth variation increases significantly (±2-3 weeks). Symphysis-fundal height is useful for monitoring growth trends but not for precise dating.
In preterm labour management, correct gestational age influences decisions about corticosteroids, magnesium sulfate for neuroprotection, and neonatal resuscitation planning. Therefore, first-trimester CRL measurement is the gold standard for establishing gestational age.
NEW QUESTION # 180
A 59-year-old woman comes to the office because her 48-year-old sister was recently diagnosed with cervical cancer. Your patient thinks her mother may have also had cervical cancer. A Papanicolaou (Pap) test performed 16 months ago had normal results, as did all previous Pap tests. Which one of the following is the best next step?
Answer: A
Explanation:
For women aged 25-69 years who have had adequate negative screening, the recommendation is to repeat cervical cytology (Pap test) every 3 years, regardless of family history. Cervical cancer is caused primarily by HPV infection, not hereditary genetics. Family history does not alter the screening interval.
Toronto Notes 2023 - Gynecology, Cervical Cancer Screening Section:
"Routine screening with Pap test is recommended every 3 years in women aged 25-69 who have had three consecutive negative tests. Family history of cervical cancer does not modify the screening interval." MCCQE1 Objectives - Obstetrics and Gynecology > Cancer Screening:
"Candidates must apply population-based cervical cancer screening guidelines. Family history is not a risk modifier for screening frequency in cervical cancer." Options A and B are inappropriate as they increase screening frequency without indication. HPV testing (D) or colposcopy (E) are not recommended without abnormal cytology.
NEW QUESTION # 181
A 55-year-old woman presents with a 6-month history of poor memory and impaired concentration. She has bipolar I disorder that has been treated with lithium carbonate for 4 years. She has gained a lot of weight since starting lithium. Physical examination findings are otherwise normal. She is concerned about her memory issues, but there are no other perception, mood, or cognition abnormalities. Which one of the following tests is most likely to have abnormal findings?
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
Lithium commonly causes hypothyroidism, which can lead to fatigue, cognitive slowing, weight gain, and memory impairment. Thyroid-stimulating hormone (TSH) levels are often elevated in such cases.
Toronto Notes 2023 - Psychiatry / Endocrinology:
"Lithium is associated with hypothyroidism and renal impairment. Monitor TSH regularly in patients on lithium therapy." MCCQE1 Objectives (Psychiatry > 71-5: Mood Stabilizers):
"Candidates must recognize the endocrine side effects of lithium, including hypothyroidism and the importance of TSH monitoring." Creatinine clearance (C) may also be affected but is less directly associated with memory issues. Liver function (A), sodium (D), and PTH (E) are not typically the first abnormal values in this presentation.
NEW QUESTION # 182
A 43-year-old man comes to your office for the first time. He has not seen a doctor in over 5 years and has no known past medical history. On examination, his blood pressure is 120/70 mm Hg, and the remainder of his examination is normal. As part of the initial visit, you order some screening blood work that reveals a fasting blood glucose of 6.3 mmol/L (3.3-5.8) and a hemoglobin A1c of 6.1% (4-6). Which one of the following is the best next step?
Answer: C
Explanation:
This patient's lab results suggest impaired fasting glucose and an elevated A1c just below the threshold for diabetes. The gold standard to confirm diabetes in such intermediate cases is the 75 g oral glucose tolerance test (OGTT).
Toronto Notes 2023 - Endocrinology, "Diabetes Mellitus" Section:
"If A1c is in the 6.0-6.4% range or fasting glucose 6.1-6.9 mmol/L, a 75 g OGTT is recommended to establish the diagnosis of diabetes or confirm impaired glucose tolerance." MCCQE1 Objectives (Internal Medicine > 76-4: Diabetes):
"Candidates must correctly apply diabetes screening and diagnostic criteria and follow up abnormal results with appropriate confirmatory testing." Urine ACR (C) is useful in diagnosed diabetes, not for initial screening. TSH (A), capillary glucose testing (B), and exercise testing (E) are not indicated at this stage.
NEW QUESTION # 183
A 27-year-old man with a bowel obstruction secondary to a terminal ileum stricture has been on various medications since he was diagnosed with Crohn disease 8 years ago. You recommend a bowel resection, but he refuses this option because he is fearful of short bowel syndrome. He states that the only surgical procedure he will undergo is a bypass of the diseased segment so that the affected bowel will heal. You know that this is the wrong operation. Which one of the following is the best next step?
Answer: E
Explanation:
This case addresses informed consent and professional integrity. MCCQE ELOM objectives emphasize that competent patients have the right to refuse recommended treatment, but they cannot demand a treatment that is medically inappropriate or contrary to the standard of care. If a proposed intervention (e.g., bypass of a strictured Crohn segment expected not to heal) is not clinically indicated and may cause harm, the physician is not ethically obligated to provide it.
The appropriate response is to decline to perform the inappropriate procedure while clearly explaining the rationale, including risks, benefits, alternatives, and likely outcomes. Shared decision-making and addressing the patient's fears (e.g., risk of short bowel syndrome) are essential. If disagreement persists, offering a second opinion is reasonable-but transferring care solely to find someone willing to perform an inappropriate surgery is unethical.
A formal competency assessment is unnecessary unless there is evidence of impaired decision-making capacity. Performing a different surgery than agreed upon would violate consent. The physician must balance respect for autonomy with nonmaleficence and adherence to evidence-based practice.
NEW QUESTION # 184
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