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| Section | Objectives |
|---|---|
| Topic 1: Dimensions of Care | - Health Promotion and Illness Prevention
|
| Topic 2: Physician Activities | - Assessment
|
>> MCCQE Latest Test Format <<
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NEW QUESTION # 230
A 12-year-old boy is brought by his mother to your clinic with a history of attention-deficit/hyperactivity disorder. His mother reports that he has been taking immediate-release methylphenidate for 2 years. Although the medication was initially effective, it no longer seems to work. The teachers say he is disorganized and fidgety, verbally interrupts class, and does not complete his work. His mother tells you that he does listen at home. Which one of the following is the most important next step in management?
Answer: B
Explanation:
Management of ADHD requires ongoing reassessment using standardized rating scales from multiple informants (e.g., parents and teachers) to evaluate symptom control and functional impairment across settings.
This child demonstrates persistent school-related symptoms despite prior response to immediate-release methylphenidate. Before adjusting therapy, it is essential to objectively reassess symptom severity, adherence, timing of doses relative to school hours, and potential environmental factors. Completion of validated rating scales helps determine whether symptoms remain clinically significant and guides appropriate dose titration.
Stimulant medications such as methylphenidate are first-line treatment, and inadequate response often requires dose optimization before switching agents. Simply increasing the dose without reassessment is not best practice. Risperidone is not indicated for uncomplicated ADHD. An EEG is unnecessary unless there are seizure concerns. Switching to atomoxetine is premature without confirming inadequate response to optimized stimulant therapy. MCCQE objectives emphasize systematic monitoring, multi-informant assessment, dose titration, and evidence-based pharmacologic management in pediatric ADHD.
NEW QUESTION # 231
A 28-year-old woman, gravida 1, para 0, aborta 0, presents to your clinic for a prenatal visit. Her pregnancy is at 20 weeks' gestation. Her ultrasonogram shows a normal fetus and a low-lying placenta. Which one of the following is the best next step?
Answer: A
Explanation:
A low-lying placenta identified at the routine 20-week anatomy scan is common and often resolves as the pregnancy progresses. As the uterus enlarges, the lower uterine segment stretches and the placenta typically
"migrates" upward relative to the internal cervical os. Therefore, immediate intervention is not indicated in an asymptomatic patient. The appropriate next step is repeat ultrasonography in the third trimester, commonly around 32 weeks' gestation, to reassess placental location. Early recommendation of cesarean delivery is premature because many low-lying placentas identified at mid-pregnancy resolve before term. Routine activity restriction or stopping work is not indicated in the absence of bleeding. Acupuncture has no evidence- based role in placental positioning. While placenta previa is associated with painless third-trimester bleeding, at 20 weeks most cases are transient findings. MCCQE objectives emphasize appropriate follow-up of incidental ultrasound findings, avoidance of unnecessary interventions, patient reassurance, and evidence- based monitoring in obstetric care.
NEW QUESTION # 232
A 32-year-old woman presents to the office and reports that she feels unwell and tired. She is worried about long-standing episodic diarrhea and vague abdominal discomfort. Laboratory investigations reveal a hemoglobin of 90 g/L (123-157), mean corpuscular volume of 75 fL (80-100), and serum ferritin level of 4 µg
/L (11-307). Which one of the following tests is most likely to produce a diagnosis?
Answer: D
Explanation:
This patient has microcytic anemia (MCV 75 fL) with very low ferritin , confirming iron deficiency anemia.
In a young woman with chronic diarrhea and abdominal discomfort, MCCQE objectives emphasize investigating for malabsorption syndromes , particularly celiac disease . Iron deficiency may be the only presenting feature of celiac disease due to impaired absorption in the proximal small intestine (duodenum), where iron uptake normally occurs.
The most appropriate diagnostic test is IgA tissue transglutaminase (tTG) antibody , which is the recommended first-line serologic test for celiac disease. If positive, diagnosis is typically confirmed with small bowel biopsy. Total iron-binding capacity would only further characterize iron deficiency but would not identify the underlying cause. Fecal fat testing evaluates steatorrhea but is less specific and not first-line for suspected celiac disease. Stool cultures are indicated for acute infectious diarrhea. Helicobacter pylori infection may contribute to anemia but does not explain chronic malabsorptive symptoms.
Thus, IgA tTG testing is most likely to establish the underlying diagnosis.
NEW QUESTION # 233
A 53-year-old man with a history of bipolar I disorder is brought to the office by his family. Recently, he has been sleeping for 4 to 5 hours per night, has been fidgety, and is increasinglypreoccupied with his granddaughter's safety. Five days ago, he consulted with your physician colleague and was instructed to exercise and meditate. Last night, he was found running in the street and attempted to hit a relative who was trying to calm him down. His son is dissatisfied with your physician colleague's management. Which one of the following is the most appropriate response?
Answer: C
Explanation:
The most appropriate and professional response is to focus on the current clinical situation and reassure the family that you will take responsibility for assessment and treatment. Criticizing a colleague (A, B, E) or deflecting to generalities (D) is unprofessional and unhelpful in crisis management.
Toronto Notes 2023 - Psychiatry, Physician-Patient-Family Communication:
"In emotionally charged or crisis situations, the physician must remain focused, empathetic, and professional.
Avoid blaming colleagues; instead, offer a concrete plan of care."
MCCQE1 Objectives - Psychiatry > Ethics and Professionalism:
"Candidates must demonstrate professionalism in managing conflicts, focusing on patient care while maintaining collegial respect."
NEW QUESTION # 234
A 14-year-old girl is brought to the Emergency Department with a 20-minute history of difficulty breathing that started during a school assembly. She has had similar symptoms 3 times in the last 2 weeks. These episodes develop rapidly and resolve gradually over several minutes. She reports tingling in her fingers and toes. On examination, her vital signs are as follows:
Blood pressure
120/80 mm Hg
Heart rate
100/min
Respiratory rate
22/min
Oxygen saturation on room air
95%
Temperature
36.9 °C, orally
Apart from mildly dilated pupils, her examination is otherwise normal. Which one of the following is the most likely diagnosis?
Answer: C
Explanation:
This teenager presents with acute-onset dyspnea, paresthesias, and normal physical findings, consistent with a panic attack. Panic attacks often mimic cardiopulmonary pathology but are marked by symptoms like hyperventilation, tingling in the extremities, palpitations, and subjective air hunger with normal vitals and oxygenation.
Toronto Notes 2023 - Psychiatry:
"Panic attacks are characterized by sudden onset of intense fear or discomfort, accompanied by somatic symptoms such as dyspnea, paresthesias, tachycardia, and fear of losing control." MCCQE1 Objectives (Psychiatry > 71-3: Anxiety Disorders):
"Candidates must recognize panic attacks based on clinical features and differentiate them from cardiopulmonary conditions." Normal O2 saturation and physical exam rule out asthma or pericarditis. Cocaine use would present with more systemic toxicity. PSVT would cause consistent tachycardia.
NEW QUESTION # 235
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