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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Dimensions of Care | 50% | - Chronic Care - Assessment and Diagnosis - Health Promotion and Illness Prevention - Acute Care |
| Topic 2: Physician Activities | 50% | - Professional Behaviours - Communication - Psychosocial Aspects - Management |
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NEW QUESTION # 44
A 34-year-old man presents to your office with a 2-week history of headaches and double vision when he looks to the right. On physical examination, you note that he is unable to gaze laterally with his right eye.
Which one of the following cranial nerves is most likely affected?
Answer: D
Explanation:
The inability to gaze laterally with the right eye indicates dysfunction of the right lateral rectus muscle , which is innervated by cranial nerve VI (the abducens nerve). The primary action of the lateral rectus muscle is abduction of the eye (movement away from the midline). Damage to the abducens nerve results in an inability to abduct the affected eye, leading to horizontal diplopia that worsens when looking toward the side of the lesion.
MCCQE objectives emphasize understanding cranial nerve function and localization. The oculomotor nerve (CN III) controls most extraocular movements but not lateral rectus. Trochlear nerve (CN IV) innervates the superior oblique muscle, affecting downward and inward gaze. The optic nerve (CN II) is responsible for vision, not eye movement. The trigeminal nerve (CN V) provides facial sensation and mastication motor function.
Headache with a new sixth nerve palsy may raise concern for increased intracranial pressure or intracranial pathology, as CN VI is vulnerable due to its long intracranial course. Further evaluation is warranted.
NEW QUESTION # 45
A 26-year-old woman, gravida 3, para 2, presents for her 1st antenatal visit. She states she is at 26 weeks' gestation and is healthy. On abdominal examination, her fundus is palpated at the umbilicus. Which one of the following is the most likely explanation for this finding?
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
At 20 weeks' gestation, the uterine fundus typically reaches the umbilicus. If the fundal height is lower than expected at a stated gestational age of 26 weeks, the most likely explanation-especially with no prior care- is a dating error.
Toronto Notes 2023 - Obstetrics:
"Fundal height at the umbilicus corresponds to ~20 weeks. In women lacking early prenatal care, dating errors are common causes of fundal height discrepancy." MCCQE1 Objectives (Obstetrics > 80-3: Routine Antenatal Care):
"Candidates must interpret fundal height and reconcile discrepancies with gestational age." IUGR and oligohydramnios are possible but require imaging confirmation. Bicornuate uterus may cause fundal shape anomalies but not significant dating discrepancy. A mole (D) would increase, not decrease, size.
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NEW QUESTION # 46
A 6-year-old boy is brought to the Emergency Department by his daycare provider because he has an injured left arm. Physical examination findings show a swollen left arm just below the shoulder and bruising around both knees and the upper right arm. Radiographs of the left arm show a fracture with early callus formation around the proximal humeral shaft. Which one of the following is the most important next step?
Answer: A
Explanation:
This presentation is classic for Zenker diverticulum, characterized by progressive dysphagia, regurgitation of undigested food, coughing, and halitosis due to food retention in a pharyngoesophageal pouch. Symptoms are chronic and episodic, often involving regurgitation hours after eating. MCCQE objectives emphasize selecting the safest and most appropriate diagnostic test. The best initial test is a barium swallow (contrast esophagram), which clearly visualizes the posterior outpouching above the upper esophageal sphincter.
Endoscopy is not the first step because there is a risk of perforation if a large diverticulum is present. pH monitoring and PPI trials are used for gastroesophageal reflux disease, which does not explain regurgitation of undigested food and halitosis. CT chest is unnecessary for diagnosis.
Therefore, a barium swallow is the safest and most informative investigation to confirm suspected Zenker diverticulum before considering surgical or endoscopic management.
NEW QUESTION # 47
A 62-year-old woman presents with abdominal pain, fever and chills. She was hospitalized 4 weeks ago for sigmoid diverticulitis. She felt well after her discharge from hospital until 5 days ago when the fever started.
She is now anorexic. On examination, she has right upper quadrant pain and her temperature is 38.5 ยฐC.
Which one of the following investigations is most likely to confirm the diagnosis?
Answer: D
Explanation:
This patient presents with fever, chills, anorexia, and right upper quadrant (RUQ) pain several weeks after hospitalization for sigmoid diverticulitis . A key complication of intra-abdominal infections such as diverticulitis is portal pylephlebitis with hepatic abscess formation , due to bacterial spread via the portal venous system. MCCQE objectives emphasize recognizing liver abscess as a delayed complication of intra- abdominal sepsis, particularly when new RUQ pain and fever develop after an initial abdominal infection.
The most appropriate initial imaging test to confirm this diagnosis is ultrasound of the abdomen , which can detect hepatic abscesses and guide further management. CT abdomen is also highly sensitive, but among the listed options, ultrasound is most appropriate.
Chest and abdominal radiographs are nonspecific. HIDA scan evaluates cystic duct obstruction in suspected acute cholecystitis, which is less likely given the recent diverticulitis and systemic features. ERCP is used for biliary obstruction or ascending cholangitis, typically associated with jaundice.
Thus, abdominal ultrasound is most likely to confirm a hepatic abscess.
NEW QUESTION # 48
While covering for a colleague away on holidays, you receive the following laboratory results for one of her patients, a 24-year-old woman:
White blood cell count: 10 ร 10#/L (4-10)
Hemoglobin: 80 g/L (123-157)
Mean corpuscular volume: 76 fL (80-100)
Platelet count: 150 ร 10#/L (130-400)
You have arranged a follow-up appointment for the patient with your colleague. Which one of the following is the most likely diagnosis?
Answer: B
Explanation:
These results show a significant anemia (Hb 80 g/L) with microcytosis (MCV 76 fL) and otherwise preserved cell lines (WBC at the upper end of normal; platelets normal). MCCQE objectives emphasize using CBC patterns to classify anemia and prioritize common causes. In a young woman, the most likely cause of microcytic anemia is iron deficiency , most often due to menstrual blood loss and/or inadequate iron intake, and it can be severe.
Leukemia and myelodysplasia typically present with abnormalities in multiple cell lines (e.g., leukocytosis with blasts or cytopenias) and are less consistent with an isolated microcytic anemia and normal platelets.
Anemia of chronic disease is usually normocytic or mildly microcytic and is less likely to produce such a low hemoglobin without an obvious chronic inflammatory condition. Thalassemia trait classically has marked microcytosis with relatively preserved hemoglobin (often only mild anemia) and is suggested by a lifelong history and family/ethnic background. The next clinical step (at follow-up) would be iron studies (ferritin first) and assessment for bleeding sources.
NEW QUESTION # 49
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