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| Section | Objectives |
|---|---|
| Topic 1: Dimensions of Care | - Health Promotion and Illness Prevention
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| Topic 2: Physician Activities | - Professionalism
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>> Medical Council of Canada MCCQE Pass Test Guide <<
According to personal propensity and various understanding level of exam candidates, we have three versions of MCCQE practice materials for your reference. Here are the respective features and detailed disparities of our MCCQE practice materials. Pdf version- it is legible to read and remember, and support customers’ printing request, so you can have a print and practice in papers. Software version-It support simulation test system, and times of setup has no restriction. Remember this version support Windows system users only. App online version-Be suitable to all kinds of equipment or digital devices. Be supportive to offline exercise on the condition that you practice it without mobile data.
NEW QUESTION # 225
A 69-year-old woman with long-standing hypertension presents to the emergency department with a 2-hour history of persistent chest and back pain. A posteroanterior chest radiograph shows suspicious widening of the mediastinal shadow. Which one of the following is most likely to yield a clinical diagnosis?
Answer: B
Explanation:
The presentation is highly suspicious for acute aortic dissection - sudden chest/back pain and mediastinal widening on chest x-ray. The most definitive and widely available test is contrast-enhanced computed tomography (CT) of the chest.
Toronto Notes 2023 - Cardiology, Aortic Dissection:
"CT angiography of the chest is the gold standard for stable patients with suspected aortic dissection. Look for mediastinal widening on chest x-ray as a clue." MCCQE1 Objectives - Internal Medicine > Cardiovascular Disease:
"Candidates should recognize acute aortic dissection and select appropriate imaging, such as CT chest, for diagnosis in stable patients." Transthoracic echo (A) may miss dissections. ECG (C) helps rule out MI but not dissection. V/Q scan (D) and pulmonary angiography (E) are for suspected pulmonary embolism.
NEW QUESTION # 226
The parents of a 12-year-old boy present to your clinic to discuss their son's submersion injury. The patient was seen in hospital for 6 months after being pulled unresponsive from a lake at his friend's house; he had been submerged for an estimated 20 minutes. After extended resuscitation and a 2-month stay in the intensive care unit, he remains in a persistent vegetative state but needs no respiratory or cardiac support. When evaluating the discharge from hospital, which one of the following is most appropriate?
Answer: A
Explanation:
Comprehensive and Detailed Explanation:
The patient is in a persistent vegetative state and medically stable, meaning he does not need continued hospitalization. The goal is to provide appropriate long-term care in the least restrictive setting, typically at home with robust home care support services. This approach aligns with ethical care, family-centered goals, and medical appropriateness.
Toronto Notes 2023 - Pediatrics / Neurodevelopment & Chronic Care:
"Home care with appropriate medical and caregiver support is often the best setting for children with severe neurological impairments who are medically stable." MCCQE1 Objectives (Pediatrics > 77-5: Chronic Neurological Disorders):
"Candidates must assess discharge planning and coordinate home care support for children with long-term care needs." Palliative facility (B) is not appropriate unless end-of-life is imminent. School (C) is not feasible in this state.
Hospital readmission for respite (D) is not standard. Rehabilitation (E) has little utility in persistent vegetative state.
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NEW QUESTION # 227
A 32-year-old woman, gravida 0, comes to your office for contraception counselling, specifically about insertion of a levonorgestrel-releasing intrauterine device. She has a past history of breast cancer and is presently on tamoxifen. Which one of the following is the best advice for your patient?
Answer: D
Explanation:
Comprehensive and Detailed Explanation:
The levonorgestrel-releasing intrauterine device (LNG-IUD) is generally contraindicated in current or recent breast cancer due to the progestin component, but may be considered in selectpatients on tamoxifen, especially if non-hormonal options are unsuitable. Consultation with the oncologist is required to evaluate risks and benefits.
Toronto Notes 2023 - Gynecology, "Contraception in Special Populations":
"Levonorgestrel IUDs are generally avoided in patients with a history of hormone-sensitive cancers; however, decisions should be made collaboratively with oncology." MCCQE1 Objectives (Gynecology > 82-2: Contraception):
"Candidates must tailor contraceptive advice to patients with medical comorbidities, including cancer survivors." Irregular bleeding (A) is a common but not contraindicating side effect. No pre-procedure antibiotics (D) are typically needed. The IUD does not cause infertility (E). Risk of recurrence (C) is unconfirmed and must be individualized.
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NEW QUESTION # 228
A 39-year-old man presents to your clinic 4 months after a motor vehicle collision. He is trying to return to work but is having a difficult time because his job requires him to drive. He used to love his job, but he is worried about going back because every time he gets into a car, he is filled with dread, gets dizzy, and feels faint. He has regular nightmares about the incident. Which one of the following is the most likely diagnosis?
Answer: B
Explanation:
Posttraumatic stress disorder (PTSD) is most likely because the patient has symptoms persisting more than 1 month after a traumatic event (motor vehicle collision) with functional impairment (difficulty returning to work/driving). MCCQE objectives emphasize PTSD core symptom clusters: intrusion (recurrent distressing dreams/nightmares), avoidance (fear and distress when attempting to drive or be in a car), negative alterations in cognition/mood, and hyperarousal. His intense dread and autonomic-type symptoms (dizziness, feeling faint) triggered by car exposure fit trauma-related reactivity and avoidance.
Panic disorder requires recurrent unexpected panic attacks with ongoing concern or maladaptive behavior; here, the episodes are situationally triggered by reminders of the trauma and accompanied by trauma nightmares, supporting PTSD over panic disorder. Generalized anxiety disorder involves excessive worry about multiple domains for at least 6 months, not specifically tied to a trauma cue with nightmares.
Malingering implies intentional symptom fabrication for external gain and is not supported by the consistent trauma-linked symptoms and re-experiencing.
NEW QUESTION # 229
An otherwise healthy 57-year-old man with a 20 pack-year history of smoking presents with a 2-day history of reddish-brown urine that has not cleared. There is no history of abdominal or flank pain. Urinalysis reveals
5 red blood cells per high power field. Which one of the following is the best next step?
Answer: E
Explanation:
This patient has gross painless hematuria (reddish-brown urine) and is over age 50 with a smoking history- major risk factors for urothelial carcinoma (bladder cancer) . MCCQE objectives emphasize that any episode of gross painless hematuria in adults warrants urgent evaluation for malignancy , regardless of the number of red blood cells seen on urinalysis. Even microscopic hematuria in higher-risk individuals requires thorough workup.
The most important next step is cystoscopy , which directly visualizes the bladder and lower urinary tract to identify tumors, the most common cause of painless hematuria in this demographic. Imaging (e.g., CT urography) is also part of a complete evaluation, but cystoscopy is essential for diagnosing bladder lesions.
Intravenous pyelography is outdated and less sensitive. Ultrasonography may detect masses but does not replace cystoscopy. Reassurance or delayed repeat urinalysis would risk missing a malignancy.
Therefore, immediate urologic referral for cystoscopic evaluation is the appropriate next step.
NEW QUESTION # 230
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