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| Section | Objectives |
|---|---|
| Topic 1: Physician Roles (CanMEDS Framework) | - Medical Expert
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>> Certification Medical Council of Canada MCCQE Test Answers <<
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NEW QUESTION # 343
An 80-year-old woman presents to the Emergency Department with dizziness. She has a medical history of coronary artery disease. On examination, she is alert and oriented. Her vital signs are as follows:
Her electrocardiogram is shown in the image.
Which one of the following is the most likely diagnosis?
Blood pressure
80/60 mm Hg
Heart rate
40/min
Respiratory rate
12/min
Her electrocardiogram is shown in the attached image. Which one of the following is the most likely diagnosis?
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
The ECG reveals:
* Regular P waves that are not consistently followed by QRS complexes
* A dissociation between the atrial (P wave) and ventricular (QRS complex) activity
* A slow ventricular rate (~40 bpm) independent of atrial rate
These findings are characteristic of a third-degree (complete) atrioventricular (AV) block, where there is no conduction of atrial impulses to the ventricles. The atria and ventricles beatindependently, and the ventricular rate is maintained by an escape rhythm, often junctional or ventricular in origin.
This correlates with the patient's symptoms (dizziness, hypotension) and bradycardia, suggesting inadequate cardiac output due to AV dissociation.
Toronto Notes 2023 - Cardiology:
"Third-degree AV block shows complete AV dissociation with independent atrial and ventricular activity. It typically presents with bradycardia and hypotension. Urgent pacing may be required." MCCQE1 Objectives (Cardiology > 34-2: Bradyarrhythmias and Conduction Disorders):
"Candidates must identify complete heart block and recognize its clinical urgency." Ruling out other options:
* A. Sinus bradycardia would show regular P waves with 1:1 P-QRS conduction.
* B. First-degree AV block has prolonged PR intervals (>200 ms) but all P waves are conducted.
* D. Junctional escape rhythm may present with bradycardia, but P waves would be absent, inverted, or occur after QRS complexes.
* E. Mobitz type I (Wenckebach) has progressively lengthening PR intervals before a dropped QRS.
NEW QUESTION # 344
You are a family physician caring for a healthy 60-year-old woman. Which one of the following preventative interventions is most useful?
Answer: C
Explanation:
For an otherwise healthy 60-year-old woman, screening mammography every 2 years provides the greatest proven population-health benefit among the listed options. MCCQE prevention objectives emphasize selecting screening that meaningfully reduces morbidity and mortality in the target age group. Breast cancer screening with mammography in women aged approximately 50-74 has evidence for earlier detection and reduction in breast-cancer mortality, and biennial screening balances benefit with harms (false positives, overdiagnosis) better than annual screening.
Annual cervical cytology is not recommended for average-risk women; screening intervals are longer (and discontinuation is generally considered after adequate prior screening at older ages). Bone densitometry is typically initiated later (commonly at 65) for average-risk women, with earlier testing reserved for additional risk factors. Routine annual fasting lipids and annual fasting glucose are not the most useful universal interventions in a healthy person; testing frequency is risk-based rather than yearly for all. Therefore, biennial mammography is the best choice for highest preventive value in this patient.
NEW QUESTION # 345
You are called to the Emergency Department to see a 6-month-old boy with a 3-day history of fever. Physical examination reveals an irritable infant with a temperature of 38.1°C. His vital signs are:
Blood pressure: 87/50 mm Hg
Respiratory rate: 80/min
Heart rate: 140/min
Oxygen saturation: 92% on room air
The infant has no skin findings. On chest examination, you hear coarse crackles on the right side of the chest.
Which one of the following is the best next step in the management of this child?
Answer: A
Explanation:
This 6-month-old presents with signs of systemic illness, tachypnea, hypoxia, and focal lung findings. In this age group, pneumonia can rapidly progress, and given the severity of symptoms, oral treatment is insufficient.
Intravenous antibiotics are urgently indicated.
Toronto Notes 2023 - Pediatrics, Respiratory Infections in Infants:
"Infants under 6 months with signs of systemic illness, hypoxia (SpO2 < 94%), and respiratory distress should receive IV antibiotics. Delayed treatment may result in rapid clinical deterioration." MCCQE1 Objectives - Pediatrics > Respiratory Conditions:
"Candidates must recognize signs of serious lower respiratory tract infection in infants and initiate prompt IV antibiotic therapy when criteria for hospitalization are met." Oral antibiotics (C) are appropriate for mild outpatient pneumonia. Reassurance (B) and oral steroids (A) are inappropriate. IV fluids (D) may be supportive but do not address the infectious cause.
NEW QUESTION # 346
A 30-year-old man comes to the office and asks you to write him a note for his employer that recommends a stress leave. He says he feels entitled to a rest. He comes across as irritable and impulsive. He appears to show little regard for the law and admits to recently embezzling $5,000 from his employer. He justifies his actions and shows no remorse. He has a history of attention-deficit/hyperactivity disorder as a child. Which one of the following is the most likely diagnosis?
Answer: C
NEW QUESTION # 347
A 35-year-old man comes to your office with a history of headaches that last 1 hour and are relieved by 1000 mg of acetaminophen. These headaches, which started 6 months ago after he got his first job as a lawyer, occur regularly. The patient wants a computed tomography scan of his head to rule out a tumour. Physical examination reveals no abnormality. Review of systems does not contribute any positive findings. Which one of the following is the best management?
Answer: D
Explanation:
This patient's headache is consistent with tension-type or stress-related headache. The symptoms are mild, responsive to over-the-counter medications, and without red flags (neurologic signs, worsening pattern, nocturnal pain). Reassurance is appropriate.
Toronto Notes 2023 - Neurology, "Headache" Section:
"In the absence of red flags (e.g., sudden onset, focal deficits, age >50, worsening pattern), reassurance is the best course. Tension headaches are often related to stress and improve with lifestyle modification and simple analgesia." MCCQE1 Objectives (Internal Medicine > 76-6: Neurologic Symptoms):
"Candidates should recognize benign headache patterns and avoid unnecessary investigations." CT head (B) is not indicated. Stronger analgesics (D) may cause rebound headache. Specialist or psychiatric referrals (A, E) are premature.
NEW QUESTION # 348
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