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| Section | Weight | Objectives |
|---|---|---|
| Physician Activities | 50% | - Management - Professional Behaviours - Communication - Psychosocial Aspects |
| Dimensions of Care | 50% | - Assessment and Diagnosis - Acute Care - Chronic Care - Health Promotion and Illness Prevention |
>> Medical Council of Canada MCCQE Related Content <<
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NEW QUESTION # 135
A 24-year-old man is brought to the Emergency Department by ambulance with a severe pelvic fracture from a motor vehicle collision. After resuscitation and stabilization, he is noted to have a bloody penile discharge.
Which one of the following is the best next step?
Answer: C
Explanation:
In a patient with a pelvic fracture and blood at the urethral meatus, urethral injury must be strongly suspected.
Other signs may include perineal hematoma, high-riding prostate, or inability to void. The key principle is do not insert a Foley catheter until urethral integrity is confirmed, as blind catheterization may worsen a partial tear into a complete disruption. The appropriate next diagnostic step is retrograde urethrography (RUG), which evaluates the urethra for extravasation of contrast and identifies the site and extent of injury.
Voiding cystography evaluates bladder injury and is performed after urethral integrity is confirmed or via suprapubic access. Transrectal ultrasound and penile sonography are not appropriate in acute trauma assessment of suspected urethral disruption. Continuous bladder irrigation is contraindicated until urethral injury is excluded.
MCCQE objectives emphasize recognition of urethral injury in pelvic trauma and adherence to trauma principles: stabilize first, suspect urethral injury when blood is present at the meatus, and perform retrograde urethrography prior to catheterization.
NEW QUESTION # 136
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 # 137
A 29-year-old man comes to the office for an initial visit. He is being treated for schizophrenia and epilepsy.
He has a 20 pack-year history of smoking. His medications are carbamazepine, clozapine, and quetiapine. In the past year, he has gained a considerable amount of weight. Asidefrom a BMI of 32, the results of his physical examination are unremarkable. Which one of the following conditions should he be investigated for?
Answer: D
Explanation:
Clozapine and quetiapine are associated with significant weight gain and increased risk of type 2 diabetes.
With a BMI of 32 and weight gain over the past year, screening for diabetes is appropriate and evidence- based.
Toronto Notes 2023 - Endocrinology, Diabetes & Psychiatry Sections:
"Second-generation antipsychotics such as clozapine increase the risk of metabolic syndrome and type 2 diabetes. Regular screening is recommended for patients with these risk factors." MCCQE1 Objectives - Internal Medicine > Endocrinology:
"Candidates should screen high-risk individuals, especially those on antipsychotics with weight gain, for diabetes using fasting glucose or HbA1c." While sleep apnea (C) is also possible, diabetes screening is the most appropriate and urgent next step in this patient. COPD (A) would present with respiratory symptoms. Cushing's (B) and acromegaly (E) are less common and have other distinct features.
NEW QUESTION # 138
A 16-month-old boy is brought to your office because of red, itchy and crusted patches on his cheeks and chin. Physical examination also reveals similar patches in the flexor creases of both arms. The groin and axillae regions are clear. Which one of the following is most likely to contribute to this condition?
Answer: B
Explanation:
This child's presentation is classic for atopic dermatitis (eczema) : pruritic, erythematous, crusted patches involving the cheeks in infants and the flexural creases in toddlers. Sparing of the groin and axillae is typical.
MCCQE objectives emphasize recognizing age-specific distribution and identifying risk factors. The strongest contributor is a family history of atopy (e.g., asthma, allergic rhinitis, eczema), reflecting a genetic predisposition involving impaired skin barrier function and immune dysregulation (often associated with filaggrin mutations).
Vaccination (e.g., MMR) does not cause eczema. Oral amoxicillin may trigger a transient rash but would not produce chronic pruritic flexural dermatitis. Early introduction of cereals is not an established cause of atopic dermatitis. Varicella-zoster infection produces a vesicular rash in various stages, not chronic flexural eczema.
Thus, a family history of atopic reactions is the most important contributing factor to this child's condition.
NEW QUESTION # 139
You receive a note from a pharmacist about your 82-year-old patient who is taking oxycodone extended- release 20 mg 3 times daily for spinal stenosis. The pharmacist suggests that you consider tapering the medication. Your patient has been taking his current dosage for 1 year. When you saw him a month ago, he was functioning well with no adverse effects from the medication. Which one of the following is the best next step?
Answer: C
Explanation:
Long-term opioid therapy requires ongoing assessment of benefits, risks, function, adverse effects, and safety, particularly in older adults. MCCQE objectives emphasize regular reassessment before making changes to chronic controlled medications. Although the pharmacist has appropriately raised concern about prolonged opioid use, the patient was reported one month ago to be functioning well without adverse effects.
The appropriate next step is to reassess the patient directly-including pain control, functional status, cognition, fall risk, constipation, signs of misuse, and overall goals of care-before altering therapy.
Automatic dose reduction without evaluation may destabilize pain control. Immediate referral to a specialist is unnecessary if the patient is stable and well managed. Adjunct therapies such as physiotherapy may be considered but should not replace proper reassessment.
Shared decision-making is essential. If reassessment reveals limited benefit, adverse effects, or safety concerns, a gradual taper can then be discussed. Clinical decisions regarding opioids should be individualized rather than based solely on duration of use.
NEW QUESTION # 140
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