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| Section | Objectives |
|---|---|
| Physician Roles (CanMEDS Framework) | - Collaborator
|
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78. Frage
A health authority implements the first-ever colon cancer screening program in its territory. Which one of the following colon cancer indices will likely increase?
Antwort: B
Begründung:
When a screening program is introduced, the incidence rate appears to rise because more cases (including subclinical ones) are identified earlier. This is known as "lead-time bias" or "ascertainment bias." Toronto Notes 2023 - Public Health, Screening and Epidemiology:
"Screening increases the apparent incidence of disease as more early or latent cases are detected." MCCQE1 Objectives - Preventive Medicine > Screening:
"Candidates should understand how implementation of screening programs affects disease incidence and epidemiologic metrics." Case fatality rate (A) may decrease. PPV (B) depends on prevalence. Positive biopsy rate (C) may remain stable. Treatment rate (E) could increase, but incidence is the most directly and consistently affected.
79. Frage
A 4-year-old girl is brought to the family practice by her father. The child has a 2-week history of low-grade fever, fatigue, and sore throat. She has also developed several small, round, mildly tender lumps bilaterally in her neck. She was previously well. Which one of the following is most likely to be found on abdominal examination?
Antwort: C
Begründung:
This child likely has infectious mononucleosis caused by Epstein-Barr virus (EBV), characterized by fever, sore throat, cervical lymphadenopathy, fatigue, and splenomegaly. A palpable spleen is a hallmark of EBV in children.
Toronto Notes 2023 - Pediatrics, "Infectious Mononucleosis":
"Key features include fever, pharyngitis, lymphadenopathy, and splenomegaly. Children may have milder symptoms but often exhibit palpable spleen." MCCQE1 Objectives (Pediatrics > 75-2: Infectious Disease):
"Candidates should recognize common viral syndromes such as EBV and identify complications including splenomegaly." Other options (renal mass, ascites, etc.) are inconsistent with this viral presentation.
80. Frage
A 59-year-old woman comes to the office because her 48-year-old sister was recently diagnosed with cervical cancer. Your patient thinks her mother may have also had cervical cancer. A Papanicolaou (Pap) test performed 16 months ago had normal results, as did all previous Pap tests. Which one of the following is the best next step?
Antwort: C
Begründung:
For women aged 25-69 years who have had adequate negative screening, the recommendation is to repeat cervical cytology (Pap test) every 3 years, regardless of family history. Cervical cancer is caused primarily by HPV infection, not hereditary genetics. Family history does not alter the screening interval.
Toronto Notes 2023 - Gynecology, Cervical Cancer Screening Section:
"Routine screening with Pap test is recommended every 3 years in women aged 25-69 who have had three consecutive negative tests. Family history of cervical cancer does not modify the screening interval." MCCQE1 Objectives - Obstetrics and Gynecology > Cancer Screening:
"Candidates must apply population-based cervical cancer screening guidelines. Family history is not a risk modifier for screening frequency in cervical cancer." Options A and B are inappropriate as they increase screening frequency without indication. HPV testing (D) or colposcopy (E) are not recommended without abnormal cytology.
81. Frage
You are undertaking the retrospective analysis of a laboratory-confirmed influenza A virus outbreak that occurred in a long-term care facility last year. Among the 163 residents in the facility during the outbreak, 101 residents had new-onset fever, cough, myalgias, and congestion. Of these, 37 residents were transferred to acute care. Of these, 17 residents died. Which one of the following is the best estimate of the attack rate in residents at the facility?
Antwort: A
Begründung:
The attack rate is a measure of cumulative incidence used in outbreak investigations. It represents the proportion of individuals at risk who develop the disease during a specified time period. MCCQE objectives emphasize understanding key epidemiologic measures, particularly in institutional outbreaks.
In this scenario, 163 residents were at risk during the influenza outbreak. Of these, 101 developed new-onset symptoms consistent with influenza. Therefore, the attack rate is calculated as:
Number of new cases ÷ Number of people at risk
= 101 ÷ 163
The number transferred to acute care (37) reflects disease severity but does not represent all cases. The number of deaths (17) would be used to calculate the case fatality rate (17/101), not the attack rate.
Thus, the best estimate of the attack rate among residents is 101/163 , representing the proportion of the at- risk population who became ill during the outbreak.
82. Frage
A previously healthy 7-year-old boy presents to the Emergency Department with a generalized tonic-clonic seizure, which subsided spontaneously after 10 minutes. There is no history of trauma. Physical examination reveals normal vital signs and a normal neurologic examination. Which one of the following diagnostic studies is urgently indicated?
Antwort: D
Begründung:
This child experienced a first unprovoked generalized tonic-clonic seizure that resolved spontaneously and now has a normal neurologic examination and stable vital signs. MCCQE objectives emphasize that the immediate priority after a first seizure is to identify reversible metabolic causes , particularly hypoglycemia and electrolyte abnormalities (e.g., hyponatremia, hypocalcemia). Therefore, urgent serum electrolytes (and glucose) are indicated.
Neuroimaging (CT or MRI) is not urgently required in a neurologically normal child without focal deficits, trauma, persistent altered consciousness, or signs of increased intracranial pressure. MRI may be arranged later for further evaluation if clinically indicated. Electroencephalography is useful in outpatient follow-up to assess seizure type and recurrence risk but is not an emergency test. Lumbar puncture is reserved for suspected central nervous system infection (e.g., fever, meningeal signs, altered mental status), which are absent here.
Thus, immediate laboratory evaluation for metabolic derangements is the appropriate urgent investigation.
83. Frage
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