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| Section | Objectives |
|---|---|
| Dimensions of Care | - Acute Care
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| Physician Activities | - Professionalism
|
>> Reliable MCCQE Practice Questions <<
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NEW QUESTION # 35
A 3-year-old boy is brought to your office because his daycare teachers are concerned about his language development. His parents speak both English and French at home, and he can say around 15 words combined in both languages. His history reveals that he has minimal interest in playing with other children. Which one of the following is most appropriate?
Answer: E
Explanation:
A limited vocabulary (fewer than 50 words by age 2-3 years) and reduced social interaction (limited interest in peers) raise concern for autism spectrum disorder (ASD). Screening for ASD is the most appropriate next step.
Toronto Notes 2023 - Pediatrics, Development and Behaviour:
"Red flags for autism include delayed language, limited social reciprocity, and poor peer interaction.
Screening should be initiated early when clinical signs are present."
MCCQE1 Objectives - Pediatrics > Developmental Disorders:
"Candidates must identify key signs of ASD and initiate appropriate screening and early intervention." Multilingual households do not typically cause such delays (E is incorrect). ADHD (B) presents with attention
/hyperactivity issues, not language/social delay. Reassurance (A) is inappropriate. Neurology referral (C) may follow but is not first-line.
NEW QUESTION # 36
A 12-year-old girl presents to your office in late November with an exacerbation of asthma which has been well controlled since her diagnosis at age 5. The family has had cats for 3 years. Last June, they moved to a basement apartment. Which one of the following is the most likely cause of her asthma exacerbation?
Answer: A
Explanation:
Comprehensive and Detailed Explanation:
Basement apartments are often damp environments, increasing the risk of mold exposure. Mold is a well- known asthma trigger. Given the timing (autumn/winter) and environment change, mold allergy is the most likely cause.
Toronto Notes 2023 - Respirology / Allergy:
"Mold is a common indoor allergen, especially in damp environments. It frequently exacerbates asthma, particularly in fall/winter." MCCQE1 Objectives (Pediatrics > 75-2: Asthma Triggers):
"Candidates must identify common environmental triggers for asthma, including mold exposure in humid or poorly ventilated housing." Cat allergy (B) would have triggered earlier. Pollen (D) is less relevant in winter. Cold intolerance (E) is not a major asthma trigger without exercise. Fungal infection (A) is unlikely without systemic symptoms.
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NEW QUESTION # 37
A 60-year-old man presents because of a 6-month history of involuntary lip smacking and tongue movements.
His medical history is significant for schizophrenia, which has been very stable with haloperidol for the past
20 years. When educating the patient about these particular symptoms, which one of the following statements is accurate?
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
This patient has tardive dyskinesia, a late-onset, often irreversible movement disorder caused by chronic dopamine receptor blockade (e.g., haloperidol). It is especially common in older adults and may not resolve after stopping the drug.
Toronto Notes 2023 - Psychiatry, "Extrapyramidal Symptoms":
"Tardive dyskinesia is often irreversible and typically occurs after prolonged antipsychotic use. Elderly patients are at greater risk." MCCQE1 Objectives (Psychiatry > 71-5: Side Effects of Psychotropics):
"Candidates must recognize tardive dyskinesia and understand that it can persist or worsen even after discontinuation of antipsychotics." Anticholinergics may worsen it (D). The condition does not reliably improve with age (C). It does not affect a majority of patients (A).
NEW QUESTION # 38
In a research study, it is found that people who smoke tobacco cigarettes drink more coffee and have higher rates of lung cancer than people who do not smoke. However, the consumption of coffee alone is not associated with lung cancer. Which one of the following best describes the contribution of drinking coffee in the study?
Answer: C
Explanation:
A confounder is a variable associated with both the exposure and the outcome but not in the causal pathway.
In this study, coffee drinking is associated with smoking (the actual risk factor for lung cancer), but not independently associated with lung cancer.
Toronto Notes 2023 - Epidemiology Chapter:
"A confounder is a third variable that distorts the observed association between an exposure and an outcome.
It must be associated with both the exposure and the outcome, but not a result of the exposure." MCCQE1 Objectives (Population Health > 97-3: Study Design and Bias):
"Recognize and control for confounding in the interpretation of observational study data." Coffee is not a risk factor (B) since it's not independently associated with lung cancer, and it's not selection bias (C), which involves how participants are enrolled in a study.
NEW QUESTION # 39
A 20-year-old woman from a remote northern community presents to the office with a 2-week history of malaise and a 2-day history of disabling pain in her left elbow. She had a sore throat 4 weeks ago. She also notes that she has had 2 weeks of pain and swelling in her right knee, followed by pain and swelling in her left elbow. On examination, you note 0.5-cm to 1-cm nodules just above both her elbows. You find no active joint swelling. An electrocardiogram shows a prolonged PR interval. Which one of the following is the most appropriate investigation?
Answer: D
Explanation:
This presentation is most consistent with acute rheumatic fever (ARF): a history of pharyngitis 4 weeks earlier, migratory large-joint pain/swelling (knee then elbow), subcutaneous nodules over extensor surfaces, and prolonged PR interval (a Jones minor criterion indicating cardiac involvement). MCCQE objectives emphasize that diagnosing ARF requires meeting Jones criteria plus evidence of preceding group A streptococcal (GAS) infection. Because the sore throat occurred weeks ago, a pharyngeal culture is often negative and is less useful for establishing prior GAS infection. The most appropriate test is therefore an antistreptolysin O (ASO) titre (or other streptococcal serology such as anti-DNase B), which documents a recent streptococcal immune response and supports the diagnosis. Echocardiography can assess severity of carditis/valvular disease, but it does not provide the required evidence of preceding GAS infection.
Rheumatoid factor and biopsy of nodules do not address the likely ARF diagnosis.
NEW QUESTION # 40
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