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| Section | Objectives |
|---|---|
| Physician Activities | - Assessment
|
| Dimensions of Care | - Chronic Care
|
MCCQEの学習教材で20〜30時間準備したと主張することができます。MCCQE試験に簡単に合格して、期待されるスコアを取得できます。 またMedical Council of Canada、MCCQE試験問題の無料デモを提供しており、MCCQEトレーニング資料の有効性と正確性を確認できます。ShikenPASS やって来てみてください！ MCCQEトレーニング資料の高い精度に驚かれることでしょう。 そして、MCCQE練習問題集の高い合格率は99％から100％なので、MCCQE Part 1 Exam試験に簡単に合格します。
質問 # 30
A 22-year-old woman is brought to the Emergency Department by her boyfriend, who says that she is experiencing a fentanyl overdose. She is unresponsive and cyanotic. She regains consciousness after naloxone is injected intravenously and demonstrates no further respiratory depression during 8 hours of observation.
She states that she is 22 weeks' pregnant and wants to stop using opioids. Which one of the following is the best next step?
正解：C
解説：
For pregnant patients with opioid use disorder, opioid agonist therapy with methadone or buprenorphine is the standard of care. Detoxification is not recommended in pregnancy due to increased risk of fetal distress, preterm labor, and relapse. Methadone reduces illicit opioid use and stabilizes both mother and fetus.
Toronto Notes 2023 - Addiction Medicine / Obstetrics:
"Methadone maintenance therapy is the treatment of choice for pregnant patients with opioid use disorder.
Detoxification is not advised during pregnancy due to relapse risk and potential harm to the fetus." MCCQE1 Objectives (Obstetrics > 80-3: Substance Use in Pregnancy):
"Candidates must manage opioid use disorder in pregnancy with evidence-based therapies, including referral for methadone or buprenorphine." Counselling alone (D) is insufficient as first-line therapy. Home detox (C) is unsafe. Inpatient detox (A) is not recommended in pregnancy.
質問 # 31
You are the emergency physician on duty in a rural hospital when heavy rains in the community cause a large landslide. There are multiple casualties expected to arrive in the emergency department. Your colleague has heard about the incident and arrives to help. Which one of the following is the best next step?
正解：D
解説：
Comprehensive and Detailed Explanation:
During mass casualty incidents, effective triage is essential to optimize care delivery. A trained physician is best used in triage or direct care. Triage is the foundation of disaster management.
Toronto Notes 2023 - Public Health / Disaster Medicine:
"In disaster response, trained healthcare providers should be deployed to triage and stabilize patients in emergency departments." MCCQE1 Objectives (Public Health > 65-1: Disaster Response):
"Candidates must understand principles of mass casualty management and assign appropriate roles during triage and care delivery." Media (D) and logistics (A, C) are secondary roles. Triage and direct care take priority.
質問 # 32
A 71-year-old man is brought to the Emergency Department with sudden onset of shortness of breath and chest pain. He was discharged from hospital 1 week ago after a total hip arthroplasty. On examination, his respiratory rate is 32/min. There is visible respiratory distress, and chest auscultation is clear. Which one of the following is the most likely diagnosis?
正解：B
解説：
Sudden onset dyspnea and pleuritic chest pain in a postoperative patient with tachypnea and clear lung fields are classic features of a pulmonary embolism (PE). Recent orthopedic surgery significantly increases VTE risk. Clear lungs on auscultation support this over pneumonia or CHF.
Toronto Notes 2023 - Respiratory, "Pulmonary Embolism":
"Presentation includes sudden dyspnea, pleuritic chest pain, and tachypnea. Risk factors include recent surgery and immobilization. Examination often reveals clear chest auscultation." MCCQE1 Objectives (Internal Medicine > Cardiopulmonary > 44-1):
"Candidates must recognize PE in patients with risk factors (e.g., surgery) and classic features and initiate appropriate diagnosis and management." Fat embolism (B) usually presents with petechiae, neurologic symptoms, and occurs within 24-72 hours post- op. Cholesterol emboli (E) are more chronic and systemic.
質問 # 33
Which one of the following bodies decides whether a physician is permitted to practise medicine in a province or territory?
正解：D
解説：
Comprehensive and Detailed Explanation:
The authority to license and regulate physicians to practise medicine is held by the medical regulatory colleges in each province or territory (e.g., CPSO in Ontario, CPSBC in BC).
MCC Objectives (ELOM > 90-1: Medical Regulation in Canada):
"Licensure to practise medicine is granted by the provincial or territorial medical regulatory authority." Toronto Notes 2023 - Ethics and Canadian Health Care System:
"Medical regulatory colleges determine physician licensure and discipline in each jurisdiction." The CFPC/RCPSC (C) certify physicians, not license them. Ministries of Health (A) oversee health policy, not licensing. Associations (E) advocate for physicians but do not regulate. Hospital boards (B) grant privileges, not licenses.
質問 # 34
A 55-year-old man with alcohol use disorder presents with a 2-day history of confusion. Onexamination, you note a sixth nerve palsy and a horizontal nystagmus. Which one of the following is the most likely diagnosis?
正解：E
解説：
Wernicke encephalopathy is a medical emergency caused by thiamine (vitamin B1) deficiency, most often seen in chronic alcohol use. The classic triad is:
* Confusion
* Oculomotor dysfunction (e.g., nystagmus, cranial nerve palsies)
* Ataxia
Toronto Notes 2023 - Neurology and Psychiatry, "Wernicke Encephalopathy" Section:
"Wernicke encephalopathy is diagnosed clinically. Symptoms include ophthalmoplegia (e.g., CN VI palsy), horizontal nystagmus, ataxia, and confusion. Immediate parenteral thiamine is indicated before glucose administration." MCCQE1 Objectives (Neurology > 75-1: Neurologic Emergencies):
"Candidates must recognize Wernicke encephalopathy in at-risk individuals and initiate urgent thiamine replacement." Other choices like cerebellar degeneration (A) and hepatic encephalopathy (D) are more chronic and lack the characteristic eye findings. Subdural hematoma (B) and hemorrhage (E) may mimic confusion but are less likely with these neurologic signs and history.
質問 # 35
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