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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Physician Activities | 50% | - Professional Behaviours - Communication - Management - Psychosocial Aspects |
| Topic 2: Dimensions of Care | 50% | - Acute Care - Assessment and Diagnosis - Health Promotion and Illness Prevention - Chronic Care |
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342. Frage
A 32-year-old woman presents to the office and reports that she feels unwell and tired. She is worried about long-standing episodic diarrhea and vague abdominal discomfort. Laboratory investigations reveal a hemoglobin of 90 g/L (123-157), mean corpuscular volume of 75 fL (80-100), and serum ferritin level of 4 µg
/L (11-307). Which one of the following tests is most likely to produce a diagnosis?
Antwort: A
Begründung:
This patient has microcytic anemia (MCV 75 fL) with very low ferritin , confirming iron deficiency anemia.
In a young woman with chronic diarrhea and abdominal discomfort, MCCQE objectives emphasize investigating for malabsorption syndromes , particularly celiac disease . Iron deficiency may be the only presenting feature of celiac disease due to impaired absorption in the proximal small intestine (duodenum), where iron uptake normally occurs.
The most appropriate diagnostic test is IgA tissue transglutaminase (tTG) antibody , which is the recommended first-line serologic test for celiac disease. If positive, diagnosis is typically confirmed with small bowel biopsy. Total iron-binding capacity would only further characterize iron deficiency but would not identify the underlying cause. Fecal fat testing evaluates steatorrhea but is less specific and not first-line for suspected celiac disease. Stool cultures are indicated for acute infectious diarrhea. Helicobacter pylori infection may contribute to anemia but does not explain chronic malabsorptive symptoms.
Thus, IgA tTG testing is most likely to establish the underlying diagnosis.
343. Frage
A mother brings her previously healthy 4-month-old girl for evaluation due to fussiness for 3 weeks. The infant becomes irritable and cries with occasional body arching 1-2 hours after feeding, frequently spits up after feeds, has developed feeding aversion, and shows slowing weight gain. She has been on cow's milk- based formula since birth. Stools are normal, and physical examination is unremarkable. Which one of the following is the most likely diagnosis?
Antwort: D
344. Frage
A 24-year-old man presents to your clinic with a 6-month history of fatigue. On examination, he is pale. His BMI is 16, and his blood pressure is 92/58 mm Hg. Initial laboratory work shows the following:
* Creatinine: 64 µmol/L (49-93)
* Potassium: 3.0 mmol/L (3.5-5.1)
* Sodium: 138 mmol/L (136-146)
* TSH: 2.40 mIU/L (0.34-5.60)
* CBC: Normal
Which one of the following is the best next step?
Antwort: A
Begründung:
This patient has clinical signs of an eating disorder - fatigue, low BMI, hypotension, and hypokalemia - likely secondary to nutritional deficiencies or purging. The first step is to sensitively explore the patient's perception of weight and body image. Effective management requires rapport and careful conversation.
Toronto Notes 2023 - Psychiatry, Eating Disorders:
"Approach patients with suspected eating disorders non-judgmentally. Begin with permission to discuss weight or body image. Screening tools like SCOFF can help guide further assessment." MCCQE1 Objectives - Psychiatry > Eating Disorders:
"Candidates must recognize signs of eating disorders and initiate a respectful and effective patient-centered discussion." Referring to the ED (B) is not urgent without hemodynamic instability. Advising caloric intake (C) bypasses assessment. GI referral (D) is not appropriate at this stage.
345. 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: C
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.
346. Frage
A 64-year-old man presents with a 3-month history of gradually increasing neck pain and stiffness. The pain radiates into his upper back, and he is having difficulty driving because of limitation of neck rotation secondary to pain. Physical examination shows restricted neck motion in all directions and neck muscle spasms. There is no abnormality on neurologic examination. A radiograph shows narrowing of all of the cervical disc spaces with prominent osteophytes. Which one of the following is the most appropriate next step?
Antwort: E
Begründung:
The presentation is consistent with cervical spondylosis - a degenerative condition. In the absence of neurologic findings, further imaging beyond plain radiography is not warranted. Management includes conservative measures such as physiotherapy and analgesia.
Toronto Notes 2023 - Rheumatology, Cervical Spondylosis:
"Patients with typical cervical spondylosis and no red flags (e.g., neurologic deficits) do not require MRI.
Treatment is conservative. Radiographs showing disc space narrowing and osteophytes confirm diagnosis." MCCQE1 Objectives - Internal Medicine > Musculoskeletal Disorders:
"Candidates must recognize typical degenerative spine disorders and avoid unnecessary investigations when clinical findings are straightforward." MRI (B) is useful if myelopathy or radiculopathy is suspected. CT (A), EMG (C), and LP (D) are not indicated here.
347. Frage
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