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| Section | Objectives |
|---|---|
| Dimensions of Care | - Chronic Care
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| Physician Activities | - Professionalism
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>> Top Medical Council of Canada MCCQE Questions <<
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NEW QUESTION # 154
You are 1 of 3 physicians on an interdisciplinary brain injury team at a hospital. The team ' s physiotherapist has concerns regarding a patient ' s medication. Which one of the following is the most appropriate course of action for communicating with the physiotherapist?
Answer: D
Explanation:
In an interdisciplinary hospital team, sharing relevant clinical information with other regulated health professionals involved in the patient's care is generally appropriate under the "circle of care" principle. The physiotherapist's concern about medication is clinically relevant because medications can affect mobility, cognition, balance, blood pressure, sedation, and rehabilitation safety-issues directly within the physiotherapist's role. Requiring written consent (A) is unnecessarily restrictive in routine team-based care; implied consent is typically sufficient when information sharing is for the patient's ongoing treatment and limited to what is necessary. Refusing to discuss because the physiotherapist does not prescribe (B) misunderstands collaborative care: team members must understand medication effects to plan safe therapy.
Contacting the patient each time (C) is usually not required for routine care communication and may delay addressing a potential safety issue. Even if you are not the physician most responsible, you should respond within your knowledge, clarify uncertainties, and coordinate with the most responsible physician as needed, ensuring timely, patient-centered care.
NEW QUESTION # 155
An otherwise healthy 57-year-old man with a 20 pack-year history of smoking presents with a 2-day history of reddish-brown urine that has not cleared. There is no history of abdominal or flank pain. Urinalysis reveals
5 red blood cells per high power field. Which one of the following is the best next step?
Answer: A
Explanation:
This patient has gross painless hematuria (reddish-brown urine) and is over age 50 with a smoking history- major risk factors for urothelial carcinoma (bladder cancer) . MCCQE objectives emphasize that any episode of gross painless hematuria in adults warrants urgent evaluation for malignancy , regardless of the number of red blood cells seen on urinalysis. Even microscopic hematuria in higher-risk individuals requires thorough workup.
The most important next step is cystoscopy , which directly visualizes the bladder and lower urinary tract to identify tumors, the most common cause of painless hematuria in this demographic. Imaging (e.g., CT urography) is also part of a complete evaluation, but cystoscopy is essential for diagnosing bladder lesions.
Intravenous pyelography is outdated and less sensitive. Ultrasonography may detect masses but does not replace cystoscopy. Reassurance or delayed repeat urinalysis would risk missing a malignancy.
Therefore, immediate urologic referral for cystoscopic evaluation is the appropriate next step.
NEW QUESTION # 156
A 32-year-old woman presents to the office with questions related to the mRNA vaccines that are approved for COVID-19. She is a health care worker. She gave birth to a healthy child 2 months ago. Before being immunized, which one of the following is the most important detail to elicit from the patient's history?
Answer: D
Explanation:
The most important pre-vaccination history to elicit is any previous anaphylaxis to vaccine components.
mRNA COVID-19 vaccines (e.g., Pfizer-BioNTech and Moderna) may contain polyethylene glycol (PEG), a potential allergen. This is a contraindication to administration.
Toronto Notes 2023 - Infectious Disease & Immunization Chapter:
"Absolute contraindications to mRNA COVID-19 vaccination include a documented anaphylactic reaction to a component of the vaccine such as polyethylene glycol (PEG)." MCCQE1 Objectives - Population Health > Preventive Medicine > Immunizations:
"The candidate must be able to assess for contraindications prior to immunization, including anaphylaxis to previous vaccines or components." Breastfeeding and occupational exposure (Options B and D) do not preclude vaccination. Current immunosuppression (Option C) may affect vaccine efficacy but is not a contraindication unless specifically advised.
NEW QUESTION # 157
A 94-year-old woman with severe dementia is referred for vaginal bleeding and a persistent foul odour from the vagina. She lives in a long-term care facility. She has been using a ring pessary for the past 15 years. Her current pessary has not been replaced in 2 years. On examination, there is moderate vaginal atrophy. After removing the pessary, which one of the following is the best next step?
Answer: C
Explanation:
In elderly women with long-term pessary use and signs of vaginal atrophy (thin epithelium, bleeding, odor), local estrogen is the most appropriate initial treatment to restore the vaginal epithelium and reduce inflammation and discharge. Vaginal estrogen improves mucosal integrity and reduces complications like ulceration, infection, and bleeding.
Toronto Notes 2023 - Gynecology, "Pelvic Organ Prolapse and Pessary Care" Section:
"Local vaginal estrogen therapy is recommended for postmenopausal women with vaginal atrophy who are using pessaries. It reduces the risk of erosions, bleeding, and infection, especially when pessary follow-up has been suboptimal." MCCQE1 Objectives (Obstetrics and Gynecology > 82-9: Vaginal Bleeding in Postmenopausal Women):
"Candidates should recognize vaginal atrophy as a common and treatable cause of bleeding in elderly women using pessaries." A biopsy (E) may be needed if symptoms persist after atrophy is treated. Hysteroscopy (A) is invasive and not first-line in this setting. Metronidazole (B) is not indicated without evidence of bacterial vaginosis. Daily saline douching (D) is not recommended and may irritate atrophic mucosa.
NEW QUESTION # 158
A 27-year-old man with a bowel obstruction secondary to a terminal ileum stricture has been on various medications since he was diagnosed with Crohn disease 8 years ago. You recommend a bowel resection, but he refuses this option because he is fearful of short bowel syndrome. He states that the only surgical procedure he will undergo is a bypass of the diseased segment so that the affected bowel will heal. You know that this is the wrong operation. Which one of the following is the best next step?
Answer: D
Explanation:
This case addresses informed consent and professional integrity. MCCQE ELOM objectives emphasize that competent patients have the right to refuse recommended treatment, but they cannot demand a treatment that is medically inappropriate or contrary to the standard of care. If a proposed intervention (e.g., bypass of a strictured Crohn segment expected not to heal) is not clinically indicated and may cause harm, the physician is not ethically obligated to provide it.
The appropriate response is to decline to perform the inappropriate procedure while clearly explaining the rationale, including risks, benefits, alternatives, and likely outcomes. Shared decision-making and addressing the patient's fears (e.g., risk of short bowel syndrome) are essential. If disagreement persists, offering a second opinion is reasonable-but transferring care solely to find someone willing to perform an inappropriate surgery is unethical.
A formal competency assessment is unnecessary unless there is evidence of impaired decision-making capacity. Performing a different surgery than agreed upon would violate consent. The physician must balance respect for autonomy with nonmaleficence and adherence to evidence-based practice.
NEW QUESTION # 159
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