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| Section | Objectives |
|---|---|
| Topic 1: Physician Activities | - Communication
|
| Topic 2: Dimensions of Care | - Health Promotion and Illness Prevention
|
弊社のMCCQE問題集は三種類の版を提供いたします。PDF版、ソフト版とオンライン版があります。PDF版のMCCQE日本語問題集は印刷されることができ、ソフト版のMCCQE日本語問題集はいくつかのパソコンでも使われることもでき、オンライン版の問題集はパソコンでもスマホでも直接に使われることができます。お客様は自分の愛用する版が選べます。
質問 # 195
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?
正解：D
質問 # 196
A 45-year-old man presents to your family practice for follow-up because he has had repeated transient ischemic attacks and had been advised not to drive. During the interview, you find out that he is still driving.
He explains that he only drives to the grocery store and his wife, who also has a driver's license, is always a passenger with him. He insists he can drive. You think that he should no longer be driving a car. Which one of the following is the best next step?
正解：A
解説：
In most Canadian provinces and territories, physicians are legally obligated to report patients who pose a danger due to medical conditions affecting driving ability. Given the history of TIAs and continued unsafe driving, reporting is necessary for public safety.
Toronto Notes 2023 - ELOM, "Fitness to Drive" Section:
"Physicians must report to motor vehicle authorities if a patient poses a risk to public safety due to a medical condition. TIAs are considered reportable if they impair ability and the patient does not comply with driving restrictions." MCCQE1 Objectives (ELOM > 99-1: Medical Fitness and Reporting):
"Candidates must recognize situations requiring mandatory reporting of patients unfit to drive due to neurologic or other impairing conditions." You may still discuss with the patient (B), but this does not replace the duty to report. Physically taking the license (C) is illegal. Refusing care (D) is unethical. A neurologist (E) could be helpful but would delay action in a clear case.
質問 # 197
A same-sex couple asks to join a family physician's practice. The physician tells them that shedoes not treat same-sex couples and will refer them to a physician with more clinical experience with same-sex couples.
Which one of the following best describes the physician's obligation under the Canadian Charter of Rights and Freedoms?
正解：E
解説：
Refusing care based on sexual orientation constitutes discrimination under the Canadian Charter of Rights and Freedoms and violates professional standards. Physicians must not deny care based on personal bias or prejudice.
Toronto Notes 2023 - ELOM, Equity in Care and Professionalism:
"Denying care based on sexual orientation violates both human rights legislation and professional obligations.
Physicians must ensure equitable access for all patients."
MCCQE1 Objectives - ELOM > Professionalism and Patient Rights:
"Candidates must act in accordance with patients' rights to equitable, non-discriminatory access to care regardless of race, gender, or sexual orientation." Referral (Option B) does not excuse discriminatory refusal. Personal discomfort or inexperience (Options D and E) do not justify discrimination.
質問 # 198
A 27-year-old woman presents with an enlarged thyroid. She had not noticed it herself until her mother brought it to her attention. She is asymptomatic from an endocrine perspective, and her serum thyroid- stimulating hormone (TSH) is normal.
Which one of the following is the most appropriate next step?
正解：D
解説：
In a euthyroid patient with an asymptomatic goiter or thyroid enlargement, the next step is a thyroid ultrasound to evaluate nodule size, composition, and features suggestive of malignancy.
Toronto Notes 2023 - Endocrinology, Thyroid Nodules and Goiter:
"TSH should be obtained first. If normal and there is a palpable mass or enlargement, ultrasound is indicated to evaluate for nodules and guide further testing (e.g., FNA)." MCCQE1 Objectives - Internal Medicine > Endocrinology:
"Candidates must use thyroid ultrasound as the initial imaging study in the evaluation of thyroid enlargement or palpable nodules." T3/T4 (A) are not needed with normal TSH. FNA (D) is done if nodules are identified. CT (C) is used for retrosternal goiters or compressive symptoms. Calcium (E) is irrelevant here.
質問 # 199
A 67-year-old man presents to the clinic because of elevated liver enzymes. He is asymptomatic.His medical history is significant for type 2 diabetes, which is being treated with metformin. On physical examination, he looks well. His blood pressure is 125/75 mm Hg, his heart rate is 80/min, and his BMI is 35. Findings of the remainder of the examination are normal. His blood work results are as follows:
* Platelet count: 170 × 10#/L (130-380)
* Creatinine: normal
* GGT: 75 µmol/L (49-93)
* ALT: 146 IU/L (15-85)
* AST: 101 IU/L (17-63)
* Bilirubin (total): 17 µmol/L (3-17)
* INR: 1.2 (0.9-1.2)
Which one of the following is the most likely diagnosis?
正解：D
解説：
The patient is obese (BMI 35), has type 2 diabetes, and shows a hepatocellular pattern of transaminitis (elevated ALT > AST). These are typical features of nonalcoholic steatohepatitis (NASH), the inflammatory subtype of nonalcoholic fatty liver disease (NAFLD).
Toronto Notes 2023 - Gastroenterology, NAFLD and NASH:
"NASH should be suspected in patients with metabolic syndrome, obesity, and type 2 diabetes, especially with elevated transaminases and normal bilirubin or INR." MCCQE1 Objectives - Internal Medicine > Hepatology:
"Candidates should recognize the clinical profile of NAFLD/NASH, particularly in asymptomatic patients with metabolic risk factors and isolated liver enzyme elevations." Acute hepatitis B (A) typically has higher ALT and symptoms. Pancreatic carcinoma (B) affects biliary enzymes or bilirubin. Metformin (D) does not elevate liver enzymes. HCC (E) would often present with systemic or localized symptoms and abnormal imaging.
質問 # 200
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MCCQE学習ガイドは、ユーザーの要求に十分に応えるため、メモリを分離するための少しの知識になりますが、それらを一緒に追加すると、時間を活用できる日が非常に多くあります。 MCCQE試験準備により、ユーザーはいつでもどこでもがれきの時間を使って勉強し、勉強と生活をより合理的に調整することができます。私たちのMCCQEシミュレーションマテリアルを選択するのは良い選択です。私たちのステップに従ってください。自分を信じて、あなたは完璧にそれをすることができます！
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