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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Dimensions of Care | 50% | - Acute Care - Chronic Care - Health Promotion and Illness Prevention - Assessment and Diagnosis |
| Topic 2: Physician Activities | 50% | - Professional Behaviours - Management - Communication - Psychosocial Aspects |
Medical Council of Canada인증MCCQE시험은 현재 치열한 IT경쟁 속에서 열기는 더욱더 뜨겁습니다. 응시자들도 더욱더 많습니다. 하지만 난이도난 전혀 낮아지지 않고 이지도 어려운 시험입니다. 어쨌든 개인적인 지식 장악도 나 정보기술 등을 테스트하는 시험입니다. 보통은Medical Council of Canada인증MCCQE시험을 넘기 위해서는 많은 시간과 신경이 필요합니다.
질문 # 197
A 26-year-old woman, gravida 2, para 2, aborta 0, has just delivered a full-term newborn via spontaneous vaginal delivery after 4 hours of labor. Following oxytocin administration and placental expulsion, there continues to be a steady trickle of bright red blood from her vagina. On examination, the placenta is intact and the fundus feels firm. Her vital signs are within normal range.
Which one of the following is the most likely diagnosis?
정답：C
설명：
Comprehensive and Detailed Explanation:
In postpartum hemorrhage with a firm uterine fundus and intact placenta, a common cause is trauma such as a vaginal or cervical tear. Uterine atony (A) typically presents with a boggy uterus. The absence of systemic instability or coagulopathy makes options D and E less likely.
Toronto Notes 2023 - Obstetrics, Postpartum Hemorrhage:
"Continued bleeding despite a firm fundus and intact placenta should raise suspicion for genital tract trauma, especially cervical or vaginal lacerations." MCCQE1 Objectives - Obstetrics > Postpartum Complications:
"Candidates must differentiate causes of postpartum hemorrhage and identify when bleeding is due to trauma vs uterine atony."
질문 # 198
A 14-month-old boy is brought to see you for a well-baby check-up and is noted to have onlyone testis.
Ultrasound confirms an undescended testis. Which one of the following is the best next step?
정답：C
설명：
Orchiopexy is the treatment of choice for cryptorchidism and should be performed between 6-18 months of age. Early surgery improves fertility outcomes and reduces malignancy risk.
Toronto Notes 2023 - Pediatrics, Urology:
"Undescended testes should be referred for orchiopexy ideally before 18 months of age. Observation beyond
6 months is not recommended."
MCCQE1 Objectives - Pediatrics > Genitourinary Disorders:
"Candidates must recognize and refer for cryptorchidism early to optimize testicular function and reduce cancer risk." Hormonal therapies (C, D) are not recommended due to limited efficacy. Observation (A) is too late beyond
질문 # 199
Your colleague's receptionist asks you to assess her 4-year-old daughter who has had 2 episodesof acute otitis media in the last month. The mother wants you to arrange a consultation with an ear, nose and throat (ENT) specialist to get a tympanostomy before her daughter starts school. You do not believe there is a surgical indication at this time. Which one of the following is the best next step?
정답：C
설명：
Referrals should be medically indicated. Physicians are not obligated to refer simply because a patient (or colleague) requests it, especially when it may lead to unnecessary care. The ethical and appropriate action is to explain your medical reasoning and decline an unwarranted referral.
Toronto Notes 2023 - ELOM, "Professionalism and Resource Stewardship" Section:
"Physicians have a responsibility to act as gatekeepers to specialist services and should not refer patients when criteria are not met. Explaining the reasoning and declining the request respectfully is appropriate." MCCQE1 Objectives (ELOM > 99-1: Professionalism and Clinical Judgment):
"Candidates must demonstrate ethical reasoning in managing requests for unwarranted interventions." Involving the emergency department (B) or another physician (C) is not appropriate unless there's a true conflict of interest. Calling a consultant (E) may be unnecessary if no medical reason exists.
질문 # 200
A 78-year-old man presents to the Emergency Department with chest pain. His electrocardiogram and blood work confirm an acute myocardial infarction. He is admitted to the Intensive Care Unit. Three days later, he develops right-sided abdominal pain. An ultrasonogram reveals an inflamed gallbladder with no evidence of stones. He does not improve after 48 hours of antibiotics. Which one of the following is the best next step?
정답：C
설명：
This presentation is consistent with acute acalculous cholecystitis, often seen in critically ill or post-MI patients. If unresponsive to antibiotics, percutaneous cholecystostomy is the preferred next step in those who are poor surgical candidates.
Toronto Notes 2023 - General Surgery, "Hepatobiliary Disorders" Section:
"Acalculous cholecystitis occurs in critically ill patients and is often managed with percutaneous cholecystostomy if the patient is not a candidate for surgery." MCCQE1 Objectives (Surgery > 84-3: Biliary Disease):
"Candidates must be able to diagnose and manage acalculous cholecystitis. Management includes antibiotics and drainage via percutaneous cholecystostomy in unstable patients." Laparoscopic cholecystectomy (C) is standard but not suitable in acutely ill ICU patients. Broadening antibiotics (A) alone is insufficient after failure of initial therapy. ERCP (B) is for biliary obstruction or cholangitis. HIDA scan (E) is diagnostic, not therapeutic.
질문 # 201
A 70-year-old woman had a total abdominal hysterectomy with bilateral salpingo-oophorectomy 2 days ago.
On examination today, her vital signs are as follows: She has been immobile since her operation. She is fatigued but is tolerating a full diet. Which one of the following is the most likely cause of this patient's fever?
정답：A
설명：
Postoperative fever on day 1-2 is commonly caused by atelectasis, particularly in patients who are immobile.
It is considered a self-limited cause of early fever after surgery and often resolves with mobilization and pulmonary exercises.
Toronto Notes 2023 - Surgery, Postoperative Complications:
"The '5 W's' of postoperative fever: Wind (atelectasis), Water (UTI), Wound (infection), Walking (DVT), and Wonder drugs. Atelectasis typically occurs in the first 48 hours and is due to hypoventilation or pain- limited breathing." MCCQE1 Objectives - Surgery > Postoperative Management:
"Candidates must recognize timing-specific causes of postoperative fever. Atelectasis is the most likely cause within the first 48 hours." PE (B) can cause fever but is less likely without respiratory compromise. Wound infection (C) and bowel trauma (D) typically present later or with more specific symptoms. Septic pelvic thrombophlebitis (A) usually presents later and with more systemic signs.
질문 # 202
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