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| Section | Objectives |
|---|---|
| Topic 1: Physician Activities | - Management
|
| Topic 2: Dimensions of Care | - Health Promotion and Illness Prevention
|
Medical Council of CanadaのMCCQE認定試験の最新教育資料はShikenPASSの専門チームが研究し続けてついに登場し、多くの人の夢が実現させることができます。今のIT業界の中で、自分の地位を固めたくて知識と情報技術を証明したいのもっとも良い方法がMedical Council of CanadaのMCCQE認定試験でございます。がMedical Council of CanadaのMCCQE「MCCQE Part 1 Exam」認定試験の合格書を取ったら仕事の上で大きな変化をもたらします。
質問 # 41
A 62-year-old woman presents with abdominal pain, fever and chills. She was hospitalized 4 weeks ago for sigmoid diverticulitis. She felt well after her discharge from hospital until 5 days ago when the fever started.
She is now anorexic. On examination, she has right upper quadrant pain and her temperature is 38.5 °C.
Which one of the following investigations is most likely to confirm the diagnosis?
正解：C
解説：
This patient presents with fever, chills, anorexia, and right upper quadrant (RUQ) pain several weeks after hospitalization for sigmoid diverticulitis . A key complication of intra-abdominal infections such as diverticulitis is portal pylephlebitis with hepatic abscess formation , due to bacterial spread via the portal venous system. MCCQE objectives emphasize recognizing liver abscess as a delayed complication of intra- abdominal sepsis, particularly when new RUQ pain and fever develop after an initial abdominal infection.
The most appropriate initial imaging test to confirm this diagnosis is ultrasound of the abdomen , which can detect hepatic abscesses and guide further management. CT abdomen is also highly sensitive, but among the listed options, ultrasound is most appropriate.
Chest and abdominal radiographs are nonspecific. HIDA scan evaluates cystic duct obstruction in suspected acute cholecystitis, which is less likely given the recent diverticulitis and systemic features. ERCP is used for biliary obstruction or ascending cholangitis, typically associated with jaundice.
Thus, abdominal ultrasound is most likely to confirm a hepatic abscess.
質問 # 42
You performed a surgical procedure on a 32-year-old woman for a herniated disk that was causing neurologic impairment. At the 8-month follow-up visit, she has healed well; however, she requests a prescription renewal of her narcotic analgesics (hydromorphone). Her pharmacy confirms that the patient adheres to the dosage you prescribed, that she has not consulted other physicians, and that her behavior has always been respectful.
You think that she no longer requires narcotic analgesics. Which one of the following approaches is most helpful to the patient?
正解：A
解説：
The patient's pain is no longer medically justified for opioids, but there is no evidence of misuse. The most appropriate and supportive action is to explain concerns, provide education about opioid tapering or dependency, and transition care to her family physician for ongoing management.
Toronto Notes 2023 - ELOM, "Safe Prescribing and Opioid Stewardship" Section:
"When opioids are no longer indicated, engage the patient in a conversation about tapering and arrange appropriate follow-up. Coordinate care with primary providers when long-term management is needed." MCCQE1 Objectives (ELOM > 99-1: Professionalism and Substance Use):
"Candidates must address the risk of dependency, counsel the patient, and ensure a safe transition to appropriate care without abrupt termination." Methadone (E) and fentanyl (A) are for opioid use disorder or chronic pain, not for tapering in low-risk patients. Discharging the patient (B) or reporting (C) is punitive and unnecessary.
質問 # 43
A 12-year-old boy is brought to the Emergency Department with a 2-week history of a limp with malaise, fever and left leg pain. On examination, he looks sick, has a temperature of 38.5°C and is able to weight-bear.
His hip examination reveals mildly decreased range of motion. Radiographs of the hip and femur show mild sclerosis of proximal femoral metaphysis. His C-reactive protein level is 15 mg/L ( < 8). Which one of the following is the most likely diagnosis?
正解：B
解説：
This presentation best fits osteomyelitis, likely subacute given the 2-week course and radiographic metaphyseal sclerosis. MCCQE objectives stress that fever, systemic malaise, and elevated inflammatory markers (CRP above normal) with localized limb pain/limp should prompt consideration of bone infection even if the child can still weight-bear. Osteomyelitis in children commonly involves the metaphysis of long bones due to vascular anatomy; early x-rays may be normal, but with time they can show periosteal reaction or sclerosis. In contrast, transient synovitis typically occurs after a viral illness, is usually afebrile or minimally febrile, and inflammatory markers are often normal. Legg-Calve-Perthes is classically age 4-8 and affects the femoral epiphysis/head with avascular necrosis changes rather than metaphyseal sclerosis and systemic illness. SCFE presents in adolescents with limp and limited internal rotation/obligate external rotation, usually without fever or elevated CRP, and x-ray shows epiphyseal slip. An undisplaced fracture would usually have trauma history and not systemic features.
質問 # 44
A 78-year-old woman is brought to the Emergency Department by her son because she has a sodium level of
124 mmol/L (136-146). The sodium was checked as part of a blood work panel ordered by her primary health care provider to investigate symptoms of urinary frequency, fatigue, and thirst. Today, she has a blood glucose level of 44.0 mmol/L (4.0-11.0). The original blood work done by her primary health care provider did not include glucose. The patient is treated for hyperglycemia and dehydration and begins insulin. The patient and her son repeatedly express their frustration that their primary health care provider missed the diagnosis. Which one of the following is the best next step?
正解：E
解説：
In situations involving potential oversight, the appropriate next step is to contact the other physician directly.
This supports collegial communication, continuity of care, and provides an opportunity to clarify the clinical situation. It avoids premature judgment while allowing the primary provider to respond and address concerns.
Toronto Notes 2023 - ELOM, "Professionalism and Interprofessional Communication":
"When concerns arise about another provider's care, direct communication is preferred before considering formal reporting. This maintains collaboration and fairness." MCCQE1 Objectives (ELOM > 90-2: Communication and Accountability):
"Candidates must demonstrate collegiality and appropriate methods for addressing concerns regarding another physician's care." Empathizing (D) and validating blame is unprofessional. Reporting (B) is premature. Offering another provider (C) could undermine continuity. (E) is incorrect since the glucose should have been checked based on the presenting symptoms.
質問 # 45
A 58-year-old woman presents to your office with refractory bipolar I disorder. She is on the following medications: lithium carbonate, valproic acid, and olanzapine. She also takes acetaminophen for osteoarthritis and pantoprazole for gastroesophageal reflux. Lately, she has noticed she bruises very easily. Laboratory work displays a platelet count of 70 × 10#/L (normal 130-400). Which one of the following is most likely to induce this side effect?
正解：A
解説：
Valproic acid is well known to cause thrombocytopenia, especially at higher serum concentrations or in patients over 60. Bruising with platelet count <100 × 10#/L is a classic manifestation.
Toronto Notes 2023 - Psychiatry, Mood Disorders & Pharmacology Section:
"Valproic acid is associated with hematologic side effects including thrombocytopenia. Platelet counts should be monitored regularly." MCCQE1 Objectives - Psychiatry > Pharmacotherapy:
"The candidate must recognize adverse effects of mood stabilizers including hematologic complications of valproic acid." Other listed medications (A-D) have no common or direct link with thrombocytopenia in this context.
質問 # 46
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