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| Section | Objectives |
|---|---|
| Dimensions of Care | - Chronic Care
|
| Physician Activities | - Communication
|
>> Medical Council of Canada MCCQE Reliable Test Answers <<
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NEW QUESTION # 66
A 25-year-old woman who is at 8 weeks' gestation plans to travel to rural Cambodia to care for her ill mother.
Which one of the following treatments should be provided to her before the trip?
Answer: D
Explanation:
Comprehensive and Detailed Explanation:
Travel to rural Cambodia poses a high risk of malaria, which can be life-threatening in pregnancy.
Antimalarial prophylaxis is strongly recommended for pregnant women traveling to endemic regions.
Chloroquine or mefloquine (depending on resistance patterns) may be used in pregnancy under specialist guidance.
Toronto Notes 2023 - Infectious Disease / Travel Medicine:
"Malaria prophylaxis is indicated in pregnant women traveling to endemic regions. The risk of severe malaria and poor fetal outcomes is high." MCCQE1 Objectives (Public Health > 65-3: Travel Medicine and Pregnancy):
"Candidates must provide preventive care to pregnant travelers including vaccination and malaria prophylaxis." Tetanus boosters (D) are given every 10 years. Hep B Ig (B) is for acute post-exposure prophylaxis.
Ciprofloxacin (C) is contraindicated in pregnancy.
NEW QUESTION # 67
A 24-year-old man is brought to the Emergency Department by ambulance with a severe pelvic fracture from a motor vehicle collision. After resuscitation and stabilization, he is noted to have a bloody penile discharge.
Which one of the following is the best next step?
Answer: E
Explanation:
In a patient with a pelvic fracture and blood at the urethral meatus, urethral injury must be strongly suspected.
Other signs may include perineal hematoma, high-riding prostate, or inability to void. The key principle is do not insert a Foley catheter until urethral integrity is confirmed, as blind catheterization may worsen a partial tear into a complete disruption. The appropriate next diagnostic step is retrograde urethrography (RUG), which evaluates the urethra for extravasation of contrast and identifies the site and extent of injury.
Voiding cystography evaluates bladder injury and is performed after urethral integrity is confirmed or via suprapubic access. Transrectal ultrasound and penile sonography are not appropriate in acute trauma assessment of suspected urethral disruption. Continuous bladder irrigation is contraindicated until urethral injury is excluded.
MCCQE objectives emphasize recognition of urethral injury in pelvic trauma and adherence to trauma principles: stabilize first, suspect urethral injury when blood is present at the meatus, and perform retrograde urethrography prior to catheterization.
NEW QUESTION # 68
A 38-year-old woman presents with diffuse nodularity in the outer upper quadrant of her right breast. There is no obvious dominant mass, nipple discharge, or skin dimpling. There are no palpable lymph nodes. Which one of the following is the most likely diagnosis?
Answer: E
Explanation:
Fibrocystic change is the most common benign breast condition in women of reproductive age. It typically presents with diffuse nodularity or "lumpy" areas, especially in the upper outer quadrant, and varies with the menstrual cycle. No dominant mass or systemic signs are expected.
Toronto Notes 2023 - Gynecology, "Benign Breast Conditions":
"Fibrocystic changes often present with bilateral or unilateral nodularity, most commonly in the upper outer quadrants, without discrete masses." MCCQE1 Objectives (Gynecology > 81-1: Breast Conditions):
"Candidates must differentiate benign breast conditions from malignant ones based on presentation and physical exam findings." Paget disease (B) presents with nipple changes. Intraductal carcinoma (C) typically shows a discrete mass or suspicious features. Phyllodes tumours are usually well-circumscribed. Mastitis (E) is inflammatory and associated with erythema, fever, and tenderness.
NEW QUESTION # 69
A 15-year-old boy is brought to the Emergency Department by his parents because he fainted at home earlier in the day. They are recent immigrants, and there is a language barrier. Which one of the following is the best option for facilitating a thorough history-taking?
Answer: B
Explanation:
Effective communication is essential for accurate diagnosis, informed consent, and patient safety. MCCQE ELOM objectives emphasize the physician's responsibility to ensure clear, accurate, and confidential communication when language barriers exist. The best practice is to use a professional interpreter service (virtual or in-person) . Professional interpreters are trained to provide accurate translation, maintain confidentiality, and avoid introducing bias or omissions.
Using family members, community volunteers, or untrained staff (e.g., a laboratory technician) risks inaccuracies, breaches of confidentiality, and potential distortion of sensitive information. This is particularly important in adolescents, where confidential history (e.g., substance use, cardiac symptoms, sexual history) may be relevant. Simply speaking slowly or using simpler language does not overcome a true language barrier.
Professional interpreter services improve clinical outcomes, enhance patient understanding, and reduce medico-legal risk. Therefore, arranging a certified interpreter-either in person or via telephone/video-is the most appropriate approach.
NEW QUESTION # 70
A 27-year-old woman, gravida 2, para 1, aborta 0, presents to the office seeking guidance on the management of her baby once it is born. The patient is in renal failure and has been taking methadone for 3 years to manage her opioid use disorder. During her pregnancy, she has been taking a stable dose of 80 mg of methadone once daily. Which one of the following is the most appropriate next step?
Answer: D
Explanation:
Methadone maintenance therapy during pregnancy is the recommended treatment for opioid use disorder and should be continued at a stable dose. However, regardless of maternal dose stability, neonates are at significant risk of neonatal abstinence syndrome (NAS) due to in utero opioid exposure. MCCQE objectives emphasize anticipatory guidance and appropriate newborn monitoring in substance-exposed pregnancies.
Symptoms of NAS (irritability, tremors, poor feeding, vomiting, diarrhea, seizures) typically begin within 24-
72 hours after birth but may be delayed with long-acting opioids such as methadone. Therefore, routine observation in hospital for at least 72 hours is recommended to monitor for withdrawal and initiate supportive or pharmacologic treatment if needed.
Naloxone is contraindicated in opioid-dependent neonates except in life-threatening respiratory depression because it may precipitate severe withdrawal. Stable maternal dosing does not eliminate NAS risk, so early discharge is inappropriate. Breastfeeding is generally encouraged in stable methadone-maintained mothers, as methadone transfer in breast milk is minimal and may reduce withdrawal severity. Continuing methadone during pregnancy is safer than untreated opioid use.
NEW QUESTION # 71
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