Medical Council of Canada MCCQE試験関連情報 & MCCQE合格受験記

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Medical Council of Canada MCCQE Exam Syllabus Topics:

Section	Objectives
Physician Activities	- Assessment 1. Physical examination 2. History taking 3. Investigations and diagnostic reasoning - Communication 1. Informed consent 2. Physician-patient communication 3. Breaking bad news 4. Team communication - Management 1. Pharmacological and non-pharmacological treatment 2. Therapeutic interventions 3. Follow-up planning - Professionalism 1. Ethics and legal duties 2. Leadership and scholarly habits 3. Self-awareness and reflection 4. Physician health for sustainable practice 5. Lifelong learning
Dimensions of Care	- Chronic Care 1. Long-term care 2. Chronic disease management 3. Rehabilitation - Health Promotion and Illness Prevention 1. Disease prevention measures 2. Risk factor reduction 3. Screening and periodic health exams 4. Health maintenance 5. Patient education - Psychosocial Aspects 1. Patient communication 2. Mental health and behavioral sciences 3. Psychosocial determinants of health - Acute Care 1. Acute presentations and stabilization 2. Management of acute medical conditions 3. Emergency and critical care

Section

Objectives

Physician Activities

- Assessment

1. Physical examination
2. History taking
3. Investigations and diagnostic reasoning

- Communication

1. Informed consent
2. Physician-patient communication
3. Breaking bad news
4. Team communication

- Management

1. Pharmacological and non-pharmacological treatment
2. Therapeutic interventions
3. Follow-up planning

- Professionalism

1. Ethics and legal duties
2. Leadership and scholarly habits
3. Self-awareness and reflection
4. Physician health for sustainable practice
5. Lifelong learning

Dimensions of Care

- Chronic Care

1. Long-term care
2. Chronic disease management
3. Rehabilitation

- Health Promotion and Illness Prevention

1. Disease prevention measures
2. Risk factor reduction
3. Screening and periodic health exams
4. Health maintenance
5. Patient education

- Psychosocial Aspects

1. Patient communication
2. Mental health and behavioral sciences
3. Psychosocial determinants of health

- Acute Care

1. Acute presentations and stabilization
2. Management of acute medical conditions
3. Emergency and critical care

>> Medical Council of Canada MCCQE試験関連情報 <<

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Medical Council of Canada MCCQE Part 1 Exam 認定 MCCQE 試験問題 (Q294-Q299):

質問 # 294
A 26-year-old woman, gravida 1, para 0, aborta 0, consults you at 36 weeks' gestation regarding newborn care. She has HIV. Which one of the following is the best advice regarding reducing the risk for transmission of HIV to her newborn?

A. Bottle-feed her newborn boiled expressed breast milk.
B. Formula-feed her newborn.
C. Breastfeed her newborn during the colostrum period only.
D. Avoid kissing her newborn.
E. Bottle-feed her newborn expressed breast milk.

正解：B

解説：
In Canada and other high-resource settings where safe alternatives are readily available, women living with HIV are advised to exclusively formula-feed their infants to eliminate the risk of postnatal HIV transmission through breast milk. HIV can be transmitted during pregnancy, delivery, and breastfeeding. While effective maternal combination antiretroviral therapy and neonatal prophylaxis significantly reduce perinatal transmission risk, breastfeeding still carries a residual risk because HIV is present in breast milk. Boiling expressed breast milk is not recommended as a standard preventive strategy in high-resource settings.
Avoiding kissing is unnecessary, as casual contact does not transmit HIV. Breastfeeding only during the colostrum period does not eliminate transmission risk. According to MCCQE objectives, physicians must provide evidence-based counseling regarding prevention of vertical transmission, including maternal antiretroviral therapy, appropriate mode of delivery when indicated, neonatal prophylaxis, and avoidance of breastfeeding when safe formula feeding is accessible. Clear counseling supports informed decision-making and optimal neonatal outcomes.

質問 # 295
A 35-year-old maintenance worker presents to your office because he thinks he has been exposed to asbestos and is afraid of developing asbestosis. He has no respiratory symptoms and is a non-smoker. Which one of the following is the best next step?

A. Order pulmonary function testing.
B. Ask him further about his work.
C. Refer him to a respirologist.
D. Order a chest radiograph.
E. Provide reassurance, since he is asymptomatic.

正解：B

解説：
In any suspected occupational exposure, the first step is a detailed occupational history to assess the nature, intensity, and duration of the exposure. This determines whether surveillance or further testing is appropriate.
Toronto Notes 2023 - Respiratory Medicine, "Occupational Lung Diseases" Section:
"When a patient presents with concerns about exposure to occupational hazards such as asbestos, detailed history is essential. Ask about job tasks, duration of exposure, use of personal protective equipment, and prior workplace assessments." MCCQE1 Objectives (Population Health > 97-2: Environmental and Occupational Health):
"Candidates must be able to obtain a detailed environmental and occupational history and determine the risk of exposure before ordering investigations." Ordering a chest radiograph (B) or PFTs (E) without confirming meaningful exposure is premature. Referral to a specialist (D) and reassurance (A) come only after the exposure risk is assessed.

質問 # 296
An 84-year-old woman is brought by ambulance to the emergency department after she was found by a neighbour. She had fallen, sustained a hip fracture, and was unable to move for the past 2 days. After starting rehydration, she reports hip pain and numbness and tingling in both her legs. Physical examination reveals faint pulses in both legs and severely swollen lower legs that are painful to palpation. The urine in the Foley catheter bag seems to be darker than normal. Which one of the following is the best next step?

A. Surgical fixation of the patient's hip fracture.
B. Myoglobin urine test.
C. Bilateral angiography of the lower legs.
D. Compartment pressure measurements of the lower legs.
E. Bilateral Doppler ultrasonography of the legs.

正解：D

解説：
This patient presents with signs of acute compartment syndrome (pain out of proportion, paresthesia, pallor, swelling, decreased pulses, and dark urine indicating rhabdomyolysis). Measuring compartment pressures is the diagnostic test of choice to confirm the diagnosis and guide urgent surgical fasciotomy.
Toronto Notes 2023 - Orthopedics:
"Acute compartment syndrome should be suspected in any patient with severe extremity pain, swelling, sensory deficits, and tense compartments. Confirm with compartment pressure measurements. Fasciotomy is indicated if pressure is >30 mmHg or within 30 mmHg of diastolic pressure." MCCQE1 Objectives (Surgery > 51-2: Limb Trauma):
"Candidates must diagnose acute compartment syndrome and initiate appropriate surgical referral after confirming with pressure measurements." Angiography and Doppler studies assess vascular compromise but are not the first step in suspected compartment syndrome. Fixing the hip (C) and testing myoglobin (E) are not diagnostic steps.

質問 # 297
A 19-year-old primigravid woman presents to the office with a rapid increase of abdominal girth and shortness of breath. Her pregnancy is at 27 weeks' gestation, as confirmed by early ultrasonogram. The symphysis-fundal height is 45 cm. The fetal heart rate is 150/min (110-160). Which one of the following is the most likely diagnosis?

A. Ovarian tumour and ascites.
B. Fetal macrosomia.
C. Twin pregnancy.
D. Partial mole.
E. Polyhydramnios.

正解：E

解説：
Polyhydramnios is the most likely diagnosis given the rapid increase in abdominal girth , maternal shortness of breath , and a symphysis-fundal height (45 cm) significantly greater than expected for 27 weeks' gestation.
MCCQE objectives emphasize that fundal height should approximately correspond (±2-3 cm) to gestational age in weeks after 20 weeks. A discrepancy this large suggests excessive amniotic fluid volume.
Polyhydramnios leads to uterine overdistension, which explains dyspnea and rapid abdominal enlargement.
Twin pregnancy can cause a large fundal height, but early ultrasound confirmation of gestational age would likely have identified multiple gestation. Partial mole is typically associated with abnormal bleeding and abnormal fetal findings. Fetal macrosomia increases fundal height but usually not to this degree at 27 weeks and is more gradual. Ovarian tumor with ascites is less likely in a confirmed intrauterine pregnancy with normal fetal heart rate. Polyhydramnios is commonly associated with maternal diabetes or fetal anomalies affecting swallowing and requires further evaluation with ultrasound and glucose screening.

質問 # 298
A 55-year-old man with alcohol use disorder presents with a 2-day history of confusion. Onexamination, you note a sixth nerve palsy and a horizontal nystagmus. Which one of the following is the most likely diagnosis?

A. Cerebellar degeneration
B. Wernicke encephalopathy
C. Hepatic encephalopathy
D. Subdural hematoma
E. Cerebellar hemorrhage

正解：B

解説：
Wernicke encephalopathy is a medical emergency caused by thiamine (vitamin B1) deficiency, most often seen in chronic alcohol use. The classic triad is:
* Confusion
* Oculomotor dysfunction (e.g., nystagmus, cranial nerve palsies)
* Ataxia
Toronto Notes 2023 - Neurology and Psychiatry, "Wernicke Encephalopathy" Section:
"Wernicke encephalopathy is diagnosed clinically. Symptoms include ophthalmoplegia (e.g., CN VI palsy), horizontal nystagmus, ataxia, and confusion. Immediate parenteral thiamine is indicated before glucose administration." MCCQE1 Objectives (Neurology > 75-1: Neurologic Emergencies):
"Candidates must recognize Wernicke encephalopathy in at-risk individuals and initiate urgent thiamine replacement." Other choices like cerebellar degeneration (A) and hepatic encephalopathy (D) are more chronic and lack the characteristic eye findings. Subdural hematoma (B) and hemorrhage (E) may mimic confusion but are less likely with these neurologic signs and history.

質問 # 299
......

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