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| Section | Objectives |
|---|---|
| Physician Activities | - Assessment
|
| Dimensions of Care | - Psychosocial Aspects
|
昇進の機会を得て仕事に就きたいと考えているなら、当社からMCCQE学習問題を選択するのが最良の選択のチャンスになります。なぜなら、MCCQE学習教材には、あなたが自分自身を改善し、他の人よりも優れたものにするのに役立つ十分な能力があるからです。当社のMCCQE学習教材は、多くの人々が認定を取得し、夢を実現するのに役立ちました。また、当社のMCCQEテストガイドに連絡する機会もあります。
質問 # 155
A 38-year-old man presents to the office for a follow-up visit. For several years, he has been having constant abdominal pain and intermittent constipation. He struggles to fall asleep because he is worried about his symptoms, and he often spends hours researching possible investigations and causes. Although he recently had extensive investigations, which have all had normal results, he continues to visit multiple physicians hoping for more investigations. He worries that he will die because no one is taking him seriously. Which one of the following is the best next step?
正解：D
解説：
This presentation is most consistent with somatic symptom disorder/illness anxiety : persistent distressing physical symptoms (abdominal pain/constipation) with excessive health-related anxiety, repeated reassurance- seeking, and "doctor shopping" despite normal investigations. MCCQE objectives emphasize avoiding iatrogenic harm from repeated testing and using a structured, therapeutic relationship to manage medically unexplained or disproportionate symptom concerns. The best next step is regularly scheduled follow-up visits with one consistent physician (e.g., monthly), focused on validating symptoms, addressing fears, monitoring for new objective findings, and gradually shifting toward coping strategies and functional goals. This approach reduces unnecessary investigations, reinforces continuity, and helps interrupt the cycle of anxiety- driven health-care utilization.
Repeating investigations (B) perpetuates reassurance-seeking and increases false positives and harm.
Consulting additional specialists (A) without new red flags similarly reinforces maladaptive beliefs and fragmentation of care. Exercise (D) may be beneficial as an adjunct but is not the core management strategy.
Therefore, planned, regular appointments are the most appropriate next step.
質問 # 156
A 60-year-old postmenopausal woman presents with 2 culture-proven uncomplicated urinary tract infections in the last 5 months. She finds them quite distressing and would like to prevent recurrence. Which one of the following is the best next step?
正解：A
解説：
Postmenopausal women are at increased risk of recurrent urinary tract infections (UTIs) due to estrogen deficiency , which leads to thinning of the vaginal epithelium, decreased glycogen, and loss of protective lactobacilli. This results in increased vaginal pH and colonization with uropathogens. MCCQE objectives emphasize addressing reversible risk factors in recurrent uncomplicated UTIs before considering long-term antibiotic prophylaxis.
Topical vaginal estrogen restores the normal vaginal flora and epithelial integrity, significantly reducing recurrence rates in postmenopausal women. It is considered first-line preventive therapy in this population unless contraindicated.
Reassurance alone is inappropriate given recurrent infections. Pelvic physiotherapy does not prevent UTIs.
Cystoscopy is not indicated in uncomplicated recurrent UTIs without hematuria, atypical organisms, or other concerning features. Evidence for probiotics remains insufficient to recommend as primary prevention.
Thus, local estrogen therapy is the most appropriate and evidence-based next step for preventing recurrent UTIs in postmenopausal women.
質問 # 157
A mother brings her 10-year-old son for his well-child check-up. She mentions that her 38-year-old husband has just had a heart attack due to high cholesterol levels and wants information regarding prevention of cardiovascular disease for her son. Which one of the following is the best approach to managing this problem?
正解：C
解説：
Children with a first-degree relative who has premature coronary artery disease or hypercholesterolemia should undergo fasting lipid screening between ages 2-10. Since the child is 10, screening is indicated.
Toronto Notes 2023 - Pediatrics, "Preventive Care in Children":
"Lipid screening is recommended for children #2 years old with a family history of early cardiovascular disease or hypercholesterolemia." MCCQE1 Objectives (Pediatrics > 78-1: Preventive Medicine):
"Candidates must screen children at high risk of cardiovascular disease appropriately, including lipid profile for familial hyperlipidemia." Diet and exercise counseling may follow screening, but testing is the first step. Reassurance alone (C) is inappropriate. Homocysteine (E) and HbA1c are not first-line tests in this setting.
質問 # 158
An 18-month-old girl is brought in with a 3-day history of frequently passing loose stools. The stools are not bloody, but when she passes the stools, she is in obvious pain. She started vomiting earlier today, but she is still wetting diapers. On examination, she is mildly dehydrated but active and alert. Physical examination findings are otherwise normal. Which one of the following is the best management of this patient's case?
正解：B
解説：
This child has acute viral gastroenteritis with mild dehydration. She remains alert, active, and continues to produce urine, indicating mild volume depletion. According to MCCQE objectives and pediatric guidelines, the first-line management of mild to moderate dehydration due to gastroenteritis is oral rehydration therapy (ORT) using a commercially prepared oral rehydration solution (ORS). ORS contains the appropriate balance of glucose and electrolytes to promote sodium and water absorption via the sodium-glucose cotransporter in the intestine. Antidiarrheal agents such as loperamide are contraindicated in young children due to risk of adverse effects and limited benefit. Withholding food until diarrhea resolves is unnecessary; early refeeding with an age-appropriate diet is recommended once rehydration begins. Apple juice and chicken broth do not provide the correct electrolyte composition and may worsen diarrhea due to high osmolarity. Routine lactose restriction is not indicated unless persistent symptoms suggest secondary lactose intolerance. Early ORT reduces the need for intravenous fluids and hospital admission.
質問 # 159
There are many expenses which are considered part of providing care to patients. Under Canadian legislation, which one of the following is an acceptable means of covering these costs?
正解：E
解説：
Physicians in Canada may charge patients for uninsured services (e.g., completion of forms, cosmetic procedures, some travel-related vaccines), but they may not charge extra for insured services or preferential access. Doing so violates the Canada Health Act, which mandates accessibility and universality of insured services.
Toronto Notes 2023 - ELOM, Health Care System:
"Physicians may charge for uninsured services but may not charge block fees for insured services, nor can they charge for expedited access to insured services." MCCQE1 Objectives - ELOM > Health Policy and System:
"Candidates must recognize practices that violate the principles of publicly funded health care, including charging for insured services or access premiums." Option A is not permitted under law. Options B, D, and E involve insured services (e.g., home visits, after- hours care) and cannot be billed directly to patients.
質問 # 160
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