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| Section | Objectives |
|---|---|
| Physician Roles (CanMEDS Framework) | - Communicator
|
TopexamのMCCQE模擬テストに関する限り、PDFバージョンは次の2つの側面に関して非常に便利です。 一方、PDFバージョンには、MCCQEテストトレントの全バージョンから選択された質問の一部が含まれているデモが含まれています。 このようにして、実際の準備試験の一般的な理解を得ることができます。これは、適切な試験ファイルの選択に役立つはずです。 一方、MCCQE Part 1 ExamのMCCQE準備資料を印刷して、Medical Council of Canada論文とPDF版で試験の勉強をすることができます。 このようなメリットがあるので、試してみませんか？
質問 # 96
You are evaluating a 75-year-old man with recently diagnosed prostate cancer and 2 painful metastases of the lumbar spine. Which one of the following therapeutic options is the most appropriate?
正解：E
解説：
Palliative radiotherapy is the treatment of choice for painful bone metastases, including those from prostate cancer. It provides localized pain relief and functional improvement.
Toronto Notes 2023 - Oncology, "Metastatic Bone Pain":
"External beam radiotherapy is first-line treatment for localized bone pain from metastases. Relief occurs within days to weeks." MCCQE1 Objectives (Internal Medicine > Oncology > 52-1):
"Candidates must identify treatment options for symptom control in metastatic cancer, including palliative radiotherapy for painful bone lesions." Androgen deprivation therapy (B, C) treats systemic disease but doesn't address acute pain. Opioids (D) may be used, but radiotherapy provides disease-targeted relief. Intrathecal steroids (A) are not standard for prostate metastases.
質問 # 97
A 39-year-old woman, gravida 2, para 1, aborta 0, presents with concerns that a friend has recently suffered from postpartum psychosis. She wonders if she is likely to suffer this disorder following delivery of her 2nd child. Which one of the following is most likely to increase your patient's risk?
正解：D
解説：
Comprehensive and Detailed Explanation:
Postpartum psychosis is strongly associated with bipolar disorder and other mood disorders. A personal or family history of bipolar disorder significantly increases the risk. It typically presents within the first 2 weeks postpartum and is a psychiatric emergency.
Toronto Notes 2023 - Psychiatry, "Postpartum Psychiatric Disorders":
"Risk factors for postpartum psychosis include personal or family history of bipolar disorder or postpartum psychosis." MCCQE1 Objectives (Psychiatry > 71-3: Mood Disorders):
"Candidates must recognize risk factors for postpartum psychiatric illness, particularly the association with bipolar spectrum disorders." Advanced maternal age (A), multiparity (B), and panic disorder (D) do not significantly increase the risk of postpartum psychosis.
質問 # 98
A 42-year-old woman, gravida 2, para 2, aborta 0, comes to the office for the first time. She reports a 6-month history of thirst, urinary frequency, and recurrent vaginitis. Aside from a BMI of 28, her physical examination findings are unremarkable. She takes no medications. Which one of the following would support the most likely diagnosis?
正解：A
解説：
This patient's symptoms of polyuria, polydipsia, and recurrent vaginitis are classic for type 2 diabetes mellitus (T2DM) . Recurrent vaginal candidiasis occurs due to glycosuria promoting yeast overgrowth. MCCQE objectives emphasize identifying risk factors and historical features supporting diabetes. A prior delivery of a macrosomic infant ( > 4000-4500 g) is strongly associated with gestational diabetes mellitus (GDM) , which significantly increases the future risk of developing T2DM. Therefore, a history of macrosomia supports undiagnosed or previous gestational hyperglycemia and increases suspicion for current diabetes.
High-risk sexual behaviors relate to sexually transmitted infections, not diabetes. Family history of hypertension is a cardiovascular risk factor but does not specifically support diabetes. Recent antibiotic use may predispose to candidiasis but would not explain polyuria and polydipsia. Dry eyes are more suggestive of autoimmune conditions (e.g., Sjogren syndrome).
Thus, prior delivery of a macrosomic newborn strengthens the likelihood that her current symptoms are due to type 2 diabetes mellitus.
質問 # 99
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：E
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 # 100
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?
正解：D
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 # 101
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