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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Physician Activities | 50% | - Professional Behaviours - Communication - Psychosocial Aspects - Management |
| Topic 2: Dimensions of Care | 50% | - Chronic Care - Health Promotion and Illness Prevention - Assessment and Diagnosis - Acute Care |
Medical Council of Canada MCCQE덤프를 구매하시기전에 사이트에서 해당 덤프의 무료샘플을 다운받아 덤프품질을 체크해보실수 있습니다. MCCQE덤프를 구매하시면 구매일로부터 1년내에 덤프가 업데이트될때마다 업데이트된 버전을 무료로 제공해드립니다.Medical Council of Canada MCCQE덤프 업데이트 서비스는 덤프비용을 환불받을시 자동으로 종료됩니다.
질문 # 125
A 12-year-old boy initially presents with a 4-month history of left knee pain. He denies any obvious history of trauma, but he plays basketball frequently and notes his pain is worse after playing. On physical examination the patient has a prominent tibial tubercle, which is swollen and tender. There is full range of motion in the knee. A radiograph of the left knee reveals an ossicle anterior to the tibial tuberosity. Which one of the following is the most likely diagnosis?
정답：C
설명：
Comprehensive and Detailed Explanation:
Osgood-Schlatter disease is a traction apophysitis of the tibial tubercle due to repetitive stress from the quadriceps during growth. It is common in active adolescents and presents with a tender, prominent tibial tuberosity and typical radiographic findings.
Toronto Notes 2023 - Pediatrics / MSK:
"Osgood-Schlatter disease presents with localized pain at the tibial tuberosity in adolescents involved in sports. X-ray may show ossicle or fragmentation." MCCQE1 Objectives (Pediatrics > 78-2: MSK Injuries and Overuse):
"Candidates must identify overuse syndromes like Osgood-Schlatter and distinguish from infections or malignancy." Osteomyelitis (A) is systemic. Osteosarcoma (B) causes deep pain, often at night. Chondromalacia (C) affects anterior knee and worsens with stairs. Patellar tendinitis (D) affects the inferior pole of patella, not tibial tubercle.
질문 # 126
A 70-year-old woman had a total abdominal hysterectomy with bilateral salpingo-oophorectomy 2 days ago.
On examination today, her vital signs are as follows: She has been immobile since her operation. She is fatigued but is tolerating a full diet. Which one of the following is the most likely cause of this patient's fever?
정답：C
설명：
Postoperative fever on day 1-2 is commonly caused by atelectasis, particularly in patients who are immobile.
It is considered a self-limited cause of early fever after surgery and often resolves with mobilization and pulmonary exercises.
Toronto Notes 2023 - Surgery, Postoperative Complications:
"The '5 W's' of postoperative fever: Wind (atelectasis), Water (UTI), Wound (infection), Walking (DVT), and Wonder drugs. Atelectasis typically occurs in the first 48 hours and is due to hypoventilation or pain- limited breathing." MCCQE1 Objectives - Surgery > Postoperative Management:
"Candidates must recognize timing-specific causes of postoperative fever. Atelectasis is the most likely cause within the first 48 hours." PE (B) can cause fever but is less likely without respiratory compromise. Wound infection (C) and bowel trauma (D) typically present later or with more specific symptoms. Septic pelvic thrombophlebitis (A) usually presents later and with more systemic signs.
질문 # 127
A 47-year-old man has been training for a marathon. After a long run, he develops mild pain and swelling in his left knee. Examination shows a mild joint effusion and a soft tissue mass in the popliteal fossa. The knee radiograph is normal. Which one of the following is the best method of confirming the diagnosis?
정답：A
설명：
This patient's presentation-knee effusion with a soft tissue mass in the popliteal fossa following exertion-is classic for a Baker (popliteal) cyst , which represents distention of the gastrocnemius-semimembranosus bursa, often associated with intra-articular pathology (e.g., meniscal injury or osteoarthritis). MCCQE objectives emphasize selecting the least invasive, most appropriate imaging modality to confirm suspected cystic lesions.
Ultrasound is the best initial diagnostic test because it is noninvasive, readily available, and highly sensitive for distinguishing a cystic structure from a solid mass or vascular pathology (e.g., popliteal artery aneurysm or deep vein thrombosis). It can also assess for complications such as cyst rupture.
Arthroscopy is invasive and not required for diagnosis. Arthrocentesis evaluates joint effusion but does not confirm a popliteal cyst. Aspiration of the mass without imaging is inappropriate due to risk of vascular injury. CT is unnecessary and exposes the patient to radiation.
Therefore, ultrasound is the preferred method to confirm a Baker cyst.
질문 # 128
A couple is diagnosed with primary infertility secondary to azoospermia. They are not interested in in vitro fertilization techniques, so you recommend insemination with a sperm donor. The male partner is hesitant. He thinks he might have difficulty accepting raising a child who is not biologically his. Which one of the following is the best next step?
정답：D
설명：
When couples face infertility-related decisions-particularly involving donor insemination-psychosocial counseling is essential. A mental health consultation helps explore emotional concerns, expectations, and readiness for non-biological parenting.
Toronto Notes 2023 - Gynecology, "Infertility and ART":
"Psychological counseling is recommended for couples considering donor gametes to address emotional, ethical, and identity issues before proceeding." MCCQE1 Objectives (ELOM > Reproductive Ethics > 83-1):
"Candidates must understand the ethical and psychosocial considerations of assisted reproductive techniques and provide appropriate referrals." Suggesting adoption or switching care dismisses valid concerns (B, C). Ovulation induction (D) does not address azoospermia.
질문 # 129
A 79-year-old woman is brought by a long-term care (LTC) facility staff member to your clinic with concerning behaviours. On history, she was admitted to an LTC facility 6 months ago with vascular dementia.
Three days ago, she became very aggressive towards her caregivers. There is no clear pattern to her aggression. Some staff members report that she is quieter than usual, whereas others report that she is agitated, talks to herself, and picks at her clothes. On examination, she appears very confused. She does not finish her answers and seems to "drift off" during conversation. Which one of the following is the most likely diagnosis?
정답：E
설명：
Delirium is the most likely diagnosis because the change is acute (3 days) with fluctuating level of activity (quiet at times, agitated at others) and prominent inattention (does not finish answers, "drifts off" during conversation). MCCQE objectives emphasize distinguishing delirium from dementia: dementia is typically chronic and progressive , whereas delirium is a sudden, reversible syndrome characterized by disturbed attention and awareness, often with altered sleep-wake cycle, perceptual disturbances, and psychomotor changes (hyperactive, hypoactive, or mixed). This patient's new aggression, confusion, and variable behavior strongly suggest delirium superimposed on existing vascular dementia-a common and high-risk scenario in LTC residents. Major depressive disorder can cause apathy and reduced concentration but does not typically cause a fluctuating course with acute confusion. Lewy body dementia is associated with chronic cognitive fluctuations and visual hallucinations/parkinsonism, not a sudden 3-day deterioration. Late-onset delusional disorder would feature fixed delusions with otherwise clearer consciousness. The next clinical priority is to search for and treat underlying causes (infection, medications, metabolic disturbance, pain, dehydration) while ensuring safety and supportive care.
질문 # 130
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