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| Section | Objectives |
|---|---|
| Physician Roles (CanMEDS Framework) | - Scholar
|
MCCQE学習ガイドの高品質と高効率は、同じ業界の製品で際立っています。私たちの教材は常にユーザーのために考慮されています。 MCCQE試験問題を選択すると、より良い自己になります。 MCCQE実際の試験では、輝かしい未来に貢献したいと考えています。私たちの教材は常に改善されています。良いアイデアがあれば、私たちの教材は喜んで受け入れます。 MCCQE試験資料は、このファミリーに参加するパートナーを増やすことを楽しみにしています。私たちは一緒に進歩し、より良くなります。
質問 # 286
A 16-year-old girl presents to the clinic with concerns about her toenails. The lesions, as shown in the attached image, have been present for 2 to 3 months. She is otherwise healthy and is in training for a triathlon.
Which one of the following is the best next step?
正解：E
解説：
In a healthy adolescent training for a triathlon, the most likely cause of subacute toenail changes is repetitive microtrauma from running-often due to shoes with inadequate toe box space or downhill running-leading to nail plate injury (e.g., subungual hemorrhage/onycholysis and dystrophic discoloration). MCCQE objectives emphasize choosing the most probable diagnosis based on context and initiating the least invasive, most appropriate first-line management. The key intervention is correcting the mechanical cause: ensuring adequate toe space, proper shoe fit, and appropriate nail trimming, which typically prevents progression and allows gradual regrowth over months.
Topical antifungal creams are unlikely to help if the primary issue is trauma and, even in onychomycosis, topical creams generally do not penetrate the nail plate effectively. Hygiene advice and avoiding pools/hot tubs may reduce superficial fungal exposure but does not address the principal driver in this scenario. Biopsy is unnecessary for typical trauma-related nail changes in a low-risk patient without concerning features (rapid growth, pigment extending onto adjacent skin, or mass).
質問 # 287
A 54-year-old woman presents to your office to discuss breast cancer screening. She is asymptomatic with no history of breast cancer. She had a fibroadenoma removed when she was 24 years old. The patient is not on any medications. Her family history is significant for a great-aunt with breast cancer. The patient has not had genetic testing but had normal breast screening 2 years ago. Which one of the following is the best next step?
正解：B
解説：
According to Canadian guidelines, women aged 50 to 74 at average risk for breast cancer should undergo routine screening mammography every 2 to 3 years. A great-aunt with breast cancer does not raise this patient
' s risk to high. Mammography is appropriate as she is now due for the next screen.
Toronto Notes 2023 - Population Health, "Screening Guidelines" Section:
"Routine mammography is recommended every 2 years for average-risk women aged 50 to 74. Family history in second-degree or more distant relatives (e.g., great-aunt) does not qualify for high-risk screening or MRI." MCCQE1 Objectives (Population Health > 97-5: Screening and Prevention):
"Candidates should apply Canadian screening recommendations including mammography for average-risk women #50 years old." Self-breast exams (C) are not recommended for screening. PET scan (D) and MRI (E) are reserved for high- risk populations or diagnostic clarification.
質問 # 288
A 19-year-old woman presents to the office. She is a new mother. She shares that she does not intend to vaccinate her son. Which one of the following is the best next step?
正解：A
解説：
When encountering vaccine hesitancy, the first and most effective step is to open a non-judgmental conversation and explore the patient's reasons. This helps build trust and tailor subsequent education and counseling.
Toronto Notes 2023 - Public Health and Preventive Medicine, Immunization:
"Addressing vaccine hesitancy requires understanding parental concerns. Begin with open-ended questions to identify underlying beliefs and information gaps." MCCQE1 Objectives - Preventive Medicine > Immunization:
"Candidates must demonstrate effective communication with vaccine-hesitant parents, beginning with eliciting their rationale before providing evidence-based recommendations." Jumping to education (B) or punitive measures (C, D) may close communication. The patient is an adult; speaking with her parents (E) violates her autonomy.
質問 # 289
A 56-year-old woman presents to your office with a 9-month history of intolerable sweating, palpitations, and periodic anxiety. Her last period was 12 months ago. She continues to have regular Papanicolaou testing with no worrisome pathology. She is otherwise healthy. Which one of the following is the most effective treatment for these symptoms?
正解：E
解説：
In postmenopausal women with severe vasomotor symptoms, hormone therapy (estrogen with progesterone in women with an intact uterus) is the most effective treatment. It improves hot flashes, sleep, and mood symptoms.
Toronto Notes 2023 - Gynecology, Menopause Management:
"Combination hormone therapy is first-line for moderate to severe menopausal symptoms. Non-hormonal agents may be considered if contraindications exist." MCCQE1 Objectives - Gynecology > Menopause:
"Candidates must recognize the indication and benefits of hormone therapy for vasomotor symptoms in appropriate patients." Lifestyle changes (A) are supportive but insufficient. Primrose oil (C) lacks robust evidence. SSRIs (D) and clonidine (E) are second-line.
質問 # 290
A 71-year-old man is brought to the Emergency Department with sudden onset of shortness of breath and chest pain. He was discharged from hospital 1 week ago after a total hip arthroplasty. On examination, his respiratory rate is 32/min. There is visible respiratory distress, and chest auscultation is clear. Which one of the following is the most likely diagnosis?
正解：C
解説：
Sudden onset dyspnea and pleuritic chest pain in a postoperative patient with tachypnea and clear lung fields are classic features of a pulmonary embolism (PE). Recent orthopedic surgery significantly increases VTE risk. Clear lungs on auscultation support this over pneumonia or CHF.
Toronto Notes 2023 - Respiratory, "Pulmonary Embolism":
"Presentation includes sudden dyspnea, pleuritic chest pain, and tachypnea. Risk factors include recent surgery and immobilization. Examination often reveals clear chest auscultation." MCCQE1 Objectives (Internal Medicine > Cardiopulmonary > 44-1):
"Candidates must recognize PE in patients with risk factors (e.g., surgery) and classic features and initiate appropriate diagnosis and management." Fat embolism (B) usually presents with petechiae, neurologic symptoms, and occurs within 24-72 hours post- op. Cholesterol emboli (E) are more chronic and systemic.
質問 # 291
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