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Ted Long Ted Long

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MCCQE Fragen&Antworten & MCCQE Musterprüfungsfragen

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Medical Council of Canada MCCQE Musterprüfungsfragen & MCCQE Prüfungsfrage

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Medical Council of Canada MCCQE Part 1 Exam MCCQE Prüfungsfragen mit Lösungen (Q136-Q141):

136. Frage
A 37-year-old man comes to the office for follow-up of his opioid use disorder. He receives opioid agonist treatment, including some take-home doses. At this follow-up visit, he reports some nonprescription opioid use since his last visit. Which one of the following is the best next step?

A. Taper the dosage of the opioid agonist
B. Increase the frequency of follow-up visits
C. Discontinue take-home doses
D. Prescribe a cannabinoid
E. Slowly taper and discontinue the opioid agonist

Antwort: B

Begründung:
Nonprescription opioid use during opioid agonist therapy is not uncommon. The response shouldbe supportive and not punitive. Increasing the frequency of follow-up enhances monitoring, supports adherence, and prevents relapse.
Toronto Notes 2023 - Psychiatry, "Substance Use Disorders":
"Patients who relapse during opioid agonist treatment benefit from closer monitoring and increased support, including more frequent follow-up and psychosocial interventions." MCCQE1 Objectives (Psychiatry > 71-5: Substance Use and Addiction):
"Candidates must manage relapses in opioid use by optimizing follow-up and support, not by discontinuing or reducing therapy prematurely." Tapering or discontinuing therapy (A, E) risks destabilizing treatment. Removing take-home doses (B) may be warranted later but not first. Cannabinoids (D) are not first-line adjuncts.

137. Frage
A 15-year-old boy is brought to your office because of concerns about his breast development. He has no other symptoms. His physical examination does not reveal any other abnormality. Which one of the following is the best next step?

A. Reassure the patient
B. Perform serum estrogen level
C. Order adrenal ultrasound
D. Perform serum prolactin level
E. Order cranial magnetic resonance imaging

Antwort: A

Begründung:
Comprehensive and Detailed Explanation:
The image and clinical history are consistent with physiologic pubertal gynecomastia, which is common in adolescent boys. It usually resolves spontaneously within 6 months to 2 years and does not require investigation unless other signs of endocrine pathology are present.
Toronto Notes 2023 - Pediatrics / Endocrinology:
"Pubertal gynecomastia is benign, self-limited, and common in adolescent males. No further investigation is needed in the absence of systemic signs." MCCQE1 Objectives (Pediatrics > 77-2: Endocrine Disorders):
"Candidates must differentiate physiologic gynecomastia from pathologic causes based on history and physical exam." Other tests (A-C, E) are unnecessary unless there are red flags (e.g., testicular mass, rapid progression, neurological symptoms).
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138. Frage
A 32-year-old woman presents to your outpatient clinic with concerns regarding a 6-month history of both a pulsatile buzzing sound in her ears and headaches. There is no history of hearing loss, vertigo, ear pain, or discharge from the ears. There is a long-standing history of prolonged exposure to occupational noise. She has a BMI of 32. Otoscopic examination is unremarkable, and there are no neck masses present. You determine that the buzzing sound is synchronous with her radial pulse. Which of the following investigations should be ordered next?

A. Audiogram
B. Electroencephalography
C. Magnetic resonance imaging of the brain
D. C-reactive protein

Antwort: C

Begründung:
Comprehensive and Detailed Explanation:
Pulsatile tinnitus synchronous with the pulse may be vascular in origin. The association with headaches and elevated BMI (a risk factor for idiopathic intracranial hypertension, IIH) warrants neuroimaging to assess for cerebral venous sinus thrombosis, vascular malformations, or raised intracranial pressure.
Toronto Notes 2023 - Neurology / ENT:
"Pulsatile tinnitus requires investigation for vascular causes including idiopathic intracranial hypertension.
MRI or MRV is the next step."
MCCQE1 Objectives (Neurology > 35-1: Headache and Tinnitus):
"Candidates must investigate pulsatile tinnitus with neuroimaging when vascular causes are suspected." Audiogram (A) is for hearing loss. EEG (C) is not useful for tinnitus. CRP (D) is irrelevant.

139. Frage
A 78-year-old man presents to the Emergency Department with chest pain. His electrocardiogram and blood work confirm an acute myocardial infarction. He is admitted to the Intensive Care Unit. Three days later, he develops right-sided abdominal pain. An ultrasonogram reveals an inflamed gallbladder with no evidence of stones. He does not improve after 48 hours of antibiotics. Which one of the following is the best next step?

A. Arrange for endoscopic retrograde cholangiopancreatography
B. Broaden antibiotic therapy
C. Send for hepatobiliary iminodiacetic acid (HIDA) scan
D. Send for laparoscopic cholecystectomy
E. Arrange for percutaneous cholecystostomy

Antwort: E

Begründung:
This presentation is consistent with acute acalculous cholecystitis, often seen in critically ill or post-MI patients. If unresponsive to antibiotics, percutaneous cholecystostomy is the preferred next step in those who are poor surgical candidates.
Toronto Notes 2023 - General Surgery, "Hepatobiliary Disorders" Section:
"Acalculous cholecystitis occurs in critically ill patients and is often managed with percutaneous cholecystostomy if the patient is not a candidate for surgery." MCCQE1 Objectives (Surgery > 84-3: Biliary Disease):
"Candidates must be able to diagnose and manage acalculous cholecystitis. Management includes antibiotics and drainage via percutaneous cholecystostomy in unstable patients." Laparoscopic cholecystectomy (C) is standard but not suitable in acutely ill ICU patients. Broadening antibiotics (A) alone is insufficient after failure of initial therapy. ERCP (B) is for biliary obstruction or cholangitis. HIDA scan (E) is diagnostic, not therapeutic.

140. Frage
A 1-week-old boy born at full term is brought by his parents to the office with a 2-day history of eye swelling and watery discharge. This morning, the discharge became thick and yellow. On physical exam, he is afebrile and fussy with bilateral eyelid edema, purulent discharge, and erythematous conjunctivae. After taking appropriate cultures of the eyes, which one of the following is the best next step?

A. Advise warm compresses every 2 to 3 hours until discharge is cleared
B. Prescribe an oral antibiotic and reassess in 48 hours
C. Admit the patient and start antibiotic therapy
D. Reassure the parents and prescribe a topical antibiotic
E. Recommend lacrimal sac massage

Antwort: C

141. Frage
......

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