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Pass Guaranteed Quiz Medical Council of Canada MCCQE - MCCQE Part 1 Exam Valid Test Testking
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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q69-Q74):
NEW QUESTION # 69
A 25-year-old woman presents to the Emergency Department with a 4-hour history of severe left flank pain.
Her vital signs are as follows:
* Heart rate: 94/min
* Blood pressure: 130/80 mm Hg
* Temperature: 37.3 °C
A non-contrast computed tomography shows a 6 mm stone in the distal left ureter with mild associated hydronephrosis. In addition to appropriate analgesia, which one of the following is the best next step?
- A. Provide reassurance
- B. Prescribe antibiotics
- C. Administer an alpha blocker
- D. Increase intravenous fluids
- E. Refer for urology consultation
Answer: C
Explanation:
Alpha blockers such as tamsulosin can facilitate the passage of ureteral stones, especially those between 5-10 mm. This is part of medical expulsive therapy.
Toronto Notes 2023 - Urology, Nephrolithiasis:
"Alpha blockers help relax the ureteral smooth muscle and improve stone passage in symptomatic distal ureteral stones." MCCQE1 Objectives - Surgery > Urologic Emergencies:
"Candidates should initiate medical expulsive therapy for ureteral stones under 10 mm with alpha blockers." Reassurance alone (A) is inadequate. Antibiotics (B) are not indicated without infection. IV fluids (E) do not significantly aid stone passage. Urology consult (D) is not needed unless there's infection, intractable pain, or obstruction.
NEW QUESTION # 70
You are called to the Emergency Department to see a 6-month-old boy with a 3-day history of fever. Physical examination reveals an irritable infant with a temperature of 38.1°C. His vital signs are:
Blood pressure: 87/50 mm Hg
Respiratory rate: 80/min
Heart rate: 140/min
Oxygen saturation: 92% on room air
The infant has no skin findings. On chest examination, you hear coarse crackles on the right side of the chest.
Which one of the following is the best next step in the management of this child?
- A. Intravenous antibiotics.
- B. Reassurance.
- C. Oral steroids.
- D. Intravenous fluids.
- E. Oral antibiotics.
Answer: A
Explanation:
This 6-month-old presents with signs of systemic illness, tachypnea, hypoxia, and focal lung findings. In this age group, pneumonia can rapidly progress, and given the severity of symptoms, oral treatment is insufficient.
Intravenous antibiotics are urgently indicated.
Toronto Notes 2023 - Pediatrics, Respiratory Infections in Infants:
"Infants under 6 months with signs of systemic illness, hypoxia (SpO2 < 94%), and respiratory distress should receive IV antibiotics. Delayed treatment may result in rapid clinical deterioration." MCCQE1 Objectives - Pediatrics > Respiratory Conditions:
"Candidates must recognize signs of serious lower respiratory tract infection in infants and initiate prompt IV antibiotic therapy when criteria for hospitalization are met." Oral antibiotics (C) are appropriate for mild outpatient pneumonia. Reassurance (B) and oral steroids (A) are inappropriate. IV fluids (D) may be supportive but do not address the infectious cause.
NEW QUESTION # 71
A 25-year-old man presents to the Emergency Department with diffuse abdominal pain and anorexia. He was tackled in a football game yesterday. He reports a 3-week history of sore throat and fatigue. Vital signs are as follows:
Blood pressure: 95/45 mm Hg
Heart rate: 96/min
Temperature: 37.6°C
Which one of the following is the most likely diagnosis?
- A. Ruptured spleen
- B. Pneumonia
- C. Appendicitis
- D. Pyelonephritis
- E. Ruptured duodenum
Answer: A
Explanation:
This patient presents with hypotension, diffuse abdominal pain, and a history of contact sports injury with preceding symptoms of infectious mononucleosis (sore throat, fatigue). The spleen is commonly enlarged in mononucleosis, making it vulnerable to rupture after even minor trauma.
Toronto Notes 2023 - General Surgery and Infectious Diseases Sections:
"Splenic rupture is a known complication of mononucleosis, particularly after trauma. Symptoms may include diffuse abdominal pain, hypotension, and signs of hemorrhagic shock." MCCQE1 Objectives (Surgery > 84-1: Abdominal Trauma):
"Candidates should identify splenic rupture as a cause of hypotension and abdominal pain following blunt abdominal trauma, especially in patients with splenomegaly." Appendicitis (B) would present with localized right lower quadrant pain. Pneumonia (C) and pyelonephritis (D) would present with respiratory or urinary symptoms. Ruptured duodenum (E) is much less likely without specific trauma to that region or signs of peritonitis.
NEW QUESTION # 72
A 28-year-old woman presents to the office in great distress because she has no money for groceries or rent.
She is a single mother of a 7-year-old girl. She has a history of gambling disorder. She has felt unable to cope for the last 3 months and has started gambling again. Today, she is crying, and she shares that her boyfriend became violent with her yesterday. Which one of the following is the highest priority for assessment?
- A. Evaluate for depression.
- B. Define the extent of the patient's gambling disorder.
- C. Investigate the patient's need for financial assistance.
- D. Screen for recreational drug and alcohol use.
- E. Determine the risk of violence to the patient and her child.
Answer: E
Explanation:
The highest priority is the immediate safety of the patient and her child. In the presence of domestic violence, risk assessment for harm or neglect must be conducted urgently, particularly since a child may be at risk.
Safety trumps psychiatric or social evaluations in triage.
Toronto Notes 2023 - Psychiatry, "Crisis and Risk Assessment" Section:
"When intimate partner violence (IPV) is disclosed, it is critical to assess immediate safety and consider mandatory reporting, especially when children are involved." MCCQE1 Objectives (Psychiatry > 79-6: Violence and Abuse):
"Candidates must assess for and respond to risk of harm in situations of domestic violence, especially when dependents are involved. This includes ensuring immediate safety and following legal obligations for child protection." Although the other concerns (e.g., gambling, depression, substance use, financial need) are valid, the presence of violence makes D the first and most urgent priority.
NEW QUESTION # 73
A 38-year-old marathon runner presents to your office with a 6-month history of increasing right hip pain.
The pain is worse with acclivity and has prevented him from running for the last 4 months. He denies fever or chills. His wife adds that she is concerned because he is increasingly disengaged with the family and not interested in other activities he usually enjoys, including sex. Which one of the following is the best next step in management?
- A. Further inquiry into depressive symptoms.
- B. Short course of anti-inflammatory medications.
- C. Physiotherapy for hip strengthening.
- D. Blood work including inflammatory markers.
- E. Magnetic resonance imaging of the pelvis and right hip.
Answer: A
Explanation:
In a patient presenting with physical symptoms (e.g., hip pain) and prominent psychosocial red flags - loss of interest, decreased libido, and withdrawal - the next step is to screen for depression. Somatization is common in mood disorders.
Toronto Notes 2023 - Psychiatry, Depression:
"Patients with depression may present with somatic complaints. A thorough psychosocial assessment is essential in such cases, particularly when symptoms interfere with functioning." MCCQE1 Objectives - Psychiatry > Mood Disorders:
"Candidates must consider depression in patients with non-specific physical symptoms and reduced interest or motivation, particularly with social withdrawal." Imaging or physiotherapy may be needed later, but the most urgent and informative step is psychiatric screening.
NEW QUESTION # 74
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