MCCQE : MCCQE Part 1 Exam

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Medical Council of Canada MCCQE Part 1 認定 MCCQE 試験問題:

1. 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) Ruptured duodenum
C) Appendicitis
D) Pyelonephritis
E) Pneumonia

2. A 26-year-old man presents to the office with a tender mass in his right neck. He was recently treated for a dental infection but is otherwise well. On examination, there is a 2-cm tender, mobile lymph node in the right anterior cervical chain. No other lymphadenopathy or abnormalities are found on physical examination.
Which one of the following is the best next step?

A) Follow-up in 8 weeks
B) Computed tomography of the neck
C) Lymph node biopsy
D) Bone marrow biopsy
E) Ultrasonography of the spleen

3. A 68-year-old man with a history of diabetes, hypertension, delirium tremens, and tobacco addiction comes to the Emergency Department with his daughter. She tells you that his behavior has become unmanageable and she feels he may require an increased level of care. His vital signs are:
Blood pressure: 162/105 mm Hg
Heart rate: 112/min, regular
Temperature: 37.8°C
On history, his daughter explains she had to confiscate a half-empty bottle of alcohol from his room yesterday. He is now convinced that there are bugs crawling all over him and he will not relax. He appears pale, sweaty, and shaky. His most recent blood glucose is 7.8 mmol/L (3.8-11.1). Which one of the following is the best next step?

A) Interview the patient in private to ensure this is not a case of elder abuse.
B) Provide the family member with a prescription of antipsychotics for the patient.
C) Administer benzodiazepines and intravenous hydration.
D) Consult a Geriatric Psychiatrist to assess the patient.

4. An 84-year-old woman is brought by ambulance to the emergency department after she was found by a neighbour. She had fallen, sustained a hip fracture, and was unable to move for the past 2 days. After starting rehydration, she reports hip pain and numbness and tingling in both her legs. Physical examination reveals faint pulses in both legs and severely swollen lower legs that are painful to palpation. The urine in the Foley catheter bag seems to be darker than normal. Which one of the following is the best next step?

A) Compartment pressure measurements of the lower legs.
B) Bilateral Doppler ultrasonography of the legs.
C) Bilateral angiography of the lower legs.
D) Surgical fixation of the patient ' s hip fracture.
E) Myoglobin urine test.

5. A 27-year-old man with a bowel obstruction secondary to a terminal ileum stricture has been on various medications since he was diagnosed with Crohn disease 8 years ago. You recommend a bowel resection, but he refuses this option because he is fearful of short bowel syndrome. He states that the only surgical procedure he will undergo is a bypass of the diseased segment so that the affected bowel will heal. You know that this is the wrong operation. Which one of the following is the best next step?

A) Administer a high dose of intravenous steroids for trial.
B) Obtain a formal competency assessment.
C) Decline to do the bypass but carefully explain why.
D) Get consent for exploratory laparotomy and do a resection.
E) Transfer care to a colleague that you know is receptive to the patient's request.

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