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Medical Council of Canada MCCQE - MCCQE Part 1 Exam

Page: 3 / 7
Total 230 questions

A 51-year-old man comes to your clinic for follow-up regarding his type 1 diabetes. His hemoglobin A1c is 12.5% (normal 4–6%). He has never had such high blood sugar results. He drinks 2 beers per night to help with sleep. He is not well rested because he has been sleeping on a friend’s couch since losing his job last year. Which one of the following is the best next step?

A.

Ensure that he has the finances to adequately monitor his diabetes.

B.

Prescribe an antidepressant to improve his energy and motivation.

C.

Send him for thyroid function testing.

D.

Ask him to create a food journal and refer him to a dietitian.

A 29-year-old concert pianist with severe chronic kidney disease presents with a 6-month history of loss of appetite and pruritus. Although the issue of initiating dialysis has been discussed with him and his questions answered, he has declined dialysis thus far. You understand his concerns that it will interfere with his concert tour and recording schedule. Which one of the following is the best next step?

A.

Offer to arrange for him to meet patients in the peritoneal dialysis clinic.

B.

Warn him of the consequences of refusing dialysis.

C.

Explain to him you will see him again when he decides to start dialysis.

D.

Provide him access to his medical records and full chart.

E.

Explore employment alternatives that would better accommodate the dialysis schedule.

A 45-year-old man presents to your family practice for follow-up because he has had repeated transient ischemic attacks and had been advised not to drive. During the interview, you find out that he is still driving. He explains that he only drives to the grocery store and his wife, who also has a driver's license, is always a passenger with him. He insists he can drive. You think that he should no longer be driving a car. Which one of the following is the best next step?

A.

Communicate your concerns to the motor vehicle licensing authority.

B.

Discuss this further with him.

C.

Physically take away his license.

D.

Refuse to treat him further unless he stops driving.

E.

Consult a neurologist to assess whether the patient is fit to drive.

You are counselling a couple that is concerned about the risk that their second child could be affected by the same X-linked recessive disorder (hemophilia A) as their last child, a boy. Neither parent has this disorder. What is the probability that their second child will be affected?

A.

25% if the child is a girl

B.

25% if the child is a boy

C.

50% if the child is a girl

D.

50% if the child is a boy

E.

100% whether the child is a boy or a girl

A 60-year-old man has a strong family history of aortic aneurysms. Screening abdominal ultrasonography reveals an incidental <1 cm mass in his left kidney. Computed tomography confirms that the mass is consistent with renal adenocarcinoma. Which one of the following is the most appropriate step in management?

A.

Arrange magnetic resonance imaging of the abdomen

B.

Refer to radiation oncology

C.

Plan partial nephrectomy

D.

Repeat computed tomography in 6 months

E.

Organize angiographic ablation of the renal mass

A 29-year-old man comes to the office for an initial visit. He is being treated for schizophrenia and epilepsy. He has a 20 pack-year history of smoking. His medications are carbamazepine, clozapine, and quetiapine. In the past year, he has gained a considerable amount of weight. Asidefrom a BMI of 32, the results of his physical examination are unremarkable. Which one of the following conditions should he be investigated for?

A.

Chronic obstructive pulmonary disease

B.

Cushing disease

C.

Sleep apnea

D.

Type 2 diabetes

E.

Acromegaly

A 71-year-old man with stable chronic low back pain on hydromorphone (8 mg twice daily) presents upset, requesting an early refill. He reports his granddaughter has been stealing his medication and pressuring him for refills. Which one of the following is the best next step?

A.

Call the police and report the patient’s granddaughter.

B.

Provide an early refill of hydromorphone.

C.

Begin tapering the hydromorphone.

D.

Increase the dispensed quantity of the patient’s hydromorphone.

E.

Arrange for daily dispensing of hydromorphone.

A 70-year-old woman consults you for progressive vision problems. She describes seeing haloes at night around street lights and having double vision. Her near vision has improved. Which one of the following is an ophthalmologic examination most likely to uncover?

A.

Arcus senilis.

B.

Kayser-Fleischer ring.

C.

Altered red reflex.

D.

Retinal exudates.

E.

Increased intra-ocular pressure.

A 59-year-old woman is referred to you because of a 2-month history of left nipple discharge. She is otherwise healthy and is not on any medication. There are no palpable lesions on breast examination. She is able to express a small amount of blood-tinged liquid from her breast. Which one of the following would be the best next step?

A.

Biopsy of nipple complex.

B.

Mammography.

C.

Serum prolactin.

D.

Galactography.

E.

Magnetic resonance imaging of breast.

A 62-year-old man (wealthy philanthropist) with emphysema from smoking and a 21-year-old woman (elementary teacher) with cystic fibrosis are both compatible matches for a lung transplant. Which criterion determines organ allocation?

A.

The patient’s value and contributions to society.

B.

The patient has family members who rely on them for income.

C.

Whether the underlying condition is due to self-induced illness.

D.

The clinical severity of the patient’s pulmonary disease.

E.

The date the patient was placed on the waiting list.