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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q241-Q246):

NEW QUESTION # 241
A 56-year-old woman is admitted to hospital with gastrointestinal bleeding. Her hemoglobin level is low and the physician who saw her in the Emergency Department has recommended a blood transfusion. You attend her on the unit and tell her that a blood transfusion will help her feel better. Which one of the following is the best next step?

Answer: C

Explanation:
The best next step is to ensure valid informed consent by discussing the risks, benefits, alternatives, and consequences of refusal of a blood transfusion. According to MCCQE objectives, informed consent requires that the patient be capable, receive sufficient relevant information, understand the information provided, and voluntarily agree to the intervention. Simply informing the patient that a transfusion will help her feel better is inadequate and does not meet the standard for informed decision-making.
Administering the transfusion without this discussion violates patient autonomy unless there is an immediate life-threatening emergency and the patient lacks capacity. Asking a colleague to repeat the recommendation does not fulfill the obligation. Withholding treatment for liability reasons is inappropriate. Prior consent documented in the chart does not replace consent for the current clinical situation.
Therefore, a thorough discussion of indications, expected benefits (improved oxygen delivery, symptom relief), potential risks (transfusion reactions, infection, fluid overload), and alternatives is ethically and legally required before proceeding.


NEW QUESTION # 242
A 70-year-old hypertensive woman with a history of congestive heart failure (CHF) secondary to left ventricular dysfunction presents to your office with a persistent dry hacking cough. She claims it began when she was started on ramipril. Which one of the following medications would be most appropriate to replace ramipril, to ensure that the risk of morbidity associated with CHF remains low?

Answer: E

Explanation:
ACE inhibitors such as ramipril are first-line for CHF with reduced ejection fraction, but a common adverse effect is a dry cough due to bradykinin accumulation. Angiotensin II receptor blockers (ARBs) offer the same hemodynamic and survival benefits without causing cough.
Toronto Notes 2023 - Cardiology, "Heart Failure" Section:
"In patients intolerant to ACE inhibitors due to cough, an ARB (e.g., losartan, valsartan) is the recommended substitute. ARBs also reduce mortality and hospitalizations in heart failure with reduced ejection fraction." MCCQE1 Objectives (Internal Medicine > 76-3: Congestive Heart Failure):
"Candidates should recognize ARBs as an alternative to ACE inhibitors in patients who develop adverse effects such as cough, while maintaining the mortality benefit." Other options (B-E) do not offer mortality benefits in CHF and may worsen the condition (e.g., CCBs, alpha- blockers, NSAIDs like COX-2 inhibitors).


NEW QUESTION # 243
A 37-year-old woman diagnosed with schizophrenia comes to her family physician because she has been choking on her food lately. She has a history of mild spasmodic dysphonia. She was recently started on haloperidol for auditory hallucinations. Which one of the following is the best short-term management?

Answer: D

Explanation:
Comprehensive and Detailed Explanation:
This patient is likely experiencing extrapyramidal symptoms (dysphagia/dystonia) due to haloperidol.
Switching to an atypical antipsychotic (like quetiapine), which has a lower risk of EPS, is appropriate.
Dysphagia in the context of antipsychotic use requires prompt medication review.
Toronto Notes 2023 - Psychiatry, "Antipsychotics and Extrapyramidal Effects":
"Dysphagia can be a sign of extrapyramidal side effects. Consider switching to an atypical antipsychotic with lower EPS risk." MCCQE1 Objectives (Psychiatry > 71-5: Antipsychotic Adverse Effects):
"Candidates must recognize and manage EPS, including drug-induced dysphagia." Dantrolene (C) is for neuroleptic malignant syndrome, not isolated dysphagia. Laryngoscopy (B) may be useful later but not first-line. Reassurance (D) is unsafe. Lorazepam (E) may help in dystonia but doesn't address the root cause.


NEW QUESTION # 244
An 80-year-old woman presents to the Emergency Department with dizziness. She has a medical history of coronary artery disease. On examination, she is alert and oriented. Her vital signs are as follows:
Her electrocardiogram is shown in the image.
Which one of the following is the most likely diagnosis?
Blood pressure
80/60 mm Hg
Heart rate
40/min
Respiratory rate
12/min
Her electrocardiogram is shown in the attached image. Which one of the following is the most likely diagnosis?

Answer: C

Explanation:
Comprehensive and Detailed Explanation:
The ECG reveals:
Regular P waves that are not consistently followed by QRS complexes
A dissociation between the atrial (P wave) and ventricular (QRS complex) activity A slow ventricular rate (~40 bpm) independent of atrial rate These findings are characteristic of a third-degree (complete) atrioventricular (AV) block, where there is no conduction of atrial impulses to the ventricles. The atria and ventricles beat independently, and the ventricular rate is maintained by an escape rhythm, often junctional or ventricular in origin.
This correlates with the patient's symptoms (dizziness, hypotension) and bradycardia, suggesting inadequate cardiac output due to AV dissociation.
Toronto Notes 2023 - Cardiology:
"Third-degree AV block shows complete AV dissociation with independent atrial and ventricular activity. It typically presents with bradycardia and hypotension. Urgent pacing may be required." MCCQE1 Objectives (Cardiology > 34-2: Bradyarrhythmias and Conduction Disorders):
"Candidates must identify complete heart block and recognize its clinical urgency." Ruling out other options:
A). Sinus bradycardia would show regular P waves with 1:1 P-QRS conduction.
B). First-degree AV block has prolonged PR intervals ( > 200 ms) but all P waves are conducted.
D). Junctional escape rhythm may present with bradycardia, but P waves would be absent, inverted, or occur after QRS complexes.
E). Mobitz type I (Wenckebach) has progressively lengthening PR intervals before a dropped QRS.


NEW QUESTION # 245
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?

Answer: C

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 # 246
......

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