MCCQE Part 1 MCCQE練習テストエンジン: 今すぐ試そう232試験問題
試験合格保証付きのMCCQE Part 1 MCCQE試験問題集
質問 # 79
A 66-year-old woman suffering from a progressive neurological disease is admitted to a long-term care centre. Her husband does not wish to participate in discussions about the seriousness of his wife's disease and is convinced that she will soon come back home. During his 2nd visit to the centre, he gives you a cheque for a substantial sum made out to you, the treating physician, for your own research. Which one of the following is the best response to your patient's husband?
- A. Accept the money as a contribution to the long-term care centre's fundraising campaign
- B. Refer the husband to the centre's social worker
- C. Suggest he donate to your medical group
- D. Decline to accept the cheque
- E. Inform him you would only be able to accept a smaller amount of money
正解：D
解説：
Comprehensive and Detailed Explanation:
Physicians must avoid conflicts of interest and maintain professional boundaries with patients and their families. Accepting a personal financial gift, regardless of intent, is inappropriate and unethical.
Toronto Notes 2023 - Ethics and Professionalism:
"Personal gifts of significant value from patients or families should be declined to avoid real or perceived conflicts of interest." MCCQE1 Objectives (ELOM > 90-3: Professionalism and Boundaries):
"Candidates must maintain ethical boundaries and refuse financial incentives that could compromise or appear to compromise clinical judgment." Other options (A, B, E) still involve a conflict. D is helpful, but the ethical obligation is to decline the cheque directly.
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質問 # 80
A 22-year-old woman is brought to the Emergency Department by her boyfriend, who says that she is experiencing a fentanyl overdose. She is unresponsive and cyanotic. She regains consciousness after naloxone is injected intravenously and demonstrates no further respiratory depression during 8 hours of observation.
She states that she is 22 weeks' pregnant and wants to stop using opioids. Which one of the following is the best next step?
- A. Refer the patient for opioid use disorder counselling
- B. Admit the patient for medically supervised detoxification
- C. Prescribe medications for symptom control so that the patient can detoxify at home
- D. Refer the patient for initiation of methadone
正解：D
解説：
For pregnant patients with opioid use disorder, opioid agonist therapy with methadone or buprenorphine is the standard of care. Detoxification is not recommended in pregnancy due to increased risk of fetal distress, preterm labor, and relapse. Methadone reduces illicit opioid use and stabilizes both mother and fetus.
Toronto Notes 2023 - Addiction Medicine / Obstetrics:
"Methadone maintenance therapy is the treatment of choice for pregnant patients with opioid use disorder.
Detoxification is not advised during pregnancy due to relapse risk and potential harm to the fetus." MCCQE1 Objectives (Obstetrics > 80-3: Substance Use in Pregnancy):
"Candidates must manage opioid use disorder in pregnancy with evidence-based therapies, including referral for methadone or buprenorphine." Counselling alone (D) is insufficient as first-line therapy. Home detox (C) is unsafe. Inpatient detox (A) is not recommended in pregnancy.
質問 # 81
A 2-month-old infant is brought by his parents to your clinic with concerns regarding his frequent crying spells. He has been crying for more than 3 hours daily for many weeks. The infant has reached all age-specific developmental milestones. Which one of the following is the most important to share with the parents regarding this situation?
- A. Resolution of the crying spells is expected between ages 6 and 12 months
- B. Most infants respond well to low-dose sedative medications
- C. Investigations are required to confirm a diagnosis
- D. This is a self-limited condition
- E. There is an increased risk for dependent personality traits in adulthood
正解：D
解説：
This infant likely has infantile colic, defined by the "rule of 3s": crying >3 hours per day, >3 days per week, for >3 weeks, usually starting in the first few months of life. It is benign and self-limited, typically resolving by 3-4 months of age.
Toronto Notes 2023 - Pediatrics, "Common Concerns in Infancy":
"Colic is self-limited. No routine testing is required in healthy, thriving infants. Reassurance and support for parents are key." MCCQE1 Objectives (Pediatrics > 78-1: Behavioral Pediatrics):
"Candidates must recognize normal variations such as colic and avoid unnecessary interventions. Counseling and reassurance are essential." Sedatives (D) are contraindicated. Investigations (C) are unnecessary without red flags. Resolution (B) usually occurs by 3-4 months, not as late as 12 months.
質問 # 82
A 60-year-old man presents to the office with concerns regarding a pruritic rash, which he has had for several years. He reports a "crawling" sensation on his skin. He is concerned that this rash may be caused by a parasite he may have picked up while serving in the military overseas. On examination, you note multiple crusted lesions on his forearms, neck, chest, scalp, and thighs. There is a complete sparing of the skin on his back. He brought a bottle with fibrous material of different colours that he picked from his wounds. He is otherwise healthy and reports no other symptoms except some chronic fatigue and insomnia related to the itching. Which one of the following treatments is the most appropriate?
- A. Permethrin
- B. Doxycycline
- C. Butenafine
- D. Ivermectin
- E. Fluconazole
正解：D
解説：
This case describes classic signs of delusional parasitosis (also known as Morgellons syndrome).However, the presence of widespread crusted lesions raises suspicion for crusted scabies, particularly in older adults.
Crusted scabies may be misinterpreted as chronic dermatitis or psychocutaneous disorder. The most effective treatment is oral ivermectin.
Toronto Notes 2023 - Dermatology:
"Crusted scabies presents as widespread hyperkeratotic plaques with crusting. First-line treatment is oral ivermectin, often with topical permethrin." MCCQE1 Objectives (Medicine > Dermatology > 23-1):
"Candidates must recognize presentations of ectoparasitic infections, including scabies, and provide appropriate treatment." Permethrin (B) is for typical scabies, but crusted scabies often requires systemic ivermectin due to severity and spread.
質問 # 83
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. Prescribe antibiotics
- B. Provide reassurance
- C. Administer an alpha blocker
- D. Refer for urology consultation
- E. Increase intravenous fluids
正解：C
解説：
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.
質問 # 84
A 55-year-old woman presents with a 6-month history of poor memory and impaired concentration. She has bipolar I disorder that has been treated with lithium carbonate for 4 years. She has gained a lot of weight since starting lithium. Physical examination findings are otherwise normal. She is concerned about her memory issues, but there are no other perception, mood, or cognition abnormalities. Which one of the following tests is most likely to have abnormal findings?
- A. Parathyroid hormone
- B. Serum thyrotropin (thyroid-stimulating hormone) level
- C. Serum sodium level
- D. Creatinine clearance
- E. Liver function tests
正解：B
解説：
Comprehensive and Detailed Explanation:
Lithium commonly causes hypothyroidism, which can lead to fatigue, cognitive slowing, weight gain, and memory impairment. Thyroid-stimulating hormone (TSH) levels are often elevated in such cases.
Toronto Notes 2023 - Psychiatry / Endocrinology:
"Lithium is associated with hypothyroidism and renal impairment. Monitor TSH regularly in patients on lithium therapy." MCCQE1 Objectives (Psychiatry > 71-5: Mood Stabilizers):
"Candidates must recognize the endocrine side effects of lithium, including hypothyroidism and the importance of TSH monitoring." Creatinine clearance (C) may also be affected but is less directly associated with memory issues. Liver function (A), sodium (D), and PTH (E) are not typically the first abnormal values in this presentation.
質問 # 85
You are the emergency physician on duty in a rural hospital when heavy rains in the community cause a large landslide. There are multiple casualties expected to arrive in the emergency department. Your colleague has heard about the incident and arrives to help. Which one of the following is the best next step?
- A. Send your colleague to the affected area to evaluate the health risks involved
- B. Ask your colleague to handle media inquiries
- C. Send your colleague to set up an emergency type O blood bank collecting unit
- D. Ask your colleague to help triage incoming patients in the emergency department
正解：D
解説：
Comprehensive and Detailed Explanation:
During mass casualty incidents, effective triage is essential to optimize care delivery. A trained physician is best used in triage or direct care. Triage is the foundation of disaster management.
Toronto Notes 2023 - Public Health / Disaster Medicine:
"In disaster response, trained healthcare providers should be deployed to triage and stabilize patients in emergency departments." MCCQE1 Objectives (Public Health > 65-1: Disaster Response):
"Candidates must understand principles of mass casualty management and assign appropriate roles during triage and care delivery." Media (D) and logistics (A, C) are secondary roles. Triage and direct care take priority.
質問 # 86
A 43-year-old man comes to your office for the first time. He has not seen a doctor in over 5 years and has no known past medical history. On examination, his blood pressure is 120/70 mm Hg, and the remainder of his examination is normal. As part of the initial visit, you order some screening blood work that reveals a fasting blood glucose of 6.3 mmol/L (3.3-5.8) and a hemoglobin A1c of 6.1% (4-6). Which one of the following is the best next step?
- A. Test capillary blood glucose 4 times a day.
- B. Order thyrotroph (thyroid-stimulating hormone) level.
- C. Order an exercise stress test.
- D. Perform a 75 g oral glucose tolerance test.
- E. Order a urine albumin:creatinine ratio.
正解：D
解説：
This patient's lab results suggest impaired fasting glucose and an elevated A1c just below the threshold for diabetes. The gold standard to confirm diabetes in such intermediate cases is the 75 g oral glucose tolerance test (OGTT).
Toronto Notes 2023 - Endocrinology, "Diabetes Mellitus" Section:
"If A1c is in the 6.0-6.4% range or fasting glucose 6.1-6.9 mmol/L, a 75 g OGTT is recommended to establish the diagnosis of diabetes or confirm impaired glucose tolerance." MCCQE1 Objectives (Internal Medicine > 76-4: Diabetes):
"Candidates must correctly apply diabetes screening and diagnostic criteria and follow up abnormal results with appropriate confirmatory testing." Urine ACR (C) is useful in diagnosed diabetes, not for initial screening. TSH (A), capillary glucose testing (B), and exercise testing (E) are not indicated at this stage.
質問 # 87
A 23-year-old woman with borderline personality disorder is brought to the Emergency Department having ingested non-lethal substances after her boyfriend broke up with her. The staff tells you that she has consulted
8 times under similar circumstances in the past 3 years. Which one of the following pieces of information would be useful to provide to the staff?
- A. Not much can be done with personality disorders
- B. She is overusing health care services
- C. She will never commit suicide
- D. Suicidal thoughts must be an indication of major depressive disorder
- E. Symptoms of borderline personality disorder will likely attenuate over time
正解：E
解説：
Comprehensive and Detailed Explanation:
While borderline personality disorder is challenging, symptoms (particularly impulsivity and suicidal behaviors) often attenuate with age and appropriate therapy (e.g., dialectical behavior therapy). Providing hope and clinical context to staff improves care and reduces stigma.
Toronto Notes 2023 - Psychiatry, "Personality Disorders":
"BPD is associated with emotional dysregulation and impulsivity. Long-term prognosis is better than once believed, with many patients showing symptom remission over time." MCCQE1 Objectives (Psychiatry > 71-4: Personality Disorders):
"Candidates must provide appropriate education to patients and staff regarding prognosis and treatment of BPD." Statements A-D are false, stigmatizing, or dangerous.
質問 # 88
A patient's mother comes to you with a prospective cohort study linking autism to the measles, mumps and rubella vaccine. After reviewing the study carefully, you question the results because of problems with the study design and execution. Which one of the following sources of error would be most important in the study design or execution?
- A. Vaccine company sponsorship of study
- B. Reporting standard error with point estimates of difference
- C. Parental recall of vaccine administration
- D. Recruitment of study families at an autism seminar
- E. Not accounting for all potential confounders during recruitment
正解：D
解説：
Recruiting participants from an autism seminar introduces selection bias. This non-random selection increases the likelihood of overestimating associations due to pre-existing beliefs or exposures in that subgroup.
Toronto Notes 2023 - Epidemiology:
"Selection bias occurs when participants are not representative of the general population, as in recruitment from disease-specific support groups." MCCQE1 Objectives (Population Health > 65-2: Study Design and Appraisal):
"Candidates must recognize sources of bias in epidemiologic studies, including selection bias due to non- representative recruitment." Recall bias (D) is more of a concern in retrospective studies. Sponsorship (B) may create perception bias but is not a flaw in methodology itself. Standard error reporting (A) is normal. Not accounting for confounders (E) matters but recruitment source is more directly biasing.
質問 # 89
You are seeing a 5-month-old infant who has had intermittent stridor since age 2 months. He is otherwise healthy. He has been drinking well and has been reaching all the age-specific developmental milestones.
Which one of the following is the most likely diagnosis?
- A. Laryngomalacia.
- B. Subglottic hemangioma.
- C. Tracheoesophageal fistula.
- D. Vascular ring.
- E. Aspiration of a foreign body.
正解：A
解説：
Laryngomalacia is the most common cause of chronic stridor in infants. It presents with inspiratory stridor that worsens with feeding, supine positioning, or agitation. The child remains otherwise well and meets developmental milestones.
Toronto Notes 2023 - Pediatrics, Airway Disorders:
"Laryngomalacia presents with intermittent inspiratory stridor, typically beginning in the first few months of life. Diagnosis is clinical and prognosis is usually good." MCCQE1 Objectives - Pediatrics > Respiratory Disorders:
"Candidates must recognize the typical presentation of laryngomalacia and differentiate it from other causes of pediatric stridor." Vascular ring (A) or subglottic hemangioma (C) often present with more severe or progressive symptoms.
Foreign body aspiration (D) presents acutely. TE fistula (E) usually causes feeding difficulties from birth.
質問 # 90
A 37-year-old man presents with chronic back, neck, and shoulder pain following a workplace injury 4 years ago. He has a history of alcohol misuse and PTSD related to the incident. Current medications (acetaminophen, naproxen, amitriptyline, gabapentin) provide inadequate pain relief. He requests oxycodone after self-trialing it with temporary benefit. After history and physical assessment, which one of the following is the best next step?
- A. Prescribing a short course of a short-acting opioid to be used only as needed.
- B. Prescribing a low-dose, long-acting opioid and reassessing in 1 week for effectiveness.
- C. Prescribing cannabis.
- D. Referring the patient to substance use and mental health support services.
- E. Ordering repeat imaging of the spine and shoulder to confirm the diagnosis.
正解：D
解説：
The patient has chronic non-cancer pain with comorbid PTSD and alcohol misuse - high-risk factors for opioid use disorder. Before any opioid prescribing, a comprehensive interdisciplinary approach including mental health and substance use support is essential.
Toronto Notes 2023 - Pain Management and Addiction Medicine:
"In chronic pain patients with substance use or mental health comorbidities, refer to addiction/mental health services before considering opioid therapy." MCCQE1 Objectives (ELOM > 99-4: Safe Prescribing):
"Candidates must assess for substance use risk factors and manage chronic pain using a multidisciplinary approach." Imaging (A) is unlikely to alter management. Opioids (B, C) should not be first-line in this context. Cannabis (E) is not first-line and lacks robust evidence in complex chronic pain.
質問 # 91
You are being consulted for a 79-year-old man who is about to undergo a total hip arthroplasty. His orthopedic surgeon is aware of the diagnosis of Alzheimer disease and would like your suggestions to help avoid acute postsurgical delirium. To that end, which one of the following is the most effective strategy?
- A. Avoid medications with anticholinergic potential
- B. Refrain from prescribing opiate analgesics to treat postoperative pain
- C. Screen the patient with the Mini-Mental Status Examination prior to surgery
- D. Treat postsurgical insomnia with benzodiazepines
- E. Keep family visits to a minimum to avoid postsurgical overstimulation
正解：A
解説：
One of the strongest modifiable risk factors for postoperative delirium in older adults is exposure to anticholinergic medications (e.g., diphenhydramine, certain antidepressants). Avoiding these can reduce delirium risk.
Toronto Notes 2023 - Geriatrics, "Delirium Prevention":
"Avoid high-risk medications including anticholinergics, benzodiazepines, and narcotics if possible. Maintain orientation cues and adequate pain control." MCCQE1 Objectives (Medicine > Geriatrics > 41-1: Cognitive Impairment):
"Candidates must recognize predisposing factors for delirium and apply prevention strategies, including medication review." Opiates (B) should be used judiciously; untreated pain can also cause delirium. Cognitive screening (C) is helpful for baseline but does not prevent delirium. Benzodiazepines (D) increase delirium risk. Family involvement is actually helpful (E).
質問 # 92
A 76-year-old man is brought to the emergency department in an unresponsive state. He has a history of chronic kidney disease with a baseline serum creatinine level of 300 µmol/L (49-93) and a history of dilated cardiomyopathy with an ejection fraction of 30%. On assessment, he has no pulse or blood pressure. Cardiac monitor demonstrates a wide complex tachycardia. Which one of the following recently started medications is the most likely cause of this arrhythmia?
- A. Diltiazem
- B. Hydrochlorothiazide
- C. Metoprolol
- D. Clopidogrel
- E. Spironolactone
正解：E
解説：
Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia, especially in patients with impaired renal function. Hyperkalemia can lead to life-threatening arrhythmias, particularly wide complex tachycardia or ventricular fibrillation.
Toronto Notes 2023 - Cardiology and Nephrology, "Hyperkalemia" Section:
"Patients with CKD are at increased risk for hyperkalemia, particularly when taking potassium-sparing medications such as spironolactone. Severe hyperkalemia may cause bradycardia or wide-complex tachyarrhythmias." MCCQE1 Objectives (Internal Medicine > 76-2: Electrolyte Abnormalities):
"Candidates must recognize drug-induced hyperkalemia as a cause of cardiac arrhythmias, especially in patients with renal dysfunction." Hydrochlorothiazide (B) can cause hypokalemia. Metoprolol (C) and diltiazem (E) are rate-controlling agents but do not typically cause wide complex tachycardia. Clopidogrel (D) has no effect on cardiac conduction.
質問 # 93
An 18-year-old woman comes to the office because of fatigue. She tells you she is struggling in her first year of university. She mentions that she spends much of her time rewriting her notes and filing and organizing her study materials. She is doing all the work in her group assignments because she feels others cannot do the work to a high enough standard. She has abandoned all enjoyable activities and seems to be constantly working and worrying about her grades. Which one of the following is the most likely diagnosis?
- A. Generalized anxiety disorder.
- B. Obsessive-compulsive personality disorder.
- C. Major depressive disorder.
- D. Obsessive-compulsive disorder.
正解：B
解説：
This patient exhibits perfectionism, preoccupation with order and control, and reluctance to delegate - classic features of obsessive-compulsive personality disorder (OCPD). Unlike OCD, there are no intrusive thoughts or compulsions; rather, behaviors are ego-syntonic.
Toronto Notes 2023 - Psychiatry, Personality Disorders:
"OCPD is marked by perfectionism, rigidity, and preoccupation with productivity. It differs from OCD in lacking obsessions or compulsions." MCCQE1 Objectives - Psychiatry > Personality Disorders:
"Candidates must distinguish OCPD by traits of excessive perfectionism, control, and inflexibility, particularly when these interfere with functioning." Major depression (A) is marked by pervasive low mood, which is not reported. OCD (B) involves distressing obsessions and compulsions. GAD (C) is more generalized worry without the perfectionism and rigidity.
質問 # 94
A 56-year-old woman with a 4-year history of fibromyalgia presents for follow-up. She reports that she is struggling with her health and daily life. She is unhappy with her lack of progress and says she feels tired all the time and stays in bed all day. When asked why, she states she is confused about why she is not getting better. Physical exam and investigations are unchanged from baseline. Which one of the following is the best next step?
- A. Educate the patient about her illness
- B. Initiate iron and vitamin B12 supplementation
- C. Start a selective serotonin reuptake inhibitor
- D. Prescribe cannabinoid therapy
正解：A
解説：
Patient education is foundational in managing fibromyalgia. Understanding the chronic but non-progressive nature of the disease, reassurance, and emphasis on self-management are crucial. It helps set realistic expectations and enhances engagement in therapy.
Toronto Notes 2023 - Rheumatology, Fibromyalgia:
"Patient education is essential. Explain the nature of fibromyalgia, emphasizing that although it is chronic, it is non-deforming and can be managed through exercise, sleep hygiene, and cognitive strategies." MCCQE1 Objectives - Psychiatry & Rheumatology > Chronic Pain Syndromes:
"Candidates must recognize the value of education and behavioral interventions in managing functional syndromes." SSRIs (D) may be used if depression is present. Iron/B12 (B) are not indicated without evidence of deficiency. Cannabinoids (A) lack strong evidence in fibromyalgia.
質問 # 95
You are caring for a 78-year-old man admitted to hospital for heart failure. On your rounds, he asks why he is not getting better. He has a history of heart failure, hypertension, and type 2 diabetes. He has an implantable cardioverter-defibrillator. This is his fourth admission in the past 6 months for acute decompensation of his heart failure. Between hospital admissions, he reports worsening shortness of breath and a progressive decline in function. Which one of the following is the next best step?
- A. Advise the patient to have his defibrillator deactivated
- B. Explain the end-stage nature of the patient's illness
- C. Reassure the patient that his condition will improve with proper medication adherence
正解：B
解説：
Comprehensive and Detailed Explanation:
This patient has end-stage heart failure with frequent hospitalizations, progressive symptoms, and functional decline. The most appropriate next step is to initiate a goals-of-care conversation, including acknowledgment of the prognosis.
Toronto Notes 2023 - Cardiology / Palliative Care:
"In advanced heart failure with recurrent admissions and functional decline, a goals-of-care discussion should be initiated to align treatment with patient values." MCCQE1 Objectives (Cardiology > 34-4 / ELOM > 90-2):
"Candidates must recognize end-stage illness and provide appropriate communication and palliative care planning." Deactivating the defibrillator (B) may be appropriate later but should follow a goals-of-care conversation.
Reassuring (C) ignores the true clinical trajectory.
質問 # 96
A 72-year-old man presents to your clinic with worsening lower leg edema. He has hypertension, type 2 diabetes, and a history of heavy drinking. On examination, he is pale and has a BMI of 35. Vital signs are as follows:
Blood pressure: 110/60 mm Hg
Heart rate: 102/min
Temperature: Afebrile
His jugular venous pressure is 4 cm above the sternal angle. Cardiac auscultation is normal, and his lungs are clear. His liver is not palpable; he has abdominal distension, bulging flanks, and pitting edema below the knees. While awaiting test results, which one of the following is the best next step?
- A. Ramipril
- B. Lactulose
- C. Nadolol
- D. Sodium restriction
- E. Compression stockings
正解：D
解説：
This patient has signs suggestive of decompensated liver cirrhosis (ascites, peripheral edema, low-normal BP, alcohol use, abdominal distension). Sodium restriction is the cornerstone of first-line management to prevent fluid retention in cirrhotic ascites.
Toronto Notes 2023 - Gastroenterology, "Cirrhosis and Ascites" Section:
"Sodium restriction (<2 g/day) is the most important non-pharmacologic management for ascites. Fluid restriction is added only in cases of severe hyponatremia." MCCQE1 Objectives (Internal Medicine > 76-5: Liver Disease):
"Candidates must manage ascites conservatively using sodium restriction, with diuretics added as needed." Lactulose (E) is used for hepatic encephalopathy, not ascites. Ramipril (B) may worsen renal function in cirrhosis. Nadolol (C) is used for variceal bleeding prophylaxis. Compression stockings (D) are not helpful in ascites-related edema.
質問 # 97
A 32-year-old woman, gravida 0, comes to your office for contraception counselling, specifically about insertion of a levonorgestrel-releasing intrauterine device. She has a past history of breast cancer and is presently on tamoxifen. Which one of the following is the best advice for your patient?
- A. After consultation with her oncologist, she may choose this option
- B. She will require pre-procedure antibiotics
- C. It may increase her risk of breast cancer recurrence
- D. She has a high risk of irregular bleeding following insertion
- E. This device will increase her risk of future infertility
正解：A
解説：
Comprehensive and Detailed Explanation:
The levonorgestrel-releasing intrauterine device (LNG-IUD) is generally contraindicated in current or recent breast cancer due to the progestin component, but may be considered in selectpatients on tamoxifen, especially if non-hormonal options are unsuitable. Consultation with the oncologist is required to evaluate risks and benefits.
Toronto Notes 2023 - Gynecology, "Contraception in Special Populations":
"Levonorgestrel IUDs are generally avoided in patients with a history of hormone-sensitive cancers; however, decisions should be made collaboratively with oncology." MCCQE1 Objectives (Gynecology > 82-2: Contraception):
"Candidates must tailor contraceptive advice to patients with medical comorbidities, including cancer survivors." Irregular bleeding (A) is a common but not contraindicating side effect. No pre-procedure antibiotics (D) are typically needed. The IUD does not cause infertility (E). Risk of recurrence (C) is unconfirmed and must be individualized.
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質問 # 98
A 16-year-old boy presents to the emergency department with a 12-hour history of fever and rigors. He has sickle cell anemia. On examination, his vital signs include the following:
Heart rate
110/min (60-100)
Respiratory rate
20/min (12-18)
Temperature
38.8 °C, oral (36.5-37.5)
Which one of the following places this patient at risk for sepsis?
- A. Chronic anemia
- B. Functional asplenia
- C. Systemic iron overload
- D. Neutrophil dysfunction
- E. Immunoglobulin deficiency
正解：B
解説：
Patients with sickle cell anemia often develop functional asplenia due to repeated splenic infarction. The spleen plays a critical role in clearing encapsulated organisms such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. Functional asplenia significantly increases the risk of overwhelming sepsis.
Toronto Notes 2023 - Hematology, "Sickle Cell Disease":
"Functional asplenia is common in sickle cell disease and increases the risk for sepsis due to impaired clearance of encapsulated bacteria." MCCQE1 Objectives (Pediatrics > 77-2: Hematology):
"Candidates must recognize that patients with functional asplenia are at increased risk for sepsis and require prompt evaluation for fever." Neutrophil dysfunction (B) and immunoglobulin deficiency (C) are not typical features of sickle cell anemia.
Chronic anemia (D) and iron overload (E) do not directly increase sepsis risk.
質問 # 99
A 9-year-old girl is brought to the Emergency Department because she has generalized urticaria, abdominal cramping, and postural dizziness 30 minutes after eating at a friend's birthday party. Which one of the following is the most appropriate route of administration for epinephrine?
- A. Intramuscular
- B. Inhaled
- C. Intravenous
- D. Subcutaneous
- E. Intranasal
正解：A
解説：
Anaphylaxis requires immediate administration of epinephrine via the intramuscular (IM) route, typically in the lateral thigh. This route provides the fastest and most reliable absorption for emergency treatment.
Toronto Notes 2023 - Pediatrics, Anaphylaxis:
"Epinephrine 0.01 mg/kg IM is the first-line treatment for anaphylaxis. The intramuscular route provides the most rapid and safe absorption in emergencies." MCCQE1 Objectives - Pediatrics > Allergy and Immunology:
"Candidates must know the emergency management of anaphylaxis, including proper dosage and intramuscular administration of epinephrine." IV administration (A) is reserved for critical care settings. Subcutaneous (C) and intranasal/inhaled routes (D, E) are ineffective in anaphylaxis.
質問 # 100
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