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早速ダウンロードMCCQE日本語pdf問題 | 最初の試行で簡単に勉強して試験に合格する & 優秀なMedical Council of Canada MCCQE Part 1 Exam
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Medical Council of Canada MCCQE Part 1 Exam 認定 MCCQE 試験問題 (Q25-Q30):
質問 # 25
You are asked to see a 50-year-old man 2 hours after he underwent a laparotomy for gastric resection. Lab results are as follows:
pH
7.28 (7.35-7.45)
PaCO#
60 mm Hg (35-40)
PaO#
60 mm Hg (85-105) with 4 L/min via nasal prongs
Bicarbonate (HCO#)
24 mmol/L (24-30)
Which one of the following is most consistent with this clinical presentation?
- A. Respiratory insufficiency
- B. Compensatory respiratory alkalosis
- C. Metabolic acidosis
- D. Normal recovery from an inhalation anesthetic
- E. Postoperative hypermetabolic period
正解：A
解説：
This ABG reveals primary respiratory acidosis (#pH, #PaCO#, normal HCO#), likely from hypoventilation due to postoperative pain, sedation, or narcotics. PaO# is also low, suggesting inadequate oxygenation.
Toronto Notes 2023 - Respiratory, "Postoperative Respiratory Complications":
"Postoperative respiratory acidosis results from hypoventilation, often due to pain, sedatives, or poor respiratory effort. Assess airway, breathing, and support oxygenation." MCCQE1 Objectives (Internal Medicine > 44-3: Acid-Base Disturbances):
"Candidates must recognize respiratory acidosis on ABG and relate findings to common postoperative complications." Metabolic acidosis (C) would show #HCO#. Compensated alkalosis (D) would show opposite ABG changes.
Hypermetabolic states increase respiratory drive, not decrease it.
質問 # 26
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. Acromegaly
- B. Chronic obstructive pulmonary disease
- C. Cushing disease
- D. Sleep apnea
- E. Type 2 diabetes
正解：E
解説：
Clozapine and quetiapine are associated with significant weight gain and increased risk of type 2 diabetes.
With a BMI of 32 and weight gain over the past year, screening for diabetes is appropriate and evidence- based.
Toronto Notes 2023 - Endocrinology, Diabetes & Psychiatry Sections:
"Second-generation antipsychotics such as clozapine increase the risk of metabolic syndrome and type 2 diabetes. Regular screening is recommended for patients with these risk factors." MCCQE1 Objectives - Internal Medicine > Endocrinology:
"Candidates should screen high-risk individuals, especially those on antipsychotics with weight gain, for diabetes using fasting glucose or HbA1c." While sleep apnea (C) is also possible, diabetes screening is the most appropriate and urgent next step in this patient. COPD (A) would present with respiratory symptoms. Cushing's (B) and acromegaly (E) are less common and have other distinct features.
質問 # 27
A 10-year-old girl is brought to the Emergency Department by her mother because her daughter is crying and says she "can't pee." Her daughter fell on the monkey bars at school earlier that day. On examination, there is a large vulvar bruise anteriorly. Which one of the following is the best next step?
- A. Arrange a retrograde outpatient arthrography.
- B. Consult gynecology if bladder catheterization is difficult.
- C. Ask the mother to leave the room and ask the patient if someone abused her.
- D. Discharge the patient home to do sitz baths.
- E. Order complete blood count and coagulation studies.
正解：B
解説：
In pediatric trauma, inability to void with perineal bruising raises concern for urethral injury or urinary retention due to soft tissue swelling. The most immediate step is to attempt bladder catheterization. If unsuccessful, consult gynecology or urology urgently to avoid bladder overdistension.
Toronto Notes 2023 - Pediatrics, Genitourinary Trauma:
"In females, perineal trauma can lead to urinary retention due to labial hematomas or urethral injury. If catheterization is difficult, consult gynecology or urology for assistance." MCCQE1 Objectives - Pediatrics > Trauma and Emergency Care:
"Candidates must recognize when specialist consultation is required in pediatric genitourinary trauma, especially in cases of failed catheterization." Options B and D delay necessary care. Coagulation studies (C) may be considered if bleeding is unexplained.
Abuse assessment (E) may be necessary later but does not address immediate retention.
質問 # 28
A 33-year-old man with severe bacterial meningitis is intubated and unresponsive in the Intensive Care Unit.
If he receives immediate treatment, his prognosis is excellent. If he does not, he will likely die. Three years ago, the patient had Huntington disease diagnosed, but he has been asymptomatic since then. His advance directive, which was made before this hospitalization, states that he should be allowed to die if he contracts a life-threatening illness. His parents demand that he be treated for the meningitis. Which one of the following is the best next step?
- A. Do not provide any treatment other than comfort measures
- B. Initiate treatment, using the parents as substitute decision-makers
- C. Order an electroencephalography
- D. Consult a second physician for an opinion on emergent treatment
- E. Ask for a current mental capacity assessment
正解：A
解説：
Comprehensive and Detailed Explanation:
An advance directive is a legally binding document that outlines a competent person's preferences regarding future medical care. If the patient clearly stated a refusal of treatment in the event of a life-threatening condition, this directive must be followed, even if the patient is currently incapacitated and family disagrees.
Toronto Notes 2023 - Ethics and Law:
"Advance directives must be respected when valid, clear, and applicable. Substitute decision-makers cannot override them." MCCQE1 Objectives (ELOM > 90-4: Informed Consent and Advance Directives):
"Candidates must apply valid advance directives to guide care for incapacitated patients." B (parents as SDMs) is incorrect if an advance directive exists. A and D are irrelevant-capacity has already been documented. C is unnecessary when an advance directive is clear.
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質問 # 29
A 20-year-old nulligravid woman presents with severe pain during menstruation. She is unable to take nonsteroidal anti-inflammatory drugs (NSAIDs) and is adamant about not taking any hormonal therapy. She has questions about non-medicinal therapeutic options. Which one of the following recommendations is the most appropriate?
- A. Spinal manipulation
- B. Progesterone-releasing intrauterine device
- C. High-frequency transcutaneous electrical nerve stimulation (TENS)
- D. Massage therapy
- E. Laparoscopic uterine nerve ablation (LUNA)
正解：C
解説：
TENS has been shown to be effective for managing primary dysmenorrhea when pharmacological options are contraindicated or refused. It works by interfering with pain signal transmission and increasing endorphin levels.
Toronto Notes 2023 - Gynecology, Dysmenorrhea:
"High-frequency TENS is effective in managing primary dysmenorrhea and can be considered when NSAIDs or hormonal therapies are not acceptable to the patient." MCCQE1 Objectives - Gynecology > Menstrual Disorders:
"Candidates must be aware of non-pharmacological interventions for dysmenorrhea, including TENS and heat therapy." Options D and E involve hormonal or surgical intervention. Spinal manipulation and massage (B and C) lack consistent evidence for dysmenorrhea relief.
質問 # 30
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