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Sophia Murphy Sophia Murphy

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Medical Council of Canada MCCQE Part 1 Exam MCCQE Prüfungsfragen mit Lösungen (Q47-Q52):

47. Frage
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?

A. Angiotensin II receptor blocker
B. Cox-2 inhibitor
C. Calcium channel blocker
D. Nitrates
E. Alpha-blocker

Antwort: A

Begründung:
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).

48. Frage
A 31-year-old man presents with nocturnal non-exertional chest pain. During an exercise stress test, he does not experience chest pain, and there are no significant ST segment changes on the electrocardiogram. He achieves 17 metabolic equivalent of task (MET), a blood pressure of 190/96 mm Hg (resting blood pressure of
130/80 mm Hg), and a maximum heart rate of 162/min (85% of age-predicted maximum). Which one of the following is the most appropriate next step?

A. Prescribe hydrochlorothiazide
B. Schedule cardiac catheterization
C. Prescribe acetylsalicylic acid and metoprolol
D. Advise against vigorous exercise
E. Offer reassurance

Antwort: A

Begründung:
Comprehensive and Detailed Explanation:
This patient demonstrates excellent exercise tolerance (17 METs) and no ischemic changes or exertional symptoms, which makes cardiac ischemia unlikely. However, the hypertensive response to exercise (BP >190 systolic) indicates masked or latent hypertension. This should be managed proactively, typically starting with a thiazide.
Toronto Notes 2023 - Cardiology:
"An exaggerated hypertensive response during exercise is predictive of future hypertension. Treatment with antihypertensive agents such as thiazides may be warranted." MCCQE1 Objectives (Internal Medicine > 31-1: Hypertension and Risk Management):
"Candidates must identify abnormal BP responses to exercise and initiate appropriate treatment." Reassurance alone (A) ignores the hypertensive response. Catheterization (C) and beta-blockers (D) are unnecessary without ischemia. Advising against exercise (B) is counterproductive in a young, otherwise healthy patient.
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49. Frage
A 19-year-old woman returns to your clinic to discuss her recent laboratory tests. She initially presented with dysuria, dyspareunia, and abnormal uterine bleeding. Her vulvovaginal examination was normal. Her last sexual encounter was 3 weeks prior to the onset of her symptoms. Which one of the following pathogens is most likely to explain this clinical presentation?

A. Chlamydia trachomatis
B. Treponema pallidum
C. Human papillomavirus
D. Actinomyces israelii
E. Herpes simplex virus

Antwort: A

Begründung:
Chlamydia trachomatis is the most common cause of cervicitis in young sexually active women and frequently presents with dysuria, dyspareunia, intermenstrual bleeding, and a normal vulvovaginal exam. It may be asymptomatic or have subtle signs and often affects the endocervix.
Toronto Notes 2023 - Gynecology, "Sexually Transmitted Infections" Section:
"Chlamydia is the most common bacterial STI. Symptoms may include intermenstrual bleeding, postcoital bleeding, dyspareunia, mucopurulent cervical discharge, and dysuria. The vulva and vagina may appear normal." MCCQE1 Objectives (Obstetrics and Gynecology > 82-1: Abnormal Uterine Bleeding):
"Candidates should evaluate STI-related cervicitis as a common cause of postcoital and intermenstrual bleeding in young women." Other options:
* A. Actinomyces israelii is associated with IUD use, not relevant here.
* B. Herpes simplex virus usually presents with painful ulcerations, not abnormal bleeding.
* C. Treponema pallidum (syphilis) causes painless ulcers or systemic symptoms in later stages.
* D. HPV causes warts or asymptomatic cervical dysplasia, not acute symptoms.

50. Frage
You are covering for your colleague who is on vacation this week. You receive the results from an ultrasonography that had been ordered for a 32-year-old woman, gravida 2, para 1, aborta 0. The ultrasonography-estimated fetal weight is below the fifth percentile for 30 weeks' gestation; gestational age was confirmed by an earlier ultrasonogram. The amniotic fluid volume is within normal range. Her first child's birth weight was 2800 g at full term. Which one of the following is the best next step?

A. Schedule an urgent uterine artery Doppler ultrasonography
B. Ask the patient to present to the obstetrics ward for further fetal assessment
C. Reassure the patient that the fetus is probably at the lower range of normal weight
D. Plan a follow-up appointment as soon as your colleague is back from vacation
E. Discuss the benefits of acetylsalicylic acid

Antwort: B

Begründung:
Comprehensive and Detailed Explanation:
An estimated fetal weight below the 5th percentile at 30 weeks is concerning for intrauterine growth restriction (IUGR). This warrants prompt evaluation of fetal well-being via biophysical profile and Doppler assessment. The patient should be referred for further fetal assessment immediately to rule out placental insufficiency or other complications.
Toronto Notes 2023 - Obstetrics, "Fetal Growth Restriction":
"EFW < 10th percentile, especially < 5th, warrants further evaluation including Doppler studies and biophysical profile. Immediate assessment is warranted to determine fetal well-being." MCCQE1 Objectives (Obstetrics > 80-4: Antepartum Surveillance):
"Candidates must initiate urgent assessment in cases of abnormal fetal growth to reduce perinatal morbidity." Delaying care (B) is inappropriate. Reassurance (A) is unsafe. ASA (D) is preventative, not corrective.
Doppler (E) is important but should be coordinated through obstetrical triage.

51. Frage
A 6-year-old girl is found to have a blood pressure of 130/75 mm Hg. She was born prematurely at 32 weeks' gestation and required ventilation. There is a family history of hypertension in 3 grandparents. Clinical examination reveals a grade 1/6 mid-systolic murmur, no renal bruits, and femoral pulses are difficult to feel.
Which one of the following is the most likely diagnosis?

A. Reflux nephropathy
B. Renal artery thrombosis
C. Aortic coarctation
D. Essential hypertension
E. Ventricular septal defect

Antwort: C

Begründung:
Comprehensive and Detailed Explanation:
The combination of upper extremity hypertension and weak femoral pulses is classic for aortic coarctation. A soft systolic murmur may be present. This condition often becomes apparent during routine screening in school-aged children.
Toronto Notes 2023 - Pediatrics / Cardiology:
"Coarctation of the aorta presents with upper limb hypertension, diminished femoral pulses, and sometimes a systolic murmur. BP discrepancy is key." MCCQE1 Objectives (Pediatrics > 78-1: Congenital Heart Disease):
"Candidates must recognize signs of aortic coarctation, including weak lower limb pulses and systemic hypertension in children." VSD (A) typically presents with a louder murmur. Reflux nephropathy (B) may cause hypertension but without femoral pulse discrepancy. Renal artery thrombosis (C) is rare. Essential hypertension (D) is less likely in this age group with these findings.
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52. Frage
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