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Medical Council of Canada MCCQE Part 1 認定 MCCQE 試験問題:

1. A 26-year-old man presents with pain, numbness, and weakness in his right upper extremity. He works as a computer programmer, and his BMI is 32. Symptoms have worsened since he started spending more time on the keyboard. He reports that his right hand feels clumsier while he is typing. Physical examination reveals mild weakness in the intrinsic muscles of that hand, with a positive Tinel sign at the ulnar nerve. Which one of the following is the best next step?

A) Nerve conduction studies to localize the level of the lesion.
B) Magnetic resonance imaging of the cervical spine.
C) Physiotherapy.
D) Elbow extension brace for use during sleep.
E) Wrist splint to test for carpal tunnel.

2. You receive a note from a pharmacist about your 82-year-old patient who is taking oxycodone extended- release 20 mg 3 times daily for spinal stenosis. The pharmacist suggests that you consider tapering the medication. Your patient has been taking his current dosage for 1 year. When you saw him a month ago, he was functioning well with no adverse effects from the medication. Which one of the following is the best next step?

A) Refer the patient to a pain specialist to help you decide on the best management.
B) Reassess the patient.
C) Prescribe a lower dosage of oxycodone.
D) Refer the patient for physiotherapy and acupuncture.

3. A 68-year-old man with a history of diabetes, hypertension, delirium tremens, and tobacco addiction comes to the Emergency Department with his daughter. She tells you that his behavior has become unmanageable and she feels he may require an increased level of care. His vital signs are:
Blood pressure: 162/105 mm Hg
Heart rate: 112/min, regular
Temperature: 37.8°C
On history, his daughter explains she had to confiscate a half-empty bottle of alcohol from his room yesterday. He is now convinced that there are bugs crawling all over him and he will not relax. He appears pale, sweaty, and shaky. His most recent blood glucose is 7.8 mmol/L (3.8-11.1). Which one of the following is the best next step?

A) Consult a Geriatric Psychiatrist to assess the patient.
B) Interview the patient in private to ensure this is not a case of elder abuse.
C) Provide the family member with a prescription of antipsychotics for the patient.
D) Administer benzodiazepines and intravenous hydration.

4. A 63-year-old man is brought to the Emergency Department by ambulance after he injured his abdomen.
While working on a house, he fell 1 m from a scaffold and landed on a metal pipe. He is clinically stable but reports localized abdominal pain. On examination, he has a 17-cm laceration to his abdomen in the left hypochondrium. The laceration is 4 cm deep, but there is no fascial laceration. Which one of the following is the best next step?

A) Abdominal computed tomography.
B) Antibiotic irrigation of the wound.
C) Surgical debridement and delayed closure.
D) Exploratory laparotomy.
E) Primary repair of the laceration.

5. A previously well 4-year-old boy is brought to your office by his mother. She is concerned by his behaviour.
Shortly after falling asleep, he awakens, screams loudly and cries. He appears frightened and does not respond to his mother's efforts to calm him. During these episodes, he appears agitated and flushed. After 15-20 minutes, he settles back to sleep. Physical examination is unremarkable. Which one of the following is the most likely diagnosis?

A) Nightmare disorder.
B) Nocturnal seizures.
C) Panic disorder.
D) Temper tantrums.
E) Non-rapid eye movement sleep arousal disorder.

質問と回答：