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正確的MCCQE真題＆保證Medical Council of Canada MCCQE考試成功與可靠的MCCQE考試題庫
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Medical Council of Canada MCCQE考試題庫 & MCCQE考題免費下載
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最新的 MCCQE Part 1 MCCQE 免費考試真題 (Q176-Q181):
問題 #176
A 37-year-old man comes to the office for follow-up of his opioid use disorder. He receives opioid agonist treatment, including some take-home doses. At this follow-up visit, he reports some nonprescription opioid use since his last visit. Which one of the following is the best next step?
- A. Increase the frequency of follow-up visits
- B. Prescribe a cannabinoid
- C. Slowly taper and discontinue the opioid agonist
- D. Discontinue take-home doses
- E. Taper the dosage of the opioid agonist
答案：A
解題說明：
Nonprescription opioid use during opioid agonist therapy is not uncommon. The response shouldbe supportive and not punitive. Increasing the frequency of follow-up enhances monitoring, supports adherence, and prevents relapse.
Toronto Notes 2023 - Psychiatry, "Substance Use Disorders":
"Patients who relapse during opioid agonist treatment benefit from closer monitoring and increased support, including more frequent follow-up and psychosocial interventions." MCCQE1 Objectives (Psychiatry > 71-5: Substance Use and Addiction):
"Candidates must manage relapses in opioid use by optimizing follow-up and support, not by discontinuing or reducing therapy prematurely." Tapering or discontinuing therapy (A, E) risks destabilizing treatment. Removing take-home doses (B) may be warranted later but not first. Cannabinoids (D) are not first-line adjuncts.
問題 #177
A 32-year-old man presents to the clinic for assessment of a dog bite sustained 3 days ago while traveling in another country. He recalls having seen the dog eat where he was staying, and the animal did not appear well.
On examination, the patient has 2 distinct deep puncture wounds on his left leg. There is an erythematous border but no exudate. He is unsure of his immunization status. Which one of the following is the most appropriate management?
- A. Irrigate the wounds with hydrogen peroxide
- B. Arrange for wound debridement
- C. Order serum creatine kinase
- D. Give rabies immunoglobulin and vaccine
- E. Start antibiotic treatment with ciprofloxacin
答案：D
解題說明：
Dog bites from animals of unknown rabies status, especially from endemic regions and in patients with uncertain immunization status, require immediate post-exposure prophylaxis (PEP) including both rabies immunoglobulin and vaccine. The decision is urgent given the fatal nature of rabies.
Toronto Notes 2023 - Infectious Diseases, "Rabies Exposure":
"Rabies PEP is indicated for bites from animals with unknown vaccination status or those showing abnormal behavior, particularly in endemic regions. PEP includes both vaccine and immunoglobulin." MCCQE1 Objectives (Public Health > 64-1: Rabies and Animal Bites):
"Candidates must recognize indications for rabies post-exposure prophylaxis." Ciprofloxacin (C) is not the antibiotic of choice (amoxicillin-clavulanate is preferred). Hydrogen peroxide (E) can be cytotoxic. Debridement (B) and CK (D) are not immediate priorities here.
問題 #178
An investigator interested in the etiology of neonatal jaundice conducted a study where he selected 150 children diagnosed with this condition and 150 children born in the same time period and in the same hospital who did not have a diagnosis of neonatal jaundice. He then reviewed the delivery records of their mothers to determine various prenatal and perinatal exposures. This is an example of which one of the following?
- A. Cross-sectional study
- B. Cohort study
- C. Clinical trial
- D. Ecological study
- E. Case-control study
答案：E
解題說明：
In a case-control study, participants are selected based on outcome (e.g., presence or absence of neonatal jaundice), and then past exposures are evaluated. This is consistent with the described methodology.
Toronto Notes 2023 - Epidemiology, "Study Designs":
"Case-control studies start with the outcome and look backward to assess exposures. They are efficient for studying rare conditions or those with long latency." MCCQE1 Objectives (Population Health > 65-2: Epidemiology and Study Design):
"Candidates must distinguish between common study designs and recognize the correct classification based on study structure." Cross-sectional studies (A) assess exposure and outcome at the same time. Cohort studies (C) begin with exposure and follow forward. Clinical trials (D) are interventional. Ecological studies (E) analyze population- level data.
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問題 #179
A 34-year-old woman, gravida 3, para 2, aborta 0, presents at 38 weeks' gestation. She is in early labor with ruptured membranes. Her previous pregnancy was complicated by fever during labor. Which one of the following would increase the risk of fever recurrence?
- A. Epidural analgesia
- B. Advanced maternal age
- C. Multiparity
- D. Precipitous labor
答案：A
解題說明：
Comprehensive and Detailed Explanation:
Epidural analgesia is associated with increased maternal intrapartum fever due to non-infectious(neurogenic) thermoregulation impairment. This is a well-known phenomenon in laboring women.
Toronto Notes 2023 - Obstetrics / Anesthesia:
"Epidural analgesia increases risk of intrapartum fever by up to 20% via non-infectious mechanisms." MCCQE1 Objectives (Obstetrics > 80-5: Intrapartum Care):
"Candidates must recognize risk factors for intrapartum complications, including effects of epidural use." Multiparity (A), precipitous labor (B), and maternal age (C) are not established risk factors for intrapartum fever.
問題 #180
A 1-week-old boy born at full term is brought by his parents to the office with a 2-day history of eye swelling and watery discharge. This morning, the discharge became thick and yellow. On physical exam, he is afebrile and fussy with bilateral eyelid edema, purulent discharge, and erythematous conjunctivae. After taking appropriate cultures of the eyes, which one of the following is the best next step?
- A. Reassure the parents and prescribe a topical antibiotic
- B. Admit the patient and start antibiotic therapy
- C. Prescribe an oral antibiotic and reassess in 48 hours
- D. Recommend lacrimal sac massage
- E. Advise warm compresses every 2 to 3 hours until discharge is cleared
答案：B
解題說明：
Comprehensive and Detailed Explanation:
This neonate likely has gonococcal conjunctivitis, which typically presents 2-5 days after birth with bilateral purulent discharge and swelling. This is an emergency due to the risk of corneal perforation. Empiric IV antibiotics and hospital admission are indicated.
Toronto Notes 2023 - Pediatrics, Neonatal Infections:
"Neonatal conjunctivitis within the first 1-2 weeks should raise suspicion for gonococcal or chlamydial infection. Gonorrhea requires urgent IV antibiotics and hospitalization." MCCQE1 Objectives - Pediatrics > Neonatal Infection:
"Candidates must recognize neonatal conjunctivitis and initiate empiric treatment while awaiting culture results." Lacrimal massage (E) and warm compresses (D) are used for nasolacrimal duct obstruction. Oral or topical antibiotics (B, C) are insufficient for suspected gonococcal infection.
問題 #181
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