MCCQE1 Questions With Correct
Answers
An 80-year-old woman comes to the urgent care clinic with dyspnoea on exertion.
| | | | | | | | | | | |
On physical examination, her blood pressure is 100/70, and her pulse is 75. She
| | | | | | | | | | | | | | |
has no pulsus paradoxus. Her jugular veins are distended, and she has distant
| | | | | | | | | | | | |
heart sounds. In addition, she has extra third and fourth heart sounds. Her liver is
| | | | | | | | | | | | | |
enlarged, and she has pedal oedema. She has occasional premature ventricular
| | | | | | | | | | | |
contractions on her electrocardiogram. A chest x-ray reveals clear lung fields with
| | | | | | | | | | | |
a dilated cardiac silhouette. Her echocardiogram reveals ventricular walls with a
| | | | | | | | | |
"speckled pattern". Which of the following is the most likely diagnosis?
| | | | | | | | | | |
- Alcoholic cardiomyopathy
| |
- Amyloidosis
|
- Haemochromatosis
|
- Tuberculosis
|
- Viral myocarditis - CORRECT ANSWER✔✔-Amyloidosis
| | | | |
Restrictive cardiomyopathy with 'speckled' left ventricular wall
| | | | | |
Primary cardiac amyloidosis usually develops into diastolic dysfunction
| | | | | | |
Alcoholic cardiomyopathy: biventricular dilated cardiomyopathy
| | | |
A 92-year-old man with a 45-year history of chronic obstructive pulmonary
| | | | | | | | | | |
disease is intubated in the ICU because of a bout of viral pneumonia that fails to
| | | | | | | | | | | | | | | |
improve after 72 hours of antibiotics. Although the inspired fraction of oxygen is
| | | | | | | | | | | | |
100%, the patient's pO2 remains at 57 mmHg. Positive-end expiratory pressure
| | | | | | | | | | |
,(PEEP) is added to allow the inspired fraction of oxygen. Twelve hours after the
| | | | | | | | | | | | | |
introduction of PEEP the patient suddenly become hypotensive. At the same | | | | | | | | | | |
time, his oxygen saturation drops from 92% to 61%. On physical examination, his
| | | | | | | | | | | | |
BP is 80/50 mmHg and his pulse is 124/min. He has distended neck veins and
| | | | | | | | | | | | | | |
distant heart sounds. Which of the following would also most likely be seen on
| | | | | | | | | | | | | |
this patient's physical examination?
| | |
- Absence of breath sounds in the right hemithorax
| | | | | | | |
- High amplitude carotid artery upstroke
| | | | |
- A pleural friction rub
| | | |
- Pulsus alternans
| |
- Splenomegaly - CORRECT ANSWER✔✔-Absence of breath sounds in the right
| | | | | | | | | | |
hemithorax
Patient has developed a tension pneumothorax, characterised by PEEP followed
| | | | | | | | | |
by sudden hypotension and decreased oxygenation
| | | | |
Jugular venous distention occurs because venous return to the right side of the
| | | | | | | | | | | | |
heart is being compressed | | |
Rx: immediate needle/tube thoracostomy
| | |
A 46-year-old man with a history of hypertension and hypercholesterolemia visits
| | | | | | | | | | |
the physician for a routine followup. The patient's job involves a lot of travelling,
| | | | | | | | | | | | | |
and he admits to occasionally forgetting to take his medications with him when
| | | | | | | | | | | | |
he travels. He complains of several episodes of chest pain in the past few months.
| | | | | | | | | | | | | |
|The pain is sharp in nature, mainly over his lower chest and epigastrium, and
| | | | | | | | | | | | | |
tends to come on when walking. He believes these episodes are due to
| | | | | | | | | | | | |
indigestion and has been taking antacids. There is a family history of heart| | | | | | | | | | | | |
disease, and his father died of a heart attack at age 48. On physical examination,
| | | | | | | | | | | | | | |
his blood pressure is 150/80 mmHg and heart rate is 86/min. His lungs are clear
| | | | | | | | | | | | | | |
to auscultation. Cardiac auscultation reveals normal rate and rhythm, without
| | | | | | | | | |
rubs, gallops, or murmurs. There is no pedal oedema. He is sent for an exercise
| | | | | | | | | | | | | | |
,stress test. Five minutes into the test, he develops ST - CORRECT ANSWER✔✔-
| | | | | | | | | | | |
Coronary angiography |
Multiple risk factors for atherosclerotic coronary artery disease
| | | | | | |
A stress test is considered positive when there are ST depression of >1mm for
| | | | | | | | | | | | | |
longer than 0.08 seconds| | |
Positive stress test = coronary angiography
| | | | |
A 74-year-old woman, who has been followed for the past 25 years for chronic
| | | | | | | | | | | | | |
obstructive pulmonary disease comes to the ED complaining of 48 hours of
| | | | | | | | | | | |
temperature to 38.6 C and worsening shortness of breath. She has a chronic
| | | | | | | | | | | | |
productive cough, which has become more copious. On physical examination, she
| | | | | | | | | |
|has rhonchi and increased fremitus in the posterior mid-lung field. A Gram's stain
| | | | | | | | | | | |
|reveals many epithelial cells and multiple gram-positive and gram-negative
| | | | | | | | |
organisms; no neutrophils are seen. Which of the following is the most likely
| | | | | | | | | | | | |
organism causing the symptoms? | | |
- Escherichia coli
| |
- Haemophilus influenzae
| |
- Klebsiella pneumoniae
| |
- Mycobacterium tuberculosis
| |
- Mycoplasma pneumoniae - CORRECT ANSWER✔✔-Haemophilus influenzae
| | | | | |
Evidence of community-acquired pneumonia and common organisms in patients
| | | | | | | | |
with COPD are Strep. pneumoniae, Haem. influenzae and Moraxella catarrhalis.
| | | | | | | | |
Klebseilla pneumonia is typically found in alcoholic patients.
| | | | | | |
Primary E. coli pneumonia is rare and there is no history of infection elsewhere
| | | | | | | | | | | | | |
(e.g. UTI). |
, Mycoplasma pneumoniae does not present with a lobar consolidation and
| | | | | | | | | |
generally occurs in younger patients - x-ray reveals faint bilateral interstitial
| | | | | | | | | | |
infiltrates.
A 62-year-old man is being treated for an acute myocardial infarction. He
| | | | | | | | | | | |
originally came to the ED with substernal chest pain and diaphoresis. Given his
| | | | | | | | | | | | |
risk factors of hypertension, diabetes, tobacco use, and family history, he is
| | | | | | | | | | | |
considered high risk. An ECG in the ED reveals a left-bundle branch pattern, and
| | | | | | | | | | | | | |
cardiac enzymes are elevated slightly. After a focused evaluation in the ED, the
| | | | | | | | | | | | |
patient receives IV thrombolytics. Although his bundle branch pattern never
| | | | | | | | | |
resolves, the patient is chest pain-free and haemodynamically stable after
| | | | | | | | | |
thrombolysis. Two days later, however, the patient reports episodes of recurrent
| | | | | | | | | | |
chest discomfort and shortness of breath overnight. In evaluating for potential
| | | | | | | | | | |
myocardial reinfarction, which of the following is the most appropriate diagnostic
| | | | | | | | | | |
test?
- Creatinine kinase
| |
- Dynamic ECG changes
| | |
- Lactate dehydrogenase
| |
- Myoglobin levels
| |
- Troponin I level - CORRECT ANSWER✔✔-Creatinine kinase
| | | | | | |
CK, total levels and specific MB fraction, are elevated as early as 3 hours after
| | | | | | | | | | | | | | |
onset of chest pain and have a duration of no more than 2 days, peaking within
| | | | | | | | | | | | | | | |
18-24 hours |
Myoglobin is the first enzyme elevated and lasts no more than 1 day, but is
| | | | | | | | | | | | | | |
nonspecific to AMI | |
Troponin levels increase in 3-12 hours, peak in approximately 1 day, and gradually
| | | | | | | | | | | |
taper over the next 10 days
| | | | | |
Answers
An 80-year-old woman comes to the urgent care clinic with dyspnoea on exertion.
| | | | | | | | | | | |
On physical examination, her blood pressure is 100/70, and her pulse is 75. She
| | | | | | | | | | | | | | |
has no pulsus paradoxus. Her jugular veins are distended, and she has distant
| | | | | | | | | | | | |
heart sounds. In addition, she has extra third and fourth heart sounds. Her liver is
| | | | | | | | | | | | | |
enlarged, and she has pedal oedema. She has occasional premature ventricular
| | | | | | | | | | | |
contractions on her electrocardiogram. A chest x-ray reveals clear lung fields with
| | | | | | | | | | | |
a dilated cardiac silhouette. Her echocardiogram reveals ventricular walls with a
| | | | | | | | | |
"speckled pattern". Which of the following is the most likely diagnosis?
| | | | | | | | | | |
- Alcoholic cardiomyopathy
| |
- Amyloidosis
|
- Haemochromatosis
|
- Tuberculosis
|
- Viral myocarditis - CORRECT ANSWER✔✔-Amyloidosis
| | | | |
Restrictive cardiomyopathy with 'speckled' left ventricular wall
| | | | | |
Primary cardiac amyloidosis usually develops into diastolic dysfunction
| | | | | | |
Alcoholic cardiomyopathy: biventricular dilated cardiomyopathy
| | | |
A 92-year-old man with a 45-year history of chronic obstructive pulmonary
| | | | | | | | | | |
disease is intubated in the ICU because of a bout of viral pneumonia that fails to
| | | | | | | | | | | | | | | |
improve after 72 hours of antibiotics. Although the inspired fraction of oxygen is
| | | | | | | | | | | | |
100%, the patient's pO2 remains at 57 mmHg. Positive-end expiratory pressure
| | | | | | | | | | |
,(PEEP) is added to allow the inspired fraction of oxygen. Twelve hours after the
| | | | | | | | | | | | | |
introduction of PEEP the patient suddenly become hypotensive. At the same | | | | | | | | | | |
time, his oxygen saturation drops from 92% to 61%. On physical examination, his
| | | | | | | | | | | | |
BP is 80/50 mmHg and his pulse is 124/min. He has distended neck veins and
| | | | | | | | | | | | | | |
distant heart sounds. Which of the following would also most likely be seen on
| | | | | | | | | | | | | |
this patient's physical examination?
| | |
- Absence of breath sounds in the right hemithorax
| | | | | | | |
- High amplitude carotid artery upstroke
| | | | |
- A pleural friction rub
| | | |
- Pulsus alternans
| |
- Splenomegaly - CORRECT ANSWER✔✔-Absence of breath sounds in the right
| | | | | | | | | | |
hemithorax
Patient has developed a tension pneumothorax, characterised by PEEP followed
| | | | | | | | | |
by sudden hypotension and decreased oxygenation
| | | | |
Jugular venous distention occurs because venous return to the right side of the
| | | | | | | | | | | | |
heart is being compressed | | |
Rx: immediate needle/tube thoracostomy
| | |
A 46-year-old man with a history of hypertension and hypercholesterolemia visits
| | | | | | | | | | |
the physician for a routine followup. The patient's job involves a lot of travelling,
| | | | | | | | | | | | | |
and he admits to occasionally forgetting to take his medications with him when
| | | | | | | | | | | | |
he travels. He complains of several episodes of chest pain in the past few months.
| | | | | | | | | | | | | |
|The pain is sharp in nature, mainly over his lower chest and epigastrium, and
| | | | | | | | | | | | | |
tends to come on when walking. He believes these episodes are due to
| | | | | | | | | | | | |
indigestion and has been taking antacids. There is a family history of heart| | | | | | | | | | | | |
disease, and his father died of a heart attack at age 48. On physical examination,
| | | | | | | | | | | | | | |
his blood pressure is 150/80 mmHg and heart rate is 86/min. His lungs are clear
| | | | | | | | | | | | | | |
to auscultation. Cardiac auscultation reveals normal rate and rhythm, without
| | | | | | | | | |
rubs, gallops, or murmurs. There is no pedal oedema. He is sent for an exercise
| | | | | | | | | | | | | | |
,stress test. Five minutes into the test, he develops ST - CORRECT ANSWER✔✔-
| | | | | | | | | | | |
Coronary angiography |
Multiple risk factors for atherosclerotic coronary artery disease
| | | | | | |
A stress test is considered positive when there are ST depression of >1mm for
| | | | | | | | | | | | | |
longer than 0.08 seconds| | |
Positive stress test = coronary angiography
| | | | |
A 74-year-old woman, who has been followed for the past 25 years for chronic
| | | | | | | | | | | | | |
obstructive pulmonary disease comes to the ED complaining of 48 hours of
| | | | | | | | | | | |
temperature to 38.6 C and worsening shortness of breath. She has a chronic
| | | | | | | | | | | | |
productive cough, which has become more copious. On physical examination, she
| | | | | | | | | |
|has rhonchi and increased fremitus in the posterior mid-lung field. A Gram's stain
| | | | | | | | | | | |
|reveals many epithelial cells and multiple gram-positive and gram-negative
| | | | | | | | |
organisms; no neutrophils are seen. Which of the following is the most likely
| | | | | | | | | | | | |
organism causing the symptoms? | | |
- Escherichia coli
| |
- Haemophilus influenzae
| |
- Klebsiella pneumoniae
| |
- Mycobacterium tuberculosis
| |
- Mycoplasma pneumoniae - CORRECT ANSWER✔✔-Haemophilus influenzae
| | | | | |
Evidence of community-acquired pneumonia and common organisms in patients
| | | | | | | | |
with COPD are Strep. pneumoniae, Haem. influenzae and Moraxella catarrhalis.
| | | | | | | | |
Klebseilla pneumonia is typically found in alcoholic patients.
| | | | | | |
Primary E. coli pneumonia is rare and there is no history of infection elsewhere
| | | | | | | | | | | | | |
(e.g. UTI). |
, Mycoplasma pneumoniae does not present with a lobar consolidation and
| | | | | | | | | |
generally occurs in younger patients - x-ray reveals faint bilateral interstitial
| | | | | | | | | | |
infiltrates.
A 62-year-old man is being treated for an acute myocardial infarction. He
| | | | | | | | | | | |
originally came to the ED with substernal chest pain and diaphoresis. Given his
| | | | | | | | | | | | |
risk factors of hypertension, diabetes, tobacco use, and family history, he is
| | | | | | | | | | | |
considered high risk. An ECG in the ED reveals a left-bundle branch pattern, and
| | | | | | | | | | | | | |
cardiac enzymes are elevated slightly. After a focused evaluation in the ED, the
| | | | | | | | | | | | |
patient receives IV thrombolytics. Although his bundle branch pattern never
| | | | | | | | | |
resolves, the patient is chest pain-free and haemodynamically stable after
| | | | | | | | | |
thrombolysis. Two days later, however, the patient reports episodes of recurrent
| | | | | | | | | | |
chest discomfort and shortness of breath overnight. In evaluating for potential
| | | | | | | | | | |
myocardial reinfarction, which of the following is the most appropriate diagnostic
| | | | | | | | | | |
test?
- Creatinine kinase
| |
- Dynamic ECG changes
| | |
- Lactate dehydrogenase
| |
- Myoglobin levels
| |
- Troponin I level - CORRECT ANSWER✔✔-Creatinine kinase
| | | | | | |
CK, total levels and specific MB fraction, are elevated as early as 3 hours after
| | | | | | | | | | | | | | |
onset of chest pain and have a duration of no more than 2 days, peaking within
| | | | | | | | | | | | | | | |
18-24 hours |
Myoglobin is the first enzyme elevated and lasts no more than 1 day, but is
| | | | | | | | | | | | | | |
nonspecific to AMI | |
Troponin levels increase in 3-12 hours, peak in approximately 1 day, and gradually
| | | | | | | | | | | |
taper over the next 10 days
| | | | | |
