Free Access Medical Council of Canada MCCQE New Release

A tender, mobile lymph node following a recent localized infection (e.g., dental infection) is most likely reactive. In a young, otherwise well patient with no systemic symptoms or concerning features, observation is appropriate.

Toronto Notes 2023 – Internal Medicine, Lymphadenopathy:

“In patients with localized lymphadenopathy and a recent infection, observation for 4–8 weeks is often appropriate before further investigation.”

MCCQE1 Objectives – Internal Medicine > Hematology:

“Candidates should recognize benign features of lymphadenopathy (tender, mobile, < 2 cm, localized) and manage conservatively unless red flags are present.”

Biopsy (B) and imaging (C, E) are premature. Bone marrow biopsy (D) is not relevant.

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This infant likely has infantile colic, defined by the “rule of 3s”: crying > 3 hours per day, > 3 days per week, for > 3 weeks, usually starting in the first few months of life. It is benign and self-limited, typically resolving by 3–4 months of age.

Toronto Notes 2023 – Pediatrics, “Common Concerns in Infancy”:

“Colic is self-limited. No routine testing is required in healthy, thriving infants. Reassurance and support for parents are key.”

MCCQE1 Objectives (Pediatrics > 78-1: Behavioral Pediatrics):

“Candidates must recognize normal variations such as colic and avoid unnecessary interventions. Counseling and reassurance are essential.”

Sedatives (D) are contraindicated. Investigations (C) are unnecessary without red flags. Resolution (B) usually occurs by 3–4 months, not as late as 12 months.

In a patient with a pelvic fracture and blood at the urethral meatus, urethral injury must be strongly suspected. Other signs may include perineal hematoma, high-riding prostate, or inability to void. The key principle is do not insert a Foley catheter until urethral integrity is confirmed, as blind catheterization may worsen a partial tear into a complete disruption. The appropriate next diagnostic step is retrograde urethrography (RUG), which evaluates the urethra for extravasation of contrast and identifies the site and extent of injury.

Voiding cystography evaluates bladder injury and is performed after urethral integrity is confirmed or via suprapubic access. Transrectal ultrasound and penile sonography are not appropriate in acute trauma assessment of suspected urethral disruption. Continuous bladder irrigation is contraindicated until urethral injury is excluded.

MCCQE objectives emphasize recognition of urethral injury in pelvic trauma and adherence to trauma principles: stabilize first, suspect urethral injury when blood is present at the meatus, and perform retrograde urethrography prior to catheterization.

This case describes classic signs of delusional parasitosis (also known as Morgellons syndrome). However, the presence of widespread crusted lesions raises suspicion for crusted scabies, particularly in older adults. Crusted scabies may be misinterpreted as chronic dermatitis or psychocutaneous disorder. The most effective treatment is oral ivermectin.

Toronto Notes 2023 – Dermatology:

“Crusted scabies presents as widespread hyperkeratotic plaques with crusting. First-line treatment is oral ivermectin, often with topical permethrin.”

MCCQE1 Objectives (Medicine > Dermatology > 23-1):

“Candidates must recognize presentations of ectoparasitic infections, including scabies, and provide appropriate treatment.”

Permethrin (B) is for typical scabies, but crusted scabies often requires systemic ivermectin due to severity and spread.

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