MCCQE Part 1 MCCQE Exam Questions and Answers PDF

Comprehensive and Detailed Explanation:

This patient presents with the classic triad of normal pressure hydrocephalus (NPH): gait disturbance (often wide-based and magnetic), cognitive decline, and urinary incontinence. The combination, especially with the gait being most prominent, is highly suggestive.

Toronto Notes 2023 – Geriatrics / Neurology:

“NPH presents with gait disturbance, dementia, and urinary incontinence. Gait is typically broad-based and magnetic. Imaging shows ventriculomegaly without elevated pressure.”

MCCQE1 Objectives (Geriatrics > 41-1: Cognitive Disorders):

“Candidates must identify NPH and distinguish it from other dementias based on clinical triad and gait features.”

Alzheimer’s (B) primarily presents with memory loss. Parkinson’s (A) has bradykinesia and rigidity. Lewy body dementia (C) includes visual hallucinations and fluctuating cognition. FTD (E) has personality and behavioral changes.

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Comprehensive and Detailed Explanation:

Providing clinical advice (particularly treatment advice) without formally seeing or evaluating the patient creates a physician-patient relationship, potentially establishing a duty of care. If the advice leads to harm, you could be found liable, even if you never saw the patient directly.

Toronto Notes 2023 – Legal Medicine:

“Giving specific medical advice about diagnosis or treatment may imply a physician-patient relationship and establish duty of care.”

MCCQE1 Objectives (ELOM > 90-2: Legal Risk Management):

“Candidates must understand that liability can arise from informal consultations where medical advice is given.”

Providing advice (D) is riskier than simply hearing about a case or patient (A, C). Recommending consultation (B) does not establish duty of care. Not seeing the patient (E) does not automatically shield from liability if treatment advice was given.

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Comprehensive and Detailed Explanation:

Mid-cycle acute onset pelvic pain with localized adnexal tenderness in a reproductive-age woman suggests a hemorrhagic ovarian cyst, particularly a ruptured one. The hemodynamic parameters are stable, but elevated HR supports acute pain and possible blood loss.

Toronto Notes 2023 – Gynecology / Acute Pelvic Pain:

“Hemorrhagic ovarian cysts present with sudden unilateral pelvic pain, mid-cycle, with guarding and rebound tenderness. Ultrasound is key.”

MCCQE1 Objectives (Gynecology > 82-4: Acute Pelvic Pain):

“Candidates must recognize common causes of acute pelvic pain, including ovarian cysts.”

Diverticulitis (A) is rare in young women and usually LLQ. Appendicitis (B) is more likely RLQ. Adenomyosis (C) and endometriosis (D) cause chronic cyclical pain, not acute tenderness.

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This patient exhibits classic symptoms of a major depressive episode (MDE): anhedonia, low mood, social withdrawal, feelings of worthlessness, hypersomnia, and loss of appetite. These symptoms are persistent and pervasive beyond what is typical in grief.

Toronto Notes 2023 – Psychiatry, “Depressive Disorders” Section:

“MDE is characterized by ≥5 symptoms present nearly every day for ≥2 weeks including low mood, anhedonia, sleep/appetite disturbances, low energy, feelings of worthlessness, and suicidal ideation. It must cause significant impairment in functioning.”

MCCQE1 Objectives (Psychiatry > 79-1: Mood Disorders):

“Candidates must distinguish between grief, adjustment disorders, and major depression in patients with chronic illness and initiate appropriate management.”

Normal grief (A) may involve sadness and crying but does not involve pervasive hopelessness or worthlessness. Side effects of chemotherapy (C) and hepatic encephalopathy (E) have other specific physical signs. Brain metastasis (D) would more likely present with focal neurologic symptoms or cognitive impairment.

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