MCCQE VCE Exam Download

This presentation suggests hereditary hemochromatosis. Common features include hyperpigmentation ("bronze diabetes"), hepatomegaly, diabetes, fatigue, and elevated liver enzymes. Serum ferritin is a screening test for iron overload, and elevated levels support the diagnosis.

Toronto Notes 2023 – Endocrinology / Gastroenterology:

“Hemochromatosis presents with skin hyperpigmentation, hepatomegaly, diabetes, fatigue. Diagnosis begins with serum ferritin and transferrin saturation.”

MCCQE1 Objectives (Internal Medicine > Metabolic and Endocrine > 37-1):

“Candidates must investigate iron overload syndromes using ferritin and transferrin saturation.”

Cortisol (B) is for adrenal insufficiency. A1AT (C) is a liver disease cause but not typical here. Amylase (E) is for pancreatitis. A1c (A) would confirm diabetes but not the underlying cause.

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Microcephaly, intrauterine growth restriction, hepatosplenomegaly, and normal vital signs in a term newborn strongly suggest congenital viral infection (e.g., CMV, toxoplasmosis, rubella).

Toronto Notes 2023 – Pediatrics, Congenital Infections:

“Signs of congenital TORCH infections include microcephaly, hepatosplenomegaly, and growth restriction. Early identification is key.”

MCCQE1 Objectives – Pediatrics > Infectious Disease:

“Candidates must recognize signs suggestive of congenital infections and distinguish from genetic or structural abnormalities.”

Cephalic molding (A) is benign and resolves spontaneously. Lipid storage diseases (B) are not present at birth. Cystic fibrosis (C) does not cause microcephaly or hepatosplenomegaly at birth. Trisomy 21 (D) has distinct dysmorphic features not described here.

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Spontaneous, unilateral, blood-tinged nipple discharge in a postmenopausal woman is considered pathologic and warrants imaging to rule out intraductal pathology including malignancy. The best initial test is diagnostic mammography, often with ultrasound if indicated.

Toronto Notes 2023 – Breast Disorders:

“Unilateral, spontaneous, bloody nipple discharge should be evaluated with mammography and targeted ultrasound. Further tests such as MRI or duct excision are based on findings.”

MCCQE1 Objectives (Gynecology > 81-1: Breast Conditions):

“Candidates must recognize red flags for breast malignancy and apply appropriate initial diagnostic imaging.”

Serum prolactin (C) is indicated in galactorrhea. Galactography (D) and MRI (E) are second-line. Biopsy (A) is premature without imaging.

Given the lack of prenatal care, the mother's withdrawal, and prior involvement of child protection services, a newborn drug screen is warranted to assess for possible in utero exposure. This is part of the safety assessment.

Toronto Notes 2023 – Pediatrics, Newborn Assessment:

“Infants born to mothers with no prenatal care or prior social concerns should undergo a full newborn screening, including toxicology if indicated.”

MCCQE1 Objectives – Pediatrics > Newborn Care and Social Issues:

“Candidates must identify social risk factors and initiate appropriate newborn evaluations, including toxicology screens when substance use is suspected.”

The mother was previously immune to hepatitis B, so (A) is not immediately required. Skin-to-skin care (D) is beneficial but secondary to screening in this context. Donor milk (B) is not indicated unless breastfeeding is contraindicated.

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