Medical Council of Canada MCCQE Based on Real Exam Environment

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.

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This patient has classic signs of cardiac tamponade (Beck's triad: hypotension, muffled heartsounds, elevated JVP, plus pulsus paradoxus). However, she also has advanced metastatic cancer, functional decline, and has stopped active treatment. In this context, a goals-of-care discussion is the most appropriate next step to determine her wishes regarding interventions like pericardiocentesis.

Toronto Notes 2023 – Palliative Care:

“End-of-life care should prioritize quality of life and patient preferences. In patients with terminal illness and life-threatening conditions (e.g., tamponade), initiate a conversation about goals before aggressive intervention.”

MCCQE1 Objectives – Internal Medicine > Palliative and End-of-Life Care:

“Candidates must assess prognosis, patient values, and initiate appropriate end-of-life discussions before invasive treatment.”

Although pericardiocentesis (A) may relieve symptoms, it should follow consent based on the patient’s goals. ICU (E), fluids (B), or transfusion (D) are not appropriate without this discussion.

According to Canadian guidelines, women aged 50 to 74 at average risk for breast cancer should undergo routine screening mammography every 2 to 3 years. A great-aunt with breast cancerdoes not raise this patient's risk to high. Mammography is appropriate as she is now due for the next screen.

Toronto Notes 2023 – Population Health, “Screening Guidelines” Section:

“Routine mammography is recommended every 2 years for average-risk women aged 50 to 74. Family history in second-degree or more distant relatives (e.g., great-aunt) does not qualify for high-risk screening or MRI.”

MCCQE1 Objectives (Population Health > 97-5: Screening and Prevention):

“Candidates should apply Canadian screening recommendations including mammography for average-risk women ≥50 years old.”

Self-breast exams (C) are not recommended for screening. PET scan (D) and MRI (E) are reserved for high-risk populations or diagnostic clarification.

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The clinical presentation ofmultiple fractures at different stages of healingin a young child raisesstrong suspicion of physical abuse(non-accidental trauma). In such situations,mandatory reporting to child protection services is legally and ethically required, even in the absence of parental admission or clear history.

Toronto Notes 2023 – Pediatrics, Child Maltreatment Section:

“Red flags include inconsistent history, delay in seeking care, multiple injuries in various stages of healing, and injuries not consistent with developmental level. Health care professionals arelegally obligatedto report suspected child abuse or neglect to child protection authorities without delay.”

MCCQE1 Objectives (Medical Expert > Pediatrics > 77-2):

"The candidate must be able to recognize when the findings are consistent with child abuse... When child abuse is suspected,the physician has a legal obligation to report to the appropriate child protection agencyimmediately."

Options B, C, D, and E do not address the immediate child safety risk and legal duty. Social work involvement (E) is supportive but must follow or accompany notification to child protection, not replace it.