Exam (elaborations)
MCCQE1 |Questions And Answers Latest |Update| Verified Answers
- Course
- Institution
MCCQE1 Questions And Answers Latest |Update| Verified Answers
[Show more]
Content preview
100 Free MCCQE1 QuestionsAn 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 - ANS>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 - ANS>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 - ANS>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 - ANS>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 - ANS>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
A 41-year-old man comes to the clinic complaining of a chronic cough over the
past 4 months, which has now been accompanied by haemoptysis. He denies
smoking or any past medical history. On physical examination, his head and neck
examination is normal. His lungs have diffuse bilateral rales. Cardiac examination
is normal. Laboratory findings reveal Na 142 mEq/L, K 4.2 mEq/L, Cl 110 mEq/L,
HCO3 24 mEq/L, BUN (blood urea nitrogen) 39 mg/dL, creatinine 2.9 mg/dL.
Urinalysis reveals microscopic haematuria and 4+ proteinuria. Which of the
following serologic blood tests would most help confirm the suspected diagnosis?
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Schoolflix. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $14.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
77764 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now