MCCQE Part 1| 159 Questions| With
Complete Solutions
SPIKES correct answer: Setting up interview, assessing patient
Perception, obtaining patient's Invitation to disclose information,
giving Knowldege and information to patient, addressing
patient's Emotions, Strategy and Summary
Canada Health Act correct answer: Accessibility,
Comprehensiveness, Portability, Public administration,
Universality
HTN correct answer: 135/85 on 3 separate occasions,
>=180/110 on dedicated office visit, or diabetes >= 130/80
ACR for DM and CKD correct answer: ACR > 30 mg/mmol is
abnormal
When to start management of HTN correct answer:
BP>160/100 or >140/90 when pt has other RF like diabetes and
smoking
Pharmacological for HTN correct answer: HTN alone =
thiazide, HTN + atherosclerosis = ACEI, HTN + postMI = beta
blockers, HTN + DM = ACEI
Preeclampsia-eclampsia correct answer: HTN with proteinuria
AFTER 20 weeks of gestation
,Sx of preeclapmpsia correct answer: Visual disturbance, new
onset h/a, epigastric or RUQ pain, rapidly progressing peripheral
edema, rapid weight gain
Px of preeclampsia correct answer: Positive roll over test (>=15
dBP increase), vasospasm/retinal edema, clonus (severe
preeclampsia), RUQ tenderness
Protein in urine preeclampsia correct answer: >=300 mg/d of
protein
Treatment of preeclampsia correct answer: Delivery,
betamethasone (<34 weeks gestation), mg sulphate
Malignant HTN correct answer: HTN emergency: BP >180/120
with retinal hemorrhages, excudates or papilledema. May also
have malignant nephrosclerosis
Hypertensive encephalopathy correct answer: HTN emergency:
BP >180/120 with cerebral edema
Mx of malignant HTN correct answer: Reduce dBP to 100-105
over 2-6 hours (initial fall in BP should not exceed 25% of
current BP)
Hypovolemic shock Mx correct answer: Crystalloids 1-2L IV
bolius. Maintain MAP of 60 or maintain sBP>90, urine output
>0.5ml/kg/h. If hemorrhagic, transfuse in addition to crystalloid.
Maintain Hct 30-35%
, Distributive shock Mx correct answer: Rapid fluid repletion (4-
6 L N/S) +/- dopamine if no response
Distributive shock Mx (sepsis) correct answer: Third generation
cephalosporin + aminoglycoside OR imipenem alone. Gram
positive = add vancomycin or naficillin. Anaerobes suspected =
clindamycin or metronidazole. Legionella = erythromycin.
Fungemia = amphotericine B
Distributive shock (neurogenic) correct answer:
Methylprednisone
Distributive shock (anaphylaxis) correct answer: ABCs, IM
epinephrine every 3-5 min, 100% O2, rapid infusion of N/S,
cetirizine (or diphenhydramine if IV), consider corticosteroid.
IV epi if needed
Cardiogenic shock correct answer: ACLS, dopamine, IV
furosemide and morphine to treat pulmonary edema if applicable
Physiologic variables of shock (PCWP, CO, SVR, mixed venous
O2 saturation) correct answer: Hypovolemic - PCWP decrease,
CO decrease, SVR increase, Mixed venous O2 decreased.
Cardiogenic - PCWP increase, CO decrease, SVR increase,
mixed venous O2 decrease. Distributive - preload decrease or
normal, CO increase, SVR decrease, mixed venous O2 increase
HR for exercise stress test correct answer: HR must achieve
>=85% maximial predicted HR (220-age) for exercise stress test
to be diagnostic
Complete Solutions
SPIKES correct answer: Setting up interview, assessing patient
Perception, obtaining patient's Invitation to disclose information,
giving Knowldege and information to patient, addressing
patient's Emotions, Strategy and Summary
Canada Health Act correct answer: Accessibility,
Comprehensiveness, Portability, Public administration,
Universality
HTN correct answer: 135/85 on 3 separate occasions,
>=180/110 on dedicated office visit, or diabetes >= 130/80
ACR for DM and CKD correct answer: ACR > 30 mg/mmol is
abnormal
When to start management of HTN correct answer:
BP>160/100 or >140/90 when pt has other RF like diabetes and
smoking
Pharmacological for HTN correct answer: HTN alone =
thiazide, HTN + atherosclerosis = ACEI, HTN + postMI = beta
blockers, HTN + DM = ACEI
Preeclampsia-eclampsia correct answer: HTN with proteinuria
AFTER 20 weeks of gestation
,Sx of preeclapmpsia correct answer: Visual disturbance, new
onset h/a, epigastric or RUQ pain, rapidly progressing peripheral
edema, rapid weight gain
Px of preeclampsia correct answer: Positive roll over test (>=15
dBP increase), vasospasm/retinal edema, clonus (severe
preeclampsia), RUQ tenderness
Protein in urine preeclampsia correct answer: >=300 mg/d of
protein
Treatment of preeclampsia correct answer: Delivery,
betamethasone (<34 weeks gestation), mg sulphate
Malignant HTN correct answer: HTN emergency: BP >180/120
with retinal hemorrhages, excudates or papilledema. May also
have malignant nephrosclerosis
Hypertensive encephalopathy correct answer: HTN emergency:
BP >180/120 with cerebral edema
Mx of malignant HTN correct answer: Reduce dBP to 100-105
over 2-6 hours (initial fall in BP should not exceed 25% of
current BP)
Hypovolemic shock Mx correct answer: Crystalloids 1-2L IV
bolius. Maintain MAP of 60 or maintain sBP>90, urine output
>0.5ml/kg/h. If hemorrhagic, transfuse in addition to crystalloid.
Maintain Hct 30-35%
, Distributive shock Mx correct answer: Rapid fluid repletion (4-
6 L N/S) +/- dopamine if no response
Distributive shock Mx (sepsis) correct answer: Third generation
cephalosporin + aminoglycoside OR imipenem alone. Gram
positive = add vancomycin or naficillin. Anaerobes suspected =
clindamycin or metronidazole. Legionella = erythromycin.
Fungemia = amphotericine B
Distributive shock (neurogenic) correct answer:
Methylprednisone
Distributive shock (anaphylaxis) correct answer: ABCs, IM
epinephrine every 3-5 min, 100% O2, rapid infusion of N/S,
cetirizine (or diphenhydramine if IV), consider corticosteroid.
IV epi if needed
Cardiogenic shock correct answer: ACLS, dopamine, IV
furosemide and morphine to treat pulmonary edema if applicable
Physiologic variables of shock (PCWP, CO, SVR, mixed venous
O2 saturation) correct answer: Hypovolemic - PCWP decrease,
CO decrease, SVR increase, Mixed venous O2 decreased.
Cardiogenic - PCWP increase, CO decrease, SVR increase,
mixed venous O2 decrease. Distributive - preload decrease or
normal, CO increase, SVR decrease, mixed venous O2 increase
HR for exercise stress test correct answer: HR must achieve
>=85% maximial predicted HR (220-age) for exercise stress test
to be diagnostic
