Try Medical Council of Canada : MCCQE practice torrent pass for sure

A 20-year-old woman from a remote northern community presents to the office with a 2-week history of malaise and a 2-day history of disabling pain in her left elbow. She had a sore throat 4 weeks ago. She also notes that she has had 2 weeks of pain and swelling in her right knee, followed by pain and swelling in her left elbow. On examination, you note 0.5-cm to 1-cm nodules just above both her elbows. You find no active joint swelling. An electrocardiogram shows a prolonged PR interval. Which one of the following is the most appropriate investigation?

• A. Antistreptolysin O titre.
• B. Excisional biopsy of nodules.
• C. Pharyngeal culture.
• D. Rheumatoid factor.
• E. Echocardiography.

You are conducting a virtual appointment by voice-only call with a 68-year-old man regarding back pain.
When he answers, you ask for him by name and identify yourself and the clinic from which you are calling.
Which one of the following is the best next step?

• A. Ask for additional confirmation of the patient ' s identity.
• B. Establish the reason for the virtual care visit.
• C. Confirm the name of the patient ' s primary care provider.

A 22-year-old woman is brought to the Emergency Department by her boyfriend, who says that she is experiencing a fentanyl overdose. She is unresponsive and cyanotic. She regains consciousness after naloxone is injected intravenously and demonstrates no further respiratory depression during 8 hours of observation.
She states that she is 22 weeks ' pregnant and wants to stop using opioids. Which one of the following is the best next step?

• A. Refer the patient for initiation of methadone
• B. Prescribe medications for symptom control so that the patient can detoxify at home
• C. Refer the patient for opioid use disorder counselling
• D. Admit the patient for medically supervised detoxification

A mother brings her previously healthy 4-month-old girl for evaluation due to fussiness for 3 weeks. The infant becomes irritable and cries with occasional body arching 1-2 hours after feeding, frequently spits up after feeds, has developed feeding aversion, and shows slowing weight gain. She has been on cow ' s milk- based formula since birth. Stools are normal, and physical examination is unremarkable. Which one of the following is the most likely diagnosis?

• A. Hypertrophic pyloric stenosis.
• B. Intermittent intussusception.
• C. Celiac disease.
• D. Gastroesophageal reflux disease.
• E. Peptic ulcer.

A 19-year-old woman returns to your clinic to discuss her recent laboratory tests. She initially presented with dysuria, dyspareunia, and abnormal uterine bleeding. Her vulvovaginal examination was normal. Her last sexual encounter was 3 weeks prior to the onset of her symptoms. Which one of the following pathogens is most likely to explain this clinical presentation?

• A. Chlamydia trachomatis
• B. Treponema pallidum
• C. Herpes simplex virus
• D. Human papillomavirus
• E. Actinomyces israelii