Mccee, Usmle and Mccqe1 preparation
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Helping medical students to succeed in Medical Council of Canada licensing exams and USMLE exams. Providing online lessons. After achieving a great success in the Canadian licensing exam(MCCEE 454, and MCCQE1 723) I decided to share my knowledge with motivated and dedicated students who are looking for high scores in these exams. For this reason, I have prepared my own material(MCQs and explanations) that will definitely help my students to achieve high scores. I will also post some of my work on this page, hoping for an efficient discussion.
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facebook.comA 76 year-old patient presents to the emergency department with the sudden onset of cough and shortness of breath. On exam, BP 130/80, Pulse 110/m, oxygen saturation 95%; lung exam shows localized wheezing at the right lower zone. CT scan shows foreign body in the right lower lobe. Which one of the following is the most appropriate next step in management? 1- Thoracotomy. 2- Positional maneuvers. 3- Rigid bronchoscopy. 4- Flexible bronchoscopy. 5- An anti-inflammatory and antibiotics.
A 76 year-old patient presents to the emergency department with the sudden onset of cough and shortness of breath. On exam, BP 130/80, Pulse 110/m, oxygen saturation 95%; lung exam shows localized wheezing at the right lower zone. AP Chest X-Ray is normal. Which one of the following is the most appropriate next step in management? 1- Lateral CXR. 2- CT scan chest. 3- Rigid bronchoscopy. 4- Flexible bronchoscopy. 5- An anti-inflammatory and antibiotics.
A 76 year-old patient presents to the emergency department with the sudden onset of cough and shortness of breath. On exam, BP 130/80, Pulse 110/m, oxygen saturation 95%; lung exam shows localized wheezing at the right lower zone. Chest X-Ray is normal. Which one of the following factors most likely predisposes to this condition? 1- Cigarettes smoking. 2- Alcohol intoxication. 3- Allergy. 4- Immunosuppression. 5- Deep venous thrombosis.
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Mccee, Usmle and Mccqe1 preparation
I will post few questions every few days for discussion. You are also welcome to post any question you want to discuss. Thanks.
A 58 year-old man presents to the office with a three months history of intermittent retrosternal chest discomfort described as chest tightness. The pain occurs mainly in the morning and after exercise. It lasts for two to five minutes and is relieved with rest. His past medical history includes hypertension and diabetes mellitus type2. His medications include metformin and telmisartan. Physical examination and ECG are both normal. What is the most appropriate next step in the management of this patient? 1- Stress testing. 2- Hospital admission. 3- Coronary angiography. 4- Cardiac markers. 5- Echocardiography.
A 75 year-old man presents to the clinic with a 2-month history of exertional retrosternal chest pain that is relieved with rest. Medical history is significant for diabetes mellitus, hypertension osteoarthritis and severe asthma. The patient is unable to exercise to a satisfactory workload. Blood pressure is 150/80, heart auscultation is normal and lung auscultation reveals bilateral expiratory wheezing. His ECG shows LBBB. Which one of the following is the most appropriate next diagnostic step? 1- Coronary angiography. 2- Adenosin radionuclide stress myocardial perfusion imaging (MPI). 3- Dobutamin radionuclide stress myocardial perfusion imaging (MPI). 4- Exercise stress electrocardiography. 5- Dipyridamole radionuclide stress myocardial perfusion imaging (MPI).
A 64 year-old man presents to the clinic with 1 month history of exertional retrosternal chest pain. Medical history is significant for hypertension and diabetes mellitus. His medications include atorvastatin, metformin, aspirin, metoprolol, and lisinopril. You order an exercise stress ECG. Which of the following is the most appropriate next management step prior to the test? 1- Stop metformin. 2- Stop aspirin. 3- Stop metoprolol. 4- Stop lisinopril. 5- Continue all medications.
A 66 year-old man presents to the clinic for evaluation of his poorly controlled angina pectoris despite optimal medical therapy. Medical history includes angina pectoris and hypertension. Clinical examination is normal. His baseline ECG is normal. Which of the following is the most appropriate next management step? 1- Coronary angiography. 2- Adenosin radionuclide stress myocardial perfusion imaging (MPI). 3- Dobutamin radionuclide stress myocardial perfusion imaging (MPI). 4- Exercise stress electrocardiography. 5- Dipyridamole radionuclide stress myocardial perfusion imaging (MPI).
A 66 year-old man presents to the clinic for evaluation of his poorly controlled angina pectoris despite optimal medical therapy. Medical history includes angina pectoris and hypertension. His medications include metoprolol, aspirin, atorvastatin, nitrate, ranolazine, lisinopril and diltiazem. Clinical examination is normal. His baseline ECG is normal. Coronary angiography shows a 70% stenosis of his main left coronary artery. Which of the following is the most appropriate next management step? 1- Add clopidogrel. 2- Coronary artery bypass graft surgery. 3- PCI with sirolimus-eluting stents. 4- PCI with bare metal stent. 5- Exercise stress ECG.
You see a 68 year-old woman after a coronary arteries bypass surgery. History is significant for diabetes mellitus, poorly controlled angina pectoris and hypertension. Medications are atorvastatin, metoprolol, Ramipril, aspirin, metformin and nitrate. Her clinical examination is normal. ECG is normal. Which of the following is the most appropriate discharge recommendation? 1- Arrange for exercise ECG test after one month. 2- Add clopidogrel and continue for 1 year. 3- Add clopidogrel and continue indefinitely. 4- Arrange for stress echocardiography after one month. 5- Arrange for a routine appointment and make no change to her current regimen.