Medical Council of Canada MCCQE Dumps

Comprehensive and Detailed Explanation:

This patient has tardive dyskinesia, a late-onset, often irreversible movement disorder caused by chronic dopamine receptor blockade (e.g., haloperidol). It is especially common in older adults and may not resolve after stopping the drug.

Toronto Notes 2023 – Psychiatry, “Extrapyramidal Symptoms”:

“Tardive dyskinesia is often irreversible and typically occurs after prolonged antipsychotic use. Elderly patients are at greater risk.”

MCCQE1 Objectives (Psychiatry > 71-5: Side Effects of Psychotropics):

“Candidates must recognize tardive dyskinesia and understand that it can persist or worsen even after discontinuation of antipsychotics.”

Anticholinergics may worsen it (D). The condition does not reliably improve with age (C). It does not affect a majority of patients (A).

The presentation is highly suspicious for acute aortic dissection — sudden chest/back pain and mediastinal widening on chest x-ray. The most definitive and widely available test is contrast-enhanced computed tomography (CT) of the chest.

Toronto Notes 2023 – Cardiology, Aortic Dissection:

“CT angiography of the chest is the gold standard for stable patients with suspected aortic dissection. Look for mediastinal widening on chest x-ray as a clue.”

MCCQE1 Objectives – Internal Medicine > Cardiovascular Disease:

“Candidates should recognize acute aortic dissection and select appropriate imaging, such as CT chest, for diagnosis in stable patients.”

Transthoracic echo (A) may miss dissections. ECG (C) helps rule out MI but not dissection. V/Q scan (D) and pulmonary angiography (E) are for suspected pulmonary embolism.

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The presentation is consistent with cervical spondylosis — a degenerative condition. In the absence of neurologic findings, further imaging beyond plain radiography is not warranted. Management includes conservative measures such as physiotherapy and analgesia.

Toronto Notes 2023 – Rheumatology, Cervical Spondylosis:

“Patients with typical cervical spondylosis and no red flags (e.g., neurologic deficits) do not require MRI. Treatment is conservative. Radiographs showing disc space narrowing and osteophytes confirm diagnosis.”

MCCQE1 Objectives – Internal Medicine > Musculoskeletal Disorders:

“Candidates must recognize typical degenerative spine disorders and avoid unnecessary investigations when clinical findings are straightforward.”

MRI (B) is useful if myelopathy or radiculopathy is suspected. CT (A), EMG (C), and LP (D) are not indicated here.

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