High-yield clinical decision-making for Part A and Part B MCCQE Part I.
The Canadian Cardiovascular Society (CCS) recommends a primary PCI strategy for STEMI within 90 minutes of first medical contact when available, with fibrinolysis only if PCI is delayed beyond 120 minutes. For NSTEMI, risk-stratify with the GRACE score and initiate dual antiplatelet therapy (ASA + ticagrelor or clopidogrel) plus anticoagulation (fondaparinux or LMWH).
| Condition | First-line investigation | First-line treatment | Canadian reference |
|---|---|---|---|
| STEMI | ECG < 10 min | Primary PCI < 90 min | CCS 2018 |
| NSTEMI | ECG + hs-TnT serial | ASA + P2Y12 + LMWH | CCS NSTEMI 2018 |
| Acute HF | BNP, CXR, echo | IV furosemide, O2, NIV | CCS HF 2021 |
| PE (intermediate risk) | CTPA | LMWH then DOAC | Thrombosis Canada 2022 |
For an acute exacerbation of COPD, the Canadian Thoracic Society (CTS) recommends short-acting bronchodilators, systemic corticosteroids (prednisone 40 mg PO × 5 days), antibiotics if 2 of 3 Anthonisen criteria are met, and consideration of non-invasive ventilation (NIV) for hypercapnic respiratory failure (pH < 7.35, PaCO2 > 45 mmHg).
Diabetes Canada 2018 guidelines: HbA1c target ≤ 7.0 % for most adults with T2DM, with metformin as first-line. Add a GLP-1 RA or SGLT-2 inhibitor if established cardiovascular disease or CKD. DKA management: IV fluids → insulin infusion 0.1 U/kg/h → K+ replacement when K < 5.2 mmol/L → bicarbonate only if pH < 6.9.
Classic presentation: peri-umbilical pain migrating to RLQ, anorexia, low-grade fever. Use Alvarado score or Pediatric Appendicitis Score (PAS) to risk-stratify. CT abdomen with IV contrast is the gold standard in adults; ultrasound first in children and pregnant patients (ALARA principle).
Apply the Tokyo Guidelines 2018 (TG18) for grading severity (Grade I-III). Treatment: NPO, IV antibiotics (piperacillin-tazobactam), and laparoscopic cholecystectomy within 72 hours for Grade I-II.
According to the Canadian C-Spine Rule (Stiell, 2001): "No imaging is required in alert (GCS 15), stable trauma patients meeting all low-risk criteria and able to rotate the neck 45° left and right." Source: ohri.ca/emerg/cdr (accessed 2026-05-27).
BP target < 130/80 mmHg in diabetics and high-risk patients (SPRINT-derived). First-line agents: ACE-I or ARB or CCB or thiazide-like diuretic (chlorthalidone preferred over HCTZ).
Use the PHQ-9 for screening and severity. First-line pharmacotherapy: SSRI (sertraline, escitalopram) or SNRI (venlafaxine, duloxetine). Adjunctive CBT improves remission. CANMAT 2016 guidelines recommend reassessment at 2-4 weeks and dose escalation if no response.
A 58-year-old man, smoker (40 pack-years), presents with hemoptysis × 3 weeks and 5 kg unintentional weight loss. Chest X-ray shows a 3 cm right upper lobe mass.
Best next investigation (write-in): CT chest with IV contrast.
Then: bronchoscopy with biopsy + staging PET-CT.
Reason: Suspicion of lung cancer per CTFPHC and Cancer Care Ontario lung pathway.
| Condition | Key Diagnostic Finding | First-Line Treatment |
|---|---|---|
| STEMI (inferior) | ST ↑ in II, III, aVF; ST ↓ in V1-V4 | Primary PCI < 90 min or thrombolysis |
| Pulmonary embolism | S1Q3T3, sudden dyspnoea, pleuritic pain | LMWH + anticoagulation; thrombolysis if massive |
| DKA | Glucose > 14, ketones, pH < 7.3, AG > 12 | IV fluids, insulin infusion, K+ replacement |
| Sepsis (Sepsis-3) | SOFA ≥ 2, suspected infection | Cultures, broad-spectrum ABx within 1h, fluid 30 mL/kg |
| Acute kidney injury | Creatinine ↑ × 1.5 from baseline | Identify prerenal/renal/postrenal; treat cause |
For MCCQE Part I: when asked about preventive care intervals, always default to Canadian Task Force recommendations — NOT US Preventive Services Task Force (USPSTF), which differs significantly.
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