LMCC Practice Test Video Answer

1. B
The presentation of high fever, drooling, difficulty breathing, and tripod positioning (sitting upright, leaning forward with neck extended) is classic for acute epiglottitis. This is a medical emergency caused most commonly by Haemophilus influenzae type B, though incidence has decreased with vaccination. Direct visualization of the epiglottis should be avoided outside the operating room due to risk of complete airway obstruction.

2. B
Acute kidney injury is characterized by elevated serum creatinine and elevated blood urea nitrogen (BUN). The creatinine rises due to decreased glomerular filtration rate, and BUN increases due to reduced renal clearance. The BUN to creatinine ratio can help distinguish prerenal from intrinsic renal causes of acute kidney injury.

3. B
The presentation of severe headache, visual disturbances, and blood pressure of 160/110 mmHg at 32 weeks gestation is classic for preeclampsia. This is a serious pregnancy complication that requires immediate evaluation and management to prevent progression to eclampsia.

4. B
In a patient presenting with sudden severe “thunderclap” headache described as the worst headache of their life, subarachnoid hemorrhage must be ruled out immediately. Non-contrast CT head is the most appropriate initial test as it can detect acute blood in over 95% of cases when performed within 6 hours of symptom onset. If CT is negative and clinical suspicion remains high, lumbar puncture should be performed.


5. B
For acute otitis media in a 6-month-old infant with clear signs of infection (fever, irritability, bulging erythematous tympanic membrane), oral antibiotics are indicated. Amoxicillin is the first-line antibiotic of choice for acute otitis media in children.

6. B
The Wells score is the most commonly used clinical prediction rule for assessing the probability of deep vein thrombosis (DVT). It incorporates clinical features such as active cancer, paralysis, recent immobilization, localized tenderness, and swelling to stratify patients into probability categories.

7. C
According to current guidelines, acute bacterial sinusitis is typically diagnosed when symptoms persist for 7-10 days or longer without improvement, or when symptoms worsen after initial improvement. Most cases of acute sinusitis are viral and resolve spontaneously within 7-10 days, so antibiotic therapy is not routinely recommended for shorter durations unless there are severe symptoms.

8. B
According to Canadian immunization guidelines, the first dose of MMR (measles, mumps, rubella) vaccine should be administered at 12 months of age, with a second dose given at 18 months or between 4-6 years of age.

9. D
Long-term oxygen therapy is indicated for patients with chronic hypoxemia, but it should not be initiated during an acute exacerbation as oxygen requirements may change after treatment. Assessment for long-term oxygen therapy should be done when the patient is clinically stable.

10. C
A specific suicide plan with readily available means indicates the highest imminent risk for completed suicide. While previous attempts and family history are important risk factors, the presence of a concrete plan with access to lethal means requires immediate intervention and hospitalization.

11. B
HbA1c is the best test to confirm diabetes mellitus as it reflects average blood glucose levels over the previous 2-3 months. A value of 6.5% or higher confirms the diagnosis of diabetes. The patient’s fasting glucose of 8.5 mmol/L is in the diabetic range (≥7.0 mmol/L), and HbA1c provides additional confirmation.

12. B
Colonoscopy every 10 years is one of the recommended screening options for colorectal cancer in average-risk adults beginning at age 50. Other options include fecal immunochemical test (FIT) every 1-2 years or flexible sigmoidoscopy every 10 years combined with annual FIT.

13. B
The International Normalized Ratio (INR) is used to monitor warfarin therapy. The target INR typically ranges from 2.0 to 3.0 for most indications, though some conditions (such as mechanical heart valves) may require higher target ranges.

14. B
Short-acting beta-2 agonists (such as salbutamol) are the first-line treatment for acute asthma exacerbation. They provide rapid bronchodilation and should be administered immediately. Systemic corticosteroids are also important but beta-agonists provide the most immediate relief.

15. C
The sudden onset of severe unilateral headache with third cranial nerve palsy (drooping eyelid and dilated pupil) is highly suggestive of a posterior communicating artery aneurysm with potential rupture or expansion. This is a neurosurgical emergency requiring immediate imaging and intervention.

16. B
Streptococcus pneumoniae is the most common cause of community-acquired pneumonia in adults, accounting for approximately 20-60% of cases. It is the primary target of empiric antibiotic therapy for community-acquired pneumonia.

17. D
Serum thyroid-stimulating hormone (TSH) is the most appropriate initial test for evaluating a thyroid nodule. TSH level helps determine thyroid function status and guides further evaluation. If TSH is low, a thyroid scan may be indicated to assess for a hyperfunctioning nodule. Ultrasound and FNA are subsequent steps based on initial findings.

18. B
Ceftriaxone and vancomycin is the recommended empiric antibiotic combination for acute bacterial meningitis in adults. This combination covers the most common pathogens including Streptococcus pneumoniae (including resistant strains), Neisseria meningitidis, and Listeria monocytogenes in older adults.

19. C
The CHA2DS2-VASc score is used to assess stroke risk in patients with atrial fibrillation and guide decisions about anticoagulation therapy. It incorporates factors including congestive heart failure, hypertension, age, diabetes, prior stroke/TIA, vascular disease, and sex category.

20. B
Blood pressure of 185/110 mmHg or higher is a contraindication to thrombolytic therapy in acute ischemic stroke due to increased risk of intracerebral hemorrhage. Blood pressure must be lowered below 185/110 mmHg before thrombolytics can be safely administered.

21. C
Jaundice appearing within the first 24 hours of life is always pathological and most concerning for hemolytic disease of the newborn (such as ABO or Rh incompatibility). This requires immediate investigation and treatment to prevent kernicterus. Physiologic jaundice typically appears after 24 hours of life.

22. C
The target time for door-to-balloon time in STEMI patients is 90 minutes or less. This refers to the time from patient arrival at the hospital to the inflation of the angioplasty balloon during percutaneous coronary intervention. Earlier reperfusion is associated with better outcomes.

23. A
Elevated TSH with low free T4 indicates primary hypothyroidism, where the thyroid gland itself is failing to produce adequate thyroid hormone. This is most commonly caused by Hashimoto’s thyroiditis. The elevated TSH reflects the pituitary’s attempt to stimulate the failing thyroid gland.

24. B
Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacological treatment for generalized anxiety disorder. They have demonstrated efficacy, good tolerability, and lower risk of dependence compared to benzodiazepines. Benzodiazepines may be used for short-term relief but are not recommended for long-term management.

25. C
ACE inhibitors (and ARBs) can cause hyperkalemia, especially in patients with chronic kidney disease. They reduce aldosterone secretion, leading to potassium retention. While beneficial for renal protection, potassium levels must be monitored regularly in CKD patients on these medications.

26. C
In a patient with suspected pulmonary embolism and hemodynamic instability (massive PE), thrombolytic therapy should be administered immediately without waiting for confirmatory imaging. This is a life-threatening emergency requiring rapid intervention to restore pulmonary perfusion.

27. B
Malignancy is the most common cause of hypercalcemia in hospitalized patients, accounting for approximately 50% of cases. This can occur through bone metastases with osteolysis or through production of parathyroid hormone-related peptide (PTHrP). Primary hyperparathyroidism is the most common cause in outpatients.

28. C
The clinical presentation of lower back pain that improves with exercise, worsens with rest, and is associated with prolonged morning stiffness (>1 hour) in a young man is characteristic of inflammatory back pain seen in ankylosing spondylitis. This is a form of seronegative spondyloarthropathy.

29. C
According to current Canadian Cervical Cancer Screening guidelines, routine Pap screening should begin at age 25. Screening before this age is not recommended due to low incidence of cervical cancer in younger women and potential harm from overtreatment of transient HPV infections.

30. B
Gallstones are the most common cause of acute pancreatitis in Canada and most developed countries, accounting for approximately 40-50% of cases. Alcohol is the second most common cause. The clinical presentation of severe epigastric pain radiating to the back with elevated lipase is classic for acute pancreatitis.

31. B
Iron deficiency anemia is characterized by low mean corpuscular volume (MCV) indicating microcytic anemia, and low ferritin reflecting depleted iron stores. Other findings include low serum iron and elevated total iron-binding capacity (TIBC).

32. B
ACE inhibitors have been shown to reduce mortality in patients with heart failure with reduced ejection fraction. They are recommended as first-line therapy along with beta-blockers. Beta-blockers also reduce mortality, but ACE inhibitors are typically initiated first unless contraindicated.

33. C
CT scan of the abdomen and pelvis with intravenous contrast is the recommended first-line imaging modality for suspected acute appendicitis in adults. It has high sensitivity and specificity (both >95%) and can identify alternative diagnoses. Ultrasound is preferred in children and pregnant women.

34. B
Methotrexate is the first-line disease-modifying antirheumatic drug (DMARD) for rheumatoid arthritis. It is effective in controlling disease activity, slowing radiographic progression, and is generally well-tolerated. Patients require regular monitoring of liver function and complete blood counts.

35. B
The modified Duke criteria are used for the diagnosis of infective endocarditis and require major criteria including positive blood cultures with typical organisms and evidence of endocardial involvement on echocardiography. Two major criteria or one major plus three minor criteria are needed for definite diagnosis.

36. C
The presentation of pelvic pain, vaginal discharge, fever, and cervical motion tenderness is classic for pelvic inflammatory disease (PID). This is typically caused by ascending infection from sexually transmitted organisms such as Chlamydia trachomatis or Neisseria gonorrhoeae.

37. B
Aspirin should generally be discontinued 7-10 days before elective surgery due to its irreversible inhibition of platelet function and increased bleeding risk. However, the decision to discontinue depends on the type of surgery and cardiovascular risk; some cardiac patients may need to continue aspirin perioperatively.

38. C
Prophylaxis for Pneumocystis jirovecii pneumonia (PCP) should be initiated when the CD4 count falls below 200 cells/μL or if the CD4 percentage is less than 14%. The preferred prophylactic agent is trimethoprim-sulfamethoxazole. PCP is one of the most common opportunistic infections in patients with AIDS.

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