CDM TYPE QUESTIONS FOR THE MCCQE1

1. A 30-year-old female presents with abdominal pain and bloating. What is the most likely
diagnosis? What initial tests should be ordered? What is the most appropriate next step in
management?

Answer:

Part 1: The most likely diagnosis is irritable bowel syndrome (IBS).

Part 2: Initial tests should include a complete blood count, thyroid function tests, and a stool culture to
rule out other causes of the patient's symptoms.

Part 3: The most appropriate next step in management is to provide dietary and lifestyle modifications,
prescribe symptomatic relief agents such as antispasmodics, and refer the patient to a
gastroenterologist if symptoms persist or worsen.

2. A 25-year-old female presents with a sore throat, fever, and enlarged lymph nodes in her neck.
What is the most likely diagnosis? What initial tests should be ordered? What is the most
appropriate next step in management?

Answer:

Part 1: The most likely diagnosis is infectious mononucleosis.

Part 2: Initial tests should include a complete blood count, a heterophile antibody test, and a throat
culture to rule out strep throat.

Part 3: The most appropriate next step in management is to prescribe supportive therapy such as rest,
fluids, and pain relief medications, and to advise the patient to avoid contact sports for at least 1 month.

3. A 40-year-old male with a history of alcohol abuse presents with abdominal pain, nausea, and
vomiting. What is the most likely diagnosis? What initial tests should be ordered? What is the
most appropriate next step in management?

Answer:

Part 1: The most likely diagnosis is acute pancreatitis.

Part 2: Initial tests should include a complete blood count, liver function tests, pancreatic enzymes, and
imaging studies such as an abdominal ultrasound or CT scan.

Part 3: The most appropriate next step in management is to initiate aggressive supportive care such as
IV fluids, pain relief medications, and nutritional support, and to address the underlying cause of the
pancreatitis, such as alcohol cessation or gallstone removal.

4. A 60-year-old male presents with chest pain and shortness of breath. What is the most likely
diagnosis? What initial tests should be ordered? What is the most appropriate next step in
management?

Answer:

Part 1: The most likely diagnosis is acute coronary syndrome.

Part 2: Initial tests should include an electrocardiogram (ECG), cardiac enzymes such as troponin, and a
chest X-ray to rule out other causes of the patient's symptoms.

Part 3: The most appropriate next step in management is to initiate immediate anticoagulant therapy,
provide pain relief medications, and refer the patient for urgent cardiac catheterization or reperfusion
therapy if indicated.

5. A 50-year-old female presents with a lump in her breast. What is the most likely diagnosis?
What initial tests should be ordered? What is the most appropriate next step in management?

Answer:

Part 1: The most likely diagnosis is breast cancer.

Part 2: Initial tests should include a mammogram, ultrasound, and a biopsy to confirm the diagnosis and
determine the stage of the cancer.

Part 3: The most appropriate next step in management is to refer the patient to an oncologist for further
evaluation and treatment options, which may include surgery, radiation therapy, chemotherapy, or a
combination of these treatments.

6. A 70-year-old male with a history of smoking presents with hemoptysis. What is the most likely
diagnosis? What initial tests should be ordered? What is the most appropriate next step in
management?

Answer:
  Part 1: The most likely diagnosis is lung cancer.

 Part 2: Initial tests should include a chest X-ray, CT scan of the chest, and a bronchoscopy to
confirm the diagnosis and determine the stage of the cancer.

 Part 3: The most appropriate next step in management is to refer the patient to an oncologist
for further evaluation and treatment options, which may include surgery, radiation therapy,
chemotherapy, or a combination of these treatments.

7. A 35-year-old male presents with a painful, swollen joint in his big toe. What is the most likely
diagnosis? What initial tests should be ordered? What is the most appropriate next step in
management?

Answer:

 Part 1: The most likely diagnosis is gout.

 Part 2: Initial tests should include a serum uric acid level and a joint aspiration to confirm the
diagnosis and rule out other causes of joint pain.

 Part 3: The most appropriate next step in management is to prescribe anti-inflammatory

medications and advise the patient on dietary modifications to manage his condition, as well as
consider long-term urate-lowering therapy if necessary.

8. A 20-year-old female presents with a fever and a rash. What is the most likely diagnosis? What
initial tests should be ordered? What is the most appropriate next step in management?

Answer:

 Part 1: The most likely diagnosis is a viral exanthem such as measles or rubella.

 Part 2: Initial tests should include a complete blood count, serology testing for viral antibodies,
and a skin biopsy if necessary to confirm the diagnosis and rule out other causes of the rash.

 Part 3: The most appropriate next step in management is to provide supportive care such as rest
and fluids, and to advise the patient on infection control measures to prevent further spread of
the virus.

9. A 45-year-old male presents with abdominal pain, weight loss, and diarrhea. What is the most
likely diagnosis? What initial tests should be ordered? What is the most appropriate next step in
management?
Answer:

 Part 1: The most likely diagnosis is inflammatory bowel disease such as Crohn's disease or
ulcerative colitis.

 Part 2: Initial tests should include a complete blood count, inflammatory markers such as C-
reactive protein and erythrocyte sedimentation rate, stool culture, and colonoscopy with
biopsies to confirm the diagnosis and assess the extent of the disease.

 Part 3: The most appropriate next step in management is to prescribe anti-inflammatory

medications and immunosuppressants, and to refer the patient to a gastroenterologist for
ongoing management and monitoring.

10. A 65-year-old female presents with fatigue, weakness, and shortness of breath on exertion.
What is the most likely diagnosis? What initial tests should be ordered? What is the most
appropriate next step in management?

Answer:

 Part 1: The most likely diagnosis is anemia due to chronic disease or iron deficiency.

 Part 2: Initial tests should include a complete blood count, iron studies, and a stool occult blood
test to rule out gastrointestinal bleeding as a cause of the patient's symptoms.

 Part 3: The most appropriate next step in management is to treat the underlying cause of the
anemia if possible, and to prescribe iron supplementation or erythropoietin-stimulating agents if
indicated to correct the anemia and improve the patient's symptoms.

11. A 30-year-old male presents with a painful, swollen testicle. What is the most likely diagnosis?
What initial tests should be ordered? What is the most appropriate next step in management?

Answer:

 Part 1: The most likely diagnosis is testicular torsion.

 Part 2: Initial tests should include a scrotal ultrasound to confirm the diagnosis and assess the
blood flow to the affected testicle.

 Part 3: The most appropriate next step in management is to immediately perform surgical
intervention to correct the torsion and prevent testicular ischemia and necrosis.
 12. A 55-year-old female presents with a new-onset headache, blurred vision, and fatigue. What is
the most likely diagnosis? What initial tests should be ordered? What is the most appropriate
next step in management?

Answer:

 Part 1: The most likely diagnosis is giant cell arteritis.

 Part 2: Initial tests should include a complete blood count, erythrocyte sedimentation rate, and
C-reactive protein level, as well as a temporal artery biopsy to confirm the diagnosis and assess
the extent of the inflammation.

 Part 3: The most appropriate next step in management is to immediately initiate high-dose
corticosteroid therapy to reduce the inflammation and prevent vision loss, and to refer the
patient to a rheumatologist for ongoing management and monitoring.

13. A 50-year-old male presents with difficulty swallowing and weight loss. What is the most likely
diagnosis? What initial tests should be ordered? What is the most appropriate next step in
management?

Answer:

 Part 1: The most likely diagnosis is esophageal cancer.

 Part 2: Initial tests should include an upper gastrointestinal endoscopy with biopsy, CT scan of
the chest and abdomen, and a complete blood count to confirm the diagnosis and assess the
extent of the cancer.

 Part 3: The most appropriate next step in management is to refer the patient to an oncologist
for further evaluation and treatment options, which may include surgery, radiation therapy,
chemotherapy, or a combination of these treatments.

14. A 40-year-old female presents with a sudden onset of severe abdominal pain and vomiting.
What is the most likely diagnosis? What initial tests should be ordered? What is the most
appropriate next step in management?

Answer:

 Part 1: The most likely diagnosis is acute appendicitis.

 Part 2: Initial tests should include a complete blood count, urinalysis, and abdominal ultrasound
or CT scan to confirm the diagnosis and assess the severity of the inflammation.
  Part 3: The most appropriate next step in management is to perform an appendectomy as soon
as possible to prevent perforation and peritonitis.

15. A 60-year-old male presents with dyspnea, cough, and fever. What is the most likely diagnosis?
What initial tests should be ordered? What is the most appropriate next step in management?

Answer:

 Part 1: The most likely diagnosis is community-acquired pneumonia.

 Part 2: Initial tests should include a chest X-ray, complete blood count, and sputum culture to
confirm the diagnosis and determine the causative organism.

 Part 3: The most appropriate next step in management is to prescribe appropriate antibiotics
based on the suspected or confirmed organism, and to provide supportive care such as rest and
fluids to help the patient recover from the infection.

16. A 25-year-old female presents with recurrent episodes of joint pain and swelling, along with a
rash and oral ulcers. What is the most likely diagnosis? What initial tests should be ordered?
What is the most appropriate next step in management?

Answer:

 Part 1: The most likely diagnosis is systemic lupus erythematosus.

 Part 2: Initial tests should include a complete blood count, comprehensive metabolic panel,
antinuclear antibody test, and anti-double stranded DNA test to confirm the diagnosis and
assess the extent of the disease.

 Part 3: The most appropriate next step in management is to prescribe immuneosuppressive

medications such as corticosteroids or immunomodulators, and to refer the patient to a
rheumatologist for ongoing management and monitoring.

17. A 45-year-old male presents with abdominal pain and jaundice. What is the most likely
diagnosis? What initial tests should be ordered? What is the most appropriate next step in
management?

Answer:

 Part 1: The most likely diagnosis is gallstone pancreatitis.

  Part 2: Initial tests should include a complete blood count, liver function tests, abdominal
ultrasound or CT scan, and amylase and lipase levels to confirm the diagnosis and assess the
severity of the inflammation.

 Part 3: The most appropriate next step in management is to provide supportive care such as
pain management, hydration, and electrolyte balance, and to perform cholecystectomy to
remove the gallstones and prevent recurrence.

18. A 30-year-old female presents with fever, fatigue, and night sweats. What is the most likely
diagnosis? What initial tests should be ordered? What is the most appropriate next step in
management?

Answer:

 Part 1: The most likely diagnosis is tuberculosis.

 Part 2: Initial tests should include a chest X-ray, sputum culture, and tuberculin skin test or
interferon-gamma release assay to confirm the diagnosis and assess the extent of the infection.

 Part 3: The most appropriate next step in management is to prescribe a combination of

antibiotics for 6-9 months to treat the infection, and to provide supportive care such as rest and
nutrition to help the patient recover.

19. A 70-year-old male presents with rectal bleeding and changes in bowel habits. What is the most
likely diagnosis? What initial tests should be ordered? What is the most appropriate next step in
management?

Answer:

 Part 1: The most likely diagnosis is colorectal cancer.

 Part 2: Initial tests should include a colonoscopy with biopsy, CT scan of the abdomen and pelvis,
and a complete blood count to confirm the diagnosis and assess the extent of the cancer.

 Part 3: The most appropriate next step in management is to refer the patient to an oncologist
for further evaluation and treatment options, which may include surgery, radiation therapy,
chemotherapy, or a combination of these treatments.

20. A 60-year-old female presents with sudden onset of severe chest pain and shortness of breath.
What is the most likely diagnosis? What initial tests should be ordered? What is the most
appropriate next step in management?
Answer:

Part 1: The most likely diagnosis is acute myocardial infarction.

Part 2: Initial tests should include an electrocardiogram, cardiac biomarkers such as troponin levels, and
chest X-ray to confirm the diagnosis and assess the extent of the damage.

Part 3: The most appropriate next step in management is to provide emergent reperfusion therapy such
as percutaneous coronary intervention or thrombolytic therapy to restore blood flow to the affected
area of the heart, and to provide ongoing cardiac care and monitoring to prevent recurrence.

21. A 25-year-old female presents with painful urination and frequency. What is the most likely
diagnosis? What initial tests should be ordered? What is the most appropriate next step in
management?

Answer:

 Part 1: The most likely diagnosis is urinary tract infection.

 Part 2: Initial tests should include a urine culture and sensitivity to confirm the diagnosis and
identify the appropriate antibiotic for treatment.

 Part 3: The most appropriate next step in management is to prescribe antibiotics for 3-7 days
and encourage hydration to help flush out the bacteria. Symptomatic relief such as pain
management may also be recommended.

22. A 50-year-old male presents with new-onset headache and visual disturbances. What is the
most likely diagnosis? What initial tests should be ordered? What is the most appropriate next
step in management?

Answer:

 Part 1: The most likely diagnosis is giant cell arteritis.

 Part 2: Initial tests should include erythrocyte sedimentation rate, C-reactive protein, and
temporal artery biopsy to confirm the diagnosis and assess the extent of the inflammation.

 Part 3: The most appropriate next step in management is to start corticosteroid therapy
immediately to prevent irreversible vision loss and other complications. The patient should also
be referred to a rheumatologist for ongoing management and monitoring.
 23. A 35-year-old female presents with lower back pain and sciatica. What is the most likely
diagnosis? What initial tests should be ordered? What is the most appropriate next step in
management?

Answer:

 Part 1: The most likely diagnosis is herniated disc.

 Part 2: Initial tests should include a physical exam, imaging such as MRI or CT scan, and
electromyography or nerve conduction study to confirm the diagnosis and assess the extent of
nerve damage.

 Part 3: The most appropriate next step in management is to prescribe pain management,
physical therapy, and/or referral to a spine specialist for further evaluation and treatment
options such as epidural steroid injection, surgery, or other interventions.

24. A 65-year-old male presents with confusion and memory loss. What is the most likely diagnosis?
What initial tests should be ordered? What is the most appropriate next step in management?

Answer:

 Part 1: The most likely diagnosis is dementia, most commonly Alzheimer's disease.

 Part 2: Initial tests should include a comprehensive neurological and cognitive evaluation, brain
imaging such as MRI or CT scan, and laboratory tests such as thyroid function and vitamin B12
levels to rule out other possible causes.

 Part 3: The most appropriate next step in management is to provide supportive care such as
counseling, education, and social support for the patient and their caregivers. Symptomatic
treatment such as cholinesterase inhibitors or memantine may also be recommended, as well as
referral to a geriatric specialist for ongoing management and monitoring.

25. A 20-year-old male presents with acute onset of severe testicular pain and swelling. What is the
most likely diagnosis? What initial tests should be ordered? What is the most appropriate next
step in management?

Answer:

 Part 1: The most likely diagnosis is testicular torsion.

 Part 2: Initial tests should include a physical exam, ultrasound of the scrotum, and complete
blood count to confirm the diagnosis and assess the extent of tissue damage.
 Part 3: The most appropriate next step in management is emergent surgical intervention to
untwist the testicle and restore blood flow, typically within 6 hours of symptom onset to
prevent irreversible damage and loss of the testicle. Pain management may also be provided as
needed.