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| Section | Objectives |
|---|---|
| Topic 1: Physician Activities | - Communication
|
| Topic 2: Dimensions of Care | - Chronic Care
|
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NEW QUESTION # 154
A 66-year-old woman has a 3-month history of dry cough and weight loss. A new chest radiograph reveals a large 2-cm mass in her right upper lobe, which is consistent with carcinoma. You look at her previous films and realize that you had read her chest radiograph as normal 1 year ago, but now clearly see a faint opacity in precisely the same location as her current lesion. Which one of the following is the best next step?
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
Physicians must be transparent and honest in documentation. If a previous abnormality was missed, it must be acknowledged. The correct action is to comment on both the previous and current findings in your report and follow institutional disclosure policies.
Toronto Notes 2023 - ELOM, "Medical Error and Disclosure":
"Physicians must report and document prior missed findings honestly and provide full disclosure when reviewing comparative studies." MCCQE1 Objectives (ELOM > 90-2: Accountability and Communication):
"Candidates must accurately document previous findings when reviewing comparative data, even if it reveals past oversight." Delaying reporting (C-E) or omitting prior findings (A) is unethical.
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NEW QUESTION # 155
A 14-year-old girl, accompanied by her mother, presents to your office with a 3-month history of feeling " dizzy. " After you take an initial history, which one of the following is the most appropriate next step?
Answer: C
Explanation:
In adolescents presenting with vague or potentially sensitive symptoms, it is critical to speak with them alone to obtain a complete and honest history, including mental health, sexual activity, substance use, and abuse screening.
Toronto Notes 2023 - Pediatrics, Adolescent Medicine:
"Private interviews are essential to obtain accurate histories in adolescents, especially when symptoms may have underlying psychosocial or reproductive causes." MCCQE1 Objectives - Pediatrics > Adolescent Health:
"Candidates must demonstrate adolescent-appropriate interviewing techniques, including private questioning to identify sensitive or risk-related concerns." Physical examination and pregnancy testing (A, B, D) may follow based on the private history. Vital signs (E) are standard but do not replace psychosocial assessment.
NEW QUESTION # 156
A 27-year-old woman presents to her family physician's office and states that she is pregnant and would like to be referred for an abortion. She is at approximately 9 weeks' gestation by dates. The family physician has personal conscience-based objections to the procedure. Which one of the following would be the best next step for this physician?
Answer: B
Explanation:
Physicians in Canada who have conscientious objections to procedures such as abortion are legally and ethically required to make an effective referral to another provider or service that can offer the treatment. The provider must not delay access to care.
Toronto Notes 2023 - ELOM, "Conscientious Objection":
"A physician who objects to providing a service for reasons of conscience must make an effective referral to another provider or agency." MCCQE1 Objectives (ELOM > Professionalism > 90-1):
"Candidates must recognize the obligation to refer patients for services they themselves will not provide due to personal or religious beliefs." Delaying care (C), imposing personal beliefs (A), or suggesting alternatives like adoption (D) is inappropriate and may violate patient autonomy.
NEW QUESTION # 157
A 25-year-old nulligravida woman presents after trying to conceive for 2 years without success. She is healthy, with regular menstrual periods. She denies any unusual hair growth, weight changes, or breast discharge. She gets occasional outbreaks of acne. Blood work done with her next menstrual period produces the following results:
Follicle-stimulating hormone, follicular phase: 6.2 U/L (5.0-20.0) on day 3 of menstrual cycle Luteinizing hormone, follicular phase: 6 U/L (5-22) on day 3 of menstrual cycle Estradiol: 163 pmol/L (50-200) on day 15 of menstrual cycle Thyrotropin (thyroid-stimulating hormone): 2.5 mU/L (0.4-5.0) Prolactin: 40 µg/L (4-30) Given the results of her blood work, which one of the following is the best next step?
Answer: B
Explanation:
This patient meets the definition of infertility (no conception after 12 months; here 2 years). Her day-3 FSH
/LH and mid-cycle estradiol are within expected ranges, and TSH is normal, making thyroid disease unlikely.
The key abnormality is elevated prolactin (40 µg/L) . MCCQE objectives emphasize identifying reversible endocrine causes of infertility: hyperprolactinemia can impair fertility by disrupting hypothalamic GnRH pulsatility and ovulatory function, and treatment improves pregnancy rates. The appropriate next management is a dopamine agonist (e.g., bromocriptine) to lower prolactin and restore normal reproductive axis function.
Pituitary MRI is generally reserved for marked or persistent elevations suggestive of prolactinoma (often much higher levels) or when there are neurologic symptoms (e.g., headaches, visual field defects). IVF is not first-line when a treatable endocrine abnormality is present. Mammography is unrelated to mild hyperprolactinemia without breast findings. Treating the elevated prolactin addresses a likely contributor before proceeding to more invasive fertility interventions.
NEW QUESTION # 158
A 27-year-old woman, gravida 2, para 1, aborta 0, presents to the office seeking guidance on the management of her baby once it is born. The patient is in renal failure and has been taking methadone for 3 years to manage her opioid use disorder. During her pregnancy, she has been taking a stable dose of 80 mg of methadone once daily. Which one of the following is the most appropriate next step?
Answer: B
Explanation:
Methadone maintenance therapy during pregnancy is the recommended treatment for opioid use disorder and should be continued at a stable dose. However, regardless of maternal dose stability, neonates are at significant risk of neonatal abstinence syndrome (NAS) due to in utero opioid exposure. MCCQE objectives emphasize anticipatory guidance and appropriate newborn monitoring in substance-exposed pregnancies.
Symptoms of NAS (irritability, tremors, poor feeding, vomiting, diarrhea, seizures) typically begin within 24-
72 hours after birth but may be delayed with long-acting opioids such as methadone. Therefore, routine observation in hospital for at least 72 hours is recommended to monitor for withdrawal and initiate supportive or pharmacologic treatment if needed.
Naloxone is contraindicated in opioid-dependent neonates except in life-threatening respiratory depression because it may precipitate severe withdrawal. Stable maternal dosing does not eliminate NAS risk, so early discharge is inappropriate. Breastfeeding is generally encouraged in stable methadone-maintained mothers, as methadone transfer in breast milk is minimal and may reduce withdrawal severity. Continuing methadone during pregnancy is safer than untreated opioid use.
NEW QUESTION # 159
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