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| Section | Objectives |
|---|---|
| Physician Roles (CanMEDS Framework) | - Medical Expert
|
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NEW QUESTION # 338
A 53-year-old man with a history of bipolar I disorder is brought to the office by his family. Recently, he has been sleeping for 4 to 5 hours per night, has been fidgety, and is increasinglypreoccupied with his granddaughter's safety. Five days ago, he consulted with your physician colleague and was instructed to exercise and meditate. Last night, he was found running in the street and attempted to hit a relative who was trying to calm him down. His son is dissatisfied with your physician colleague's management. Which one of the following is the most appropriate response?
Answer: C
Explanation:
The most appropriate and professional response is to focus on the current clinical situation and reassure the family that you will take responsibility for assessment and treatment. Criticizing a colleague (A, B, E) or deflecting to generalities (D) is unprofessional and unhelpful in crisis management.
Toronto Notes 2023 - Psychiatry, Physician-Patient-Family Communication:
"In emotionally charged or crisis situations, the physician must remain focused, empathetic, and professional.
Avoid blaming colleagues; instead, offer a concrete plan of care."
MCCQE1 Objectives - Psychiatry > Ethics and Professionalism:
"Candidates must demonstrate professionalism in managing conflicts, focusing on patient care while maintaining collegial respect."
NEW QUESTION # 339
A 26-year-old man presents to the office with a tender mass in his right neck. He was recently treated for a dental infection but is otherwise well. On examination, there is a 2-cm tender, mobile lymph node in the right anterior cervical chain. No other lymphadenopathy or abnormalities are found on physical examination.
Which one of the following is the best next step?
Answer: A
Explanation:
A tender, mobile lymph node following a recent localized infection (e.g., dental infection) is most likely reactive. In a young, otherwise well patient with no systemic symptoms or concerning features, observation is appropriate.
Toronto Notes 2023 - Internal Medicine, Lymphadenopathy:
"In patients with localized lymphadenopathy and a recent infection, observation for 4-8 weeks is often appropriate before further investigation." MCCQE1 Objectives - Internal Medicine > Hematology:
"Candidates should recognize benign features of lymphadenopathy (tender, mobile, <2 cm, localized) and manage conservatively unless red flags are present." Biopsy (B) and imaging (C, E) are premature. Bone marrow biopsy (D) is not relevant.
NEW QUESTION # 340
A 38-year-old woman has progressive renal failure despite optimal medical treatment for her glomerulonephritis. Her ex-husband asks if he might be considered as a kidney donor. They have joint custody of their 10-year-old son. Which one of the following is the best response to the ex-husband's request?
Answer: B
Explanation:
Living kidney donation is based on voluntary, informed consent and thorough medical and psychosocial evaluation of the donor. MCCQE ELOM objectives emphasize respect for autonomy and avoidance of unjustified discrimination. An ex-spouse may be considered as a potential donor if he meets medical criteria and demonstrates informed, voluntary decision-making free of coercion. Marital status or divorce is not a valid reason to exclude someone from donor assessment.
Concerns about the welfare of their child are important but are addressed during the standard donor evaluation process, which includes psychosocial assessment and discussion of risks. Donation cannot be automatically refused on speculative grounds. Instead, transplant programs conduct rigorous screening to ensure donor safety and voluntariness.
Therefore, the appropriate response is to allow him to proceed with formal donor assessment , where suitability, risks, motivations, and support systems will be evaluated comprehensively before any final decision is made.
NEW QUESTION # 341
Which one of the following bodies decides whether a physician is permitted to practise medicine in a province or territory?
Answer: D
Explanation:
Comprehensive and Detailed Explanation:
The authority to license and regulate physicians to practise medicine is held by the medical regulatory colleges in each province or territory (e.g., CPSO in Ontario, CPSBC in BC).
MCC Objectives (ELOM > 90-1: Medical Regulation in Canada):
"Licensure to practise medicine is granted by the provincial or territorial medical regulatory authority." Toronto Notes 2023 - Ethics and Canadian Health Care System:
"Medical regulatory colleges determine physician licensure and discipline in each jurisdiction." The CFPC/RCPSC (C) certify physicians, not license them. Ministries of Health (A) oversee health policy, not licensing. Associations (E) advocate for physicians but do not regulate. Hospital boards (B) grant privileges, not licenses.
NEW QUESTION # 342
A 72-year-old man presents to your clinic with worsening lower leg edema. He has hypertension, type 2 diabetes, and a history of heavy drinking. On examination, he is pale and has a BMI of 35. Vital signs are as follows:
Blood pressure: 110/60 mm Hg
Heart rate: 102/min
Temperature: Afebrile
His jugular venous pressure is 4 cm above the sternal angle. Cardiac auscultation is normal, and his lungs are clear. His liver is not palpable; he has abdominal distension, bulging flanks, and pitting edema below the knees. While awaiting test results, which one of the following is the best next step?
Answer: A
Explanation:
This patient has signs suggestive of decompensated liver cirrhosis (ascites, peripheral edema, low-normal BP, alcohol use, abdominal distension). Sodium restriction is the cornerstone of first-line management to prevent fluid retention in cirrhotic ascites.
Toronto Notes 2023 - Gastroenterology, "Cirrhosis and Ascites" Section:
"Sodium restriction (<2 g/day) is the most important non-pharmacologic management for ascites. Fluid restriction is added only in cases of severe hyponatremia." MCCQE1 Objectives (Internal Medicine > 76-5: Liver Disease):
"Candidates must manage ascites conservatively using sodium restriction, with diuretics added as needed." Lactulose (E) is used for hepatic encephalopathy, not ascites. Ramipril (B) may worsen renal function in cirrhosis. Nadolol (C) is used for variceal bleeding prophylaxis. Compression stockings (D) are not helpful in ascites-related edema.
NEW QUESTION # 343
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