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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Physician Activities | 50% | - Management - Communication - Professional Behaviours - Psychosocial Aspects |
| Topic 2: Dimensions of Care | 50% | - Assessment and Diagnosis - Health Promotion and Illness Prevention - Chronic Care - Acute Care |
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NEW QUESTION # 127
A 56-year-old woman comes to your office because she has not been herself since her husband died in a car crash 6 weeks ago. She has no prior psychiatric history. Her son is concerned because she cries frequently, has a poor appetite, rarely leaves home and is distraught. Her sadness fluctuates and increases when she thinks of her husband. She often thinks about death, and she wishes she could join her deceased husband. Which one of the following is the best next step?
Answer: D
Explanation:
Her presentation at 6 weeks after a spouse's death is most consistent with acute/normal grief : intense sadness, crying, social withdrawal, reduced appetite, and waves of distress triggered by reminders of the deceased.
MCCQE objectives stress distinguishing grief from major depressive disorder by the fluctuating nature of symptoms , grief "pangs," and the link to thoughts of the deceased. Although she expresses wishing to "join" her husband, this can occur in normal bereavement; the key clinical duty is to assess safety (suicidal intent, plan, means, past attempts, protective factors). In the absence of imminent risk or psychosis, inpatient/day- hospital admission is not the default. "Reassurance" alone is insufficient because she is significantly impaired and needs structured support. The best next step is referral for bereavement-focused support (often via social work), which can provide grief counseling, coping strategies, mobilization of supports, and monitoring, and can facilitate escalation if complicated grief or major depression emerges. Family systems therapy may help later, but immediate practical and grief-specific support plus safety assessment is the priority.
NEW QUESTION # 128
A 30-year-old man comes to the office and asks you to write him a note for his employer that recommends a stress leave. He says he feels entitled to a rest. He comes across as irritable and impulsive. He appears to show little regard for the law and admits to recently embezzling $5,000 from his employer. He justifies his actions and shows no remorse. He has a history of attention-deficit/hyperactivity disorder as a child. Which one of the following is the most likely diagnosis?
Answer: A
Explanation:
This case features hallmark traits of antisocial personality disorder: disregard for social norms, criminal behavior, lack of remorse, impulsivity, and a history of conduct disorder (suggested by childhood ADHD and likely early behavioral problems).
Toronto Notes 2023 - Psychiatry, Personality Disorders:
"Antisocial personality disorder is characterized by disregard for rights of others, impulsivity, deceitfulness, lack of remorse, and criminal activity beginning in adolescence." MCCQE1 Objectives - Psychiatry > Personality Disorders:
"Candidates must distinguish antisocial personality disorder by a pattern of behavior that violates the rights of others, with evidence of conduct disorder before age 15." Other options do not explain the full behavioral pattern, especially the criminality and lack of remorse.
NEW QUESTION # 129
A 91-year-old man comes to the Emergency Department reporting blood in his stools, which has now resolved. He is able to give a history and mentions that this also happened 2 years ago. At that time, a colonoscopy was done and revealed diverticular disease as the cause. Which one of the following is the best next step?
Answer: E
Explanation:
In a patient with known diverticular bleeding and no red flags (e.g., weight loss, anemia, family history), repeating colonoscopy is not required. Diverticular bleeding is typically self-limited. Colonoscopy within the past few years with clear findings suffices.
Toronto Notes 2023 - Gastroenterology, Lower GI Bleed:
"Patients with known diverticulosis and self-limited bleeding who have had prior complete colonoscopy do not require repeat endoscopy unless symptoms recur or persist." MCCQE1 Objectives - Internal Medicine > Gastroenterology:
"Candidates must recognize when no further invasive investigation is necessary in elderly patients with known benign findings and resolved symptoms." Option E is considerate but not clinically necessary for independent patients. Options A, B, and D are not indicated in resolved, low-risk cases.
NEW QUESTION # 130
A 38-year-old man presents to the office for a follow-up visit. For several years, he has been having constant abdominal pain and intermittent constipation. He struggles to fall asleep because he is worried about his symptoms, and he often spends hours researching possible investigations and causes. Although he recently had extensive investigations, which have all had normal results, he continues to visit multiple physicians hoping for more investigations. He worries that he will die because no one is taking him seriously. Which one of the following is the best next step?
Answer: C
Explanation:
This presentation is most consistent with somatic symptom disorder/illness anxiety : persistent distressing physical symptoms (abdominal pain/constipation) with excessive health-related anxiety, repeated reassurance- seeking, and "doctor shopping" despite normal investigations. MCCQE objectives emphasize avoiding iatrogenic harm from repeated testing and using a structured, therapeutic relationship to manage medically unexplained or disproportionate symptom concerns. The best next step is regularly scheduled follow-up visits with one consistent physician (e.g., monthly), focused on validating symptoms, addressing fears, monitoring for new objective findings, and gradually shifting toward coping strategies and functional goals. This approach reduces unnecessary investigations, reinforces continuity, and helps interrupt the cycle of anxiety- driven health-care utilization.
Repeating investigations (B) perpetuates reassurance-seeking and increases false positives and harm.
Consulting additional specialists (A) without new red flags similarly reinforces maladaptive beliefs and fragmentation of care. Exercise (D) may be beneficial as an adjunct but is not the core management strategy.
Therefore, planned, regular appointments are the most appropriate next step.
NEW QUESTION # 131
A 72-year-old man presents to your office with reports of a hard lump slowly enlarging in the right inguinal area. He is otherwise healthy. Which one of the following is most likely to reveal the cause of his lump?
Answer: E
Explanation:
A slowly enlarging, hard inguinal "lump" in an older adult is concerning for inguinal lymphadenopathy or an inguinal hernia , and MCCQE objectives emphasize targeted examination of the regional drainage areas to identify a primary source. Inguinal lymph nodes receive lymphatic drainage from the external genitalia and scrotal skin , perineum, and lower abdominal wall and lower extremity. Therefore, careful genital examination
-including the testicles/scrotum-can reveal common underlying causes such as skin malignancy of the scrotum , penile/scrotal lesions, chronic infection, or other local pathology that would explain a hard inguinal node.
Digital rectal examination assesses the prostate and rectum, whose lymphatic drainage is primarily to pelvic nodes rather than superficial inguinal nodes, making it less likely to identify the cause here. Palpation of liver or spleen looks for systemic malignancy/hematologic disease but is less likely to reveal the cause of a unilateral inguinal mass. Sexual history may suggest STI-related nodes, but these are typically tender and acute; a focused physical exam is more likely to reveal the etiology.
NEW QUESTION # 132
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