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| Section | Objectives |
|---|---|
| Dimensions of Care | - Chronic Care
|
| Physician Activities | - Assessment
|
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NEW QUESTION # 284
A 12-year-old boy initially presents with a 4-month history of left knee pain. He denies any obvious history of trauma, but he plays basketball frequently and notes his pain is worse after playing. On physical examination the patient has a prominent tibial tubercle, which is swollen and tender. There is full range of motion in the knee. A radiograph of the left knee reveals an ossicle anterior to the tibial tuberosity. Which one of the following is the most likely diagnosis?
Answer: A
Explanation:
Comprehensive and Detailed Explanation:
Osgood-Schlatter disease is a traction apophysitis of the tibial tubercle due to repetitive stress from the quadriceps during growth. It is common in active adolescents and presents with a tender, prominent tibial tuberosity and typical radiographic findings.
Toronto Notes 2023 - Pediatrics / MSK:
"Osgood-Schlatter disease presents with localized pain at the tibial tuberosity in adolescents involved in sports. X-ray may show ossicle or fragmentation." MCCQE1 Objectives (Pediatrics > 78-2: MSK Injuries and Overuse):
"Candidates must identify overuse syndromes like Osgood-Schlatter and distinguish from infections or malignancy." Osteomyelitis (A) is systemic. Osteosarcoma (B) causes deep pain, often at night. Chondromalacia (C) affects anterior knee and worsens with stairs. Patellar tendinitis (D) affects the inferior pole of patella, not tibial tubercle.
NEW QUESTION # 285
A 9-year-old girl is brought to the Emergency Department because she has generalized urticaria, abdominal cramping, and postural dizziness 30 minutes after eating at a friend's birthday party. Which one of the following is the most appropriate route of administration for epinephrine?
Answer: D
Explanation:
Anaphylaxis requires immediate administration of epinephrine via the intramuscular (IM) route, typically in the lateral thigh. This route provides the fastest and most reliable absorption for emergency treatment.
Toronto Notes 2023 - Pediatrics, Anaphylaxis:
"Epinephrine 0.01 mg/kg IM is the first-line treatment for anaphylaxis. The intramuscular route provides the most rapid and safe absorption in emergencies." MCCQE1 Objectives - Pediatrics > Allergy and Immunology:
"Candidates must know the emergency management of anaphylaxis, including proper dosage and intramuscular administration of epinephrine." IV administration (A) is reserved for critical care settings. Subcutaneous (C) and intranasal/inhaled routes (D, E) are ineffective in anaphylaxis.
NEW QUESTION # 286
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 # 287
A 3-year-old boy is brought to your office because his daycare teachers are concerned about his language development. His parents speak both English and French at home, and he can say around 15 words combined in both languages. His history reveals that he has minimal interest in playing with other children. Which one of the following is most appropriate?
Answer: A
Explanation:
A limited vocabulary (fewer than 50 words by age 2-3 years) and reduced social interaction (limited interest in peers) raise concern for autism spectrum disorder (ASD). Screening for ASD is the most appropriate next step.
Toronto Notes 2023 - Pediatrics, Development and Behaviour:
"Red flags for autism include delayed language, limited social reciprocity, and poor peer interaction.
Screening should be initiated early when clinical signs are present."
MCCQE1 Objectives - Pediatrics > Developmental Disorders:
"Candidates must identify key signs of ASD and initiate appropriate screening and early intervention." Multilingual households do not typically cause such delays (E is incorrect). ADHD (B) presents with attention
/hyperactivity issues, not language/social delay. Reassurance (A) is inappropriate. Neurology referral (C) may follow but is not first-line.
NEW QUESTION # 288
A 72-year-old man reports that his wife says he has hearing trouble. Examination reveals that air conduction on the right side is less than on the left side and greater than bone conduction bilaterally. He hears a tuning fork placed on the top of his head better with his left ear. Which one of the following is the most appropriate next step in management?
Answer: E
Explanation:
The patient demonstrates signs of asymmetric sensorineural hearing loss (SNHL). In Weber test, sound localizes to the better ear in SNHL. Air conduction > bone conduction on Rinne test bilaterally supports SNHL. Audiometry is the best next diagnostic step to quantify and characterize the hearing loss.
Toronto Notes 2023 - ENT, "Hearing Loss":
"Audiometry is the first-line investigation to distinguish conductive from sensorineural hearing loss and to assess severity and frequency involvement." MCCQE1 Objectives (Medicine > ENT > 20-1):
"Candidates must know the approach to hearing loss and interpret Weber and Rinne tests to guide investigations such as audiometry." Imaging (A, C) is reserved for red flags such as unilateral persistent SNHL, which may later prompt MRI to rule out acoustic neuroma. Wax removal (D) is for conductive loss. Hearing aids (E) are management, not diagnostic, and come after audiologic evaluation.
NEW QUESTION # 289
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