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| Section | Weight | Objectives |
|---|---|---|
| Physician Activities | 50% | - Management - Professional Behaviours - Psychosocial Aspects - Communication |
| Dimensions of Care | 50% | - Assessment and Diagnosis - Acute Care - Health Promotion and Illness Prevention - Chronic Care |
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NEW QUESTION # 342
An 80-year-old woman presents to your office with weight loss and generalized weakness. Her husband calls you after the appointment and asks that his wife not be told if she is diagnosed with cancer as hearing this will likely "kill her." Investigations subsequently show that she has metastatic lung cancer. Which one of the following is the best next step?
Answer: E
Explanation:
According to Canadian medical ethics and legal standards, physicians mustcommunicate diagnosis and treatment options directly to the patient, unless the patient hasexplicitly waived their right to knowor delegated decision-making authority. The patient's autonomy is paramount.
Toronto Notes 2023 - Ethical, Legal, and Organizational Medicine, "Truth-Telling" Section:
"Physicians are obligated to disclose relevant health information to patients unless the patient has clearly indicated a desire not to be informed. Family members do not have the authority to request that information be withheld from a competent adult." MCCQE1 Objectives (ELOM > Ethical Issues > Medical Ethics):
"The candidate must be able to apply the principles of patient autonomy... This includes full disclosure of diagnosis, prognosis, and treatment options unless waived by the patient." Booking an immediate appointment (C) allows you to assess her decision-making capacity and proceed with informed discussion. The other options either bypass the patient (A, B, E) or provide misleading/incomplete information (A, D), which violates ethical and legal obligations.
NEW QUESTION # 343
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: D
NEW QUESTION # 344
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 # 345
A 34-year-old woman, gravida 3, para 2, aborta 0, presents at 38 weeks' gestation. She is in early labor with ruptured membranes. Her previous pregnancy was complicated by fever during labor. Which one of the following would increase the risk of fever recurrence?
Answer: A
Explanation:
Comprehensive and Detailed Explanation:
Epidural analgesia is associated with increased maternal intrapartum fever due to non-infectious(neurogenic) thermoregulation impairment. This is a well-known phenomenon in laboring women.
Toronto Notes 2023 - Obstetrics / Anesthesia:
"Epidural analgesia increases risk of intrapartum fever by up to 20% via non-infectious mechanisms." MCCQE1 Objectives (Obstetrics > 80-5: Intrapartum Care):
"Candidates must recognize risk factors for intrapartum complications, including effects of epidural use." Multiparity (A), precipitous labor (B), and maternal age (C) are not established risk factors for intrapartum fever.
NEW QUESTION # 346
A 42-year-old woman, gravida 2, para 2, aborta 0, comes to the office for the first time. She reports a 6-month history of thirst, urinary frequency, and recurrent vaginitis. Aside from a BMI of 28, her physical examination findings are unremarkable. She takes no medications. Which one of the following would support the most likely diagnosis?
Answer: A
Explanation:
This patient's symptoms of polyuria, polydipsia, and recurrent vaginitis are classic for type 2 diabetes mellitus (T2DM) . Recurrent vaginal candidiasis occurs due to glycosuria promoting yeast overgrowth. MCCQE objectives emphasize identifying risk factors and historical features supporting diabetes. A prior delivery of a macrosomic infant ( > 4000-4500 g) is strongly associated with gestational diabetes mellitus (GDM) , which significantly increases the future risk of developing T2DM. Therefore, a history of macrosomia supports undiagnosed or previous gestational hyperglycemia and increases suspicion for current diabetes.
High-risk sexual behaviors relate to sexually transmitted infections, not diabetes. Family history of hypertension is a cardiovascular risk factor but does not specifically support diabetes. Recent antibiotic use may predispose to candidiasis but would not explain polyuria and polydipsia. Dry eyes are more suggestive of autoimmune conditions (e.g., Sjogren syndrome).
Thus, prior delivery of a macrosomic newborn strengthens the likelihood that her current symptoms are due to type 2 diabetes mellitus.
NEW QUESTION # 347
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