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| Section | Objectives |
|---|---|
| Physician Roles (CanMEDS Framework) | - Health Advocate
|
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NEW QUESTION # 218
An 18-year-old man presents to your clinic with a history of intermittent, dull, achy pain on the left side of his scrotum, and he has now noted left scrotal enlargement. On examination, you note a swelling in the left scrotum when he is standing that disappears when he is supine. Which one of the following is the most likely diagnosis?
Answer: C
Explanation:
A varicocele is a dilatation of the pampiniform plexus that presents with a "bag of worms" appearance, worsens with standing, and improves when lying down. It is most common on the left side due to anatomical drainage differences.
Toronto Notes 2023 - Urology, Scrotal Disorders:
"Varicoceles often present with a dull, aching pain and scrotal swelling that worsens when upright and disappears when supine." MCCQE1 Objectives - Internal Medicine > Urology:
"Candidates must recognize and diagnose varicocele by physical exam findings and typical symptom history." Cryptorchidism (A) refers to undescended testes. Torsion (B) presents acutely with severe pain. Hydrocele (C) transilluminates and is not posture-dependent. "Spermatocyte" (D) is not a clinical diagnosis.
NEW QUESTION # 219
A 37-year-old man presents with chronic back, neck, and shoulder pain following a workplace injury 4 years ago. He has a history of alcohol misuse and PTSD related to the incident. Current medications (acetaminophen, naproxen, amitriptyline, gabapentin) provide inadequate pain relief. He requests oxycodone after self-trialing it with temporary benefit. After history and physical assessment, which one of the following is the best next step?
Answer: E
Explanation:
The patient has chronic non-cancer pain with comorbid PTSD and alcohol misuse - high-risk factors for opioid use disorder. Before any opioid prescribing, a comprehensive interdisciplinary approach including mental health and substance use support is essential.
Toronto Notes 2023 - Pain Management and Addiction Medicine:
"In chronic pain patients with substance use or mental health comorbidities, refer to addiction/mental health services before considering opioid therapy." MCCQE1 Objectives (ELOM > 99-4: Safe Prescribing):
"Candidates must assess for substance use risk factors and manage chronic pain using a multidisciplinary approach." Imaging (A) is unlikely to alter management. Opioids (B, C) should not be first-line in this context. Cannabis (E) is not first-line and lacks robust evidence in complex chronic pain.
NEW QUESTION # 220
A 32-year-old woman presents to the office with questions related to the mRNA vaccines that are approved for COVID-19. She is a health care worker. She gave birth to a healthy child 2 months ago. Before being immunized, which one of the following is the most important detail to elicit from the patient's history?
Answer: A
Explanation:
The most important pre-vaccination history to elicit is any previous anaphylaxis to vaccine components.
mRNA COVID-19 vaccines (e.g., Pfizer-BioNTech and Moderna) may contain polyethylene glycol (PEG), a potential allergen. This is a contraindication to administration.
Toronto Notes 2023 - Infectious Disease & Immunization Chapter:
"Absolute contraindications to mRNA COVID-19 vaccination include a documented anaphylactic reaction to a component of the vaccine such as polyethylene glycol (PEG)." MCCQE1 Objectives - Population Health > Preventive Medicine > Immunizations:
"The candidate must be able to assess for contraindications prior to immunization, including anaphylaxis to previous vaccines or components." Breastfeeding and occupational exposure (Options B and D) do not preclude vaccination. Current immunosuppression (Option C) may affect vaccine efficacy but is not a contraindication unless specifically advised.
NEW QUESTION # 221
A 3-month-old girl is brought by her parents to the emergency department with a 3-day history of cough, coryza, and low-grade fever; she was previously well. In the last 24 hours, she has been noted to have rapid breathing with audible wheezing. Which one of the following pathogens is the most likely cause of the patient' s symptoms?
Answer: D
Explanation:
This presentation is most consistent with acute bronchiolitis, which classically affects infants under 2 years (peak 2-6 months) and begins with upper respiratory symptoms (coryza, cough, low-grade fever) followed by increased work of breathing, tachypnea, and wheeze. The most common causative agent is respiratory syncytial virus (RSV), making it the best answer. Parainfluenza virus is more strongly associated with croup (barking cough, inspiratory stridor, hoarseness). Chlamydia trachomatis pneumonia typically occurs in young infants with a staccato cough, afebrile course, and may be associated with conjunctivitis rather than acute wheezing after coryza. Human metapneumovirus can cause bronchiolitis-like illness but is less common than RSV. Influenza A often produces higher fever and systemic symptoms and is not the leading cause of bronchiolitis in this age group. MCCQE objectives emphasize recognizing bronchiolitis clinically and identifying RSV as the predominant pathogen in infants with this classic progression of symptoms.
NEW QUESTION # 222
An infrastructure engineer in an AI factory has successfully replaced a power supply unit on an NVIDIA DGX H100. After installation, both the IN and OUT LEDs on the new power supply illuminate solid green.
Which NVSM CLI command should the engineer use to quickly verify the overall system status and ensure it is operating as expected?
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
The NVIDIA System Management (NVSM) tool is the definitive CLI utility for monitoring the health of DGX platforms. While replacing a PSU (Power Supply Unit) is a common maintenance task, verifying that the new component is correctly integrated into the system's health model is mandatory. While `nvsm show power` would provide specific data regarding wattage and voltage for the PSU, the most comprehensive way to ensure the replacement hasn ' t caused secondary issues or that the system hasn ' t remained in a " Degraded
" state is to run `nvsm show health`. This command performs a global check across all subsystems: GPUs, NVLink switches, storage, fans, and power. If the PSU replacement was successful and the system is back to full redundancy, `nvsm show health` will return a " Healthy " status. In an AI factory setting, where DGX H100 nodes pull significant power, ensuring that all 6 PSUs (in an N+N or N+1 configuration) are not only physically green but logically acknowledged by the Baseboard Management Controller (BMC) is critical for preventing unexpected shutdowns during high-load training iterations.
NEW QUESTION # 223
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