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| Section | Objectives |
|---|---|
| Physician Roles (CanMEDS Framework) | - Professional
|
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NEW QUESTION # 165
A 38-year-old man is brought by his wife to the Emergency Department with fatigue, dizziness, and nausea after completing a hiking tour on a hot, humid day. His wife became worried after he had collapsed. He has been sweating heavily and vomited twice on the drive in. His medical history is unremarkable, and he takes no medications. His vital signs on arrival are as follows:
Blood pressure
85/57 mm Hg
Heart rate
120/min
Respiratory rate
18/min
Temperature
40.1 °C
Oxygen saturation
95%, room air
-
On physical examination, the patient's skin is dry, flushed, and warm to the touch. He has a diffuse erythematous papular rash. Findings of a thorough physical examination are otherwise unremarkable. An electrocardiogram shows sinus tachycardia. Which one of the following is the best next step?
Answer: B
Explanation:
This patient has classic features of exertional heat stroke-hyperthermia, hypotension, CNS symptoms (collapse), and hot, dry skin. A key complication of heat stroke is rhabdomyolysis, which can cause renal failure. Serum creatine kinase (CK) is the best next diagnostic step to confirm muscle breakdown.
Toronto Notes 2023 - Emergency Medicine, "Environmental Exposures":
"In heat stroke, check for rhabdomyolysis (#CK), renal impairment, and coagulopathy. Prompt cooling and hydration are critical." MCCQE1 Objectives (Internal Medicine > 59-3: Environmental and Toxic Exposures):
"Candidates must recognize heat-related illnesses and investigate for complications such as rhabdomyolysis and acute kidney injury." CT head (C) is not indicated unless persistent neurological symptoms. TSH (B), CRP (D), and blood cultures (E) are irrelevant to acute exertional hyperthermia.
NEW QUESTION # 166
An 85-year-old man is transferred from an acute care hospital to your long-term care (LTC) facility after treatment for a hip fracture. He has a fever, headache, myalgia, and malaise. He has been in contact with LTC staff and family but not with other residents. None of the other residents or LTC staff are symptomatic. As additional investigations are being arranged, which one of the following is the best next step?
Answer: A
Explanation:
This elderly resident presents with symptoms suggestive of influenza or another respiratory viral illness shortly after admission to a long-term care (LTC) facility. MCCQE population health objectives emphasize early outbreak prevention in institutional settings. The first and most immediate step when a potentially contagious illness is identified is to isolate the symptomatic individual using appropriate droplet and contact precautions.
Prompt isolation reduces the risk of transmission to other vulnerable LTC residents, who are at high risk of severe complications. Additional steps-such as notifying public health authorities or closing the facility-are considered if an outbreak is confirmed or multiple cases occur. At this stage, there is only a single symptomatic patient.
Immunization during an acute febrile illness is not appropriate and would not provide immediate protection.
Therefore, immediate isolation while arranging diagnostic testing and monitoring for additional cases is the correct infection prevention and control measure.
NEW QUESTION # 167
A 10-day-old boy is brought to the Emergency Department with a fever. The newborn looks well. Other than a rectal temperature of 38.6 °C, findings of the physical examination are unremarkable. When you list all the recommended testing their baby will have to undergo, the parents become upset at all the testing their baby will have to undergo. Which one of the following is the best approach?
Answer: C
Explanation:
A febrile neonate (#28 days old) requires a full sepsis evaluation (e.g., blood cultures, urine testing, lumbar puncture) because of the high risk of serious bacterial infection despite a well appearance. MCCQE objectives emphasize both appropriate medical management and effective communication with parents. When caregivers are distressed about painful procedures, the best approach is empathetic communication and reassurance that adequate analgesia and comfort measures (e.g., topical anesthetic, oral sucrose, swaddling) will be provided.
Threatening child protection involvement is inappropriate unless there is clear refusal of life-saving care after thorough discussion. Saying the infant "will not remember" dismisses parental concerns and undermines trust.
Proceeding without addressing concerns violates principles of shared decision-making. Excluding parents from procedures may increase anxiety and is not routinely recommended.
The physician should acknowledge concerns, explain the rationale for testing (risk of occult sepsis), outline pain-control strategies, and invite questions. This maintains trust while ensuring timely, evidence-based care.
NEW QUESTION # 168
A 54-year-old man presents to the office because of progressively severe frontal headaches that are worse in the morning. He also has a chronic productive cough. He has a 30 pack-year history of smoking tobacco cigarettes. His blood pressure is 160/95 mm Hg. Which one of the following is the best next step?
Answer: E
Explanation:
This presentation has "red flags" for raised intracranial pressure: headaches that are progressive, worse in the morning, and worsened by coughing/valsalva. In MCCQE objectives, these features require urgent evaluation for secondary causes (e.g., intracranial mass, hemorrhage, obstructive hydrocephalus) rather than empiric treatment for primary headache. His chronic cough and heavy smoking increase concern for an underlying malignancy with possible brain metastasis or paraneoplastic processes, further strengthening the indication for neuroimaging. Therefore, the best next step is CT head (often the fastest initial test to identify mass effect, hemorrhage, or hydrocephalus; MRI may follow depending on findings).
Treating presumed migraine with a triptan is inappropriate when secondary headache is possible and could also pose vascular risk. His blood pressure is elevated but not in a hypertensive emergency and does not explain these classic intracranial pressure features; serial BP monitoring or starting antihypertensives should not delay imaging. Temporal arteritis is less likely without temporal tenderness, jaw claudication, visual symptoms, or systemic inflammatory clues.
NEW QUESTION # 169
A 25-year-old woman who is at 8 weeks ' gestation plans to travel to rural Cambodia to care for her ill mother. Which one of the following treatments should be provided to her before the trip?
Answer: D
Explanation:
Comprehensive and Detailed Explanation:
Travel to rural Cambodia poses a high risk of malaria, which can be life-threatening in pregnancy.
Antimalarial prophylaxis is strongly recommended for pregnant women traveling to endemic regions.
Chloroquine or mefloquine (depending on resistance patterns) may be used in pregnancy under specialist guidance.
Toronto Notes 2023 - Infectious Disease / Travel Medicine:
"Malaria prophylaxis is indicated in pregnant women traveling to endemic regions. The risk of severe malaria and poor fetal outcomes is high." MCCQE1 Objectives (Public Health > 65-3: Travel Medicine and Pregnancy):
"Candidates must provide preventive care to pregnant travelers including vaccination and malaria prophylaxis." Tetanus boosters (D) are given every 10 years. Hep B Ig (B) is for acute post-exposure prophylaxis.
Ciprofloxacin (C) is contraindicated in pregnancy.
NEW QUESTION # 170
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