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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Dimensions of Care | 50% | - Health Promotion and Illness Prevention - Chronic Care - Acute Care - Assessment and Diagnosis |
| Topic 2: Physician Activities | 50% | - Communication - Management - Professional Behaviours - Psychosocial Aspects |
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NEW QUESTION # 332
A 42-year-old woman presents to your clinic requesting an increase in her stimulant dosage for the treatment of her adult attention-deficit/hyperactivity disorder. Her medical history includes hypertension and type 1 diabetes with associated nephropathy. She has been taking methylphenidate daily for 15 years. Which one of the following would need to be addressed before the dosage can be increased?
Answer: B
Explanation:
Stimulants like methylphenidate can increase heart rate and blood pressure. In patients with cardiovascular risk (e.g., hypertension, nephropathy), stimulants should not be increased without first addressing elevated blood pressure.
Toronto Notes 2023 - Psychiatry, "ADHD in Adults":
"Stimulants can exacerbate hypertension and must be used cautiously. Evaluate cardiovascular risk factors and control blood pressure before dose increases." MCCQE1 Objectives (Psychiatry > 71-1: ADHD):
"Candidates must consider the cardiovascular risks of stimulant therapy and monitor for hypertension prior to adjusting doses." While poor glycemic control (B) and renal disease (A) are important, BP control is most critical for immediate stimulant safety.
NEW QUESTION # 333
A 4-year-old boy is brought by his parents to your walk-in clinic with a 3-week history of fatigue, bruising, and intermittent fever. He was previously healthy. Physical examination reveals hepatosplenomegaly and petechiae. His complete blood count shows the following:
Platelet count, blood: 15.0 × 10#/L (206.4-443.3)
White blood cell (WBC) count, blood: 1.0 × 10#/L (4.7-13.5)
Hemoglobin (Hgb), blood: 70 g/L (105-135)
Which one of the following is the most likely diagnosis?
Answer: C
Explanation:
This child has pancytopenia (severe thrombocytopenia, leukopenia, and anemia) plus systemic symptoms (fatigue, intermittent fever) and hepatosplenomegaly, strongly suggesting bone marrow failure/infiltration, most commonly acute lymphoblastic leukemia (ALL) in this age group. MCCQE objectives emphasize recognizing red flags for childhood malignancy: unexplained bruising/petechiae from thrombocytopenia, recurrent or persistent fever, pallor, and organomegaly due to leukemic infiltration or extramedullary hematopoiesis.
Immune thrombocytopenia typically causes isolated thrombocytopenia with otherwise normal hemoglobin and WBC count and usually no hepatosplenomegaly. Iron deficiency anemia causes microcytic anemia but does not explain profound thrombocytopenia and leukopenia. Viral illness may transiently suppress counts but is less likely to cause marked pancytopenia with significant organomegaly. Bacterial sepsis can cause thrombocytopenia but usually presents with acute toxicity and does not typically produce this pattern of sustained pancytopenia and hepatosplenomegaly.
Next steps (clinically) would include urgent peripheral smear, oncology referral, and bone marrow evaluation.
NEW QUESTION # 334
Which one of the following bodies decides whether a physician is permitted to practise medicine in a province or territory?
Answer: E
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 # 335
A 1-week-old boy born at full term is brought by his parents to the office with a 2-day history of eye swelling and watery discharge. This morning, the discharge became thick and yellow. On physical exam, he is afebrile and fussy with bilateral eyelid edema, purulent discharge, and erythematous conjunctivae. After taking appropriate cultures of the eyes, which one of the following is the best next step?
Answer: B
NEW QUESTION # 336
A 3-year-old boy is brought to the office because he has progressive weight gain and short stature. He has marked truncal obesity, hypertrichosis of the upper lip, and facial swelling. Which one of the following is a physical examination most likely to reveal?
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
The child's presentation (weight gain, short stature, truncal obesity, facial swelling, hypertrichosis) is classic for Cushing syndrome. One of the hallmark findings on physical examination in pediatric Cushing syndrome is hypertension, due to increased cortisol-mediated mineralocorticoid receptor activation.
Toronto Notes 2023 - Pediatrics / Endocrinology:
"Cushing syndrome in children presents with growth failure, weight gain, moon facies, truncal obesity, and hypertension." MCCQE1 Objectives (Pediatrics > 77-2: Endocrine Disorders in Children):
"Candidates must identify clinical signs of hypercortisolism and evaluate for associated findings such as elevated blood pressure." Cafe-au-lait spots (A) suggest neurofibromatosis. Goiter (C) is more related to thyroid dysfunction.
Hepatomegaly (D) and acanthosis (E) are more commonly seen in metabolic syndrome or insulin resistance.
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NEW QUESTION # 337
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