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| Section | Objectives |
|---|---|
| Topic 1: Dimensions of Care | - Psychosocial Aspects
|
| Topic 2: Physician Activities | - Professionalism
|
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NEW QUESTION # 34
A 59-year-old woman comes to the office because her 48-year-old sister was recently diagnosed with cervical cancer. Your patient thinks her mother may have also had cervical cancer. A Papanicolaou (Pap) test performed 16 months ago had normal results, as did all previous Pap tests. Which one of the following is the best next step?
Answer: B
Explanation:
For women aged 25-69 years who have had adequate negative screening, the recommendation is to repeat cervical cytology (Pap test) every 3 years, regardless of family history. Cervical cancer is caused primarily by HPV infection, not hereditary genetics. Family history does not alter the screening interval.
Toronto Notes 2023 - Gynecology, Cervical Cancer Screening Section:
"Routine screening with Pap test is recommended every 3 years in women aged 25-69 who have had three consecutive negative tests. Family history of cervical cancer does not modify the screening interval." MCCQE1 Objectives - Obstetrics and Gynecology > Cancer Screening:
"Candidates must apply population-based cervical cancer screening guidelines. Family history is not a risk modifier for screening frequency in cervical cancer." Options A and B are inappropriate as they increase screening frequency without indication. HPV testing (D) or colposcopy (E) are not recommended without abnormal cytology.
NEW QUESTION # 35
A 42-year-old woman presents to the emergency department with a 24-hour history of severe pain in her right eye. On examination, you notice a right conjunctival injection that is worst adjacent to the iris. Direct and consensual responses to light are intact but sluggish, with severe photophobia in the right pupil is slightly smaller than the left. The patient's visual acuity is 20/20 on the left and 20/40 on the right. Visual field testing results are normal. Intraocular pressure findings are normal. Slit-lamp examination findings of the cornea are normal, and there are no cells in the anterior chamber. You are unable to visualize her fundus. Which one of the following is the most likely diagnosis?
Answer: B
Explanation:
The most likely diagnosis is acute anterior uveitis (iritis). The key MCCQE clinical pattern is painful red eye with ciliary flush (injection worst adjacent to the iris/limbus) and marked photophobia, especially consensual photophobia, which strongly points to inflammation of the iris and ciliary body. The sluggish light response and miosis (smaller pupil) are also typical of iritis due to sphincter spasm and inflammation. Intraocular pressure is normal, helping to rule out acute angle-closure glaucoma, which usually presents with elevated IOP, corneal haze, and a mid-dilated fixed pupil. Optic neuritis classically causes decreased color vision and pain with eye movement rather than ciliary flush. Viral conjunctivitis causes diffuse conjunctival injection and irritation/grittiness, not severe pain with consensual photophobia. Scleritis causes deep "boring" pain and violaceous scleral hue, not miosis/consensual photophobia as dominant features. Difficulty visualizing the fundus can occur with significant miosis.
NEW QUESTION # 36
A 37-year-old man comes to the office for follow-up of his opioid use disorder. He receives opioid agonist treatment, including some take-home doses. At this follow-up visit, he reports some nonprescription opioid use since his last visit. Which one of the following is the best next step?
Answer: E
Explanation:
Nonprescription opioid use during opioid agonist therapy is not uncommon. The response shouldbe supportive and not punitive. Increasing the frequency of follow-up enhances monitoring, supports adherence, and prevents relapse.
Toronto Notes 2023 - Psychiatry, "Substance Use Disorders":
"Patients who relapse during opioid agonist treatment benefit from closer monitoring and increased support, including more frequent follow-up and psychosocial interventions." MCCQE1 Objectives (Psychiatry > 71-5: Substance Use and Addiction):
"Candidates must manage relapses in opioid use by optimizing follow-up and support, not by discontinuing or reducing therapy prematurely." Tapering or discontinuing therapy (A, E) risks destabilizing treatment. Removing take-home doses (B) may be warranted later but not first. Cannabinoids (D) are not first-line adjuncts.
NEW QUESTION # 37
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
Explanation:
Comprehensive and Detailed Explanation:
This neonate likely has gonococcal conjunctivitis, which typically presents 2-5 days after birth with bilateral purulent discharge and swelling. This is an emergency due to the risk of corneal perforation. Empiric IV antibiotics and hospital admission are indicated.
Toronto Notes 2023 - Pediatrics, Neonatal Infections:
"Neonatal conjunctivitis within the first 1-2 weeks should raise suspicion for gonococcal or chlamydial infection. Gonorrhea requires urgent IV antibiotics and hospitalization." MCCQE1 Objectives - Pediatrics > Neonatal Infection:
"Candidates must recognize neonatal conjunctivitis and initiate empiric treatment while awaiting culture results." Lacrimal massage (E) and warm compresses (D) are used for nasolacrimal duct obstruction. Oral or topical antibiotics (B, C) are insufficient for suspected gonococcal infection.
NEW QUESTION # 38
You are travelling on a transatlantic flight. Halfway through the flight, an older passenger (# 65 years) begins to have chest pain and shortness of breath. An announcement is made over the intercom asking for help from any physicians or medical personnel. Which one of the following is the best next step?
Answer: B
Explanation:
In Canada and in most jurisdictions internationally, physicians have a professional and in some cases legal obligation to provide emergency assistance. Documentation should be done in your own records afterward.
Aviation laws and Good Samaritan protections offer liability coverage for health professionals acting in good faith.
Toronto Notes 2023 - ELOM, "Physician Obligations and Medical-Legal Responsibility":
"Physicians should respond to in-flight or public emergencies when capable. Documentation should be completed after the event, and liability is protected under Good Samaritan laws." MCCQE1 Objectives (ELOM > Professionalism > 90-1):
"Candidates must demonstrate appropriate professional behavior, including willingness to assist in emergencies and understanding of legal protections." Avoiding assistance (A), or placing conditional barriers (D), is unethical and inappropriate.
NEW QUESTION # 39
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