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| Section | Objectives |
|---|---|
| Topic 1: Physician Activities | - Assessment
|
| Topic 2: Dimensions of Care | - Chronic Care
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NEW QUESTION # 164
An 80-year-old man is admitted to hospital with what turns out to be tuberculosis. The attending physician informs all staff at the hospital of the patient ' s identity and diagnosis. Which one of the following best describes privacy concerns in this situation?
Answer: A
Explanation:
Tuberculosis is a communicable disease, so there can be a justified "duty to protect" others in the hospital through infection-control measures and public health notification. However, MCCQE ethics objectives emphasize that confidentiality remains the default obligation even when disclosure is permitted or required. In such cases, disclosure must follow the minimum necessary principle: only the information essential to reduce risk should be shared, and only with those who need it to perform their role (e.g., direct care team, infection prevention and control, occupational health, and public health). Informing "all staff at the hospital" and including the patient's identity generally exceeds what is required and constitutes an avoidable breach of privacy.
Consent is not always required when disclosure is mandated by law (reportable diseases) or necessary to prevent serious harm, so option B is too absolute. Option A wrongly implies loss of privacy rights. Option D is incorrect because limited disclosure may be ethically and legally permitted to protect others. Option E is false; clinicians and institutions can be accountable for unjustified or excessive disclosure.
NEW QUESTION # 165
A 34-year-old man sustained a blunt testicular trauma 2 hours ago. On physical examination, the patient has a
1.5-cm tall scrotal hematoma. You cannot palpate the testicle. Which one of the following is the best initial management?
Answer: B
Explanation:
In cases of blunt testicular trauma with inability to palpate the testicle due to hematoma, scrotal ultrasonography is the first-line investigation to assess for testicular rupture or other injury.
Toronto Notes 2023 - Urology, "Testicular Trauma":
"Scrotal ultrasound is the investigation of choice to assess for testicular rupture, hematoma, or torsion. Early imaging is critical if testis is non-palpable or if hematoma is significant." MCCQE1 Objectives (Surgery > 51-2: Genitourinary Trauma):
"Candidates must investigate testicular trauma using ultrasound to rule out rupture or torsion." Exploration (B) is done if ultrasound confirms rupture. Observation or discharge (A, E) without imaging risks missing serious injury.
NEW QUESTION # 166
You are evaluating a 75-year-old man with recently diagnosed prostate cancer and 2 painful metastases of the lumbar spine. Which one of the following therapeutic options is the most appropriate?
Answer: B
Explanation:
Palliative radiotherapy is the treatment of choice for painful bone metastases, including those from prostate cancer. It provides localized pain relief and functional improvement.
Toronto Notes 2023 - Oncology, "Metastatic Bone Pain":
"External beam radiotherapy is first-line treatment for localized bone pain from metastases. Relief occurs within days to weeks." MCCQE1 Objectives (Internal Medicine > Oncology > 52-1):
"Candidates must identify treatment options for symptom control in metastatic cancer, including palliative radiotherapy for painful bone lesions." Androgen deprivation therapy (B, C) treats systemic disease but doesn't address acute pain. Opioids (D) may be used, but radiotherapy provides disease-targeted relief. Intrathecal steroids (A) are not standard for prostate metastases.
NEW QUESTION # 167
A 36-year-old woman, gravida 1, para 0, aborta 0, presents to the Labour and Delivery unit of a primary care hospital. She is at 40 weeks' gestation. She is having contractions and leaking fluid. She is fearful and does not want to deliver vaginally. Which one of the following is the best next step?
Answer: A
Explanation:
The most appropriate next step is to explore her concerns and provide counselling regarding labour and pain management options . MCCQE objectives emphasize patient-centered care, informed decision-making, and respect for autonomy while ensuring that patients receive appropriate information about risks and benefits.
This patient is in active labour at term with ruptured membranes and expresses fear about vaginal delivery.
The immediate priority is to assess the source of her fear (pain, complications, prior trauma, misinformation) and provide education about available analgesia options (e.g., epidural, intravenous opioids, nonpharmacologic methods) and the relative risks and benefits of cesarean versus vaginal delivery.
Automatically arranging a cesarean without discussion is inappropriate, particularly in a primary care setting without clear medical indication. Conversely, refusing cesarean outright is paternalistic and fails to address her concerns. Analgesia may be appropriate but should follow exploration of her preferences. Therefore, empathetic discussion and shared decision-making are the best initial approach.
NEW QUESTION # 168
A 40-year-old woman presents to your clinic for follow-up regarding her major depressive disorder, which is being treated with the starting dosage of escitalopram. Most of her symptoms have now improved. However, she has noted anorgasmia since taking this medication. This has significantly affected her relationship with her wife. Which one of the following is the best next step?
Answer: A
Explanation:
Comprehensive and Detailed Explanation:
Sexual dysfunction, including anorgasmia, is a common side effect of SSRIs like escitalopram. Bupropion, a norepinephrine-dopamine reuptake inhibitor, has minimal sexual side effects and can be safely added to mitigate this issue while preserving the antidepressant effect.
Toronto Notes 2023 - Psychiatry / Pharmacology:
"SSRI-induced sexual dysfunction can be managed by dose reduction, switching agents, or adding bupropion." MCCQE1 Objectives (Psychiatry > 71-1: Depressive Disorders):
"Candidates should be able to address side effects of antidepressants, including sexual dysfunction, and adjust therapy appropriately." Increasing the dose (A) may worsen sexual dysfunction. Venlafaxine (B), an SNRI, also has sexual side effects. D (no change) does not address the patient's concern.
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NEW QUESTION # 169
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