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| Section | Objectives |
|---|---|
| Dimensions of Care | - Health Promotion and Illness Prevention
|
| Physician Activities | - Assessment
|
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NEW QUESTION # 231
A 45-year-old woman presents to the emergency department after being involved in a motor vehicle collision.
She reports severe right hip pain. On examination, the right hip is flexed and adducted. A radiograph shows a posterior dislocation. Which one of the following is the most appropriate management?
Answer: D
Explanation:
A posterior hip dislocation is an orthopedic emergency . The classic position is a shortened limb held in flexion, adduction, and internal rotation after high-energy trauma. MCCQE objectives emphasize immediate recognition and urgent management to prevent complications, especially avascular necrosis (AVN) of the femoral head and sciatic nerve injury . The key treatment is prompt closed reduction (ideally within hours) under procedural sedation or anesthesia, after appropriate analgesia and neurovascular assessment. Post- reduction priorities include confirming concentric reduction with imaging, repeating a neurovascular exam (particularly sciatic nerve function), and evaluating for associated fractures (acetabular or femoral head/neck) that may require CT and possible operative management.
Open reduction is reserved for irreducible dislocations, incarcerated fragments, or associated fractures preventing stable closed reduction. Skeletal traction is not definitive acute management. Total hip arthroplasty is not indicated as first-line in an acute traumatic dislocation in this context. Urgent closed reduction best aligns with time-sensitive limb- and joint-preserving care.
NEW QUESTION # 232
An 85-year-old man is transferred from an acute care hospital to your long-term care (LTC) facility. He has a fever, fatigue, myalgia, and malaise. His test result is positive for influenza A virus. Two other residents and 1 LTC staff member have experienced the same symptoms. Which one of the following is the best next step to prevent further infections at the LTC facility?
Answer: D
Explanation:
During an outbreak in a long-term care facility, prompt control measures include keeping symptomatic staff at home to prevent spread. Staff are often vectors of infection, and exclusion is a key public health intervention.
Toronto Notes 2023 - Infectious Diseases, "Infection Control and Prevention":
"During influenza outbreaks in institutional settings, exclusion of symptomatic staff is critical to controlling spread." MCCQE1 Objectives (Population Health > 63-2: Outbreak Management):
"Candidates must understand outbreak control, including staff exclusion, cohorting, and surveillance in congregate settings." Vaccination (B) is preventive but not immediately effective during an outbreak. Masking and visitor vaccination are supportive but secondary measures.
NEW QUESTION # 233
A 24-year-old man presents to your clinic with a 6-month history of fatigue. On examination, he is pale. His BMI is 16, and his blood pressure is 92/58 mm Hg. Initial laboratory work shows the following:
* Creatinine: 64 µmol/L (49-93)
* Potassium: 3.0 mmol/L (3.5-5.1)
* Sodium: 138 mmol/L (136-146)
* TSH: 2.40 mIU/L (0.34-5.60)
* CBC: Normal
Which one of the following is the best next step?
Answer: B
Explanation:
This patient has clinical signs of an eating disorder - fatigue, low BMI, hypotension, and hypokalemia - likely secondary to nutritional deficiencies or purging. The first step is to sensitively explore the patient's perception of weight and body image. Effective management requires rapport and careful conversation.
Toronto Notes 2023 - Psychiatry, Eating Disorders:
"Approach patients with suspected eating disorders non-judgmentally. Begin with permission to discuss weight or body image. Screening tools like SCOFF can help guide further assessment." MCCQE1 Objectives - Psychiatry > Eating Disorders:
"Candidates must recognize signs of eating disorders and initiate a respectful and effective patient-centered discussion." Referring to the ED (B) is not urgent without hemodynamic instability. Advising caloric intake (C) bypasses assessment. GI referral (D) is not appropriate at this stage.
NEW QUESTION # 234
A mother brings her 10-year-old son for his well-child check-up. She mentions that her 38-year-old husband has just had a heart attack due to high cholesterol levels and wants information regarding prevention of cardiovascular disease for her son. Which one of the following is the best approach to managing this problem?
Answer: A
Explanation:
Children with a first-degree relative who has premature coronary artery disease or hypercholesterolemia should undergo fasting lipid screening between ages 2-10. Since the child is 10, screening is indicated.
Toronto Notes 2023 - Pediatrics, "Preventive Care in Children":
"Lipid screening is recommended for children #2 years old with a family history of early cardiovascular disease or hypercholesterolemia." MCCQE1 Objectives (Pediatrics > 78-1: Preventive Medicine):
"Candidates must screen children at high risk of cardiovascular disease appropriately, including lipid profile for familial hyperlipidemia." Diet and exercise counseling may follow screening, but testing is the first step. Reassurance alone (C) is inappropriate. Homocysteine (E) and HbA1c are not first-line tests in this setting.
NEW QUESTION # 235
You are counselling a couple that is concerned about the risk that their second child could be affected by the same X-linked recessive disorder (hemophilia A) as their last child, a boy. Neither parent has this disorder.
What is the probability that their second child will be affected?
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
In X-linked recessive disorders such as hemophilia A, carrier mothers (usually asymptomatic) have a 50% chance of passing the affected X chromosome to each son, who would then express the disease. Each daughter has a 50% chance of being a carrier but is generally not affected.
Toronto Notes 2023 - Genetics:
"X-linked recessive inheritance: Carrier mother has a 50% chance of having an affected son and a 50% chance of having a carrier daughter." MCCQE1 Objectives (Genetics > 61-1: Inheritance Patterns):
"Candidates must apply principles of X-linked inheritance to assess risk in offspring." If the mother is a known carrier (as inferred from having an affected son), the chance of a second affected boy is 50%.
NEW QUESTION # 236
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