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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Physician Activities | 50% | - Psychosocial Aspects - Communication - Management - Professional Behaviours |
| Topic 2: Dimensions of Care | 50% | - Health Promotion and Illness Prevention - Chronic Care - Acute Care - Assessment and Diagnosis |
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NEW QUESTION # 85
A 23-year-old woman with borderline personality disorder is brought to the Emergency Department having ingested non-lethal substances after her boyfriend broke up with her. The staff tells you that she has consulted
8 times under similar circumstances in the past 3 years. Which one of the following pieces of information would be useful to provide to the staff?
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
While borderline personality disorder is challenging, symptoms (particularly impulsivity and suicidal behaviors) often attenuate with age and appropriate therapy (e.g., dialectical behavior therapy). Providing hope and clinical context to staff improves care and reduces stigma.
Toronto Notes 2023 - Psychiatry, "Personality Disorders":
"BPD is associated with emotional dysregulation and impulsivity. Long-term prognosis is better than once believed, with many patients showing symptom remission over time." MCCQE1 Objectives (Psychiatry > 71-4: Personality Disorders):
"Candidates must provide appropriate education to patients and staff regarding prognosis and treatment of BPD." Statements A-D are false, stigmatizing, or dangerous.
NEW QUESTION # 86
A 26-year-old woman, gravida 3, para 2, presents for her 1st antenatal visit. She states she is at 26 weeks' gestation and is healthy. On abdominal examination, her fundus is palpated at the umbilicus. Which one of the following is the most likely explanation for this finding?
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
At 20 weeks' gestation, the uterine fundus typically reaches the umbilicus. If the fundal height is lower than expected at a stated gestational age of 26 weeks, the most likely explanation-especially with no prior care- is a dating error.
Toronto Notes 2023 - Obstetrics:
"Fundal height at the umbilicus corresponds to ~20 weeks. In women lacking early prenatal care, dating errors are common causes of fundal height discrepancy." MCCQE1 Objectives (Obstetrics > 80-3: Routine Antenatal Care):
"Candidates must interpret fundal height and reconcile discrepancies with gestational age." IUGR and oligohydramnios are possible but require imaging confirmation. Bicornuate uterus may cause fundal shape anomalies but not significant dating discrepancy. A mole (D) would increase, not decrease, size.
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NEW QUESTION # 87
A 16-month-old boy is brought to your office because of red, itchy and crusted patches on his cheeks and chin. Physical examination also reveals similar patches in the flexor creases of both arms. The groin and axillae regions are clear. Which one of the following is most likely to contribute to this condition?
Answer: D
Explanation:
This child's presentation is classic for atopic dermatitis (eczema) : pruritic, erythematous, crusted patches involving the cheeks in infants and the flexural creases in toddlers. Sparing of the groin and axillae is typical.
MCCQE objectives emphasize recognizing age-specific distribution and identifying risk factors. The strongest contributor is a family history of atopy (e.g., asthma, allergic rhinitis, eczema), reflecting a genetic predisposition involving impaired skin barrier function and immune dysregulation (often associated with filaggrin mutations).
Vaccination (e.g., MMR) does not cause eczema. Oral amoxicillin may trigger a transient rash but would not produce chronic pruritic flexural dermatitis. Early introduction of cereals is not an established cause of atopic dermatitis. Varicella-zoster infection produces a vesicular rash in various stages, not chronic flexural eczema.
Thus, a family history of atopic reactions is the most important contributing factor to this child's condition.
NEW QUESTION # 88
A 67-year-old man presents to the clinic because of elevated liver enzymes. He is asymptomatic.His medical history is significant for type 2 diabetes, which is being treated with metformin. On physical examination, he looks well. His blood pressure is 125/75 mm Hg, his heart rate is 80/min, and his BMI is 35. Findings of the remainder of the examination are normal. His blood work results are as follows:
* Platelet count: 170 × 10#/L (130-380)
* Creatinine: normal
* GGT: 75 µmol/L (49-93)
* ALT: 146 IU/L (15-85)
* AST: 101 IU/L (17-63)
* Bilirubin (total): 17 µmol/L (3-17)
* INR: 1.2 (0.9-1.2)
Which one of the following is the most likely diagnosis?
Answer: A
Explanation:
The patient is obese (BMI 35), has type 2 diabetes, and shows a hepatocellular pattern of transaminitis (elevated ALT > AST). These are typical features of nonalcoholic steatohepatitis (NASH), the inflammatory subtype of nonalcoholic fatty liver disease (NAFLD).
Toronto Notes 2023 - Gastroenterology, NAFLD and NASH:
"NASH should be suspected in patients with metabolic syndrome, obesity, and type 2 diabetes, especially with elevated transaminases and normal bilirubin or INR." MCCQE1 Objectives - Internal Medicine > Hepatology:
"Candidates should recognize the clinical profile of NAFLD/NASH, particularly in asymptomatic patients with metabolic risk factors and isolated liver enzyme elevations." Acute hepatitis B (A) typically has higher ALT and symptoms. Pancreatic carcinoma (B) affects biliary enzymes or bilirubin. Metformin (D) does not elevate liver enzymes. HCC (E) would often present with systemic or localized symptoms and abnormal imaging.
NEW QUESTION # 89
A 78-year-old man presents to the Emergency Department with chest pain. His electrocardiogram and blood work confirm an acute myocardial infarction. He is admitted to the Intensive Care Unit. Three days later, he develops right-sided abdominal pain. An ultrasonogram reveals an inflamed gallbladder with no evidence of stones. He does not improve after 48 hours of antibiotics. Which one of the following is the best next step?
Answer: B
Explanation:
This presentation is consistent with acute acalculous cholecystitis, often seen in critically ill or post-MI patients. If unresponsive to antibiotics, percutaneous cholecystostomy is the preferred next step in those who are poor surgical candidates.
Toronto Notes 2023 - General Surgery, "Hepatobiliary Disorders" Section:
"Acalculous cholecystitis occurs in critically ill patients and is often managed with percutaneous cholecystostomy if the patient is not a candidate for surgery." MCCQE1 Objectives (Surgery > 84-3: Biliary Disease):
"Candidates must be able to diagnose and manage acalculous cholecystitis. Management includes antibiotics and drainage via percutaneous cholecystostomy in unstable patients." Laparoscopic cholecystectomy (C) is standard but not suitable in acutely ill ICU patients. Broadening antibiotics (A) alone is insufficient after failure of initial therapy. ERCP (B) is for biliary obstruction or cholangitis. HIDA scan (E) is diagnostic, not therapeutic.
NEW QUESTION # 90
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