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| Section | Objectives |
|---|---|
| Topic 1: Physician Roles (CanMEDS Framework) | - Leader (Manager)
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NEW QUESTION # 244
A 6-year-old boy is brought to the Emergency Department with a 2-day history of a limp. On examination, he looks well, has a temperature of 38 °C and is able to weight-bear. His hip examination reveals mild decreased range of motion. Radiographs of his hip and pelvis show no abnormality. His C-reactive protein level is 8 mg
/L (< 6). Which one of the following is the most likely diagnosis?
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
Transient synovitis is the most common cause of hip pain and limp in children aged 3-10 years. It is often preceded by a viral infection. Patients appear well, can often bear weight, and have only mild to moderate elevation in inflammatory markers. Radiographs are normal.
Toronto Notes 2023 - Pediatrics, "Limping Child":
"Transient synovitis is benign and self-limiting. Presentation includes mild limp, low-grade fever, normal or slightly elevated CRP/ESR, and ability to bear weight." MCCQE1 Objectives (Pediatrics > 78-2: Musculoskeletal Disorders):
"Candidates must distinguish between transient synovitis and more serious causes of limping, such as septic arthritis." Septic arthritis (A) usually causes inability to bear weight and more significant fever and CRP elevation.
Osteomyelitis (B) typically presents with localized tenderness and systemic signs. Bursitis (D) is rare in young children. JIA (E) is chronic.
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NEW QUESTION # 245
A 62-year-old woman with type 2 diabetes comes in for follow-up. She has noticed that her vision has been getting blurry over the past year and that she now needs a bright light to look at photos of her grandchildren.
Upon fundoscopic examination, you note yellow deposits in the central retina. Which one of the following is the most likely diagnosis?
Answer: A
Explanation:
Yellow deposits in the central retina (macula) are most consistent with drusen, the hallmark finding of age- related macular degeneration (AMD). MCCQE objectives emphasize correlating key funduscopic findings with patterns of vision loss. AMD typically causes gradual, progressive central vision blurring (difficulty reading, recognizing faces, and seeing fine detail), while peripheral vision is relatively preserved. The history of needing brighter light for near tasks aligns with impaired macular function and reduced contrast sensitivity seen in AMD.
Diabetic retinopathy more commonly shows microaneurysms, dot-blot hemorrhages, hard exudates scattered in the retina, venous beading, and/or neovascularization rather than discrete drusen in the macula as the defining feature. Retinal vein occlusion usually presents more abruptly with extensive hemorrhages and
"blood and thunder" appearance. Cataracts cause lens opacity with impaired red reflex and generalized haze on fundoscopy rather than macular deposits. Open-angle glaucoma causes optic disc cupping and peripheral field loss, not central drusen. Recognizing AMD prompts appropriate counseling (smoking cessation, risk factor control), vision monitoring, and ophthalmology referral to assess for dry vs wet AMD.
NEW QUESTION # 246
A 39-year-old woman comes to see you for her periodic health examination. Her father died at 55 of colon cancer, and she is concerned about the possible risk of her developing bowel cancer. Which one of the following would you advise her in terms of screening for colorectal cancer?
Answer: E
Explanation:
A first-degree relative with colorectal cancer diagnosed before age 60 places this patient in an increased-risk screening category. For individuals with one first-degree relative diagnosed with colorectal cancer (or advanced adenoma) before age 60, recommended screening is colonoscopy starting at age 40, or 10 years earlier than the age at diagnosis in the affected relative-whichever comes first-then repeated at shorter intervals than average-risk screening (often every 5 years if results are normal, depending on local guidance and findings). Here, her father was diagnosed at 55, so "10 years earlier" would be age 45; however, the
"whichever comes first" rule makes age 40 the correct start. Average-risk strategies such as FIT starting at 50 are not sufficient for this risk level. Flexible sigmoidoscopy alone is less appropriate because it does not evaluate the proximal colon and is not the preferred increased-risk test. Double-contrast barium enema is obsolete for screening, and CT colonography is not first-line in this context. MCCQE objectives emphasize tailoring screening to family-history risk and selecting the appropriate test and start age.
NEW QUESTION # 247
A 20-year-old nulligravid woman presents with severe pain during menstruation. She is unable to take nonsteroidal anti-inflammatory drugs (NSAIDs) and is adamant about not taking any hormonal therapy. She has questions about non-medicinal therapeutic options. Which one of the following recommendations is the most appropriate?
Answer: E
Explanation:
TENS has been shown to be effective for managing primary dysmenorrhea when pharmacological options are contraindicated or refused. It works by interfering with pain signal transmission and increasing endorphin levels.
Toronto Notes 2023 - Gynecology, Dysmenorrhea:
"High-frequency TENS is effective in managing primary dysmenorrhea and can be considered when NSAIDs or hormonal therapies are not acceptable to the patient." MCCQE1 Objectives - Gynecology > Menstrual Disorders:
"Candidates must be aware of non-pharmacological interventions for dysmenorrhea, including TENS and heat therapy." Options D and E involve hormonal or surgical intervention. Spinal manipulation and massage (B and C) lack consistent evidence for dysmenorrhea relief.
NEW QUESTION # 248
An otherwise healthy 43-year-old woman presents to your clinic for a left breast mass. Six months ago, she underwent a bilateral breast magnetic resonance imaging (MRI) after watching a television program on breast cancer prevention. An ultrasound-guided biopsy of a 1.5 cm massconfirmed, at the time, that she had fibroadenoma. The follow-up ultrasound now reveals a mass measuring 1.7 cm. Which one of the following is the best next step in the management of this patient?
Answer: B
Explanation:
Fibroadenomas can grow slightly or fluctuate in size. A minimal increase (from 1.5 cm to 1.7 cm) over six months is clinically insignificant. No malignant features are reported, and the previous biopsy confirmed benign nature. Annual follow-up is appropriate.
Toronto Notes 2023 - Obstetrics and Gynecology, "Breast Disorders" Section:
"Fibroadenomas are benign breast masses that may slightly enlarge. Routine imaging follow-up at 6 to 12 months is appropriate for lesions with benign imaging and histology." MCCQE1 Objectives (Obstetrics and Gynecology > 82-3: Breast Mass):
"Candidates must distinguish between benign and suspicious masses and determine appropriate intervals for follow-up imaging." Repeat biopsy (A) or surgery (B) is unwarranted without suspicious change. MRI (C) is not needed in stable, benign lesions. Tamoxifen (D) is not used for fibroadenomas.
NEW QUESTION # 249
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