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| Section | Objectives |
|---|---|
| Dimensions of Care | - Chronic Care
|
| Physician Activities | - Assessment
|
>> MCCQE Reliable Test Duration <<
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NEW QUESTION # 124
A 31-year-old man presents with nocturnal non-exertional chest pain. During an exercise stress test, he does not experience chest pain, and there are no significant ST segment changes on the electrocardiogram. He achieves 17 metabolic equivalent of task (MET), a blood pressure of 190/96 mm Hg (resting blood pressure of
130/80 mm Hg), and a maximum heart rate of 162/min (85% of age-predicted maximum). Which one of the following is the most appropriate next step?
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
This patient demonstrates excellent exercise tolerance (17 METs) and no ischemic changes or exertional symptoms, which makes cardiac ischemia unlikely. However, the hypertensive response to exercise (BP >
190 systolic) indicates masked or latent hypertension. This should be managed proactively, typically starting with a thiazide.
Toronto Notes 2023 - Cardiology:
"An exaggerated hypertensive response during exercise is predictive of future hypertension. Treatment with antihypertensive agents such as thiazides may be warranted." MCCQE1 Objectives (Internal Medicine > 31-1: Hypertension and Risk Management):
"Candidates must identify abnormal BP responses to exercise and initiate appropriate treatment." Reassurance alone (A) ignores the hypertensive response. Catheterization (C) and beta-blockers (D) are unnecessary without ischemia. Advising against exercise (B) is counterproductive in a young, otherwise healthy patient.
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NEW QUESTION # 125
A same-sex couple asks to join a family physician's practice. The physician tells them that shedoes not treat same-sex couples and will refer them to a physician with more clinical experience with same-sex couples.
Which one of the following best describes the physician's obligation under the Canadian Charter of Rights and Freedoms?
Answer: A
Explanation:
Refusing care based on sexual orientation constitutes discrimination under the Canadian Charter of Rights and Freedoms and violates professional standards. Physicians must not deny care based on personal bias or prejudice.
Toronto Notes 2023 - ELOM, Equity in Care and Professionalism:
"Denying care based on sexual orientation violates both human rights legislation and professional obligations.
Physicians must ensure equitable access for all patients."
MCCQE1 Objectives - ELOM > Professionalism and Patient Rights:
"Candidates must act in accordance with patients' rights to equitable, non-discriminatory access to care regardless of race, gender, or sexual orientation." Referral (Option B) does not excuse discriminatory refusal. Personal discomfort or inexperience (Options D and E) do not justify discrimination.
NEW QUESTION # 126
You are called to attend an 18-year-old woman, gravida 2, para 1, aborta 0, who is in precipitous labour. She did not realize she was pregnant and has not had any prenatal care. After the delivery, you examine the newborn boy; he is vigorous, and it appears that he was born at full term. Physical examination findings of the newborn are normal. Review of the prenatal record from the mother's last pregnancy shows the following:
* HIV: Negative
* Hepatitis B surface antibody: Positive
* Hepatitis C: Negative
* Syphilis serology: Negative
The mother's previous child was placed in foster care. The mother is withdrawn and uncommunicative after delivery. Which one of the following is the best next step?
Answer: B
Explanation:
Given the lack of prenatal care, the mother's withdrawal, and prior involvement of child protection services, a newborn drug screen is warranted to assess for possible in utero exposure. This is part of the safety assessment.
Toronto Notes 2023 - Pediatrics, Newborn Assessment:
"Infants born to mothers with no prenatal care or prior social concerns should undergo a full newborn screening, including toxicology if indicated." MCCQE1 Objectives - Pediatrics > Newborn Care and Social Issues:
"Candidates must identify social risk factors and initiate appropriate newborn evaluations, including toxicology screens when substance use is suspected." The mother was previously immune to hepatitis B, so (A) is not immediately required. Skin-to-skin care (D) is beneficial but secondary to screening in this context. Donor milk (B) is not indicated unless breastfeeding is contraindicated.
NEW QUESTION # 127
A 53-year-old man presents to the Emergency Department with a 3-week history of believing his neighbor is poisoning him by pumping gas through his home's air vent. He appears distracted, irritable, and is speaking very quickly. He has a family history of depression. Which one of the following is the most likely diagnosis?
Answer: A
Explanation:
This man exhibits a classic manic episode with psychotic features: persecutory delusions, distractibility, pressured speech, irritability, and possible grandiosity. The chronicity and mood symptoms are most consistent with Bipolar I disorder.
Toronto Notes 2023 - Psychiatry, "Mood Disorders" Section:
"Bipolar I disorder is characterized by episodes of mania, often with psychotic features.Symptoms include grandiosity, decreased need for sleep, distractibility, and mood-congruent delusions." MCCQE1 Objectives (Psychiatry > 79-1: Mood Disorders):
"Candidates must recognize mania and differentiate from brief psychosis or organic causes." Delirium (A) is acute, fluctuating, and involves impaired attention. Malingering (B) requires external gain.
Brief psychotic disorder (C) resolves within 1 month. Brain injury-related psychosis (E) would require a supporting history or findings.
(Part 2 )
NEW QUESTION # 128
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: D
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 # 129
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