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| Section | Objectives |
|---|---|
| Dimensions of Care | - Health Promotion and Illness Prevention
|
| Physician Activities | - Management
|
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NEW QUESTION # 157
You are on duty in the Emergency Department when 5 patients are brought in by ambulance after a high- speed motor vehicle collision. Which one of the following patients requires the most urgent medical care?
Answer: C
Explanation:
The patient with the angulated thigh, hypotension relative to baseline, and tachycardia likely has a femoral shaft fracture with concealed hemorrhage. This poses an immediate risk of hypovolemic shock and requires urgent assessment and stabilization.
Toronto Notes 2023 - Emergency Medicine, "Trauma Triage and Prioritization":
"Patients with long bone fractures, especially femoral fractures, are at high risk for hemorrhage and should be prioritized for stabilization and hemorrhage control." MCCQE1 Objectives (Surgery > 51-1: Trauma):
"Candidates must prioritize trauma patients based on signs of instability or risk of deterioration, such as tachycardia and occult bleeding."
NEW QUESTION # 158
A 67-year-old woman presents with headaches, muscle weakness, pain in her shoulders and hips, weight loss, and depression. While also arranging appropriate investigations to confirm a diagnosis, which one of the following is the most important objective of treatment?
Answer: D
Explanation:
This clinical picture suggests giant cell arteritis (GCA) associated with polymyalgia rheumatica: new-onset headache in an older patient, proximal muscle pain and stiffness (shoulders and hips), systemic symptoms (weight loss), and mood changes. MCCQE objectives emphasize that GCA is a medical emergency because inflammation of the temporal and other cranial arteries can lead to irreversible vision loss due to ischemic optic neuropathy.
The most important objective of treatment is prevention of blindness , which requires prompt initiation of high-dose corticosteroids-often before confirmatory temporal artery biopsy-to reduce arterial inflammation and prevent vascular occlusion. While improving musculoskeletal pain and headache are important symptomatic goals, they are secondary to preventing permanent complications. Jaw claudication is a symptom of arterial insufficiency but not itself the primary outcome to prevent.
Early recognition and immediate corticosteroid therapy significantly reduce the risk of bilateral, permanent visual loss. Therefore, prevention of blindness is the most critical treatment objective.
NEW QUESTION # 159
A 45-year-old man with confusion is brought to the Emergency Department by ambulance. He has end-stage renal disease and has missed his last 3 dialysis appointments. He also has a past medical history of antisocial personality disorder and hepatitis C. On examination, he is in respiratory distress. His blood pressure is 170
/90 mm Hg, and his oxygen saturation is 84% on room air. His jugular venous pressure is 8 cm above the sternal angle, and he has crackles in his lungs bilaterally. A venous blood gas shows a bicarbonate of 11 mmol
/L (24-30) and potassium of 7.1 mmol/L (3.5-5.0). Which one of the following is the best next step?
Answer: C
Explanation:
This patient has life-threatening complications of missed dialysis , including severe hyperkalemia (K# 7.1 mmol/L), metabolic acidosis (HCO## 11 mmol/L), volume overload with pulmonary edema (hypoxia, crackles, elevated JVP), and altered mental status. MCCQE objectives emphasize immediate recognition and treatment of emergent indications for dialysis (AEIOU: Acidosis, Electrolyte abnormalities, Intoxication, Overload, Uremia) . This patient meets multiple criteria-particularly refractory hyperkalemia and pulmonary edema-requiring urgent hemodialysis .
In emergencies where delay would risk death or serious harm, treatment proceeds under implied consent , even if the patient is confused and capacity is uncertain. Contacting family or psychiatry would dangerously delay life-saving care. While temporizing measures (e.g., IV calcium, insulin/glucose) may be given, definitive management is emergent dialysis. Morphine and furosemide alone are inadequate in severe renal failure with life-threatening hyperkalemia. Therefore, immediate initiation of urgent dialysis is the correct next step.
NEW QUESTION # 160
A 39-year-old man presents to a psychiatrist. He says, "It often seems to me that I am not part of this world.
My voice sounds strange to me, and other people seem like figures in a dream." He has had these feelings intermittently for about 2 years. There is no history of hallucinations, and there are no current indications of disorganized thinking. Which one of the following is the most likely diagnosis?
Answer: C
Explanation:
The patient describes classic symptoms of depersonalization ("my voice sounds strange to me") and derealization ("others seem like figures in a dream"), which define depersonalization/derealization disorder.
There is preserved reality testing and no psychosis.
Toronto Notes 2023 - Psychiatry, "Dissociative Disorders" Section:
"Depersonalization/derealization disorder involves persistent or recurrent experiences of detachment from oneself (depersonalization) or surroundings (derealization), with intact reality testing and no delusions or hallucinations." MCCQE1 Objectives (Psychiatry > 79-4: Dissociative Disorders):
"Candidates must identify depersonalization/derealization disorder as a dissociative disorder distinct from psychosis or mood disorders." Schizophrenia (A) would include hallucinations or disorganized thinking. Conversion disorder (B) presents with neurological symptoms inconsistent with known diseases. Persistent depressive disorder (D) involves chronic low mood. Delusional disorder (E) would involve fixed false beliefs, which are not present here.
NEW QUESTION # 161
A 63-year-old woman presents to your office with a history of progressive abdominal discomfort over the past five months. She reports bloating and difficult digestion with constipation. She has no urinary symptoms and denies vaginal or rectal bleeding. An abdominal ultrasound shows a large complex pelvic mass with internal multiloculation and moderate ascites. The cancer antigen 125 (CA 125) is elevated at 1023 U/mL (< 35 U
/mL). Which one of the following is the most likely diagnosis?
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
Postmenopausal women with abdominal distension, bloating, a complex pelvic mass, and elevated CA-125 are highly suggestive of epithelial ovarian cancer, especially serous cystadenocarcinoma-the most common type.
Toronto Notes 2023 - Gynecology / Oncology:
"Serous epithelial ovarian carcinoma presents with vague abdominal symptoms, ascites, complex pelvic mass, and elevated CA-125." MCCQE1 Objectives (Gynecology > 82-5: Ovarian Masses):
"Candidates must recognize signs and investigations of ovarian cancer, including elevated tumor markers and imaging findings." Ovarian hyperstimulation (A) occurs in fertility treatments. Colorectal cancer (C) may mimic these symptoms but typically causes rectal bleeding and has lower CA-125 levels. Uterine adenocarcinoma (D) usually causes bleeding. Hematosalpinx (E) presents with pelvic pain, not ascites.
NEW QUESTION # 162
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