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| Section | Weight | Objectives |
|---|---|---|
| Physician Activities | 50% | - Psychosocial Aspects - Management - Communication - Professional Behaviours |
| Dimensions of Care | 50% | - Acute Care - Assessment and Diagnosis - Health Promotion and Illness Prevention - Chronic Care |
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NEW QUESTION # 212
A 1-month-old breastfed baby is brought to your office by his parents for his well-baby check-up. He was born at 32 weeks' gestation. Growth parameters at birth revealed head circumference, weight and length at the
50th percentile. Today, his weight is at the 10th percentile. Which one of the following is the most appropriate plan of action?
Answer: C
Explanation:
This infant was born at 32 weeks' gestation and therefore growth must be interpreted using corrected (adjusted) age , not chronological age. At 1 month chronological age, his corrected age is approximately term (40 weeks). MCCQE pediatric objectives emphasize that preterm infants commonly shift percentiles after birth due to expected postnatal fluid changes and adaptation. A drop from the 50th to the 10th percentile in the first month-particularly in a clinically well, breastfed infant-can be normal when plotted appropriately on preterm growth charts and corrected for gestational age. There is no information suggesting feeding difficulty, malabsorption, or systemic illness. A sweat chloride test (for cystic fibrosis) or celiac serology is not indicated in a thriving 1-month-old infant. Routine formula supplementation is unnecessary without evidence of poor intake or failure to thrive. The appropriate management is reassurance, continued monitoring of growth using corrected age, and support for breastfeeding, with follow-up to ensure appropriate weight gain trajectory.
NEW QUESTION # 213
A 35-year-old woman presents to your clinic for follow-up regarding her persistent primary immune thrombocytopenic purpura. She was admitted to hospital with a relapse and received treatment with dexamethasone, intravenous immunoglobulin, and rituximab. She was recently discharged from hospital with a platelet count of 55 × 10#/L (130-360), and also continues to take 10 mg of prednisone once daily. She is scheduled for a splenectomy in 4 weeks. Which one of the following is the best next step in preparation for the patient ' s surgical procedure?
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
Patients undergoing splenectomy are at lifelong risk for overwhelming post-splenectomy infection (OPSI), particularly from encapsulated organisms. Vaccination against Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis is recommended at least 2 weeks prior to elective splenectomy.
Toronto Notes 2023 - Hematology / Surgery:
"Patients undergoing elective splenectomy should receive vaccines against pneumococcus, H. influenzae type b, and meningococcus at least 2 weeks before surgery." MCCQE1 Objectives (Hematology > 38-2: Thrombocytopenia and Splenectomy):
"Candidates must ensure vaccination prior to splenectomy to prevent postsplenectomy sepsis." Calcium (B) may be considered in chronic steroid users but is not the priority. Azithromycin (C) is not indicated. D is unsafe without tapering. E is only for acute bleeding or extremely low platelets.
NEW QUESTION # 214
A health authority implements the first-ever colon cancer screening program in its territory. Which one of the following colon cancer indices will likely increase?
Answer: A
Explanation:
When a screening program is introduced, the incidence rate appears to rise because more cases (including subclinical ones) are identified earlier. This is known as "lead-time bias" or "ascertainment bias." Toronto Notes 2023 - Public Health, Screening and Epidemiology:
"Screening increases the apparent incidence of disease as more early or latent cases are detected." MCCQE1 Objectives - Preventive Medicine > Screening:
"Candidates should understand how implementation of screening programs affects disease incidence and epidemiologic metrics." Case fatality rate (A) may decrease. PPV (B) depends on prevalence. Positive biopsy rate (C) may remain stable. Treatment rate (E) could increase, but incidence is the most directly and consistently affected.
NEW QUESTION # 215
A patient's mother comes to you with a prospective cohort study linking autism to the measles, mumps and rubella vaccine. After reviewing the study carefully, you question the results because of problems with the study design and execution. Which one of the following sources of error would be most important in the study design or execution?
Answer: B
Explanation:
Recruiting participants from an autism seminar introduces selection bias. This non-random selection increases the likelihood of overestimating associations due to pre-existing beliefs or exposures in that subgroup.
Toronto Notes 2023 - Epidemiology:
"Selection bias occurs when participants are not representative of the general population, as in recruitment from disease-specific support groups." MCCQE1 Objectives (Population Health > 65-2: Study Design and Appraisal):
"Candidates must recognize sources of bias in epidemiologic studies, including selection bias due to non- representative recruitment." Recall bias (D) is more of a concern in retrospective studies. Sponsorship (B) may create perception bias but is not a flaw in methodology itself. Standard error reporting (A) is normal. Not accounting for confounders (E) matters but recruitment source is more directly biasing.
NEW QUESTION # 216
A 39-year-old man presents to your clinic 4 months after a motor vehicle collision. He is trying to return to work but is having a difficult time because his job requires him to drive. He used to love his job, but he is worried about going back because every time he gets into a car, he is filled with dread, gets dizzy, and feels faint. He has regular nightmares about the incident. Which one of the following is the most likely diagnosis?
Answer: C
Explanation:
Posttraumatic stress disorder (PTSD) is most likely because the patient has symptoms persisting more than 1 month after a traumatic event (motor vehicle collision) with functional impairment (difficulty returning to work/driving). MCCQE objectives emphasize PTSD core symptom clusters: intrusion (recurrent distressing dreams/nightmares), avoidance (fear and distress when attempting to drive or be in a car), negative alterations in cognition/mood, and hyperarousal. His intense dread and autonomic-type symptoms (dizziness, feeling faint) triggered by car exposure fit trauma-related reactivity and avoidance.
Panic disorder requires recurrent unexpected panic attacks with ongoing concern or maladaptive behavior; here, the episodes are situationally triggered by reminders of the trauma and accompanied by trauma nightmares, supporting PTSD over panic disorder. Generalized anxiety disorder involves excessive worry about multiple domains for at least 6 months, not specifically tied to a trauma cue with nightmares.
Malingering implies intentional symptom fabrication for external gain and is not supported by the consistent trauma-linked symptoms and re-experiencing.
NEW QUESTION # 217
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