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| Section | Objectives |
|---|---|
| Topic 1: Physician Roles (CanMEDS Framework) | - Communicator
|
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NEW QUESTION # 27
A 42-year-old woman presents with a 2-day history of a low-grade fever and a painful left breast mass. On examination, there is a fluctuant erythematous tender mass with surrounding induration in the left breast and enlarged lymph nodes in the left axilla. An ultrasound shows a loculated cystic mass. Which one of the following is the most likely diagnosis?
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
A fluctuant, erythematous, tender breast mass with systemic signs (fever, lymphadenopathy) and ultrasound showing a cystic lesion is diagnostic for a breast abscess. It commonly arises from untreated mastitis.
Toronto Notes 2023 - Surgery, "Breast Disease":
"Abscess presents as a fluctuant, erythematous mass. Ultrasound confirms loculated fluid. Treatment includes drainage and antibiotics." MCCQE1 Objectives (Surgery > 50-1: Breast Conditions):
"Candidates must identify signs of infection and abscess and differentiate from malignancy or benign lesions." Fibroadenoma (C) is non-tender, mobile, and firm. Ductal ectasia (B) causes nipple discharge. Fibrocystic changes (D) are bilateral and cyclic. Inflammatory breast cancer (E) is rapidly progressive but lacks fluctuation and cystic features.
NEW QUESTION # 28
An intoxicated 28-year-old man is brought to the Emergency Department after being found in the snow. His vital signs are as follows:
Temperature: 33°C
Respiratory rate: 22/min
Heart rate: 123/min
The patient is shivering and displays some dysarthria and ataxia. After his wet clothing is removed, he is provided with a warm blanket. The results of the subsequent physical examination are unremarkable, except for frostbite of the ears and fingers. Which one of the following is the best next step?
Answer: A
Explanation:
This patient is experiencing mild hypothermia (32-35°C), evidenced by shivering, ataxia, and tachycardia.
First-line management includes passive external rewarming - removing wet clothing, providing warm blankets, and ensuring a warm environment (ambient temperature ~28°C).
Toronto Notes 2023 - Emergency Medicine, Environmental Injuries:
"Mild hypothermia (32-35°C): Treatment includes passive rewarming (warm blankets, warm environment).
Avoid active rewarming methods to extremities due to risk of afterdrop." MCCQE1 Objectives - Internal Medicine > Environmental Exposure:
"Candidates must recognize appropriate levels of hypothermia and select evidence-based rewarming strategies based on severity." Options A, C, and D are used in moderate to severe hypothermia (<32°C or unconscious patients). Heating pads (B) may cause tissue damage, especially with frostbite.
NEW QUESTION # 29
A 19-year-old woman presents to the office. She is a new mother. She shares that she does not intend to vaccinate her son. Which one of the following is the best next step?
Answer: D
Explanation:
When encountering vaccine hesitancy, the first and most effective step is to open a non-judgmental conversation and explore the patient's reasons. This helps build trust and tailor subsequent education and counseling.
Toronto Notes 2023 - Public Health and Preventive Medicine, Immunization:
"Addressing vaccine hesitancy requires understanding parental concerns. Begin with open-ended questions to identify underlying beliefs and information gaps." MCCQE1 Objectives - Preventive Medicine > Immunization:
"Candidates must demonstrate effective communication with vaccine-hesitant parents, beginning with eliciting their rationale before providing evidence-based recommendations." Jumping to education (B) or punitive measures (C, D) may close communication. The patient is an adult; speaking with her parents (E) violates her autonomy.
NEW QUESTION # 30
While covering for a colleague away on holidays, you receive the following laboratory results for one of her patients, a 24-year-old woman:
White blood cell count: 10 × 10#/L (4-10)
Hemoglobin: 80 g/L (123-157)
Mean corpuscular volume: 76 fL (80-100)
Platelet count: 150 × 10#/L (130-400)
You have arranged a follow-up appointment for the patient with your colleague. Which one of the following is the most likely diagnosis?
Answer: E
Explanation:
These results show a significant anemia (Hb 80 g/L) with microcytosis (MCV 76 fL) and otherwise preserved cell lines (WBC at the upper end of normal; platelets normal). MCCQE objectives emphasize using CBC patterns to classify anemia and prioritize common causes. In a young woman, the most likely cause of microcytic anemia is iron deficiency , most often due to menstrual blood loss and/or inadequate iron intake, and it can be severe.
Leukemia and myelodysplasia typically present with abnormalities in multiple cell lines (e.g., leukocytosis with blasts or cytopenias) and are less consistent with an isolated microcytic anemia and normal platelets.
Anemia of chronic disease is usually normocytic or mildly microcytic and is less likely to produce such a low hemoglobin without an obvious chronic inflammatory condition. Thalassemia trait classically has marked microcytosis with relatively preserved hemoglobin (often only mild anemia) and is suggested by a lifelong history and family/ethnic background. The next clinical step (at follow-up) would be iron studies (ferritin first) and assessment for bleeding sources.
NEW QUESTION # 31
A 43-year-old man comes to your office for the first time. He has not seen a doctor in over 5 years and has no known past medical history. On examination, his blood pressure is 120/70 mm Hg, and the remainder of his examination is normal. As part of the initial visit, you order some screening blood work that reveals a fasting blood glucose of 6.3 mmol/L (3.3-5.8) and a hemoglobin A1c of 6.1% (4-6). Which one of the following is the best next step?
Answer: B
Explanation:
This patient's lab results suggest impaired fasting glucose and an elevated A1c just below the threshold for diabetes. The gold standard to confirm diabetes in such intermediate cases is the 75 g oral glucose tolerance test (OGTT).
Toronto Notes 2023 - Endocrinology, "Diabetes Mellitus" Section:
"If A1c is in the 6.0-6.4% range or fasting glucose 6.1-6.9 mmol/L, a 75 g OGTT is recommended to establish the diagnosis of diabetes or confirm impaired glucose tolerance." MCCQE1 Objectives (Internal Medicine > 76-4: Diabetes):
"Candidates must correctly apply diabetes screening and diagnostic criteria and follow up abnormal results with appropriate confirmatory testing." Urine ACR (C) is useful in diagnosed diabetes, not for initial screening. TSH (A), capillary glucose testing (B), and exercise testing (E) are not indicated at this stage.
NEW QUESTION # 32
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