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| Section | Objectives |
|---|---|
| Topic 1: Physician Roles (CanMEDS Framework) | - Leader (Manager)
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>> MCCQE Reliable Study Notes <<
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NEW QUESTION # 13
A 48-year-old woman presents with a 2-year history of regular, heavy menstrual flow. She has a BMI of 54, poorly controlled type 2 diabetes, and obstructive sleep apnea. Laboratory results are as follows:
Hemoglobin: 82 g/L (123-157)
Ferritin: 6 µg/L (11-307)
Endometrial biopsy: Absence of hyperplasia or malignancy
Transvaginal ultrasound:
* Uterus: 12 cm × 8.2 cm × 6 cm
* Intramural fibroids
* Endometrial thickness: 14 mm
* Ovaries: Normal
Which one of the following is the best next step?
Answer: C
Explanation:
The levonorgestrel-releasing intrauterine system (LNG-IUS) is the first-line treatment for heavy menstrual bleeding, particularly in women with risk factors for endometrial hyperplasia and contraindications to systemic hormones (e.g., morbid obesity, diabetes, OSA).
Toronto Notes 2023 - Gynecology, "Abnormal Uterine Bleeding" Section:
"The LNG-IUS is highly effective in reducing menstrual bleeding and improving hemoglobin levels. It is particularly recommended in women with obesity, chronic anovulation, or contraindications to estrogen." MCCQE1 Objectives (Obstetrics and Gynecology > 82-1: Abnormal Uterine Bleeding):
"Candidates must consider the LNG-IUS as a preferred non-surgical treatment for chronic heavy menstrual bleeding when endometrial pathology has been excluded." Oral contraceptives (C) are not first-line in morbid obesity due to increased thromboembolic risk. Cyclic medroxyprogesterone (D) is less effective than LNG-IUS. Hysterectomy (A) is definitive but should follow failure of conservative therapy.
NEW QUESTION # 14
A 12-year-old girl presents to your office in late November with an exacerbation of asthma which has been well controlled since her diagnosis at age 5. The family has had cats for 3 years. Last June, they moved to a basement apartment. Which one of the following is the most likely cause of her asthma exacerbation?
Answer: D
Explanation:
Comprehensive and Detailed Explanation:
Basement apartments are often damp environments, increasing the risk of mold exposure. Mold is a well- known asthma trigger. Given the timing (autumn/winter) and environment change, mold allergy is the most likely cause.
Toronto Notes 2023 - Respirology / Allergy:
"Mold is a common indoor allergen, especially in damp environments. It frequently exacerbates asthma, particularly in fall/winter." MCCQE1 Objectives (Pediatrics > 75-2: Asthma Triggers):
"Candidates must identify common environmental triggers for asthma, including mold exposure in humid or poorly ventilated housing." Cat allergy (B) would have triggered earlier. Pollen (D) is less relevant in winter. Cold intolerance (E) is not a major asthma trigger without exercise. Fungal infection (A) is unlikely without systemic symptoms.
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NEW QUESTION # 15
A 68-year-old man presents with a 3-day history of multiple tender joints. On examination, he has a temperature of 38.2°C and swelling and redness of his left large toe. Which one of the following is the most likely diagnosis?
Answer: E
Explanation:
This patient presents with acute onset of joint pain, fever, and classic involvement of the first metatarsophalangeal joint (podagra) with swelling and erythema. MCCQE objectives emphasize recognizing the characteristic presentation of crystal-induced arthropathy , particularly gout. Gout commonly affects older men and presents with sudden, severe monoarthritis, often involving the great toe. Systemic symptoms such as low-grade fever may occur during acute attacks.
Viral arthritis typically causes symmetric polyarthritis without marked erythema of a single joint.
Osteoarthritis presents with chronic, non-inflammatory joint pain and minimal warmth or redness. Psoriatic arthritis is usually associated with psoriasis, nail pitting, or dactylitis. Rheumatoid arthritis typically presents as chronic, symmetric small-joint polyarthritis rather than acute podagra.
Although this patient reports multiple tender joints, the prominent inflamed great toe is classic for gout, and polyarticular involvement can occur, especially in older individuals. Diagnosis is ideally confirmed by joint aspiration showing monosodium urate crystals. Initial management includes NSAIDs, colchicine, or corticosteroids.
NEW QUESTION # 16
A couple is diagnosed with primary infertility secondary to azoospermia. They are not interested in in vitro fertilization techniques, so you recommend insemination with a sperm donor. The male partner is hesitant. He thinks he might have difficulty accepting raising a child who is not biologically his. Which one of the following is the best next step?
Answer: E
Explanation:
When couples face infertility-related decisions-particularly involving donor insemination-psychosocial counseling is essential. A mental health consultation helps explore emotional concerns, expectations, and readiness for non-biological parenting.
Toronto Notes 2023 - Gynecology, "Infertility and ART":
"Psychological counseling is recommended for couples considering donor gametes to address emotional, ethical, and identity issues before proceeding." MCCQE1 Objectives (ELOM > Reproductive Ethics > 83-1):
"Candidates must understand the ethical and psychosocial considerations of assisted reproductive techniques and provide appropriate referrals." Suggesting adoption or switching care dismisses valid concerns (B, C). Ovulation induction (D) does not address azoospermia.
NEW QUESTION # 17
An 18-month-old boy is brought to the office by his guardians for a well-child visit. His guardians are concerned that his eyes do not look the same. On examination, his eyes appear as shown in the referenced photo.
Which one of the following best represents the patient's condition?
Answer: D
Explanation:
The image shows an asymmetrical light reflex (corneal light reflex not centered in both eyes), which is diagnostic of strabismus. This misalignment of the eyes must be treated early to prevent amblyopia (lazy eye).
Toronto Notes 2023 - Pediatrics, Ophthalmology:
"Strabismus presents with misaligned visual axes. The Hirschberg light reflex is off-center in the affected eye.
Prompt referral is necessary to prevent amblyopia."
MCCQE1 Objectives - Pediatrics > Vision and Developmental Disorders:
"Candidates must recognize strabismus on visual screening and refer early for correction to prevent permanent vision impairment." Pseudostrabismus (B) can be ruled out here because the light reflex is not symmetric. Ptosis (A) involves drooping of the eyelid, which is not evident. Cataracts (D) would typically present with a leukocoria (white reflex), not misalignment.
NEW QUESTION # 18
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