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| Section | Objectives |
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| Physician Roles (CanMEDS Framework) | - Leader (Manager)
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NEW QUESTION # 16
A 12-year-old girl is brought to your clinic by her parents 6 weeks after experiencing a minimally displaced buckle fracture of her distal radius. It was immobilized in a cast for 3 weeks. On examination, she supports her forearm with the opposite hand. She is unwilling to move her elbow, wrist, and fingers. The findings of her neurovascular examination are normal, and the soft tissue is supple. A repeat radiograph shows bony union. Which one of the following is the most likely diagnosis?
Answer: C
Explanation:
Complex regional pain syndrome (CRPS type I) is the most likely diagnosis because the child has persistent, function-limiting pain behavior and marked unwillingness to move the entire limb despite a minor fracture that is now healed radiographically and has a normal neurovascular exam. MCCQE objectives emphasize recognizing pain that is disproportionate to tissue injury and persists beyond expected healing, often accompanied by guarding and fear of movement. CRPS can occur after fractures or immobilization and may present with severe allodynia, hyperalgesia, edema, color/temperature changes, and motor dysfunction; however, early cases may primarily show avoidance of movement and pain with otherwise normal objective findings.
An unrecognized scaphoid fracture would cause localized wrist pain (classically snuffbox tenderness) rather than refusal to move elbow, wrist, and fingers, and would not be explained by a distal radius buckle fracture that has united. Ischemic (Volkmann) contracture would involve a tense forearm, fixed flexion deformity, and neurovascular compromise. Median nerve compression would produce sensory changes and thenar weakness.
School avoidance alone does not explain the post-injury limb-protective pattern with normal healing.
Management focuses on reassurance, early mobilization, physiotherapy, and multidisciplinary pain strategies.
NEW QUESTION # 17
A 35-year-old woman presents to your clinic with double vision and a gritty sensation in her eyes for the past several weeks. On examination, you notice her eyes are bulging. There is inflammation of her conjunctivae and swelling around her eyes. Which one of the following is the most likely diagnosis?
Answer: A
Explanation:
The findings of exophthalmos (bulging eyes), conjunctival inflammation, and periorbital swelling are hallmark features of Graves ophthalmopathy, a manifestation of autoimmune hyperthyroidism.
Toronto Notes 2023 - Endocrinology, "Thyroid Disorders":
"Graves ophthalmopathy: proptosis, periorbital edema, conjunctivitis, and diplopia due to extraocular muscle involvement. Often independent of thyroid levels." MCCQE1 Objectives (Internal Medicine > 36-1: Thyroid Disease):
"Candidates must recognize and manage Graves disease and its ocular manifestations." Myasthenia gravis may cause diplopia but not proptosis or swelling. Pseudotumor and cellulitis are painful and acute. Allergic conjunctivitis is itchy but lacks proptosis.
NEW QUESTION # 18
Following a potluck supper organized by the residency director of your training program, many of your fellow residents and other guests fall ill with gastroenteritis. Which one of the following is the best way to identify the source of this food-borne outbreak?
Answer: A
Explanation:
Calculating food-specific attack rates (i.e., number of people who became ill after eating aparticular food divided by the total number who ate that food) is the most effective method to identify the probable source of infection in a known cohort outbreak.
Toronto Notes 2023 - Public Health, Outbreak Investigations:
"Foodborne outbreaks are best analyzed using food-specific attack rates to determine associations between individual foods and illness." MCCQE1 Objectives - Preventive Medicine > Epidemiologic Principles:
"Candidates must use epidemiologic tools, such as attack rates, to identify probable sources during outbreak investigations." Cohort study (C) is also acceptable but more time-intensive. Stool and food cultures (B, D) confirm the pathogen but not the source. HACCP (E) is a preventive method, not a tool for outbreak investigation.
NEW QUESTION # 19
You are following an otherwise healthy 3-month-old girl whose severe bilateral sensorineural deafness was diagnosed after early identification through a universal newborn hearing screening program. She has reached the developmental milestones for her age and has no features of an underlying syndrome. There is no family history of hearing loss. The parents request information on the speech and language prognosis for their daughter. Which one of the following is the most appropriate response?
Answer: C
Explanation:
Early identification of sensorineural hearing loss through universal newborn screening enables early intervention (e.g., cochlear implants, speech therapy), which can result in near-normal language development.
Toronto Notes 2023 - Pediatrics, Hearing Loss:
"Children diagnosed early with bilateral hearing loss and provided with appropriate intervention (e.g., amplification or implants) can achieve normal speech and language milestones." MCCQE1 Objectives - Pediatrics > Development & Communication Disorders:
"Candidates must understand the importance of early detection and intervention in congenital hearing loss and its impact on speech and literacy outcomes." Other options (A-C, E) are outdated or overly pessimistic. Current evidence supports favorable outcomes with early diagnosis and management.
NEW QUESTION # 20
A 29-year-old woman presents to the sexually transmitted infection clinic with concerns regarding a copious vaginal discharge. Ten percent potassium hydroxide was used to confirm the diagnosis of which one of the following?
Answer: B
Explanation:
A 10% potassium hydroxide (KOH) preparation is commonly used in the evaluation of vaginal discharge. In bacterial vaginosis (BV) , adding KOH to a vaginal sample produces a characteristic "whiff test" -a strong fishy amine odor caused by volatilization of amines from anaerobic bacteria (e.g., Gardnerella vaginalis and other anaerobes). MCCQE objectives emphasize recognition of BV as the most common cause of abnormal vaginal discharge in reproductive-age women. Clinical features include thin, gray-white, malodorous discharge without significant inflammation.
KOH microscopy may also reveal clue cells (vaginal epithelial cells coated with bacteria).
Trichomonas vaginalis is diagnosed by saline wet mount showing motile trichomonads or by nucleic acid amplification testing (NAAT), not primarily by KOH. Chlamydia trachomatis and gonorrhea are diagnosed by NAAT. Group B streptococcus is identified by culture.
Thus, use of 10% KOH to confirm a fishy odor (positive whiff test) supports the diagnosis of bacterial vaginosis .
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NEW QUESTION # 21
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