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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Dimensions of Care | 50% | - Health Promotion and Illness Prevention - Assessment and Diagnosis - Chronic Care - Acute Care |
| Topic 2: Physician Activities | 50% | - Management - Communication - Psychosocial Aspects - Professional Behaviours |
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NEW QUESTION # 287
A 14-month-old boy is brought to see you for a well-baby check-up and is noted to have onlyone testis.
Ultrasound confirms an undescended testis. Which one of the following is the best next step?
Answer: A
Explanation:
Orchiopexy is the treatment of choice for cryptorchidism and should be performed between 6-18 months of age. Early surgery improves fertility outcomes and reduces malignancy risk.
Toronto Notes 2023 - Pediatrics, Urology:
"Undescended testes should be referred for orchiopexy ideally before 18 months of age. Observation beyond
6 months is not recommended."
MCCQE1 Objectives - Pediatrics > Genitourinary Disorders:
"Candidates must recognize and refer for cryptorchidism early to optimize testicular function and reduce cancer risk." Hormonal therapies (C, D) are not recommended due to limited efficacy. Observation (A) is too late beyond
NEW QUESTION # 288
A 65-year-old woman presents to the office for follow-up regarding vaginal bleeding. Her last visit was 2 months ago. At that visit, the results of a pelvic examination and a Papanicolaou test were normal. She also had an endometrial biopsy but there was "insufficient material for diagnosis." She reports that she is still losing small amounts of blood almost every day. On history, she has been taking continuous combined hormone replacement therapy for 10 years because of vasomotor symptoms. Which one of the following is the most appropriate next step in management?
Answer: A
Explanation:
Persistent postmenopausal bleeding requires thorough evaluation. An inadequate endometrial biopsy result does not rule out pathology. Hysteroscopy allows for direct visualization and targeted biopsy and is the gold standard when biopsy is non-diagnostic.
Toronto Notes 2023 - Gynecology, "Abnormal Uterine Bleeding and Endometrial Cancer" Section:
"Persistent bleeding with insufficient biopsy requires further evaluation, preferably via hysteroscopy and directed biopsy. This is especially important in patients on HRT or with risk factors for endometrial pathology." MCCQE1 Objectives (Obstetrics & Gynecology > 82-9: Postmenopausal Bleeding):
"Candidates must investigate abnormal bleeding in postmenopausal women with hysteroscopy when endometrial sampling is non-diagnostic." Changing hormones (A), reducing progestin (E), or performing colposcopy (C) are not appropriate without confirming the cause of bleeding.
NEW QUESTION # 289
A 60-year-old woman presents with a 7-day history of bloody diarrhea and diffuse mild abdominal tenderness. Stool tests (culture, ova/parasites) are negative. Which one of the following is the best next step?
Answer: B
Explanation:
Persistent bloody diarrhea with negative stool cultures and ova/parasite testing in an older adult suggests inflammatory bowel disease (IBD) or another colitis such as ischemic or microscopic colitis. Colonoscopy is the best next diagnostic step to evaluate for ulcerative colitis, Crohn disease, ischemic colitis, or malignancy.
Toronto Notes 2023 - Gastroenterology, "Inflammatory Bowel Disease":
"Persistent bloody diarrhea with negative infectious work-up should prompt colonoscopic evaluation to rule out IBD or other forms of colitis." MCCQE1 Objectives (Internal Medicine > Gastrointestinal > 47-1):
"Candidates must assess and investigate chronic or persistent diarrhea. In the presence of red flag features such as bleeding, weight loss, or anemia, colonoscopy is indicated." Antibiotics (A) are not indicated with negative stool cultures. Observation (C) and loperamide (D) risk delaying diagnosis. Steroids (E) may be required later but only after confirmation of diagnosis.
NEW QUESTION # 290
A 51-year-old man comes to your clinic for follow-up regarding his type 1 diabetes. His hemoglobin A1c is
12.5% (normal 4-6%). He has never had such high blood sugar results. He drinks 2 beers per night to help with sleep. He is not well rested because he has been sleeping on a friend's couch since losing his job last year. Which one of the following is the best next step?
Answer: D
Explanation:
This patient is experiencing social instability (homelessness, job loss) likely contributing to poorly controlled diabetes. Before investigating or prescribing further, it is essential to address his ability to afford and manage self-monitoring and insulin.
Toronto Notes 2023 - Endocrinology, Diabetes:
"Social determinants such as housing insecurity and financial barriers significantly affect diabetes self- management. Addressing access to glucose monitoring and insulin is critical." MCCQE1 Objectives - Internal Medicine > Chronic Disease Management:
"Candidates must assess barriers to effective disease control, including financial and psychosocial limitations." Antidepressants (B) may be helpful later if depression is suspected. Thyroid testing (C) is not the priority. A dietitian (D) may help long-term, but immediate access and adherence are more urgent.
NEW QUESTION # 291
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: A
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 # 292
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