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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Physician Activities | 50% | - Psychosocial Aspects - Professional Behaviours - Management - Communication |
| Topic 2: Dimensions of Care | 50% | - Assessment and Diagnosis - Chronic Care - Health Promotion and Illness Prevention - Acute Care |
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NEW QUESTION # 305
An 18-year-old man presents to your clinic with a history of intermittent, dull, achy pain on the left side of his scrotum, and he has now noted left scrotal enlargement. On examination, you note a swelling in the left scrotum when he is standing that disappears when he is supine. Which one of the following is the most likely diagnosis?
Answer: A
Explanation:
A varicocele is a dilatation of the pampiniform plexus that presents with a "bag of worms" appearance, worsens with standing, and improves when lying down. It is most common on the left side due to anatomical drainage differences.
Toronto Notes 2023 - Urology, Scrotal Disorders:
"Varicoceles often present with a dull, aching pain and scrotal swelling that worsens when upright and disappears when supine." MCCQE1 Objectives - Internal Medicine > Urology:
"Candidates must recognize and diagnose varicocele by physical exam findings and typical symptom history." Cryptorchidism (A) refers to undescended testes. Torsion (B) presents acutely with severe pain. Hydrocele (C) transilluminates and is not posture-dependent. "Spermatocyte" (D) is not a clinical diagnosis.
NEW QUESTION # 306
A 50-year-old man with prostate cancer, which is complicated by bony and cerebral metastases, presents to your office. He has a 24-hour history of increasing lower back pain and weakness in his legs. On examination, you note decreased knee and ankle reflexes on both sides. Earlier today he had fecal incontinence. Which one of the following is the best next step?
Answer: D
Explanation:
This patient with known metastatic prostate cancer presents with acute back pain, bilateral lower limb weakness, decreased reflexes, and new fecal incontinence-classic red flags for malignant spinal cord compression . MCCQE objectives emphasize that this is an oncologic emergency requiring immediate intervention to prevent irreversible neurologic damage.
The first step is prompt administration of high-dose parenteral corticosteroids (e.g., dexamethasone) to reduce vasogenic edema around the spinal cord and preserve neurologic function. Steroids should be given immediately upon suspicion, even before confirmatory imaging. Urgent MRI of the spine and consultation with oncology, radiation oncology, and/or neurosurgery follow for definitive management (radiotherapy or surgical decompression depending on stability and prognosis).
Bed rest and analgesia alone are inadequate. A stellate ganglion block is unrelated. Although radiotherapy or surgery will likely be required, steroids must be administered first without delay. Early treatment significantly improves the likelihood of maintaining ambulation and continence.
NEW QUESTION # 307
A 66-year-old woman has a 3-month history of dry cough and weight loss. A new chest radiograph reveals a large 2-cm mass in her right upper lobe, which is consistent with carcinoma. You look at her previous films and realize that you had read her chest radiograph as normal 1 year ago, but now clearly see a faint opacity in precisely the same location as her current lesion. Which one of the following is the best next step?
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
Physicians must be transparent and honest in documentation. If a previous abnormality was missed, it must be acknowledged. The correct action is to comment on both the previous and current findings in your report and follow institutional disclosure policies.
Toronto Notes 2023 - ELOM, "Medical Error and Disclosure":
"Physicians must report and document prior missed findings honestly and provide full disclosure when reviewing comparative studies." MCCQE1 Objectives (ELOM > 90-2: Accountability and Communication):
"Candidates must accurately document previous findings when reviewing comparative data, even if it reveals past oversight." Delaying reporting (C-E) or omitting prior findings (A) is unethical.
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NEW QUESTION # 308
A 54-year-old woman presents to your office to discuss breast cancer screening. She is asymptomatic with no history of breast cancer. She had a fibroadenoma removed when she was 24 years old. The patient is not on any medications. Her family history is significant for a great-aunt with breast cancer. The patient has not had genetic testing but had normal breast screening 2 years ago. Which one of the following is the best next step?
Answer: A
Explanation:
According to Canadian guidelines, women aged 50 to 74 at average risk for breast cancer should undergo routine screening mammography every 2 to 3 years. A great-aunt with breast cancer does not raise this patient
' s risk to high. Mammography is appropriate as she is now due for the next screen.
Toronto Notes 2023 - Population Health, "Screening Guidelines" Section:
"Routine mammography is recommended every 2 years for average-risk women aged 50 to 74. Family history in second-degree or more distant relatives (e.g., great-aunt) does not qualify for high-risk screening or MRI." MCCQE1 Objectives (Population Health > 97-5: Screening and Prevention):
"Candidates should apply Canadian screening recommendations including mammography for average-risk women #50 years old." Self-breast exams (C) are not recommended for screening. PET scan (D) and MRI (E) are reserved for high- risk populations or diagnostic clarification.
NEW QUESTION # 309
A 2-year-old boy is brought by his parents to your clinic because of sudden onset of high fever, refusal to drink, and drooling. Examination reveals cervical lymphadenopathy as well as multiple ulcers on the inner lips, tongue, and gums. Which one of the following is the most likely diagnosis?
Answer: D
Explanation:
Primary herpetic gingivostomatitis caused by HSV-1 is common in toddlers. It presents with high fever, irritability, drooling, refusal to eat, and painful oral ulcers on the lips, gums, and tongue. Cervical lymphadenopathy is common.
Toronto Notes 2023 - Pediatrics, "Infectious Conditions in Children":
"Primary HSV-1 infection in children presents with high fever, cervical lymphadenopathy, and painful oral ulcers (gingivostomatitis)." MCCQE1 Objectives (Pediatrics > 75-2: Infectious Diseases):
"Candidates must recognize viral exanthems and enanthems, including herpetic gingivostomatitis, based on clinical findings." Kawasaki (A) includes conjunctivitis, strawberry tongue, and extremity changes. Epiglottitis (B) presents with drooling but without oral ulcers. Mono (C) lacks the ulcerative pattern. Hand-foot-mouth (D) affects palms and soles, not inner lips and gums predominantly.
NEW QUESTION # 310
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