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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Physician Activities | 50% | - Management - Professional Behaviours - Psychosocial Aspects - Communication |
| Topic 2: Dimensions of Care | 50% | - Health Promotion and Illness Prevention - Acute Care - Chronic Care - Assessment and Diagnosis |
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NEW QUESTION # 299
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: E
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 # 300
A 34-year-old man with trisomy 21 is brought to the Emergency Department because of a painful, red great toe. He is accompanied by an older woman who begins giving you the history as you enter the room. The patient is sitting on the examination table with the foot exposed, but he does not speak. Which one of the following is the best next step?
Answer: C
Explanation:
Patients with developmental disabilities must still be engaged directly unless clearly incapable. It is vital to first establish the companion's relationship to the patient and give the patient the opportunity to communicate.
Toronto Notes 2023 - ELOM, Consent and Capacity:
"Presume capacity in adults with developmental disabilities unless proven otherwise. Direct communication with the patient is essential, and the identity of accompanying individuals should be clarified." MCCQE1 Objectives - ELOM > Patient Autonomy and Consent:
"Candidates must respect patient autonomy and include developmentally delayed individuals in medical discussions unless incapacity is determined." Options A and C delay establishing capacity and relationship. Option D is premature. Option E bypasses consent and interaction with the patient.
NEW QUESTION # 301
A 34-year-old man sustained a blunt testicular trauma 2 hours ago. On physical examination, the patient has a
1.5-cm tall scrotal hematoma. You cannot palpate the testicle. Which one of the following is the best initial management?
Answer: E
Explanation:
In cases of blunt testicular trauma with inability to palpate the testicle due to hematoma, scrotal ultrasonography is the first-line investigation to assess for testicular rupture or other injury.
Toronto Notes 2023 - Urology, "Testicular Trauma":
"Scrotal ultrasound is the investigation of choice to assess for testicular rupture, hematoma, or torsion. Early imaging is critical if testis is non-palpable or if hematoma is significant." MCCQE1 Objectives (Surgery > 51-2: Genitourinary Trauma):
"Candidates must investigate testicular trauma using ultrasound to rule out rupture or torsion." Exploration (B) is done if ultrasound confirms rupture. Observation or discharge (A, E) without imaging risks missing serious injury.
NEW QUESTION # 302
You are meeting an otherwise healthy 10-year-old boy in your office for the first time. His BMI is at the 80th percentile. He has no symptoms and his physical examination is normal. Which one of the following is the best next step?
Answer: D
Explanation:
Children with a BMI #85th percentile (overweight) and risk factors such as sedentary lifestyle or family history should be screened for cardiovascular risk. A fasting lipid profile is recommended starting at age 9-11 as part of universal screening per guidelines.
Toronto Notes 2023 - Pediatrics:
"Universal lipid screening is recommended for children aged 9-11 and 17-21. Children who are overweight should undergo targeted screening including fasting lipids." MCCQE1 Objectives (Pediatrics > 78-1: Preventive Pediatrics):
"Candidates must recognize screening indications for common pediatric risk factors, including dyslipidemia in overweight children." Thyroid and cortisol testing (C, D) are not indicated without symptoms. HbA1c (E) is used in children with BMI >95% or with additional diabetes risk factors.
NEW QUESTION # 303
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 # 304
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