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| Section | Objectives |
|---|---|
| Physician Roles (CanMEDS Framework) | - Collaborator
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NEW QUESTION # 229
Which one of the following bodies decides whether a physician is permitted to practise medicine in a province or territory?
Answer: D
Explanation:
Comprehensive and Detailed Explanation:
The authority to license and regulate physicians to practise medicine is held by the medical regulatory colleges in each province or territory (e.g., CPSO in Ontario, CPSBC in BC).
MCC Objectives (ELOM > 90-1: Medical Regulation in Canada):
"Licensure to practise medicine is granted by the provincial or territorial medical regulatory authority." Toronto Notes 2023 - Ethics and Canadian Health Care System:
"Medical regulatory colleges determine physician licensure and discipline in each jurisdiction." The CFPC/RCPSC (C) certify physicians, not license them. Ministries of Health (A) oversee health policy, not licensing. Associations (E) advocate for physicians but do not regulate. Hospital boards (B) grant privileges, not licenses.
NEW QUESTION # 230
A previously well 2-year-old girl is brought to the Emergency Department with difficulty breathing that has been gradually worsening over the last 24 hours. Her parents say she has a sore throat. On examination, you note that she appears ill. She has stridor and is in moderate respiratory distress, drooling and emitting a muffled voice. Vital signs are as follows: respiratory rate 34/min, heart rate 160/min, temperature 40.2°C.
Which one of the following is the most likely diagnosis?
Answer: C
Explanation:
Retropharyngeal abscess is most likely because the child is toxic-appearing with very high fever (40.2°C), sore throat, drooling, muffled "hot potato" voice, and stridor with progressively worsening respiratory distress over about 24 hours. In toddlers, retropharyngeal lymph nodes can become infected following an upper respiratory or pharyngeal infection and form an abscess, causing posterior pharyngeal swelling that obstructs the airway and makes swallowing painful, leading to drooling. Croup typically presents with a barking cough and hoarseness, usually with low-grade fever; drooling and muffled voice suggest a deeper space infection rather than viral laryngotracheitis. Foreign body aspiration usually has sudden onset and often lacks fever.
Laryngomalacia is a chronic infant condition (not acute, febrile illness). Bronchiolitis causes wheeze/crackles rather than prominent stridor and drooling. MCCQE priorities are airway-first management (minimize agitation, be prepared for a difficult airway), then prompt IV antibiotics and urgent ENT assessment for possible drainage.
NEW QUESTION # 231
A 26-year-old man presents with pain, numbness, and weakness in his right upper extremity. He works as a computer programmer, and his BMI is 32. Symptoms have worsened since he started spending more time on the keyboard. He reports that his right hand feels clumsier while he is typing. Physical examination reveals mild weakness in the intrinsic muscles of that hand, with a positive Tinel sign at the ulnar nerve. Which one of the following is the best next step?
Answer: A
Explanation:
This patient presents with symptoms and signs of ulnar neuropathy-most likely at the elbow (cubital tunnel).
Weakness in the intrinsic hand muscles and positive Tinel sign at the ulnar nerve are suggestive. Nerve conduction studies are the gold standard to confirm and localize the lesion.
Toronto Notes 2023 - Neurology, "Peripheral Nerve Disorders":
"In cases of suspected mononeuropathy such as ulnar nerve compression, nerve conduction studies confirm the diagnosis and localize the lesion." MCCQE1 Objectives (Medicine > Neurology > 35-2):
"Candidates should identify and investigate focal mononeuropathies using nerve conduction studies to confirm the diagnosis and location." Splinting (A, C) may help after diagnosis. Physiotherapy (B) is adjunctive. MRI (D) is not the first-line investigation.
NEW QUESTION # 232
You are covering for your colleague who is on vacation this week. You receive the results from an ultrasonography that had been ordered for a 32-year-old woman, gravida 2, para 1, aborta 0. The ultrasonography-estimated fetal weight is below the fifth percentile for 30 weeks' gestation; gestational age was confirmed by an earlier ultrasonogram. The amniotic fluid volume is within normal range. Her first child's birth weight was 2800 g at full term. Which one of the following is the best next step?
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
An estimated fetal weight below the 5th percentile at 30 weeks is concerning for intrauterine growth restriction (IUGR). This warrants prompt evaluation of fetal well-being via biophysical profile and Doppler assessment. The patient should be referred for further fetal assessment immediately to rule out placental insufficiency or other complications.
Toronto Notes 2023 - Obstetrics, "Fetal Growth Restriction":
"EFW < 10th percentile, especially < 5th, warrants further evaluation including Doppler studies and biophysical profile. Immediate assessment is warranted to determine fetal well-being." MCCQE1 Objectives (Obstetrics > 80-4: Antepartum Surveillance):
"Candidates must initiate urgent assessment in cases of abnormal fetal growth to reduce perinatal morbidity." Delaying care (B) is inappropriate. Reassurance (A) is unsafe. ASA (D) is preventative, not corrective.
Doppler (E) is important but should be coordinated through obstetrical triage.
NEW QUESTION # 233
The parents of a 12-year-old boy present to your clinic to discuss their son's submersion injury. The patient was seen in hospital for 6 months after being pulled unresponsive from a lake at his friend's house; he had been submerged for an estimated 20 minutes. After extended resuscitation and a 2-month stay in the intensive care unit, he remains in a persistent vegetative state but needs no respiratory or cardiac support. When evaluating the discharge from hospital, which one of the following is most appropriate?
Answer: A
Explanation:
Comprehensive and Detailed Explanation:
The patient is in a persistent vegetative state and medically stable, meaning he does not need continued hospitalization. The goal is to provide appropriate long-term care in the least restrictive setting, typically at home with robust home care support services. This approach aligns with ethical care, family-centered goals, and medical appropriateness.
Toronto Notes 2023 - Pediatrics / Neurodevelopment & Chronic Care:
"Home care with appropriate medical and caregiver support is often the best setting for children with severe neurological impairments who are medically stable." MCCQE1 Objectives (Pediatrics > 77-5: Chronic Neurological Disorders):
"Candidates must assess discharge planning and coordinate home care support for children with long-term care needs." Palliative facility (B) is not appropriate unless end-of-life is imminent. School (C) is not feasible in this state.
Hospital readmission for respite (D) is not standard. Rehabilitation (E) has little utility in persistent vegetative state.
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NEW QUESTION # 234
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