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| Section | Weight | Objectives |
|---|---|---|
| Physician Activities | 50% | - Psychosocial Aspects - Communication - Management - Professional Behaviours |
| Dimensions of Care | 50% | - Acute Care - Assessment and Diagnosis - Health Promotion and Illness Prevention - Chronic Care |
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NEW QUESTION # 258
An 18-month-old girl is brought in with a 3-day history of frequently passing loose stools. The stools are not bloody, but when she passes the stools, she is in obvious pain. She started vomiting earlier today, but she is still wetting diapers. On examination, she is mildly dehydrated but active and alert. Physical examination findings are otherwise normal. Which one of the following is the best management of this patient's case?
Answer: B
Explanation:
This child has acute viral gastroenteritis with mild dehydration. She remains alert, active, and continues to produce urine, indicating mild volume depletion. According to MCCQE objectives and pediatric guidelines, the first-line management of mild to moderate dehydration due to gastroenteritis is oral rehydration therapy (ORT) using a commercially prepared oral rehydration solution (ORS). ORS contains the appropriate balance of glucose and electrolytes to promote sodium and water absorption via the sodium-glucose cotransporter in the intestine. Antidiarrheal agents such as loperamide are contraindicated in young children due to risk of adverse effects and limited benefit. Withholding food until diarrhea resolves is unnecessary; early refeeding with an age-appropriate diet is recommended once rehydration begins. Apple juice and chicken broth do not provide the correct electrolyte composition and may worsen diarrhea due to high osmolarity. Routine lactose restriction is not indicated unless persistent symptoms suggest secondary lactose intolerance. Early ORT reduces the need for intravenous fluids and hospital admission.
NEW QUESTION # 259
A 68-year-old man with a history of diabetes, hypertension, delirium tremens, and tobacco addiction comes to the Emergency Department with his daughter. She tells you that his behavior has become unmanageable and she feels he may require an increased level of care. His vital signs are:
Blood pressure: 162/105 mm Hg
Heart rate: 112/min, regular
Temperature: 37.8°C
On history, his daughter explains she had to confiscate a half-empty bottle of alcohol from his room yesterday. He is now convinced that there are bugs crawling all over him and he will not relax. He appears pale, sweaty, and shaky. His most recent blood glucose is 7.8 mmol/L (3.8-11.1). Which one of the following is the best next step?
Answer: D
Explanation:
The presentation is consistent with acute alcohol withdrawal with delirium tremens: autonomic instability, agitation, visual hallucinations (formication), and recent alcohol reduction. This is a medical emergency requiring immediate treatment with benzodiazepines and supportive care.
Toronto Notes 2023 - Psychiatry, Substance Use Disorders:
"Delirium tremens is a life-threatening complication of alcohol withdrawal. Clinical features include agitation, hallucinations, tachycardia, hypertension, and diaphoresis. Management includes high-dose benzodiazepines and IV fluids." MCCQE1 Objectives - Psychiatry > Substance Use Disorders:
"Candidates must recognize and treat alcohol withdrawal delirium promptly with benzodiazepines and supportive measures." Antipsychotics (B) are not first-line in withdrawal states. Private interviews (A) and psychiatric consults (D) delay life-saving treatment.
NEW QUESTION # 260
A 76-year-old man is brought by his family to your clinic with new-onset urinary incontinence. They state that the patient is experiencing a slowly progressing cognitive decline marked by memory disturbance, apathy, and attentional problems. Examination reveals that the patient has a stooped, forward-leaning posture and a wide-based gait. Which one of the following is the most likely diagnosis?
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
This patient presents with the classic triad of normal pressure hydrocephalus (NPH): gait disturbance (often wide-based and magnetic), cognitive decline, and urinary incontinence. The combination, especially with the gait being most prominent, is highly suggestive.
Toronto Notes 2023 - Geriatrics / Neurology:
"NPH presents with gait disturbance, dementia, and urinary incontinence. Gait is typically broad-based and magnetic. Imaging shows ventriculomegaly without elevated pressure." MCCQE1 Objectives (Geriatrics > 41-1: Cognitive Disorders):
"Candidates must identify NPH and distinguish it from other dementias based on clinical triad and gait features." Alzheimer's (B) primarily presents with memory loss. Parkinson's (A) has bradykinesia and rigidity. Lewy body dementia (C) includes visual hallucinations and fluctuating cognition. FTD (E) has personality and behavioral changes.
NEW QUESTION # 261
A 20-year-old woman, gravida 0, para 0, presents with increased facial hair. Her periods are regular and moderate. Her BMI is 24, and her blood pressure is 110/70 mm Hg. Which one of the following is the most likely diagnosis?
Answer: A
Explanation:
Idiopathic hirsutism is the most likely diagnosis because this patient has isolated hirsutism with normal vital signs, normal BMI, and regular menstrual cycles , suggesting preserved ovulation and no clinically significant endocrine disturbance. MCCQE objectives emphasize that the most common causes of hirsutism are PCOS and idiopathic hirsutism; PCOS typically includes menstrual irregularity/oligo-ovulation and often metabolic features (overweight, insulin resistance), none of which are present here. Androgen-secreting ovarian tumors (hilar cell or Sertoli-Leydig cell tumors) usually cause rapid onset, severe hyperandrogenism and virilization (deepening voice, clitoromegaly, marked acne) and often disrupt menses-features not described. Nonclassic congenital adrenal hyperplasia can present with hirsutism, but it more commonly associates with acne, infertility, or menstrual abnormalities and requires biochemical suspicion rather than being the "most likely" with normal cycles. Therefore, idiopathic hirsutism-often due to increased peripheral androgen sensitivity or local 5-alpha reductase activity-is the best fit.
NEW QUESTION # 262
An 85-year-old man is transferred from an acute care hospital to your long-term care (LTC) facility. He has a fever, fatigue, myalgia, and malaise. His test result is positive for influenza A virus. Two other residents and 1 LTC staff member have experienced the same symptoms. Which one of the following is the best next step to prevent further infections at the LTC facility?
Answer: B
NEW QUESTION # 263
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