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| Section | Weight | Objectives |
|---|---|---|
| Dimensions of Care | 50% | - Chronic Care - Acute Care - Assessment and Diagnosis - Health Promotion and Illness Prevention |
| Physician Activities | 50% | - Psychosocial Aspects - Management - Communication - Professional Behaviours |
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NEW QUESTION # 340
You have been asked to develop a program in your hospital for people who are at the highest risk of death by suicide. The hospital administrator asks you to describe the types of patients they should expect in the program. Which one of the following groups is the most likely prominent demographic?
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
Middle-aged to older men with social isolation and substance use disorders (especially alcohol) are among the highest-risk groups for completed suicide. They are less likely to seek help and often use more lethal methods.
Toronto Notes 2023 - Psychiatry, "Suicide Risk Assessment":
"High-risk demographics include older men, social isolation, comorbid alcohol use, and chronic illness. These patients have the highest rates of completed suicide." MCCQE1 Objectives (Psychiatry > 71-1: Suicide Risk):
"Candidates must recognize epidemiologic risk factors for completed suicide, including demographics and comorbidities." Although women and youth have higher rates of suicidal ideation and attempts, men over 50 have the highest completion rates.
NEW QUESTION # 341
A 39-year-old woman, gravida 2, para 1, aborta 0, presents with concerns that a friend has recently suffered from postpartum psychosis. She wonders if she is likely to suffer this disorder following delivery of her 2nd child. Which one of the following is most likely to increase your patient's risk?
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
Postpartum psychosis is strongly associated with bipolar disorder and other mood disorders. A personal or family history of bipolar disorder significantly increases the risk. It typically presents within the first 2 weeks postpartum and is a psychiatric emergency.
Toronto Notes 2023 - Psychiatry, "Postpartum Psychiatric Disorders":
"Risk factors for postpartum psychosis include personal or family history of bipolar disorder or postpartum psychosis." MCCQE1 Objectives (Psychiatry > 71-3: Mood Disorders):
"Candidates must recognize risk factors for postpartum psychiatric illness, particularly the association with bipolar spectrum disorders." Advanced maternal age (A), multiparity (B), and panic disorder (D) do not significantly increase the risk of postpartum psychosis.
NEW QUESTION # 342
A 56-year-old man is admitted to hospital with pyelonephritis and started on intravenous antibiotics. On day 2 of his hospitalization, he continues to report right flank pain, but he is able to walk. His vital signs are as follows:
Temperature: 38.5°C
Blood pressure: 90/60 mm Hg
Heart rate: 105/min
The patient is mentating well but is concerned about his dog that is home alone due to his unexpected hospitalization. He requests to be released from hospital as he needs to make arrangements for his dog. Which one of the following is the best next step?
Answer: D
Explanation:
The patient is alert and capable of making his own decisions. The most ethical and respectful approach is to ensure he understands the risks and accept his choice. Holding his bed maintains continuity of care. Forcing him to stay (C) or discharging him AMA (A) is inappropriate if he intends to return.
Toronto Notes 2023 - ELOM, Consent and Autonomy:
"Capable patients have the right to refuse or leave treatment. Physicians must ensure informed decision- making and maintain therapeutic rapport." MCCQE1 Objectives - ELOM > Capacity and Patient Autonomy:
"Candidates must respect a capable patient's right to leave care after informed discussion of risks and alternatives." Offering to enter his apartment (E) is inappropriate and unethical. Oral antibiotics (B) may not be clinically appropriate given hypotension.
NEW QUESTION # 343
A 6-week-old boy is brought to your office by his parents for a follow-up following a recent urinary tract infection. His abdominal ultrasound shows dilated urinary bladder and ureters as well as bilateral hydronephrosis. Which one of the following historical findings would be most helpful in establishing the correct diagnosis?
Answer: A
NEW QUESTION # 344
A 78-year-old man, who is accompanied by his eldest son, presents for follow-up of his chronic kidney disease and neurocognitive disorder due to vascular disease. He is married and has 4 children. His creatinine clearance has slowly deteriorated over the last few years and has reached the stage where you are considering starting renal replacement therapy. After your discussion, it is clear that the patient, his son, and his wife want to start dialysis. Based on your assessment, it is clear that he does not understand the information you have relayed to him. You inform the patient that you believe he is incapable of making this decision and he agrees.
His son would prefer not to start dialysis as he is concerned about the impact this would have on his father's quality of life. Which one of the following is the best next step?
Answer: E
Explanation:
This patient has been assessed as incapable of making the decision regarding dialysis. MCCQE ELOM objectives emphasize that when a patient lacks decision-making capacity, treatment decisions must be made by a legally authorized substitute decision-maker (SDM) according to provincial/territorial hierarchy. The appropriate next step is to determine whether a formal SDM has been appointed (e.g., power of attorney for personal care) or identify the legally ranked default SDM.
Although the wife may often be the default SDM, this depends on jurisdiction and whether a formal representative has been designated. It is inappropriate to automatically follow the son's wishes, as he may not be the legal SDM. Nor should the physician impose their own recommendation without engaging the proper decision-making process. A large family meeting may be helpful later but does not replace identifying the legally authorized decision-maker.
Once identified, the SDM must make decisions based on the patient's prior capable wishes or, if unknown, the patient's best interests. Properly establishing the SDM ensures ethical and legal compliance in incapacity situations.
NEW QUESTION # 345
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