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| Section | Objectives |
|---|---|
| Topic 1: Physician Roles (CanMEDS Framework) | - Scholar
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NEW QUESTION # 42
A 26-year-old man presents to your office with fever, chills, and malaise. Aside from an episode of dysuria 8 weeks ago, which spontaneously resolved, he has been healthy. On examination, his left wrist and right ankle are tender. There is a cluster of vesiculopustular lesions on his right hand. Which one of the following is the most likely diagnosis?
Answer: B
Explanation:
Disseminated gonococcal infection (DGI) typically presents with the classic triad of polyarthralgia, tenosynovitis, and skin lesions (especially pustules on extremities). A prior urogenital infection and systemic symptoms further support this diagnosis.
Toronto Notes 2023 - Infectious Disease, STIs:
"DGI presents with arthritis-dermatitis syndrome: fever, asymmetric polyarthralgia, tenosynovitis, and vesiculopustular skin lesions. It may follow asymptomatic or unrecognized urogenital infection." MCCQE1 Objectives - Infectious Disease > STIs:
"Candidates must recognize systemic manifestations of gonorrhea including DGI and distinguish it from other forms of arthritis or systemic illness." Reactive arthritis (C) may follow STI but includes conjunctivitis and urethritis. HIV (A) does not typically cause this triad. RA (D) has different distribution and chronicity. Varicella (E) presents with diffuse vesicular rash, not joint pain.
NEW QUESTION # 43
A 19-year-old woman returns to your clinic to discuss her recent laboratory tests. She initially presented with dysuria, dyspareunia, and abnormal uterine bleeding. Her vulvovaginal examination was normal. Her last sexual encounter was 3 weeks prior to the onset of her symptoms. Which one of the following pathogens is most likely to explain this clinical presentation?
Answer: A
Explanation:
Chlamydia trachomatis is the most common cause of cervicitis in young sexually active women and frequently presents with dysuria, dyspareunia, intermenstrual bleeding, and a normal vulvovaginal exam. It may be asymptomatic or have subtle signs and often affects the endocervix.
Toronto Notes 2023 - Gynecology, "Sexually Transmitted Infections" Section:
"Chlamydia is the most common bacterial STI. Symptoms may include intermenstrual bleeding, postcoital bleeding, dyspareunia, mucopurulent cervical discharge, and dysuria. The vulva and vagina may appear normal." MCCQE1 Objectives (Obstetrics and Gynecology > 82-1: Abnormal Uterine Bleeding):
"Candidates should evaluate STI-related cervicitis as a common cause of postcoital and intermenstrual bleeding in young women." Other options:
* A. Actinomyces israelii is associated with IUD use, not relevant here.
* B. Herpes simplex virus usually presents with painful ulcerations, not abnormal bleeding.
* C. Treponema pallidum (syphilis) causes painless ulcers or systemic symptoms in later stages.
* D. HPV causes warts or asymptomatic cervical dysplasia, not acute symptoms.
NEW QUESTION # 44
A 78-year-old man presents to the office with urinary hesitancy, straining to void his bladder, and a sensation of incomplete bladder emptying. On history, he has a BMI of 36 and type 2 diabetes. Which one of the following medications would most likely help the patient's symptoms?
Answer: A
Explanation:
This elderly man has classic lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) : hesitancy, straining, and incomplete emptying (obstructive symptoms). MCCQE objectives emphasize recognizing obstructive voiding symptoms in older men as most commonly due to prostatic enlargement causing bladder outlet obstruction.
First-line pharmacologic therapy for symptomatic BPH is an alpha-1 adrenergic receptor blocker (e.g., tamsulosin), which relaxes smooth muscle in the prostate and bladder neck, thereby improving urinary flow and reducing obstruction. Tamsulosin works relatively quickly and is appropriate for symptomatic relief.
Nitrofurantoin treats urinary tract infections, which are not suggested here. Fesoterodine is an antimuscarinic used for overactive bladder and could worsen urinary retention in obstructive BPH. Empagliflozin (an SGLT2 inhibitor) increases urinary glucose excretion and may worsen urinary frequency. Hydrochlorothiazide increases urine output and would not relieve obstructive symptoms.
Therefore, tamsulosin is the most appropriate medication to improve this patient's symptoms.
NEW QUESTION # 45
A 40-year-old woman presents with a 3-month history of discharge from her right nipple. The discharge was initially milky white, but over the last 2 weeks, the patient has noted blood stains on her bra. There is mild discomfort in the same breast around the time of menses periods. On physical examination, the upper outer quadrant of the breast is tender, but there are no palpable lumps. You are able to express fluid from the nipple which is in fact blood-tinged. Which one of the following is the most likely diagnosis?
Answer: E
Explanation:
Intraductal papilloma is the most likely diagnosis because it classically presents with spontaneous unilateral bloody or blood-tinged nipple discharge in a woman aged 30-50 years, often without a palpable mass.
MCCQE objectives emphasize that the most common cause of pathologic nipple discharge (unilateral, spontaneous, from a single duct, and bloody/serous) is intraductal papilloma. These benign tumors arise within a lactiferous duct and can cause intermittent bleeding.
Ductal carcinoma in situ (DCIS) may cause nipple discharge but more often presents with mammographic microcalcifications and may have an associated mass. Mammary duct ectasia typically occurs in perimenopausal women and causes thick, greenish or multicolored discharge rather than bloody discharge.
Staphylococcal infection (mastitis) presents with erythema, warmth, systemic symptoms, and purulent discharge. Paget disease involves eczematous changes of the nipple-areolar complex with underlying malignancy, not isolated bloody discharge without skin changes.
Therefore, in a 40-year-old woman with unilateral blood-tinged discharge and no palpable mass, intraductal papilloma is the most likely diagnosis and warrants further imaging and surgical evaluation.
NEW QUESTION # 46
A young man and woman who are in a relationship present to the office for prenatal counselling. During the visit, you observe that the man ' s lips appear as shown in the referenced photo.
[Image shows grouped vesicular lesions on erythematous base affecting the lips-classic for herpes labialis (HSV-1).] Which one of the following is the best advice?
Answer: E
Explanation:
The patient shows signs of herpes labialis (HSV-1), which can transmit genital herpes via oral sex. This poses a risk to the fetus if maternal infection occurs during pregnancy, especially near delivery. Preventing new genital HSV infection during pregnancy is critical.
Toronto Notes 2023 - Obstetrics:
"HSV-1 can cause genital herpes via oral-genital transmission. Avoid oral sex during outbreaks in pregnancy to prevent primary maternal infection." MCCQE1 Objectives (Obstetrics > 80-3: Infectious Disease in Pregnancy):
"Candidates must understand the importance of preventing new HSV infection during pregnancy and counsel appropriately." Culture (A) is not useful unless symptomatic. Serology (B) is not needed in this context. Cesarean (D) is not indicated unless active genital lesions at delivery. Acyclovir (C) is for infected mothers or near delivery.
NEW QUESTION # 47
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