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| Section | Weight | Objectives |
|---|---|---|
| Dimensions of Care | 50% | - Acute Care - Chronic Care - Health Promotion and Illness Prevention - Assessment and Diagnosis |
| Physician Activities | 50% | - Professional Behaviours - Communication - Management - Psychosocial Aspects |
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NEW QUESTION # 189
A 32-year-old woman presents to the office with questions related to the mRNA vaccines that are approved for COVID-19. She is a health care worker. She gave birth to a healthy child 2 months ago. Before being immunized, which one of the following is the most important detail to elicit from the patient's history?
Answer: B
Explanation:
The most important pre-vaccination history to elicit is any previous anaphylaxis to vaccine components.
mRNA COVID-19 vaccines (e.g., Pfizer-BioNTech and Moderna) may contain polyethylene glycol (PEG), a potential allergen. This is a contraindication to administration.
Toronto Notes 2023 - Infectious Disease & Immunization Chapter:
"Absolute contraindications to mRNA COVID-19 vaccination include a documented anaphylactic reaction to a component of the vaccine such as polyethylene glycol (PEG)." MCCQE1 Objectives - Population Health > Preventive Medicine > Immunizations:
"The candidate must be able to assess for contraindications prior to immunization, including anaphylaxis to previous vaccines or components." Breastfeeding and occupational exposure (Options B and D) do not preclude vaccination. Current immunosuppression (Option C) may affect vaccine efficacy but is not a contraindication unless specifically advised.
NEW QUESTION # 190
A 66-year-old woman has a 3-month history of dry cough and weight loss. A new chest radiograph reveals a large 2-cm mass in her right upper lobe, which is consistent with carcinoma. You look at her previous films and realize that you had read her chest radiograph as normal 1 year ago, but now clearly see a faint opacity in precisely the same location as her current lesion. Which one of the following is the best next step?
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
Physicians must be transparent and honest in documentation. If a previous abnormality was missed, it must be acknowledged. The correct action is to comment on both the previous and current findings in your report and follow institutional disclosure policies.
Toronto Notes 2023 - ELOM, "Medical Error and Disclosure":
"Physicians must report and document prior missed findings honestly and provide full disclosure when reviewing comparative studies." MCCQE1 Objectives (ELOM > 90-2: Accountability and Communication):
"Candidates must accurately document previous findings when reviewing comparative data, even if it reveals past oversight." Delaying reporting (C-E) or omitting prior findings (A) is unethical.
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NEW QUESTION # 191
A 47-year-old man has been training for a marathon. After a long run, he develops mild pain and swelling in his left knee. Examination shows a mild joint effusion and a soft tissue mass in the popliteal fossa. The knee radiograph is normal. Which one of the following is the best method of confirming the diagnosis?
Answer: C
Explanation:
This patient's presentation-knee effusion with a soft tissue mass in the popliteal fossa following exertion-is classic for a Baker (popliteal) cyst , which represents distention of the gastrocnemius-semimembranosus bursa, often associated with intra-articular pathology (e.g., meniscal injury or osteoarthritis). MCCQE objectives emphasize selecting the least invasive, most appropriate imaging modality to confirm suspected cystic lesions.
Ultrasound is the best initial diagnostic test because it is noninvasive, readily available, and highly sensitive for distinguishing a cystic structure from a solid mass or vascular pathology (e.g., popliteal artery aneurysm or deep vein thrombosis). It can also assess for complications such as cyst rupture.
Arthroscopy is invasive and not required for diagnosis. Arthrocentesis evaluates joint effusion but does not confirm a popliteal cyst. Aspiration of the mass without imaging is inappropriate due to risk of vascular injury. CT is unnecessary and exposes the patient to radiation.
Therefore, ultrasound is the preferred method to confirm a Baker cyst.
NEW QUESTION # 192
A 55-year-old woman presents to the office with a 2-month history of right shoulder pain and limited function that started after she began an upper body weight training program. Examination shows tenderness inferior to the acromion. She has full passive range of motion of the shoulder but significant pain with abduction from
30° to 120° of arc. Which one of the following is the best next step?
Answer: A
Explanation:
The presentation is consistent with rotator cuff tendinopathy or subacromial impingement. The painful arc between 30°-120° with preserved passive ROM suggests this. Ultrasound is the preferred initial imaging modality due to its availability, safety, and ability to visualize soft tissues dynamically.
Toronto Notes 2023 - Orthopedics, "Shoulder Pathologies" Section:
"In rotator cuff injuries or impingement syndromes, initial imaging with musculoskeletal ultrasound is appropriate. It can identify tendinopathy, partial tears, or subacromial bursitis." MCCQE1 Objectives (Surgery > 84-7: Musculoskeletal Pain):
"Candidates should initiate workup for rotator cuff or impingement syndromes with ultrasound as the first- line test, reserving more invasive or costly procedures for unresolved or complex cases." CT (A) is used for bony detail, not soft tissues. Arthroscopy (C) is invasive and therapeutic. Arthrography (D) is outdated and largely replaced by MRI or ultrasound.
NEW QUESTION # 193
A 10-year-old girl is brought to the Emergency Department by her mother because her daughter is crying and says she "can't pee." Her daughter fell on the monkey bars at school earlier that day. On examination, there is a large vulvar bruise anteriorly. Which one of the following is the best next step?
Answer: E
Explanation:
In pediatric trauma, inability to void with perineal bruising raises concern for urethral injury or urinary retention due to soft tissue swelling. The most immediate step is to attempt bladder catheterization. If unsuccessful, consult gynecology or urology urgently to avoid bladder overdistension.
Toronto Notes 2023 - Pediatrics, Genitourinary Trauma:
"In females, perineal trauma can lead to urinary retention due to labial hematomas or urethral injury. If catheterization is difficult, consult gynecology or urology for assistance." MCCQE1 Objectives - Pediatrics > Trauma and Emergency Care:
"Candidates must recognize when specialist consultation is required in pediatric genitourinary trauma, especially in cases of failed catheterization." Options B and D delay necessary care. Coagulation studies (C) may be considered if bleeding is unexplained.
Abuse assessment (E) may be necessary later but does not address immediate retention.
NEW QUESTION # 194
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