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| Section | Objectives |
|---|---|
| Topic 1: Physician Roles (CanMEDS Framework) | - Health Advocate
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NEW QUESTION # 149
An 80-year-old woman presents to the Emergency Department with dizziness. She has a medical history of coronary artery disease. On examination, she is alert and oriented. Her vital signs are as follows:
Her electrocardiogram is shown in the image.
Which one of the following is the most likely diagnosis?
Blood pressure
80/60 mm Hg
Heart rate
40/min
Respiratory rate
12/min
Her electrocardiogram is shown in the attached image. Which one of the following is the most likely diagnosis?
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
The ECG reveals:
Regular P waves that are not consistently followed by QRS complexes
A dissociation between the atrial (P wave) and ventricular (QRS complex) activity A slow ventricular rate (~40 bpm) independent of atrial rate These findings are characteristic of a third-degree (complete) atrioventricular (AV) block, where there is no conduction of atrial impulses to the ventricles. The atria and ventricles beat independently, and the ventricular rate is maintained by an escape rhythm, often junctional or ventricular in origin.
This correlates with the patient's symptoms (dizziness, hypotension) and bradycardia, suggesting inadequate cardiac output due to AV dissociation.
Toronto Notes 2023 - Cardiology:
"Third-degree AV block shows complete AV dissociation with independent atrial and ventricular activity. It typically presents with bradycardia and hypotension. Urgent pacing may be required." MCCQE1 Objectives (Cardiology > 34-2: Bradyarrhythmias and Conduction Disorders):
"Candidates must identify complete heart block and recognize its clinical urgency." Ruling out other options:
A). Sinus bradycardia would show regular P waves with 1:1 P-QRS conduction.
B). First-degree AV block has prolonged PR intervals ( > 200 ms) but all P waves are conducted.
D). Junctional escape rhythm may present with bradycardia, but P waves would be absent, inverted, or occur after QRS complexes.
E). Mobitz type I (Wenckebach) has progressively lengthening PR intervals before a dropped QRS.
NEW QUESTION # 150
A 24-year-old woman has had several episodes of left lower lobe pneumonia. She has a chronic productive cough with occasional blood-streaked sputum. Physical examination is normal except for rales at the left base.
Chest radiograph shows a linear infiltrate in this area. Which one of the following is the most likely diagnosis?
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
Bronchiectasis is characterized by recurrent localized pneumonia, chronic productive cough, and hemoptysis.
A linear infiltrate that persists in the same area suggests localized airway damage-typical of bronchiectasis.
Toronto Notes 2023 - Respirology:
"Bronchiectasis presents with recurrent infections in the same location, productive cough, and hemoptysis.
Chest X-ray may show linear opacities; high-resolution CT is diagnostic." MCCQE1 Objectives (Respiratory > 45-1: Chronic Respiratory Symptoms):
"Candidates must investigate recurrent pneumonias and consider bronchiectasis, especially if localized." Chronic bronchitis (A) presents bilaterally. Mitral stenosis (B) may cause hemoptysis but not localized infiltrates. TB (E) usually affects upper lobes. Infarction (C) is acute and not recurrent.
NEW QUESTION # 151
A 3-month-old girl is brought by her parents to the emergency department with a 3-day history of cough, coryza, and low-grade fever; she was previously well. In the last 24 hours, she has been noted to have rapid breathing with audible wheezing. Which one of the following pathogens is the most likely cause of the patient' s symptoms?
Answer: D
Explanation:
This presentation is most consistent with acute bronchiolitis, which classically affects infants under 2 years (peak 2-6 months) and begins with upper respiratory symptoms (coryza, cough, low-grade fever) followed by increased work of breathing, tachypnea, and wheeze. The most common causative agent is respiratory syncytial virus (RSV), making it the best answer. Parainfluenza virus is more strongly associated with croup (barking cough, inspiratory stridor, hoarseness). Chlamydia trachomatis pneumonia typically occurs in young infants with a staccato cough, afebrile course, and may be associated with conjunctivitis rather than acute wheezing after coryza. Human metapneumovirus can cause bronchiolitis-like illness but is less common than RSV. Influenza A often produces higher fever and systemic symptoms and is not the leading cause of bronchiolitis in this age group. MCCQE objectives emphasize recognizing bronchiolitis clinically and identifying RSV as the predominant pathogen in infants with this classic progression of symptoms.
NEW QUESTION # 152
A 55-year-old man presents with vague abdominal pain and general weakness. His mother had colon cancer and died at age 60 years. His physical examination findings and complete blood count results are normal.
Which one of the following tests should be ordered first?
Answer: D
Explanation:
Comprehensive and Detailed Explanation:
Given his age and a first-degree relative with colon cancer diagnosed before age 60, this patient meets criteria for early colon cancer screening. Colonoscopy is the gold standard for both screening and diagnosis in this context.
Toronto Notes 2023 - Gastroenterology, "Colorectal Cancer Screening":
"Patients with a first-degree relative diagnosed with colorectal cancer before age 60 should begin screening at age 40, or 10 years before the relative's diagnosis. Colonoscopy is the preferred method." MCCQE1 Objectives (Population Health > Preventive Screening > 63-1):
"Candidates must apply colorectal cancer screening guidelines and select appropriate tests based on risk level." FIT (A) is for average-risk screening. MRI (B) and CT colonography (E) are secondary. Barium enema (D) is outdated.
NEW QUESTION # 153
A 45-year-old man presents to your family practice for follow-up because he has had repeated transient ischemic attacks and had been advised not to drive. During the interview, you find out that he is still driving.
He explains that he only drives to the grocery store and his wife, who also has a driver's license, is always a passenger with him. He insists he can drive. You think that he should no longer be driving a car. Which one of the following is the best next step?
Answer: D
Explanation:
In most Canadian provinces and territories, physicians are legally obligated to report patients who pose a danger due to medical conditions affecting driving ability. Given the history of TIAs and continued unsafe driving, reporting is necessary for public safety.
Toronto Notes 2023 - ELOM, "Fitness to Drive" Section:
"Physicians must report to motor vehicle authorities if a patient poses a risk to public safety due to a medical condition. TIAs are considered reportable if they impair ability and the patient does not comply with driving restrictions." MCCQE1 Objectives (ELOM > 99-1: Medical Fitness and Reporting):
"Candidates must recognize situations requiring mandatory reporting of patients unfit to drive due to neurologic or other impairing conditions." You may still discuss with the patient (B), but this does not replace the duty to report. Physically taking the license (C) is illegal. Refusing care (D) is unethical. A neurologist (E) could be helpful but would delay action in a clear case.
NEW QUESTION # 154
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