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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Physician Activities | 50% | - Communication - Management - Psychosocial Aspects - Professional Behaviours |
| Topic 2: Dimensions of Care | 50% | - Chronic Care - Health Promotion and Illness Prevention - Acute Care - Assessment and Diagnosis |
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NEW QUESTION # 189
A 29-year-old woman presents to the sexually transmitted infection clinic with concerns regarding a copious vaginal discharge. Ten percent potassium hydroxide was used to confirm the diagnosis of which one of the following?
Answer: D
Explanation:
A 10% potassium hydroxide (KOH) preparation is commonly used in the evaluation of vaginal discharge. In bacterial vaginosis (BV) , adding KOH to a vaginal sample produces a characteristic "whiff test" -a strong fishy amine odor caused by volatilization of amines from anaerobic bacteria (e.g., Gardnerella vaginalis and other anaerobes). MCCQE objectives emphasize recognition of BV as the most common cause of abnormal vaginal discharge in reproductive-age women. Clinical features include thin, gray-white, malodorous discharge without significant inflammation.
KOH microscopy may also reveal clue cells (vaginal epithelial cells coated with bacteria).
Trichomonas vaginalis is diagnosed by saline wet mount showing motile trichomonads or by nucleic acid amplification testing (NAAT), not primarily by KOH. Chlamydia trachomatis and gonorrhea are diagnosed by NAAT. Group B streptococcus is identified by culture.
Thus, use of 10% KOH to confirm a fishy odor (positive whiff test) supports the diagnosis of bacterial vaginosis .
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NEW QUESTION # 190
A 25-year-old woman presents to the Emergency Department with a 2-hour history of pelvic pain associated with no other symptoms. The first day of her last menstrual period was 14 days ago. On examination, her vital signs are as follows:
Blood pressure
108/72 mm Hg
Heart rate
110/min
Temperature
37 °C
Abdominal examination reveals rebound tenderness and guarding. Pelvic examination reveals exquisite left adnexal tenderness. Which one of the following is the most likely diagnosis?
Answer: A
Explanation:
Comprehensive and Detailed Explanation:
Mid-cycle acute onset pelvic pain with localized adnexal tenderness in a reproductive-age woman suggests a hemorrhagic ovarian cyst, particularly a ruptured one. The hemodynamic parameters are stable, but elevated HR supports acute pain and possible blood loss.
Toronto Notes 2023 - Gynecology / Acute Pelvic Pain:
"Hemorrhagic ovarian cysts present with sudden unilateral pelvic pain, mid-cycle, with guarding and rebound tenderness. Ultrasound is key." MCCQE1 Objectives (Gynecology > 82-4: Acute Pelvic Pain):
"Candidates must recognize common causes of acute pelvic pain, including ovarian cysts." Diverticulitis (A) is rare in young women and usually LLQ. Appendicitis (B) is more likely RLQ.
Adenomyosis (C) and endometriosis (D) cause chronic cyclical pain, not acute tenderness.
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NEW QUESTION # 191
A 28-year-old woman presents to your office with a 6-month history of intermittent dizziness associated with nausea and a rotational sensation. Physical examination shows pallor of 1 optic disk, generalized hyperreflexia and nystagmus to the left. Which one of the following is the most likely diagnosis?
Answer: E
Explanation:
Multiple sclerosis (MS) is most likely because the patient has vertigo-like symptoms plus objective central neurologic signs : optic disc pallor (suggesting prior optic neuritis with optic atrophy), generalized hyperreflexia (upper motor neuron involvement), and nystagmus (can be central when accompanied by other CNS findings). MCCQE objectives emphasize differentiating peripheral from central causes of vertigo.
Peripheral disorders (labyrinthitis, Meniere disease) typically present with vertigo and nausea but do not cause optic nerve abnormalities or diffuse hyperreflexia . Acoustic neuroma can cause vestibular symptoms but usually features progressive unilateral hearing loss/tinnitus and does not explain optic disc pallor and generalized UMN signs. Prolactinoma causes endocrine symptoms (galactorrhea, amenorrhea, infertility) and may cause bitemporal hemianopia from chiasmal compression, not intermittent vertigo with UMN findings.
MS commonly affects young women and can produce brainstem/cerebellar involvement (vertigo, nystagmus) and optic nerve involvement, with symptoms separated in time, matching a 6-month intermittent course.
NEW QUESTION # 192
A 26-year-old woman, gravida 2, para 2, aborta 0, has just delivered a full-term newborn via spontaneous vaginal delivery after 4 hours of labor. Following oxytocin administration and placental expulsion, there continues to be a steady trickle of bright red blood from her vagina. On examination, the placenta is intact and the fundus feels firm. Her vital signs are within normal range.
Which one of the following is the most likely diagnosis?
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
In postpartum hemorrhage with a firm uterine fundus and intact placenta, a common cause is trauma such as a vaginal or cervical tear. Uterine atony (A) typically presents with a boggy uterus. The absence of systemic instability or coagulopathy makes options D and E less likely.
Toronto Notes 2023 - Obstetrics, Postpartum Hemorrhage:
"Continued bleeding despite a firm fundus and intact placenta should raise suspicion for genital tract trauma, especially cervical or vaginal lacerations." MCCQE1 Objectives - Obstetrics > Postpartum Complications:
"Candidates must differentiate causes of postpartum hemorrhage and identify when bleeding is due to trauma vs uterine atony."
NEW QUESTION # 193
A 60-year-old man presents because of a 6-month history of involuntary lip smacking and tongue movements.
His medical history is significant for schizophrenia, which has been very stable with haloperidol for the past
20 years. When educating the patient about these particular symptoms, which one of the following statements is accurate?
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
This patient has tardive dyskinesia, a late-onset, often irreversible movement disorder caused by chronic dopamine receptor blockade (e.g., haloperidol). It is especially common in older adults and may not resolve after stopping the drug.
Toronto Notes 2023 - Psychiatry, "Extrapyramidal Symptoms":
"Tardive dyskinesia is often irreversible and typically occurs after prolonged antipsychotic use. Elderly patients are at greater risk." MCCQE1 Objectives (Psychiatry > 71-5: Side Effects of Psychotropics):
"Candidates must recognize tardive dyskinesia and understand that it can persist or worsen even after discontinuation of antipsychotics." Anticholinergics may worsen it (D). The condition does not reliably improve with age (C). It does not affect a majority of patients (A).
NEW QUESTION # 194
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