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| Section | Objectives |
|---|---|
| Topic 1: Physician Roles (CanMEDS Framework) | - Collaborator
|
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NEW QUESTION # 262
A 21-year-old man presents to the office with persistent pain and swelling of the wrist 2 weeks after falling on his outstretched hand. Anteroposterior and lateral radiographs of the wrist taken at the time of the injury showed no evidence of fracture or dislocation. Which one of the following is the most likely cause of the patient's symptoms?
Answer: A
Explanation:
Scaphoid fractures are often radiographically occult on initial presentation and can present later with persistent pain and swelling in the anatomical snuffbox. They typically occur following a fall on an outstretched hand. If missed, they can lead to avascular necrosis.
Toronto Notes 2023 - Orthopedics, Wrist Injuries:
"Scaphoid fractures are the most common carpal fractures. X-rays may be negative early, so high suspicion requires immobilization and repeat imaging after 10-14 days." MCCQE1 Objectives - Surgery > Musculoskeletal Trauma:
"Candidates must recognize that some fractures, such as scaphoid, may not appear on initial imaging but require clinical suspicion and follow-up imaging or immobilization." Other options (B and C) are less likely without radiographic evidence. De Quervain tenosynovitis (D) presents with radial wrist pain unrelated to trauma and worsens with thumb movement.
NEW QUESTION # 263
A 65-year-old woman presents to the office for follow-up regarding vaginal bleeding. Her last visit was 2 months ago. At that visit, the results of a pelvic examination and a Papanicolaou test were normal. She also had an endometrial biopsy but there was "insufficient material for diagnosis." She reports that she is still losing small amounts of blood almost every day. On history, she has been taking continuous combined hormone replacement therapy for 10 years because of vasomotor symptoms. Which one of the following is the most appropriate next step in management?
Answer: C
Explanation:
Persistent postmenopausal bleeding requires thorough evaluation. An inadequate endometrial biopsy result does not rule out pathology. Hysteroscopy allows for direct visualization and targeted biopsy and is the gold standard when biopsy is non-diagnostic.
Toronto Notes 2023 - Gynecology, "Abnormal Uterine Bleeding and Endometrial Cancer" Section:
"Persistent bleeding with insufficient biopsy requires further evaluation, preferably via hysteroscopy and directed biopsy. This is especially important in patients on HRT or with risk factors for endometrial pathology." MCCQE1 Objectives (Obstetrics & Gynecology > 82-9: Postmenopausal Bleeding):
"Candidates must investigate abnormal bleeding in postmenopausal women with hysteroscopy when endometrial sampling is non-diagnostic." Changing hormones (A), reducing progestin (E), or performing colposcopy (C) are not appropriate without confirming the cause of bleeding.
NEW QUESTION # 264
A 12-year-old girl presents to your office in late November with an exacerbation of asthma which has been well controlled since her diagnosis at age 5. The family has had cats for 3 years. Last June, they moved to a basement apartment. Which one of the following is the most likely cause of her asthma exacerbation?
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
Basement apartments are often damp environments, increasing the risk of mold exposure. Mold is a well- known asthma trigger. Given the timing (autumn/winter) and environment change, mold allergy is the most likely cause.
Toronto Notes 2023 - Respirology / Allergy:
"Mold is a common indoor allergen, especially in damp environments. It frequently exacerbates asthma, particularly in fall/winter." MCCQE1 Objectives (Pediatrics > 75-2: Asthma Triggers):
"Candidates must identify common environmental triggers for asthma, including mold exposure in humid or poorly ventilated housing." Cat allergy (B) would have triggered earlier. Pollen (D) is less relevant in winter. Cold intolerance (E) is not a major asthma trigger without exercise. Fungal infection (A) is unlikely without systemic symptoms.
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NEW QUESTION # 265
A 35-year-old woman, gravida 3, para 0, aborta 3, presents with her male partner because she has been unable to conceive despite trying for more than 1 year. Her menstrual cycles have been absent for 9 months, and she has occasional mild cyclic pain. She has a medical history of 3 suction curettages. Her BMI is 24.
Investigation results are as follows:
Hysterosalpingogram: Obliterated uterine cavity, no tubal dye spill
Progesterone (midluteal): 48.0 nmol/L (16.4-59.0)
Partner's semen: All parameters normal
Which one of the following is the most likely diagnosis?
Answer: A
Explanation:
This patient has secondary amenorrhea, infertility, and a history of multiple uterine curettages, which strongly points toward Asherman syndrome (intrauterine adhesions or synechiae). The hysterosalpingogram shows an obliterated uterine cavity and no tubal dye spill-classic for intrauterine synechiae. Her midluteal progesterone level is normal, indicating ovulation.
Toronto Notes 2023 - Gynecology, "Infertility" section:
"Asherman syndrome results from intrauterine adhesions due to curettage, leading to amenorrhea and infertility. HSG shows an obliterated or irregular uterine cavity." MCCQE1 Objectives (Gynecology > 82-1: Infertility):
"Candidates should evaluate secondary amenorrhea and interpret imaging such as hysterosalpingogram in the diagnosis of intrauterine abnormalities." Other options are ruled out by the presence of normal ovulation (rules out hypothalamic and PCOS) and by imaging (not suggestive of fibroids or perimenopause).
NEW QUESTION # 266
You are taking over a practice from a retiring family physician. The practice has paper records of patients dating back many years, including records of former patients. Which one of the following organizations is the most appropriate to contact regarding medical record retention requirements?
Answer: D
Explanation:
Medical record retention is governed by laws and policies established by the provincial or territorial medical regulatory authorities (e.g., College of Physicians and Surgeons of Ontario).These bodies set requirements for how long patient records must be maintained and how to handle former patients' data.
Toronto Notes 2023 - Ethics and Health Systems:
"Retention of medical records is regulated by provincial/territorial colleges, which outline minimum retention periods and storage responsibilities." MCCQE1 Objectives (ELOM > Legal Requirements > Professional Responsibilities):
"The candidate must be able to identify the legal responsibilities of physicians regarding record-keeping, as guided by regulatory authorities." National organizations such as Health Canada, CFPC, CMA, and MCC do not set these rules for individual practice management.
NEW QUESTION # 267
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