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| Section | Weight | Objectives |
|---|---|---|
| Dimensions of Care | 50% | - Chronic Care - Assessment and Diagnosis - Acute Care - Health Promotion and Illness Prevention |
| Physician Activities | 50% | - Management - Professional Behaviours - Psychosocial Aspects - Communication |
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NEW QUESTION # 222
An 84-year-old woman is brought by ambulance to the emergency department after she was found by a neighbour. She had fallen, sustained a hip fracture, and was unable to move for the past 2 days. After starting rehydration, she reports hip pain and numbness and tingling in both her legs. Physical examination reveals faint pulses in both legs and severely swollen lower legs that are painful to palpation. The urine in the Foley catheter bag seems to be darker than normal. Which one of the following is the best next step?
Answer: C
Explanation:
This patient presents with signs of acute compartment syndrome (pain out of proportion, paresthesia, pallor, swelling, decreased pulses, and dark urine indicating rhabdomyolysis). Measuring compartment pressures is the diagnostic test of choice to confirm the diagnosis and guide urgent surgical fasciotomy.
Toronto Notes 2023 - Orthopedics:
"Acute compartment syndrome should be suspected in any patient with severe extremity pain, swelling, sensory deficits, and tense compartments. Confirm with compartment pressure measurements. Fasciotomy is indicated if pressure is >30 mmHg or within 30 mmHg of diastolic pressure." MCCQE1 Objectives (Surgery > 51-2: Limb Trauma):
"Candidates must diagnose acute compartment syndrome and initiate appropriate surgical referral after confirming with pressure measurements." Angiography and Doppler studies assess vascular compromise but are not the first step in suspected compartment syndrome. Fixing the hip (C) and testing myoglobin (E) are not diagnostic steps.
NEW QUESTION # 223
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: D
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 # 224
An infrastructure engineer in an AI factory has successfully replaced a power supply unit on an NVIDIA DGX H100. After installation, both the IN and OUT LEDs on the new power supply illuminate solid green.
Which NVSM CLI command should the engineer use to quickly verify the overall system status and ensure it is operating as expected?
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
The NVIDIA System Management (NVSM) tool is the definitive CLI utility for monitoring the health of DGX platforms. While replacing a PSU (Power Supply Unit) is a common maintenance task, verifying that the new component is correctly integrated into the system's health model is mandatory. While `nvsm show power` would provide specific data regarding wattage and voltage for the PSU, the most comprehensive way to ensure the replacement hasn ' t caused secondary issues or that the system hasn ' t remained in a " Degraded
" state is to run `nvsm show health`. This command performs a global check across all subsystems: GPUs, NVLink switches, storage, fans, and power. If the PSU replacement was successful and the system is back to full redundancy, `nvsm show health` will return a " Healthy " status. In an AI factory setting, where DGX H100 nodes pull significant power, ensuring that all 6 PSUs (in an N+N or N+1 configuration) are not only physically green but logically acknowledged by the Baseboard Management Controller (BMC) is critical for preventing unexpected shutdowns during high-load training iterations.
NEW QUESTION # 225
A 63-year-old man presents to the office with a 2-year history of episodic swallowing problems that have been increasing in frequency. He states that food seems to stick in his throat, and these episodes are often associated with coughing or regurgitating undigested food. Physical examination reveals that the patient has halitosis; otherwise, findings are normal. Which one of the following is the best next step to confirm the most likely diagnosis?
Answer: A
Explanation:
This presentation is classic for Zenker diverticulum , characterized by progressive dysphagia, regurgitation of undigested food, coughing, and halitosis due to food retention in a pharyngoesophageal pouch. Symptoms are chronic and episodic, often involving regurgitation hours after eating. MCCQE objectives emphasize selecting the safest and most appropriate diagnostic test. The best initial test is a barium swallow (contrast esophagram)
, which clearly visualizes the posterior outpouching above the upper esophageal sphincter.
Endoscopy is not the first step because there is a risk of perforation if a large diverticulum is present. pH monitoring and PPI trials are used for gastroesophageal reflux disease, which does not explain regurgitation of undigested food and halitosis. CT chest is unnecessary for diagnosis.
Therefore, a barium swallow is the safest and most informative investigation to confirm suspected Zenker diverticulum before considering surgical or endoscopic management.
NEW QUESTION # 226
A 10-year-old boy and his mother present to your office with a concern about handwashing. The mother explains that her son has been at a new school for the past month and that teachers have noticed that he is washing his hands all day. He has also hidden hand sanitizer in his desk. The hand-cleaning is a response to a constant anxiety that his hands are dirty, and that he might pass an infection to someone. Which one of the following is the most appropriate initial management?
Answer: B
Explanation:
This child demonstrates classic features of obsessive-compulsive disorder (OCD): intrusive contamination fears (obsession) and repetitive handwashing behaviors (compulsion) performed to reduce anxiety. The symptoms are excessive, impairing school function, and persist beyond normal developmental concerns.
According to MCCQE objectives, first-line treatment for mild to moderate pediatric OCD is cognitive- behavioral therapy (CBT) with exposure and response prevention (ERP). ERP involves gradual exposure to feared contaminants while preventing the compulsive handwashing response, thereby reducing anxiety through habituation and cognitive restructuring. Pharmacologic treatment with selective serotonin reuptake inhibitors (e.g., fluoxetine) is indicated for moderate to severe cases or when CBT alone is insufficient, but it is not the preferred initial intervention when psychotherapy is accessible. Risperidone is not first-line and may be considered only as augmentation in refractory cases. Changing schools or providing a teaching assistant does not address the underlying anxiety disorder. Early evidence-based intervention improves prognosis and functional outcomes in pediatric OCD.
NEW QUESTION # 227
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