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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Physician Activities | 50% | - Psychosocial Aspects - Professional Behaviours - Management - Communication |
| Topic 2: Dimensions of Care | 50% | - Health Promotion and Illness Prevention - Acute Care - Chronic Care - Assessment and Diagnosis |
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NEW QUESTION # 70
A 17-year-old boy is brought by his 2 roommates to the emergency department (ED) after a party where he had been drinking and smoking cannabis. He reportedly was having a good time when he suddenly wanted to jump out of a window. His roommates describe him as "normal prior to a breakup with his girlfriend a week ago." He has since become anxious and unable to sleep. On examination, he is somnolent and appears intoxicated. Which one of the following is the most appropriate initial management?
Answer: C
Explanation:
This adolescent exhibited acute suicidal behavior (attempted to jump out of a window), which is a psychiatric emergency. Regardless of intoxication or cause, such behavior mandates a safety-first approach: involuntary psychiatric assessment and protection from self-harm.
Toronto Notes 2023 - Psychiatry, "Suicide and Crisis Intervention" Section:
"Involuntary psychiatric admission is indicated when a patient poses a danger to themselves or others.
Suicidal ideation or attempts require immediate evaluation and monitoring." MCCQE1 Objectives (Psychiatry > 79-2: Suicide and Risk Management):
"Candidates must identify suicidal behavior and initiate appropriate action, including involuntary admission if necessary for safety." Observation (B) may miss the window for action. Parents (A) should be contacted but are not a substitute for admission. Chlordiazepoxide (C) is not first-line in this scenario.
NEW QUESTION # 71
A 37-year-old woman presents to your clinic with frequent palpitations. She has no other symptoms and is quite active. Physical examination and resting electrocardiogram findings are normal. Which one of the following is the best next step?
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
The most appropriate next step for a patient with intermittent palpitations and a normal ECG is Holter monitoring (or event monitoring). This can capture and correlate symptoms with cardiac rhythm.
Toronto Notes 2023 - Cardiology, "Palpitations":
"Holter or event monitoring is indicated when the initial ECG is normal but the patient has episodic symptoms such as palpitations." MCCQE1 Objectives (Cardiology > 34-2: Arrhythmia):
"Candidates must use ambulatory ECG monitoring to investigate intermittent palpitations when resting ECG is unremarkable." Echocardiogram (A) assesses structural issues but not rhythm. #-blockers (B) should not be started without diagnosis. Stress testing (D) is for ischemia.
NEW QUESTION # 72
A 20-year-old woman, gravida 0, para 0, presents with increased facial hair. Her periods are regular and moderate. Her BMI is 24, and her blood pressure is 110/70 mm Hg. Which one of the following is the most likely diagnosis?
Answer: E
Explanation:
Idiopathic hirsutism is the most likely diagnosis because this patient has isolated hirsutism with normal vital signs, normal BMI, and regular menstrual cycles , suggesting preserved ovulation and no clinically significant endocrine disturbance. MCCQE objectives emphasize that the most common causes of hirsutism are PCOS and idiopathic hirsutism; PCOS typically includes menstrual irregularity/oligo-ovulation and often metabolic features (overweight, insulin resistance), none of which are present here. Androgen-secreting ovarian tumors (hilar cell or Sertoli-Leydig cell tumors) usually cause rapid onset, severe hyperandrogenism and virilization (deepening voice, clitoromegaly, marked acne) and often disrupt menses-features not described. Nonclassic congenital adrenal hyperplasia can present with hirsutism, but it more commonly associates with acne, infertility, or menstrual abnormalities and requires biochemical suspicion rather than being the "most likely" with normal cycles. Therefore, idiopathic hirsutism-often due to increased peripheral androgen sensitivity or local 5-alpha reductase activity-is the best fit.
NEW QUESTION # 73
A 4-month-old girl is brought by a parent to your clinic with a history of recurrent vomiting since birth. She cries with feeding and has not gained weight in the last 2 weeks. Her hemoglobin level is 95 g/L (100-125).
The patient is currently being fed thickened hypoallergenic formula. Which one of the following is the most appropriate therapy?
Answer: D
Explanation:
This infant has persistent vomiting with feeding-associated distress and poor weight gain, despite appropriate initial nonpharmacologic measures (thickened feeds and hypoallergenic formula). MCCQE pediatrics objectives emphasize distinguishing physiologic reflux ("happy spitter") from gastroesophageal reflux disease (GERD), which is suggested by feeding aversion/crying and failure to thrive. When conservative strategies fail and GERD is causing significant symptoms or complications (e.g., poor growth, suspected esophagitis contributing to irritability and possibly anemia), escalation to acid suppression is appropriate; a proton pump inhibitor such as omeprazole is used to treat acid-related esophageal injury and improve symptoms in selected infants with suspected erosive disease.
Metoclopramide is not preferred due to limited benefit and risk of extrapyramidal adverse effects. Calcium carbonate antacids are not recommended as ongoing therapy in infants due to safety concerns and inferior efficacy for esophagitis. Bismuth sulfate is not indicated. Loperamide is inappropriate and potentially harmful in infants. Continued monitoring of growth and reassessment for alternative diagnoses or alarm features is essential.
NEW QUESTION # 74
A 53-year-old man presents to the Emergency Department with a 3-week history of believing his neighbor is poisoning him by pumping gas through his home's air vent. He appears distracted, irritable, and is speaking very quickly. He has a family history of depression. Which one of the following is the most likely diagnosis?
Answer: B
Explanation:
This man exhibits a classic manic episode with psychotic features: persecutory delusions, distractibility, pressured speech, irritability, and possible grandiosity. The chronicity and mood symptoms are most consistent with Bipolar I disorder.
Toronto Notes 2023 - Psychiatry, "Mood Disorders" Section:
"Bipolar I disorder is characterized by episodes of mania, often with psychotic features.Symptoms include grandiosity, decreased need for sleep, distractibility, and mood-congruent delusions." MCCQE1 Objectives (Psychiatry > 79-1: Mood Disorders):
"Candidates must recognize mania and differentiate from brief psychosis or organic causes." Delirium (A) is acute, fluctuating, and involves impaired attention. Malingering (B) requires external gain.
Brief psychotic disorder (C) resolves within 1 month. Brain injury-related psychosis (E) would require a supporting history or findings.
(Part 2 )
NEW QUESTION # 75
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