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| Section | Objectives |
|---|---|
| Dimensions of Care | - Psychosocial Aspects
|
| Physician Activities | - Professionalism
|
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NEW QUESTION # 122
A 10-day-old boy is brought to the Emergency Department with a fever. The newborn looks well. Other than a rectal temperature of 38.6 °C, findings of the physical examination are unremarkable. When you list all the recommended testing their baby will have to undergo, the parents become upset at all the testing their baby will have to undergo. Which one of the following is the best approach?
Answer: D
Explanation:
A febrile neonate (#28 days old) requires a full sepsis evaluation (e.g., blood cultures, urine testing, lumbar puncture) because of the high risk of serious bacterial infection despite a well appearance. MCCQE objectives emphasize both appropriate medical management and effective communication with parents. When caregivers are distressed about painful procedures, the best approach is empathetic communication and reassurance that adequate analgesia and comfort measures (e.g., topical anesthetic, oral sucrose, swaddling) will be provided.
Threatening child protection involvement is inappropriate unless there is clear refusal of life-saving care after thorough discussion. Saying the infant "will not remember" dismisses parental concerns and undermines trust.
Proceeding without addressing concerns violates principles of shared decision-making. Excluding parents from procedures may increase anxiety and is not routinely recommended.
The physician should acknowledge concerns, explain the rationale for testing (risk of occult sepsis), outline pain-control strategies, and invite questions. This maintains trust while ensuring timely, evidence-based care.
NEW QUESTION # 123
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: D
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 # 124
You are on duty in the Emergency Department when 5 patients are brought in by ambulance after a high- speed motor vehicle collision. Which one of the following patients requires the most urgent medical care?
Answer: B
Explanation:
The patient with the angulated thigh, hypotension relative to baseline, and tachycardia likely has a femoral shaft fracture with concealed hemorrhage. This poses an immediate risk of hypovolemic shock and requires urgent assessment and stabilization.
Toronto Notes 2023 - Emergency Medicine, "Trauma Triage and Prioritization":
"Patients with long bone fractures, especially femoral fractures, are at high risk for hemorrhage and should be prioritized for stabilization and hemorrhage control." MCCQE1 Objectives (Surgery > 51-1: Trauma):
"Candidates must prioritize trauma patients based on signs of instability or risk of deterioration, such as tachycardia and occult bleeding."
NEW QUESTION # 125
A 37-year-old woman diagnosed with schizophrenia comes to her family physician because she has been choking on her food lately. She has a history of mild spasmodic dysphonia. She was recently started on haloperidol for auditory hallucinations. Which one of the following is the best short-term management?
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
This patient is likely experiencing extrapyramidal symptoms (dysphagia/dystonia) due to haloperidol.
Switching to an atypical antipsychotic (like quetiapine), which has a lower risk of EPS, is appropriate.
Dysphagia in the context of antipsychotic use requires prompt medication review.
Toronto Notes 2023 - Psychiatry, "Antipsychotics and Extrapyramidal Effects":
"Dysphagia can be a sign of extrapyramidal side effects. Consider switching to an atypical antipsychotic with lower EPS risk." MCCQE1 Objectives (Psychiatry > 71-5: Antipsychotic Adverse Effects):
"Candidates must recognize and manage EPS, including drug-induced dysphagia." Dantrolene (C) is for neuroleptic malignant syndrome, not isolated dysphagia. Laryngoscopy (B) may be useful later but not first-line. Reassurance (D) is unsafe. Lorazepam (E) may help in dystonia but doesn't address the root cause.
NEW QUESTION # 126
A prepubertal 9-year-old girl with severe developmental disability is brought to your office by her parents.
They are seeing you to discuss some difficulties that might occur with puberty. They are afraid that menses will complicate hygiene care and they have heard of significant mood/behavioural changes in this population when menses occur. Which one of the following recommendations is the most appropriate?
Answer: B
Explanation:
In girls with developmental disabilities, menstrual management should follow the same ethical and clinical principles as for other adolescents, emphasizing least invasive, reversible options and respect for future autonomy. Menstrual suppression may be appropriate to assist with hygiene and quality of life; however, hormonal methods are generally initiated after the onset of menarche to confirm pubertal development and exclude underlying endocrine disorders. Therefore, extended progestin-only therapy (e.g., depot medroxyprogesterone acetate) should not be started before menses begin. Hysterectomy is inappropriate as first-line management due to its irreversible nature, surgical risks, and significant ethical concerns regarding sterilization. Continuous combined oral contraceptives are not contraindicated and are commonly used for therapeutic amenorrhea. Evidence does not show consistent worsening of behavioural symptoms with appropriate hormonal suppression. Girls with developmental disabilities typically experience normal pubertal progression. MCCQE objectives emphasize patient-centered care, least restrictive interventions, ethical considerations in consent and capacity, and appropriate menstrual management strategies in adolescents with special needs.
NEW QUESTION # 127
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