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| Section | Objectives |
|---|---|
| Topic 1: Dimensions of Care | - Health Promotion and Illness Prevention
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| Topic 2: Physician Activities | - Management
|
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NEW QUESTION # 148
You are called to attend an 18-year-old woman, gravida 2, para 1, aborta 0, who is in precipitous labour. She did not realize she was pregnant and has not had any prenatal care. After the delivery, you examine the newborn boy; he is vigorous, and it appears that he was born at full term. Physical examination findings of the newborn are normal. Review of the prenatal record from the mother's last pregnancy shows the following:
* HIV: Negative
* Hepatitis B surface antibody: Positive
* Hepatitis C: Negative
* Syphilis serology: Negative
The mother's previous child was placed in foster care. The mother is withdrawn and uncommunicative after delivery. Which one of the following is the best next step?
Answer: C
Explanation:
Given the lack of prenatal care, the mother's withdrawal, and prior involvement of child protection services, a newborn drug screen is warranted to assess for possible in utero exposure. This is part of the safety assessment.
Toronto Notes 2023 - Pediatrics, Newborn Assessment:
"Infants born to mothers with no prenatal care or prior social concerns should undergo a full newborn screening, including toxicology if indicated." MCCQE1 Objectives - Pediatrics > Newborn Care and Social Issues:
"Candidates must identify social risk factors and initiate appropriate newborn evaluations, including toxicology screens when substance use is suspected." The mother was previously immune to hepatitis B, so (A) is not immediately required. Skin-to-skin care (D) is beneficial but secondary to screening in this context. Donor milk (B) is not indicated unless breastfeeding is contraindicated.
NEW QUESTION # 149
A 31-year-old man presents with nocturnal non-exertional chest pain. During an exercise stress test, he does not experience chest pain, and there are no significant ST segment changes on the electrocardiogram. He achieves 17 metabolic equivalent of task (MET), a blood pressure of 190/96 mm Hg (resting blood pressure of
130/80 mm Hg), and a maximum heart rate of 162/min (85% of age-predicted maximum). Which one of the following is the most appropriate next step?
Answer: A
Explanation:
Comprehensive and Detailed Explanation:
This patient demonstrates excellent exercise tolerance (17 METs) and no ischemic changes or exertional symptoms, which makes cardiac ischemia unlikely. However, the hypertensive response to exercise (BP >190 systolic) indicates masked or latent hypertension. This should be managed proactively, typically starting with a thiazide.
Toronto Notes 2023 - Cardiology:
"An exaggerated hypertensive response during exercise is predictive of future hypertension. Treatment with antihypertensive agents such as thiazides may be warranted." MCCQE1 Objectives (Internal Medicine > 31-1: Hypertension and Risk Management):
"Candidates must identify abnormal BP responses to exercise and initiate appropriate treatment." Reassurance alone (A) ignores the hypertensive response. Catheterization (C) and beta-blockers (D) are unnecessary without ischemia. Advising against exercise (B) is counterproductive in a young, otherwise healthy patient.
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NEW QUESTION # 150
A 43-year-old car mechanic, with no prior history, comes to the Emergency Department because of a sudden loss of balance at work. He also feels lightheaded, slightly disoriented and nauseous. Physical examination and basic blood work-up are normal. He tells you this is the 3rd time this has happened at work. Which one of the following is the most likely diagnosis?
Answer: C
Explanation:
The most likely diagnosis is organic solvent intoxication because the episodes are recurrent, acute, and specifically occur at work in a car mechanic. MCCQE objectives in occupational and environmental medicine emphasize recognizing workplace exposures that cause transient neurologic symptoms. Organic solvents (e.g., toluene, xylene, gasoline vapors, degreasers) can produce acute CNS effects such as dizziness, imbalance
/ataxia, nausea, lightheadedness, and mild confusion or disorientation, often with a normal routine exam and basic labs once exposure ceases. The clear temporal relationship to the workplace and repeated similar episodes strongly supports an exposure-related cause. Lead toxicity is typically subacute/chronic, presenting with abdominal pain, constipation, neuropathy (wrist/foot drop), cognitive changes, anemia, and basophilic stippling-rather than brief episodic disequilibrium. A cerebellar tumor would cause progressive, persistent symptoms and focal neurologic findings. Ear infection-related vertigo would not reliably recur only at work and usually has ear symptoms or exam findings. Alcohol intoxication is less consistent with a repeated workplace-only pattern without corroborating signs.
NEW QUESTION # 151
A system administrator needs to install a GPU/DPU in a server. The server has a free PCI-e slot, there are enough free PCI-e lanes, and there is enough room for the card. Which procedure should be followed?
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
The physical installation of high-performance NVIDIA components, such as H100 PCIe GPUs or BlueField DPUs, requires strict adherence to data center safety and hardware preservation standards. Option D is the only " 100% verified " procedure because it covers three critical pillars: Power, Compatibility, and Safety.
First, high-end GPUs can draw up to 300W-450W individually; verifying the server ' s PDU and internal PSU capacity is essential to prevent over-current shutdowns. Second, verifying cable compatibility (such as
12VHPWR or specific PCIe power 8-pin layouts) is vital to avoid electrical damage. Third, " Cold Service " (ensuring the server is powered down and cables are removed) is the standard for non-hot-plug PCIe components to prevent short circuits. Finally, wearing an ESD (Electrostatic Discharge) bracelet is non- negotiable when handling NVIDIA hardware, as static charges can destroy the sensitive HBM (High Bandwidth Memory) or the GPU die itself. Skipping ESD protection (as suggested in Option A) or performing the install while the system is " up and running " (as suggested in Option C) are leading causes of hardware infant mortality in AI infrastructure.
NEW QUESTION # 152
A 45-year-old woman presents to the emergency department after being involved in a motor vehicle collision.
She reports severe right hip pain. On examination, the right hip is flexed and adducted. A radiograph shows a posterior dislocation. Which one of the following is the most appropriate management?
Answer: C
Explanation:
A posterior hip dislocation is an orthopedic emergency . The classic position is a shortened limb held in flexion, adduction, and internal rotation after high-energy trauma. MCCQE objectives emphasize immediate recognition and urgent management to prevent complications, especially avascular necrosis (AVN) of the femoral head and sciatic nerve injury . The key treatment is prompt closed reduction (ideally within hours) under procedural sedation or anesthesia, after appropriate analgesia and neurovascular assessment. Post- reduction priorities include confirming concentric reduction with imaging, repeating a neurovascular exam (particularly sciatic nerve function), and evaluating for associated fractures (acetabular or femoral head/neck) that may require CT and possible operative management.
Open reduction is reserved for irreducible dislocations, incarcerated fragments, or associated fractures preventing stable closed reduction. Skeletal traction is not definitive acute management. Total hip arthroplasty is not indicated as first-line in an acute traumatic dislocation in this context. Urgent closed reduction best aligns with time-sensitive limb- and joint-preserving care.
NEW QUESTION # 153
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