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| Section | Weight | Objectives |
|---|---|---|
| Dimensions of Care | 50% | - Health Promotion and Illness Prevention - Acute Care - Chronic Care - Assessment and Diagnosis |
| Physician Activities | 50% | - Professional Behaviours - Psychosocial Aspects - Management - Communication |
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NEW QUESTION # 306
A 34-year-old woman, gravida 3, para 2, aborta 0, presents at 38 weeks' gestation. She is in early labor with ruptured membranes. Her previous pregnancy was complicated by fever during labor. Which one of the following would increase the risk of fever recurrence?
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
Epidural analgesia is associated with increased maternal intrapartum fever due to non-infectious(neurogenic) thermoregulation impairment. This is a well-known phenomenon in laboring women.
Toronto Notes 2023 - Obstetrics / Anesthesia:
"Epidural analgesia increases risk of intrapartum fever by up to 20% via non-infectious mechanisms." MCCQE1 Objectives (Obstetrics > 80-5: Intrapartum Care):
"Candidates must recognize risk factors for intrapartum complications, including effects of epidural use." Multiparity (A), precipitous labor (B), and maternal age (C) are not established risk factors for intrapartum fever.
NEW QUESTION # 307
You are seeing a 5-month-old infant who has had intermittent stridor since age 2 months. He is otherwise healthy. He has been drinking well and has been reaching all the age-specific developmental milestones.
Which one of the following is the most likely diagnosis?
Answer: D
Explanation:
Laryngomalacia is the most common cause of chronic stridor in infants. It presents with inspiratory stridor that worsens with feeding, supine positioning, or agitation. The child remains otherwise well and meets developmental milestones.
Toronto Notes 2023 - Pediatrics, Airway Disorders:
"Laryngomalacia presents with intermittent inspiratory stridor, typically beginning in the first few months of life. Diagnosis is clinical and prognosis is usually good." MCCQE1 Objectives - Pediatrics > Respiratory Disorders:
"Candidates must recognize the typical presentation of laryngomalacia and differentiate it from other causes of pediatric stridor." Vascular ring (A) or subglottic hemangioma (C) often present with more severe or progressive symptoms.
Foreign body aspiration (D) presents acutely. TE fistula (E) usually causes feeding difficulties from birth.
NEW QUESTION # 308
A 26-year-old woman, gravida 2, para 1, presents with a positive pregnancy test. Her previous pregnancy was associated with preeclampsia, and she delivered a 1000 g boy at 34 weeks ' gestation. Her blood pressure is
130/86 mm Hg. Which one of the following is the best recommendation for this pregnancy?
Answer: A
Explanation:
Accurate dating is critical in pregnancies at high risk for preeclampsia and intrauterine growth restriction.
First-trimester ultrasound is used to establish gestational age, which guides monitoring and interventions.
Toronto Notes 2023 - Obstetrics, High-Risk Pregnancy:
"In women with a history of preeclampsia, early and accurate dating allows for appropriate fetal surveillance and timely delivery." MCCQE1 Objectives - Obstetrics > Prenatal Care:
"Candidates should recognize the importance of accurate pregnancy dating in high-risk pregnancies." Prophylactic labetalol (E) is not indicated in normotensive patients. Genetic testing (A, B) is not appropriate unless additional risk factors are present. Bed rest (D) is not evidence-based for preeclampsia prevention.
NEW QUESTION # 309
A 28-year-old woman presents to the office in great distress because she has no money for groceries or rent.
She is a single mother of a 7-year-old girl. She has a history of gambling disorder. She has felt unable to cope for the last 3 months and has started gambling again. Today, she is crying, and she shares that her boyfriend became violent with her yesterday. Which one of the following is the highest priority for assessment?
Answer: B
Explanation:
The highest priority is the immediate safety of the patient and her child. In the presence of domestic violence, risk assessment for harm or neglect must be conducted urgently, particularly since a child may be at risk.
Safety trumps psychiatric or social evaluations in triage.
Toronto Notes 2023 - Psychiatry, "Crisis and Risk Assessment" Section:
"When intimate partner violence (IPV) is disclosed, it is critical to assess immediate safety and consider mandatory reporting, especially when children are involved." MCCQE1 Objectives (Psychiatry > 79-6: Violence and Abuse):
"Candidates must assess for and respond to risk of harm in situations of domestic violence, especially when dependents are involved. This includes ensuring immediate safety and following legal obligations for child protection." Although the other concerns (e.g., gambling, depression, substance use, financial need) are valid, the presence of violence makes D the first and most urgent priority.
NEW QUESTION # 310
An otherwise well 18-month-old girl is brought to your family practice office for routine immunization. Her mouth is as shown in the attached image. She has no symptoms. Which one of the following is the most likely cause of this presentation?
Image description: Severe black and brown decay of multiple upper front teeth, with relatively spared lower teeth.
Answer: A
Explanation:
The image shows classic features of "early childhood caries" (ECC), often called " baby bottle tooth decay." This typically affects upper incisors first due to prolonged exposure to milk/formula or sugary drinks during sleep.
Toronto Notes 2023 - Pediatrics, "Dental Health" Section:
"ECC is most commonly caused by prolonged nighttime bottle feeding with milk or juice. It affects upper anterior teeth due to pooling and lack of protective salivary flow." MCCQE1 Objectives (Pediatrics > 78-2: Preventive Care):
"Candidates must recognize risk factors for dental caries in young children, including nighttime bottle use and sugary liquid exposure." Antibiotics (C) or iron (D) can stain but do not cause this pattern of decay. Vitamin D (A) causes enamel hypoplasia or delayed eruption. Fluoride deficiency (B) causes diffuse decay, not selective anterior tooth loss.
NEW QUESTION # 311
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