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| Section | Objectives |
|---|---|
| Topic 1: Physician Roles (CanMEDS Framework) | - Health Advocate
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NEW QUESTION # 142
A 25-year-old nulligravida woman presents after trying to conceive for 2 years without success. She is healthy, with regular menstrual periods. She denies any unusual hair growth, weight changes, or breast discharge. She gets occasional outbreaks of acne. Blood work done with her next menstrual period produces the following results:
Follicle-stimulating hormone, follicular phase: 6.2 U/L (5.0-20.0) on day 3 of menstrual cycle Luteinizing hormone, follicular phase: 6 U/L (5-22) on day 3 of menstrual cycle Estradiol: 163 pmol/L (50-200) on day 15 of menstrual cycle Thyrotropin (thyroid-stimulating hormone): 2.5 mU/L (0.4-5.0) Prolactin: 40 µg/L (4-30) Given the results of her blood work, which one of the following is the best next step?
Answer: D
Explanation:
This patient meets the definition of infertility (no conception after 12 months; here 2 years). Her day-3 FSH
/LH and mid-cycle estradiol are within expected ranges, and TSH is normal, making thyroid disease unlikely.
The key abnormality is elevated prolactin (40 µg/L) . MCCQE objectives emphasize identifying reversible endocrine causes of infertility: hyperprolactinemia can impair fertility by disrupting hypothalamic GnRH pulsatility and ovulatory function, and treatment improves pregnancy rates. The appropriate next management is a dopamine agonist (e.g., bromocriptine) to lower prolactin and restore normal reproductive axis function.
Pituitary MRI is generally reserved for marked or persistent elevations suggestive of prolactinoma (often much higher levels) or when there are neurologic symptoms (e.g., headaches, visual field defects). IVF is not first-line when a treatable endocrine abnormality is present. Mammography is unrelated to mild hyperprolactinemia without breast findings. Treating the elevated prolactin addresses a likely contributor before proceeding to more invasive fertility interventions.
NEW QUESTION # 143
A 72-year-old man has had 4 episodes of weakness in her right arm and leg lasting 10 to 15 minutes each.
During 1 episode, she had difficulty speaking and had blurring of the vision in the left eye. Which one of the following is the most likely diagnosis?
Answer: A
Explanation:
These are recurrent, brief (10-15 minute), fully resolving focal neurologic deficits, which fits transient ischemic attacks (TIAs) rather than completed stroke. The combination of right-sided arm and leg weakness and difficulty speaking localizes to the left cerebral hemisphere (dominant hemisphere for language in most patients). The additional symptom of transient blurring of vision in the left eye is characteristic of amaurosis fugax, caused by retinal ischemia from emboli or hypoperfusion in the ipsilateral internal carotid circulation.
Together, this pattern strongly suggests left internal carotid artery occlusive disease (e.g., high-grade stenosis with artery-to-artery embolization).
Left MCA thrombosis would typically produce persistent deficits rather than multiple short, self-resolving episodes. Intracerebral hemorrhage usually presents with sudden severe symptoms that do not resolve quickly and often includes headache or reduced consciousness. Epilepsy would more likely cause positive symptoms (jerking, automatisms) and postictal confusion. Vertebrobasilar disease causes posterior circulation symptoms (vertigo, diplopia, ataxia), not unilateral monocular vision loss plus contralateral weakness.
NEW QUESTION # 144
A 1-week-old boy born at full term is brought by his parents to the office with a 2-day history of eye swelling and watery discharge. This morning, the discharge became thick and yellow. On physical exam, he is afebrile and fussy with bilateral eyelid edema, purulent discharge, and erythematous conjunctivae. After taking appropriate cultures of the eyes, which one of the following is the best next step?
Answer: E
NEW QUESTION # 145
A 62-year-old woman presents with abdominal pain, fever and chills. She was hospitalized 4 weeks ago for sigmoid diverticulitis. She felt well after her discharge from hospital until 5 days ago when the fever started.
She is now anorexic. On examination, she has right upper quadrant pain and her temperature is 38.5 °C.
Which one of the following investigations is most likely to confirm the diagnosis?
Answer: E
Explanation:
This patient presents with fever, chills, anorexia, and right upper quadrant (RUQ) pain several weeks after hospitalization for sigmoid diverticulitis . A key complication of intra-abdominal infections such as diverticulitis is portal pylephlebitis with hepatic abscess formation , due to bacterial spread via the portal venous system. MCCQE objectives emphasize recognizing liver abscess as a delayed complication of intra- abdominal sepsis, particularly when new RUQ pain and fever develop after an initial abdominal infection.
The most appropriate initial imaging test to confirm this diagnosis is ultrasound of the abdomen , which can detect hepatic abscesses and guide further management. CT abdomen is also highly sensitive, but among the listed options, ultrasound is most appropriate.
Chest and abdominal radiographs are nonspecific. HIDA scan evaluates cystic duct obstruction in suspected acute cholecystitis, which is less likely given the recent diverticulitis and systemic features. ERCP is used for biliary obstruction or ascending cholangitis, typically associated with jaundice.
Thus, abdominal ultrasound is most likely to confirm a hepatic abscess.
NEW QUESTION # 146
A surgical clinic would like to respond to the Truth and Reconciliation Commission of Canada: Calls to Action report. The clinic has implemented a mandatory cultural safety course for all employees and ongoing faculty development that includes teachings from Elders and Knowledge Keepers and teaching sessions about harm reduction, trauma-informed care, and antiracism. Which one of the following steps would further the clinic's goal of responding to this report?
Answer: A
Explanation:
Providing information in the patient's own language is a concrete way to improve access, cultural safety, and communication - key recommendations in the Truth and Reconciliation Commission's Calls to Action. It moves beyond symbolic gestures and supports equitable care.
Toronto Notes 2023 - ELOM, "Indigenous Health and Cultural Safety" Section:
"Cultural safety includes removing language barriers, engaging with Elders, and using patient-centered practices that respect Indigenous values. Communication in the patient's first language improves trust and outcomes." MCCQE1 Objectives (ELOM > 99-2: Cultural Safety and Health Equity):
"Candidates must apply the principles of culturally safe care including removing barriers to access and effective communication, as highlighted in the Truth and Reconciliation Commission's Calls to Action." Evaluating session enjoyment (A) is not impactful. Certificates (C) are symbolic. Intake questions about trauma (D) must be done with appropriate context and safety - not as a formality.
NEW QUESTION # 147
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