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| Section | Objectives |
|---|---|
| Dimensions of Care | - Psychosocial Aspects
|
| Physician Activities | - Assessment
|
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NEW QUESTION # 187
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: C
Explanation:
Accurate dating is critical in pregnancies at high risk for preeclampsia and intrauterine growthrestriction. 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 # 188
A 28-year-old woman presents because of spotting mid-menstrual cycle. Speculum examination reveals an ulcerated endocervical polyp. Which one of the following is the most appropriate management?
Answer: D
Explanation:
Endocervical polyps are common and often benign. An ulcerated polyp may bleed but is not itself suspicious unless it shows atypical features. The appropriate management is to remove the polyp (polypectomy) and send it for histopathology to exclude malignancy.
Toronto Notes 2023 - Gynecology, Cervical Pathology:
"Endocervical polyps are removed by polypectomy and sent for histological analysis. Most are benign.
Atypical or ulcerated appearance may raise concern, but biopsy is unnecessary if the entire lesion is excised." MCCQE1 Objectives - Gynecology > Abnormal Bleeding and Cervical Lesions:
"Candidates should recognize that cervical polyps causing intermenstrual bleeding should be removed and assessed histologically." Colposcopy (B) is reserved for abnormal cytology or high-risk lesions. Cryotherapy (A) is for cervical dysplasia. Punch biopsy (E) is used for lesions that are not amenable to polypectomy.
NEW QUESTION # 189
A 22-year-old woman, gravida 1, para 0, aborta 0, comes to the office at 10 weeks' gestation for her first prenatal visit. When you ask how she is doing, she becomes tearful and says she has had severe nausea and vomiting. She is not taking her prenatal vitamins regularly and feels very guilty about it. She is worried that she is harming the fetus. Which one of the following is the most appropriate management of this patient's case?
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
Ginger is a first-line, evidence-based non-pharmacologic treatment for nausea and vomiting in pregnancy. It's well tolerated and effective. Addressing nausea will help her resume vitamin use and reduce distress.
Toronto Notes 2023 - Obstetrics, "Nausea and Vomiting in Pregnancy":
"Ginger 250 mg four times daily is safe and effective for mild to moderate nausea." MCCQE1 Objectives (Obstetrics > 80-1: Early Pregnancy Management):
"Candidates must treat nausea and vomiting in pregnancy using safe and effective options." Folic acid alone (A) is less effective than a full prenatal vitamin. B may help, but nausea should be addressed first. C lacks empathy for her symptoms. D (cannabinoids) is not recommended in pregnancy.
NEW QUESTION # 190
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 # 191
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: B
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 # 192
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