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| Section | Objectives |
|---|---|
| Physician Activities | - Assessment
|
| Dimensions of Care | - Chronic Care
|
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NEW QUESTION # 286
A 42-year-old woman, gravida 2, para 2, aborta 0, comes to the office for the first time. She reports a 6-month history of thirst, urinary frequency, and recurrent vaginitis. Aside from a BMI of 28, her physical examination findings are unremarkable. She takes no medications. Which one of the following would support the most likely diagnosis?
Answer: B
Explanation:
This patient's symptoms of polyuria, polydipsia, and recurrent vaginitis are classic for type 2 diabetes mellitus (T2DM) . Recurrent vaginal candidiasis occurs due to glycosuria promoting yeast overgrowth. MCCQE objectives emphasize identifying risk factors and historical features supporting diabetes. A prior delivery of a macrosomic infant ( > 4000-4500 g) is strongly associated with gestational diabetes mellitus (GDM) , which significantly increases the future risk of developing T2DM. Therefore, a history of macrosomia supports undiagnosed or previous gestational hyperglycemia and increases suspicion for current diabetes.
High-risk sexual behaviors relate to sexually transmitted infections, not diabetes. Family history of hypertension is a cardiovascular risk factor but does not specifically support diabetes. Recent antibiotic use may predispose to candidiasis but would not explain polyuria and polydipsia. Dry eyes are more suggestive of autoimmune conditions (e.g., Sjogren syndrome).
Thus, prior delivery of a macrosomic newborn strengthens the likelihood that her current symptoms are due to type 2 diabetes mellitus.
NEW QUESTION # 287
A 36-year-old woman presents to the office with a 2-month history of multiple asymptomatic bumps on her vulva. She is not currently sexually active but has had 2 male sexual partners in the past, with the most recent relationship ending 1 year ago. On examination, she appears to have genital warts. She has not received the human papillomavirus (HPV) vaccine and is not interested in any treatment that is not absolutely necessary.
Which of the following is the best next step?
Answer: A
Explanation:
The patient has clinical evidence of genital warts (condyloma acuminata), which are caused by low-risk HPV types. Even though she is not currently sexually active and has visible warts, HPV vaccination is still beneficial for protection against other oncogenic strains (especially types 16 and 18). Vaccination is safe and recommended up to age 45.
Toronto Notes 2023 - Gynecology, "STIs and HPV":
"Vaccination is recommended up to age 45, regardless of prior exposure or visible warts. It may prevent reinfection with or acquisition of high-risk HPV strains." MCCQE1 Objectives (Gynecology > 83-3: STIs and HPV):
"Candidates must counsel patients appropriately on prevention, including the role of HPV vaccination, even after exposure or infection." Pap testing (B) is routine screening, not management of visible warts. Cryotherapy (D) is optional if the patient desires removal, but she declined treatment. Biopsy (A) is reserved for atypical lesions. Contact tracing (E) is not typically required for HPV warts.
NEW QUESTION # 288
A 66-year-old woman has a 3-month history of dry cough and weight loss. A new chest radiograph reveals a large 2-cm mass in her right upper lobe, which is consistent with carcinoma. You look at her previous films and realize that you had read her chest radiograph as normal 1 year ago, but now clearly see a faint opacity in precisely the same location as her current lesion. Which one of the following is the best next step?
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
Physicians must be transparent and honest in documentation. If a previous abnormality was missed, it must be acknowledged. The correct action is to comment on both the previous and current findings in your report and follow institutional disclosure policies.
Toronto Notes 2023 - ELOM, "Medical Error and Disclosure":
"Physicians must report and document prior missed findings honestly and provide full disclosure when reviewing comparative studies." MCCQE1 Objectives (ELOM > 90-2: Accountability and Communication):
"Candidates must accurately document previous findings when reviewing comparative data, even if it reveals past oversight." Delaying reporting (C-E) or omitting prior findings (A) is unethical.
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NEW QUESTION # 289
A 35-year-old woman presents to your clinic with double vision and a gritty sensation in her eyes for the past several weeks. On examination, you notice her eyes are bulging. There is inflammation of her conjunctivae and swelling around her eyes. Which one of the following is the most likely diagnosis?
Answer: B
Explanation:
The findings of exophthalmos (bulging eyes), conjunctival inflammation, and periorbital swelling are hallmark features of Graves ophthalmopathy, a manifestation of autoimmune hyperthyroidism.
Toronto Notes 2023 - Endocrinology, "Thyroid Disorders":
"Graves ophthalmopathy: proptosis, periorbital edema, conjunctivitis, and diplopia due to extraocular muscle involvement. Often independent of thyroid levels." MCCQE1 Objectives (Internal Medicine > 36-1: Thyroid Disease):
"Candidates must recognize and manage Graves disease and its ocular manifestations." Myasthenia gravis may cause diplopia but not proptosis or swelling. Pseudotumor and cellulitis are painful and acute. Allergic conjunctivitis is itchy but lacks proptosis.
NEW QUESTION # 290
A 24-year-old nulligravid woman presents to the office with an absence of menstruation since discontinuing her oral contraceptives 8 months ago. She previously had a regular menstrual cycle when taking oral contraceptives for the past 10 years but stopped because of headaches, which have only gotten worse since.
She also noticed mild breast discharge for the past several months. Which one of the following examination findings is most likely?
Answer: A
Explanation:
Comprehensive and Detailed Explanation:
This patient has secondary amenorrhea, galactorrhea, and worsening headaches-suggestive of hyperprolactinemia, possibly due to a pituitary adenoma (prolactinoma). Visual field defects (typically bitemporal hemianopia) can result from optic chiasm compression.
Toronto Notes 2023 - Endocrinology / Reproductive Health:
"Prolactinomas may cause amenorrhea, galactorrhea, headaches, and visual field defects. Evaluate with serum prolactin and visual field testing." MCCQE1 Objectives (Endocrinology > 37-2: Pituitary Disorders):
"Candidates must recognize clinical signs of prolactinomas and know when to assess visual fields." Hirsutism (D) suggests androgen excess. Low BMI (B) can cause hypothalamic amenorrhea but wouldn't explain galactorrhea. Nodular breast findings (A) are not related.
NEW QUESTION # 291
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