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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Dimensions of Care | 50% | - Acute Care - Assessment and Diagnosis - Chronic Care - Health Promotion and Illness Prevention |
| Topic 2: Physician Activities | 50% | - Professional Behaviours - Communication - Management - Psychosocial Aspects |
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NEW QUESTION # 251
A 55-year-old man presents with vague abdominal pain and general weakness. His mother had colon cancer and died at age 60 years. His physical examination findings and complete blood count results are normal.
Which one of the following tests should be ordered first?
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
Given his age and a first-degree relative with colon cancer diagnosed before age 60, this patient meets criteria for early colon cancer screening. Colonoscopy is the gold standard for both screening and diagnosis in this context.
Toronto Notes 2023 - Gastroenterology, "Colorectal Cancer Screening":
"Patients with a first-degree relative diagnosed with colorectal cancer before age 60 should begin screening at age 40, or 10 years before the relative's diagnosis. Colonoscopy is the preferred method." MCCQE1 Objectives (Population Health > Preventive Screening > 63-1):
"Candidates must apply colorectal cancer screening guidelines and select appropriate tests based on risk level." FIT (A) is for average-risk screening. MRI (B) and CT colonography (E) are secondary. Barium enema (D) is outdated.
NEW QUESTION # 252
A 71-year-old man is brought to the Emergency Department with sudden onset of shortness of breath and chest pain. He was discharged from hospital 1 week ago after a total hip arthroplasty. On examination, his respiratory rate is 32/min. There is visible respiratory distress, and chest auscultation is clear. Which one of the following is the most likely diagnosis?
Answer: E
Explanation:
Sudden onset dyspnea and pleuritic chest pain in a postoperative patient with tachypnea and clear lung fields are classic features of a pulmonary embolism (PE). Recent orthopedic surgery significantly increases VTE risk. Clear lungs on auscultation support this over pneumonia or CHF.
Toronto Notes 2023 - Respiratory, "Pulmonary Embolism":
"Presentation includes sudden dyspnea, pleuritic chest pain, and tachypnea. Risk factors include recent surgery and immobilization. Examination often reveals clear chest auscultation." MCCQE1 Objectives (Internal Medicine > Cardiopulmonary > 44-1):
"Candidates must recognize PE in patients with risk factors (e.g., surgery) and classic features and initiate appropriate diagnosis and management." Fat embolism (B) usually presents with petechiae, neurologic symptoms, and occurs within 24-72 hours post- op. Cholesterol emboli (E) are more chronic and systemic.
NEW QUESTION # 253
A 36-year-old woman, gravida 1, para 0, aborta 0, presents to the Labour and Delivery unit of a primary care hospital. She is at 40 weeks' gestation. She is having contractions and leaking fluid. She is fearful and does not want to deliver vaginally. Which one of the following is the best next step?
Answer: E
Explanation:
The most appropriate next step is to explore her concerns and provide counselling regarding labour and pain management options . MCCQE objectives emphasize patient-centered care, informed decision-making, and respect for autonomy while ensuring that patients receive appropriate information about risks and benefits.
This patient is in active labour at term with ruptured membranes and expresses fear about vaginal delivery.
The immediate priority is to assess the source of her fear (pain, complications, prior trauma, misinformation) and provide education about available analgesia options (e.g., epidural, intravenous opioids, nonpharmacologic methods) and the relative risks and benefits of cesarean versus vaginal delivery.
Automatically arranging a cesarean without discussion is inappropriate, particularly in a primary care setting without clear medical indication. Conversely, refusing cesarean outright is paternalistic and fails to address her concerns. Analgesia may be appropriate but should follow exploration of her preferences. Therefore, empathetic discussion and shared decision-making are the best initial approach.
NEW QUESTION # 254
You are undertaking the retrospective analysis of a laboratory-confirmed influenza A virus outbreak that occurred in a long-term care facility last year. Among the 163 residents in the facility during the outbreak, 101 residents had new-onset fever, cough, myalgias, and congestion. Of these, 37 residents were transferred to acute care. Of these, 17 residents died. Which one of the following is the best estimate of the attack rate in residents at the facility?
Answer: B
Explanation:
The attack rate is a measure of cumulative incidence used in outbreak investigations. It represents the proportion of individuals at risk who develop the disease during a specified time period. MCCQE objectives emphasize understanding key epidemiologic measures, particularly in institutional outbreaks.
In this scenario, 163 residents were at risk during the influenza outbreak. Of these, 101 developed new-onset symptoms consistent with influenza. Therefore, the attack rate is calculated as:
Number of new cases ÷ Number of people at risk
= 101 ÷ 163
The number transferred to acute care (37) reflects disease severity but does not represent all cases. The number of deaths (17) would be used to calculate the case fatality rate (17/101), not the attack rate.
Thus, the best estimate of the attack rate among residents is 101/163 , representing the proportion of the at- risk population who became ill during the outbreak.
NEW QUESTION # 255
A 62-year-old woman is taken to the operating room for an elective laparoscopic cholecystectomy. Induction of anesthesia triggers a severe hypertensive crisis that ultimately resolves after administration of a 5 mg bolus of phentolamine.
Which one of the following is most consistent with this presentation?
Answer: C
Explanation:
This presentation is classic for an undiagnosed pheochromocytoma, which causes episodic or crisis-level hypertension due to excess catecholamines. Anesthesia or surgical manipulation can trigger massive catecholamine release, leading to hypertensive crisis. Phentolamine, an alpha-blocker, is the appropriate treatment.
Toronto Notes 2023 - Endocrinology, Pheochromocytoma:
"Pheochromocytomas may precipitate hypertensive crises during surgery. Elevated plasma catecholamines and urinary metanephrines confirm diagnosis." MCCQE1 Objectives - Internal Medicine > Endocrinology:
"Candidates should suspect pheochromocytoma in perioperative hypertensive crises and confirm with plasma or urine catecholamines/metanephrines." Low metanephrines (E) would argue against pheochromocytoma. TSH (A), cortisol (D), and renin (C) are unrelated to acute intraoperative hypertensive episodes of this nature.
NEW QUESTION # 256
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