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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Dimensions of Care | 50% | - Chronic Care - Assessment and Diagnosis - Health Promotion and Illness Prevention - Acute Care |
| Topic 2: Physician Activities | 50% | - Professional Behaviours - Psychosocial Aspects - Management - Communication |
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NEW QUESTION # 93
A 22-year-old woman is brought to the Emergency Department by her boyfriend, who says that she is experiencing a fentanyl overdose. She is unresponsive and cyanotic. She regains consciousness after naloxone is injected intravenously and demonstrates no further respiratory depression during 8 hours of observation.
She states that she is 22 weeks' pregnant and wants to stop using opioids. Which one of the following is the best next step?
Answer: A
Explanation:
For pregnant patients with opioid use disorder, opioid agonist therapy with methadone or buprenorphine is the standard of care. Detoxification is not recommended in pregnancy due to increased risk of fetal distress, preterm labor, and relapse. Methadone reduces illicit opioid use and stabilizes both mother and fetus.
Toronto Notes 2023 - Addiction Medicine / Obstetrics:
"Methadone maintenance therapy is the treatment of choice for pregnant patients with opioid use disorder.
Detoxification is not advised during pregnancy due to relapse risk and potential harm to the fetus." MCCQE1 Objectives (Obstetrics > 80-3: Substance Use in Pregnancy):
"Candidates must manage opioid use disorder in pregnancy with evidence-based therapies, including referral for methadone or buprenorphine." Counselling alone (D) is insufficient as first-line therapy. Home detox (C) is unsafe. Inpatient detox (A) is not recommended in pregnancy.
NEW QUESTION # 94
A 47-year-old man presents to the office with a 1-month history of passing blood in his stool 2 to 3 times per week. He is otherwise healthy and denies any systemic symptoms. Other than a small lateral skin tag on digital rectal examination, the physical examination findings are unremarkable. Which one of the following is the best next step?
Answer: E
Explanation:
Visible rectal bleeding, even in the absence of systemic symptoms, warrants diagnostic colonoscopy to rule out colorectal cancer, polyps, or IBD-especially in adults over 40. FIT is for asymptomatic screening only.
Toronto Notes 2023 - Gastroenterology, "Approach to Lower GI Bleeding":
"In patients with overt rectal bleeding, colonoscopy is the investigation of choice regardless of age or FIT status." MCCQE1 Objectives (Internal Medicine > Gastroenterology > 47-1):
"Candidates must evaluate rectal bleeding with colonoscopy, even in the presence of minor findings on physical exam (e.g., skin tag)." FIT (A) is not appropriate for symptomatic patients. CEA (D) is a tumor marker for surveillance, not diagnosis. CT colonography (C) is less sensitive for lesions than colonoscopy.
NEW QUESTION # 95
A 59-year-old woman comes to the office because her 48-year-old sister was recently diagnosed with cervical cancer. Your patient thinks her mother may have also had cervical cancer. A Papanicolaou (Pap) test performed 16 months ago had normal results, as did all previous Pap tests. Which one of the following is the best next step?
Answer: C
Explanation:
For women aged 25-69 years who have had adequate negative screening, the recommendation is to repeat cervical cytology (Pap test) every 3 years, regardless of family history. Cervical cancer is caused primarily by HPV infection, not hereditary genetics. Family history does not alter the screening interval.
Toronto Notes 2023 - Gynecology, Cervical Cancer Screening Section:
"Routine screening with Pap test is recommended every 3 years in women aged 25-69 who have had three consecutive negative tests. Family history of cervical cancer does not modify the screening interval." MCCQE1 Objectives - Obstetrics and Gynecology > Cancer Screening:
"Candidates must apply population-based cervical cancer screening guidelines. Family history is not a risk modifier for screening frequency in cervical cancer." Options A and B are inappropriate as they increase screening frequency without indication. HPV testing (D) or colposcopy (E) are not recommended without abnormal cytology.
NEW QUESTION # 96
A 60-year-old man presents because of a 6-month history of involuntary lip smacking and tongue movements.
His medical history is significant for schizophrenia, which has been very stable with haloperidol for the past
20 years. When educating the patient about these particular symptoms, which one of the following statements is accurate?
Answer: D
Explanation:
Comprehensive and Detailed Explanation:
This patient has tardive dyskinesia, a late-onset, often irreversible movement disorder caused by chronic dopamine receptor blockade (e.g., haloperidol). It is especially common in older adults and may not resolve after stopping the drug.
Toronto Notes 2023 - Psychiatry, "Extrapyramidal Symptoms":
"Tardive dyskinesia is often irreversible and typically occurs after prolonged antipsychotic use. Elderly patients are at greater risk." MCCQE1 Objectives (Psychiatry > 71-5: Side Effects of Psychotropics):
"Candidates must recognize tardive dyskinesia and understand that it can persist or worsen even after discontinuation of antipsychotics." Anticholinergics may worsen it (D). The condition does not reliably improve with age (C). It does not affect a majority of patients (A).
NEW QUESTION # 97
You are examining a full-term baby girl in the nursery. You notice that her left forefoot is adducted and supinated relative to the contralateral foot, which makes her left foot appear C-shaped. Which one of the following findings is most instrumental in deciding on the management of this issue?
Answer: B
Explanation:
The description is classic for metatarsus adductus. The most important clinical factor guiding management is whether the foot is flexible or rigid. Flexible deformities typically resolve spontaneously and do not require intervention.
Toronto Notes 2023 - Pediatrics, "Musculoskeletal Conditions":
"Metatarsus adductus: inward deviation of the forefoot. Management depends on flexibility. Flexible cases are benign and resolve spontaneously; rigid forms may need casting." MCCQE1 Objectives (Pediatrics > 78-2: Musculoskeletal Disorders):
"Candidates must assess and differentiate between flexible and rigid deformities to guide treatment in foot abnormalities." Other findings (B-E) are either unrelated or not determinant in metatarsus adductus management.
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NEW QUESTION # 98
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